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522 UNIT IV Nursing Theories

number of people. This is inconsistent with the prac- understanding phenomena than simple rationality.
tice of health care professionals who act as agents for He believed that one must develop insight and per-
individual patients. Emotivism promotes ethical ception to recognize how principles can be applied
actions in accordance with the emotions of those to each situation (McKeon, 1941).
involved. Rational thought has no place in emotive The Dutch philosopher, Spinoza, examined the
choices, making this type of decision-making pro- nature of humans and human knowledge. He recog-
cess inappropriate in the health care arena. Social nized that, although the process and outcomes of rea-
relativism imposes the beliefs of a society onto the soning may be comparable for each person, intuitive
individual. This approach is incongruous with the and discerning thought is unique to each. Spinoza
increasing diversity of our emerging global society. believed that reason must be coupled with intuitive
The authors recognized that the inappropriateness thought for true understanding (Lloyd, 1996). Spinoza
of traditional methods of ethical reasoning brought was noted for taking well-worn philosophical con-
about the failure of the health care system to suc- cepts and transforming them into new and engaging
cessfully address bioethical issues. ideas. This is true of the Husteds’ development of Sym-
Because traditional models proved inadequate to phonology, particularly in the evolution of the mean-
guide ethical behavior for health care professionals, ing of the bioethical standards.
the Husteds began to conceive and develop a Polanyi proposed that understanding is derived
method by which health care professionals might from awareness of the entirety of a phenomenon, that
determine appropriate ethical actions. The theory the lived experience is greater than separate, observ-
was based on logical thinking, emphasizing the pro- able parts. Tacit knowledge, that which is implied, is
vision of holistic, individualized care. They drew necessary to understand and interpret that which is
from the work of Aristotle, Benedict Spinoza, and explicit (Polanyi, 1964). These concepts, the unique-
Michael Polanyi. These philosophers adhere to ra- ness of the individual and the extension of reason and
tional thought and value persons as individuals. rationality with insight and discernment to create
Aristotle was a student of Plato who advanced his true understanding, are the foundations of the sym-
teacher’s work by recognizing that there is more to phonological method.

MAJOR CONCEPTS & DEFINITIONS
Agency first two contexts are interwoven. It is an agent’s
Agency is the capacity of an agent to initiate action present awareness of all the relevant aspects (knowl-
toward a chosen goal. The shared goal of a nurse and edge and circumstances) of the situation that are
patient is to restore the patient’s agency (Husted & necessary to understand and act effectively within it
Husted, 2008). (Husted & Husted, 2008).

Context Environment-Agreement
The “context is the interweaving of the relevant facts The environment established by Symphonology is
of a situation” (Husted & Husted, 2008, p. 84). There formed by agreement within a context. Agreement is
are three interrelated elements of context: the con- a shared state of awareness on the basis of which
text of the situation, the context of knowledge, and interaction occurs (Husted & Husted, 2008). Agree-
the context of an agent’s awareness. The context of ment creates the realm in which nursing and all
the situation includes all aspects of the situation that other human interactions occur. Every agreement is
provide understanding of the situation and promote aimed toward a final value to be attained through
the ability to act effectively within it. The context of interactions made possible by understanding.
knowledge is an agent’s preexisting knowledge, The health care professional–patient agreement
which includes factors usually found within the sit- is formed by a meeting of the professional’s and the
uation. In the context of an agent’s awareness, the patient’s needs. Their agreement is one in which the