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528 UNIT IV Nursing Theories

in the following way. The professional will come to of how to achieve ethical action in health care could
understand and work from the philosophy that: not be more critical.
Since the initial development of Symphonology,
My patient’s virtues (autonomy) are such that he inductive reasoning based on observation and feed-
is moving (self-assertion) toward his goal (free- back from practitioners has provided for refinement
dom) in these circumstances (objectivity) for this of the concepts and clarification of the relationships
reason (beneficence). My virtues (autonomy) are among concepts.
such that I must act with him (interactive self-
assertion) to assist him (his freedom) within the
possibilities (of beneficence) in his circumstances Acceptance by the Nursing Community
to achieve every possible benefit that can be Practice
discovered (by objective awareness) The Husted Symphonological model for ethical deci-
(Husted & Husted, 2001, p. 154).
sion making (Husted & Husted, 2001, p. 201) was
An interactive model can be found at: http://www. developed as a practice model for applying the con-
nursing.duq.edu/faculty/husted/index.html cepts of Symphonology. This model, stressing the
centrality of the individual and the necessity of reason
directed by context, is vital in existing and emerging
Logical Form health care systems. The model provides a philo-
Abductive reasoning, like induction and deduction, sophical framework to ensure ethical care delivery by
follows a pattern: nurses and all other disciplines of health care. Unlike
• A is a collection of data (the process of discerning traditional models, the Symphonological model pro-
ethical action). vides for logically justifiable ethical decision making.
• B (if true) explains A (Symphonology). The North Memorial Medical Center in Robbinsdale,
• No other hypothesis explains A as well as B does Minnesota, has adopted the model for use by their
(traditional methods). nursing ethics committee.
• Therefore B is probably correct. The call to care in nursing is central to the profes-
The strength of an abductive conclusion depends on sion. Hartman (1998) asserted that caring is demon-
how solidly B can stand by itself, how clearly B exceeds strated when nurses recognize that the bioethical
alternatives, how comprehensive was the search for standards are so intertwined with caring that together
alternatives, the cost of B being wrong and the benefits they provide a perfect circle of ethical justification.
of being right, and how strong the need is to come to a Enns and Gregory (2006) proposed that nursing
conclusion at all (Josephson & Josephson, 1994). is losing the essence and practice of caring because
The abductive method is evident in the inception of the changing health care environment. Sympho-
and evolution of Symphonology. The strength of this nology offers a practice-based approach to care, as
theory is evident as well. The concepts of Symphonol- follows:
ogy clearly can be observed not only in health care A practice-based approach is derived from, and
but also in other walks of life. It is clear that ethical therefore is intended to be appropriate to the situ-
action based on the context of an individual’s particu- ation of a patient, the purpose of the health care
lar circumstances is far superior to the imposition of setting, and the role of the nurse. The more an
concrete directives that often contradict each other or ethical system restricts practice based on abstract
have little relationship to the situation at hand. The principles the more nurse and patient become
authors’ extensive study of the philosophy of knowl- alienated from each other
edge, science, and the human condition attests to the (Husted & Husted, 1997b, p. 14).
comprehensive search for alternative answers. The
benefit to patients and health care professionals of Many nurses practice within systems bound by pro-
receiving practice-based ethical care would be im- tocols and critical pathways. Using a Symphonological
measurable. Finally, the need to address the problem approach can ensure that nursing practice remains