Expertise in nursing practice : caring, clinical judgment - Springer ...

Chapter 1 The Relationship of Theory and Practice in the Acquisition of Skill 19
To see why, we must first distinguish illness from disease.According
to Benner and Wrubel (1989) disease is an organic dysfunction,ofwhich
modern medicine has a theory, whereas illness is the experience of the
breakdown of one’s body and thus of one’s everyday world. As theynote:
As long as one has no symptoms or other disruption of usual functioning,
there is noexperience of illness,eventhough disease may be present and the
body may be suffering damage at the cellular, tissue or organ level. Nurses
are in the unique position of being able to understand both the disease
experience and the meanings that the patient brings to that experience.
As a result, nurses can help shape the illness experience for the patient by
guiding, interpreting, and coaching. (pp. 8–9)
Nursing, because it treats both disease and illness, is at the same time a
paradigm caseofappliedtheory and an outstanding exampleofa practice
that is in principle beyond the reach of theory and analytical reason.
Disease is a dysfunction of the body, a physical object governed by
physical laws, so it should come as no surprise that Hippocrates’ vision
of the physician as scientist is finally being achieved. Yet, it would be a
mistakecharacteristicofour rationalisticculture to think that the success
of medicine in any way suggests that there can be atheory of nursing
as a caring practice. Caring in the context of nursing consists in keeping
open the possibilities that can be saved inthe world of the sick person
while aiding the person inletting go ofpossibilities that are no longer
realistic. If man were simply a rational animal, as the Greeks thought,
then there might be atheory of having a world and how to keep it. But
aschool of philosophy, developed inthe beginning of this century and
based on theexistential thought of Soren Kierkegaard, denies that man
can be understoodassomecombination of body and mind. Martin Heidegger
(1926/1962), the most famous philosopher in this school, stated
that human beings are defined bythe stand they take upon themselves,
which in turn sets up the rangeofpossibilities opento them. In this view,
human being is a unique way of being in that everything human beings do
follows fromtheir individual self-interpretation. The meaning of awhole
life is basic and determines what possibilitiesshow up and howthey make
sense to aperson. Moreover, we are not objective, theoretical spectators
of our lives and of the world but are involved participants. Things show
up as mattering to us. Heidegger sums this up by saying that the human
being does not have fixed properties like an object or animal, but that
man’s basic way of being is care. It is this way of being that must be