What is nursing? Nursing as the science of human life in a postmodern era: Clues from the past to understand the road ahead

The world is constantly changing and, as a consequence, so too is nursing. We are heading into a period where digitalization will have a major impact on human life and interaction worldwide. Therefore, one of the most important questions to answer as we enter this postmodern era where in the coming decades we are to co-exist with artificial intelligence (AI), robots and cyborgs is: what is nursing?

In pursuit of an answer, scholars need to admit that the Victorian era has had a notable impact on the current body of work on nursing. The Victorian era is usually defined as the period from 1837 to 1901, when Queen Victoria reigned over Great Britain. It was a time characterized by extended peace, as well as economic, colonial and industrial consolidation. This peaceful period was only temporarily disrupted by the Crimean War where Florence Nightingale (1820–1910) made her entrance into history. Another celebrity of the Victorian era is Charles Darwin (1809–1882). During these decades of scientific progress a kind of ‘Western knowledge’ took shape that subsequently split the world into dichotomies. A line of thinking was formed in a system based on differences: man the converse of woman, rationality the opposite of compassion. This way of thinking was later labeled ‘disembodied Western rationality’ by feminist critics. It is more commonly known as ‘objectivity’.

Nightingale and Darwin, icons and great thinkers, have had a major societal impact on this period. Both published their most famous works in 1859. They investigated, theorized and published research on what Nightingale referred to as the ‘laws of life’. And they challenged the dogmas of the time. Whilst Darwin struggled with religious authorities and the Church of England, stifling his own ideas so as to avoid the risk of being reprimanded by the church, Nightingale struggled with patriarchy, marriage and other male-dominated institutions under which she feared losing her significance and worth.

It is telling that, whilst Darwin was allowed to form explicit ‘theories’ as in his The origin of species, ¹ Nightingale was confined to writing ‘notes’ as in her famous book Notes on nursing. ² The use of the word ‘notes’ connotes a submission to, and refraining from challenging, the emerging patriarchal ideas about objectivity. In this emerging system of disembodied Western rationality, Nightingale’s, indeed every woman’s, viewpoint is, of course, biased. Darwin’s, i.e. men’s, are not.

Both Nightingale and Darwin became icons of their era and, over the decades, continued to be held up as representatives of their genders. They have been placed in a system of disembodied Western rationality as stereotypical examples – Darwin as the representative of rationality and Nightingale that of compassion. Even if they both worked on the scientific issues concerning the ‘laws of life’, as metaphors and representatives of Victorian science, Nightingale and Darwin couldn’t be further apart from each other. Darwin became the most famous icon of science ever to walk the earth. Nightingale became the iconic ‘lady with the lamp’. In this system of objectivity, indeed, privileges become invisible to those who possess them.

In the work ahead, facing the introduction of artificial intelligence and robots in care giving, a change is much needed. It will require a radically new approach. It can no longer be business as usual for nursing science. We will need inspiration from systematic theorists such as Nightingale, to consider new angles to her ‘laws of life’ and to clarify why nursing is of the utmost importance to human life in a space and time approach. To do so we need to go back to explaining nursing starting with the physical laws rather than medical terms. Like physicists, the nursing theorist needs his or her own string theory ³ and distance from the medical terms and institutions that, throughout the 1900s, stymied nursing from benefiting from a common platform of knowledge.

As an example of working towards this space and time approach I utilized an algorithm to query an online search engine. The top answers to What is nursing? were, ‘care for, take care of, look after, tend, and attend to, minister to’ and ‘he was gradually nursed back to health’. From the accumulated bulk of human knowledge in cyberspace the answer I received characterizes nursing as something that both attends to and is directed at. It attends to, via a nurse, and is directed at the goal of improving another person’s health. More precisely, nursing can be regarded as the rhythm and movements in things people do to heal others.

The rhythm of nursing is the opposite of being temperamental; the movements of caring are the opposite of being static. Nursing is the waves in space and time that are formed when a caregiver comes in contact with a person needed to be cared for. The waves form frequencies, amplitudes, spectrum, interference and diversions within different rhythms and movements. By explaining nursing in these terms we can zoom in on the fundamental value nursing has and basic asset it is in space and time and the ‘laws of life’.

Because of this, we can also draw the conclusion that the foundation of nursing rests upon the ability to ‘doubt’. Being doubtful – the ability to address a situation and its circumstances with an ‘it depends on’ approach – is fundamental in nursing. It is the ability of the caregiver to take someone else’s perspective into consideration. It is this doubt that creates the rhythm and movements and enables one to respond to another’s needs and to act on the basis of his or her situation. Based on this ability to doubt, the person who cares creates waves through concrete actions directed towards the other person’s health. These ideas about doubt in human life are not new. Descartes (1596–1650) coined the phrase, ‘I doubt, therefore I think, therefore I am’ (in Latin Dubito, ergo cogito, ergo sum) back in the 16th century as a starting point in the process of human presence. Doubt makes it possible for the human thought process to shift from ‘I am right’ to, ‘what are the other person’s needs?’

One of the scientific difficulties we face in this postmodern era where machines are repeatedly mimicking cognitive functions, refining AI such that it will soon be suitable for nursing, is how to facilitate this ability to doubt within the realm of the technology. The question is whether it is possible to create an algorithmic protocol for doubting that a machine can mimic. If it is not possible, than we cannot teach machines with AI to care, only to repeat patterns. In that case, the machine (AI) will be able to think ‘I am right’, but cannot go beyond that. That is a dangerous thought for humans, and possibly even more so for machines to think about humans.

If we are to coexist with artificial intelligence, robots and cyborgs, nursing scholars need to pay close attention to this question. Therefore, it is essential that nursing scholars systematically investigate the rhythm and movements in human life and ask: What is nursing? In a salutogenic society, the waves of nursing and caring are an essential, highly visible pattern. The rhythm and movements are visible in the way parents care for their children, nurses respond to their patients, and people take care of one another online or on the street. It is the glue that holds us together as beings and species – the ‘laws of life’. As stated previously, the rhythm and movements of nursing will more likely be described in terms of the physical – of space and time – rather than in medical terms.

To conclude, at this point in time, where new approaches are greatly needed and the stakes much higher, we need to ask ourselves: what is nursing? As nursing scholars, we are called upon to describe nursing and to share this with the world, but not necessarily to convert the results into digitalized matter. To do so, we need to pursue nursing as a general science and to form alliances with new research disciplines. We also need the inspiration of previous thinkers and icons and to boost our own courage and resolve. For example, in this short essay I have been influenced by Darwin’s own lack of acknowledgment of previous thinkers. I too have explicitly presented ideas in this text as my own.

Were I to do things differently, I might recognize my friend and long-time copartner in science, Martin Salzmann-Erikson ⁴ who, in his thesis, explicitly articulated a theory about rhythm and movements as the essence of caring. I could have made reference to the Scandinavian superstar in nursing science, Katie Eriksson, ⁵ who has shaped my own thinking since early adolescence. I might have mentioned Margaret Newman, ⁶ who established the theory of rhythm and movements many, many years ago or Carol Gilligan, ⁷ who used the phrase ‘it depends’ as the starting point for a closer look at ethics. They have all made crucial contributions to my thoughts on nursing. I did not mention them either. Is this because I am too eager to tout my own scientific contribution when granted the honor to write this editorial? I am very doubtful about this.

But perhaps it is not completely wrong for nursing scholars to do so. The circumstances within which I work today are quite different from those of Florence Nightingale and I need to honor her work from my position within this system of ‘objectivity’. In his theory of everyone’s struggle against everyone and the survival of the fittest, there was one thing Darwin didn’t fully grasp. He called this contradiction ‘altruism’. We call it ‘nursing’. For this reason, wherever they can, it is essential to the human race that nursing scholars speak out. Human life depends on it.