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130 UNIT II Nursing Philosophies

5. The phenomenal body, the body aware of itself and interpreting theory, precedes and extends theory,
with the ability to imagine and describe kines- and synthesizes and adapts theory in caring nursing
thetic sensations practice. Benner has taken a hermeneutical approach
Benner and Wrubel (1989) point out that nurses to uncover the knowledge in clinical nursing practice.
attend to all of these dimensions of the body and seek Dunlop (1986) stated, “As she does this, she is also
to understand the role of embodiment in particular uncovering the nursing-caring with which it is deeply
situations of health, illness, and recovery. intertwined” (p. 668). Dunlop also noted that Benner’s
approach “does not provide us with any universal
Health truths about caring in general or about nursing-caring
On the basis of the work of Heidegger (1962) and in particular—indeed it does not make any such pre-
Merleau-Ponty (1962), Benner and Wrubel focus tension” (p. 668).
“on the lived experience of being healthy and being As such, the competencies within each domain
ill” (1989, p. 7). Health is defined as what can be as- are in no way intended as an exhaustive list. Instead,
sessed, whereas well-being is the human experience the situation-based interpretive approach to de-
of health or wholeness. Well-being and being ill are scribing nursing practice seeks to overcome some of
understood as distinct ways of being in the world. the problems of reductionism and the problem of
Health is described as not just the absence of dis- global and overly general descriptions based on
ease and illness. Also, on the basis of the work of nursing process categories (Benner, 1984a). In a
Kleinman, Eisenberg, and Good (1978), a person further description of this approach, Benner (1992)
may have a disease and not experience illness, be- examined the role of narrative accounts for under-
cause illness is the human experience of loss or standing the notion of good or ethical caring in
dysfunction, whereas disease is what can be as- expert clinical nursing practice. “The narrative
sessed at the physical level (Benner & Wrubel, memory of the actual concrete event is taken up
1989). in embodied know-how and comportment, com-
plete with emotional responses to situations. The
Situation narrative memory can evoke perceptual or sensory
Benner and Wrubel (1989) use the term situation memories that enhance pattern recognition” (p. 16).
rather than environment, because situation conveys a Some of the relationship statements included in
social environment with social definition and mean- Benner’s work follow:
ingfulness. They use the phenomenological terms be- • “Discovering assumptions, expectations, and
ing situated and situated meaning, which are defined sets can uncover an unexamined area of practi-
by the person’s engaged interaction, interpretation, cal knowledge that can then be systematically
and understanding of the situation. “Personal inter- studied and extended or refuted” (Benner,
pretation of the situation is bounded by the way the 1984a, p. 8).
individual is in it” (Benner & Wrubel, 1989, p. 84). • Clinical knowledge is embedded in perceptions
This means that each person’s past, present, and rather than precepts.
future, which include her or his own personal mean- • “Perceptual awareness is central to good nursing
ings, habits, and perspectives, influence the current judgment and . . . [for the expert] begins with
situation. vague hunches and global assessments that ini-
tially bypass critical analysis; conceptual clarity
follows more often than it precedes” (Benner,
Theoretical Assertions 1984a, p. xviii).
Benner (1984a) stated that there is always more to any • Formal rules are limited and discretionary judgment
situation than theory predicts. The skilled practice is needed in actual clinical situations.
of nursing exceeds the bounds of formal theory. • Clinical knowledge develops over time, and each
Concrete experience facilitates learning about the ex- clinician develops a personal repertoire of practice
ceptions and shades of meaning in a situation. The knowledge that can be shared in dialog with other
knowledge embedded in practice can lead to discovering clinicians.