(Satellite photo of the world at night)

Perspectival Evidentialism ©.
Kind of a mouthful, isn’t it?

Plain Talk:  These ideas demonstrate how we might picture human nature a bit differently compared to body-mind-spirit yet still accounting for body-mind-spirit.  A perspectival view accounts not only for the patient, but also the nurse, social networks, values, and environmental aspects and how all these impact the person as a whole.

The Details:
How about a preview?
This is the name I’ve chosen (for now, anyway) for my philosophy of nursing. I think “perspectival evidentialism” is a good fit because the term itself embraces the simultaneous elegance of reality’s simplicity and complexity while permitting evidential evaluation of the whole of man’s well-being. This is the backdrop against which nursing epistemology and, by logical extension, nursing science rests. In a definite but more general sense, it is a philosophy of nursing based on human ontology of ethic, being, and doing. The beauty of this is that both client and nurse stand together in a holistic interchange. In other words, because of the perspectival reality we all live in that is comprised of ethics (which reflect our beliefs about truth), personal relationships (even including society as a whole), and our own existential being, both nurse and client are always interdependent.

I offer here a very simplistic overview of Perspectival Evidentialism:
Envision a 3-D triangle.

The perspectival component entails three perspectives (the angles of the triangle) of human ontology…three lenses, if you will, through which we develop nursing science: Normative (i.e., truth, beauty and ethic), Existential (the self, I, me), and the Situational (relationships, environmental factors, anything outside of “me”).*

Each perspective is just that: a view of the problem or situation from one perspective, but it is a view of the WHOLE in its entirety. The model is inseparable, non-linear, non-hierarchical. It is an integrative whole.  It is NOT like that old parable about 3 blind men’s interpretations of what an elephant is like, because in that parable each interpretation is actually an interpretation of a PART, which is more of a “systems” framework.

The evidential aspect refers to the “evidence” revealed by each perspective, such as a particular ethical or truth problem, a situational problem (relational, social justice, environmental, economic), or an existential problem (self-identity, self-purpose, personal desires, lack of knowledge).

I want you to think about this evidential aspect. Consider:

1. If you are a nurse, you stand in the middle of these triangulated perspectives (normative, existential, and situational) as a perspectival interpreter: to the client, to the profession of nursing, and to society, with the ultimate purpose to maximize the holistic health of mankind based on a knowledge of biobehavioral motivations.

2. It is the nurse who assists the client existentially in interpreting the knowledge (scientific or ethical or relational) available at the given moment and who upon proper assessment of the interplay of the perspectives, offers a plan of care to optimize the holistic fulfillment of the client in keeping with truth (scientific, ethical, relational).

3. It is the nurse who stands in the public arena of social justice to destroy barriers that enable disparity. These barriers are seen as roadblocks to holistic health because we interpret them as unethical, whether we are talking about laws, medical access, or economics. We are constantly measuring issues relative to the perspectival model, whether we realize it or not. We adjudicate on the basis of our understanding of truth, the reality of man, and the nature of man’s relationships. In the end it all boils down to a battle of truth. That doesn’t mean, however, that truth is always easily discerned.

4. It is the nurse who takes notice of the biobehavioral responses of the client (the existential) relative to his situation (environmental and relational) and relative to truth (scientific and ethical). Nursing research/science is thus borne from these biobehavioral observations.

Perspectival Evidentialism is broad enough for transglobal application yet readily adaptable to the narrowest client problem conceivable. I believe its success as a nursing philosophy is rooted in its description of human desire and its constant quest for balance of ethics (truth and beauty) and relationships (interpersonal and environmental relationships). The willful choices of man relative to his desires are the “evidence” of his holistic state (at any given time) and “evidence” of the influence of the related perspectives. Think about that. We constantly interpret our world within these perspectives, and then act on our strongest desire at that moment.

“Evidence-based practice” just took on a greater meaning. Do you see that?  Perspectival Evidentialism forces us to analyze the evidence of man’s self and his desires; the evidence of truth, ethic, and beauty; the evidence of relationships. The nurse as interpreter of “evidence” then refines and hones the nursing knowledge (“evidence”) discovered through nursing research/science, then stands again as interpreter (translator, disseminator) of evidence to the client.

I believe the Perspectival Evidential model holds promise for framing nursing science within a truly holistic sense at the most fundamental ontological level of personal desire, intention, and purpose. I believe it will enable us to speak more cogently, concisely, and coherently about holistic health within the current catch-phrase of “evidence-based practice”. The beauty of Perspectival Evidentialism is that evidence-based practice can now encompass holism without the sacrifice of empiricism, rationalism, or subjectivism. Indeed, holism requires all these and then some.

Perspectival Evidentialism © is a model of revelation (of what we know or believe to be true) whereby examination and research that is guided by a truthful ethic, facilitates nurses to intervene therapeutically for clients (whatever form that might take: physical, emotional, intellectual, spiritual). Kind of like a holistic GPS.

*(I had envisioned this model in rudimentary form about three years ago. Much to my delight, John M. Frame had created and exposited this same perspectival model. His book, The Doctrine of the Knowledge of God (1987, P&R Publishing), is a philosophical and theological argument for the model. I am indebted to Dr. Frame for allowing me to adapt this model for nursing philosophy. E-mail correspondence 01-23-08.)