PERSPECTIVE
https://doi.org/10.47811/bhj.200
Holistic Nursing: A philosophical reflection on practice, identity, and patterns of knowing
Georgina P. Maskay1
1College of Healthcare Education, Mountain Province State University, Mountain Province, Philippines
Corresponding author:
Sangay Zam
ABSTRACT
This perspective calls nurses to reconnect with the heart of their profession: holistic, ethical, and empowered care. Nursing is not only science but a human practice where knowledge, compassion, and moral judgment unite. Guided by Carper’s patterns of knowing and Roy’s Adaptation Model, it shows how evidence, empathy, and ethical insight shape daily practice. Yet, invisibility persists through gender roles, stereotypes, and undervaluation of relational work. Reclaiming voice through education, leadership, and advocacy can shift perceptions and strengthen impact. Nursing, at its core is about healing both bodies and lives, upheld with courage, conscience, and dignity.
Keywords: Holistic Nursing; Reflective Practice; Humanistic Nursing
INTRODUCTION
Nursing is more than a clinical skillset; it is a deeply human, ethical, and reflective practice. Notably, nursing integrates science with compassion, reason with empathy, and evidence with personal and cultural understanding. Despite its indispensable role in shaping patient outcomes and safeguarding dignity in moments of vulnerability, nurses often remain invisible within the healthcare system and society as a whole. Task-oriented expectations, rigid hierarchies, and media stereotypes continue to narrow the public perception of what nurses truly do and who they are1,2.
This philosophical reflection urges all nurses to reclaim the full identity of nursing by embracing holistic philosophies rooted in a post-positivist view, integrating science and ethics, and empowering themselves to lead, influence, and elevate the profession. It reflects on the ways empirical, ethical, personal, and aesthetic patterns of knowing come together in shaping the essence of truly transformative care. This paper highlights how the integration of evidence-based practice, moral reasoning, and relational insight enables nurses to move beyond systemic barriers, transcend limiting stereotypes, and lead with integrity. It further explores how embracing a holistic identity not only enhances patient care but also empowers nurses to become influential leaders, advocates, and agents of change in today’s rapidly evolving healthcare landscape.
PHILOSOPHICAL REFLECTION ON PRACTICE, IDENTITY, AND PATTERNS OF KNOWING
As a nurse, practice is guided by the post-positivist philosophy, which acknowledges that while empirical science is fundamental in guiding decisions, it is incomplete without ethics, personal knowing, and human values3. The best care emerges from the fusion of evidence and ethics using research to inform care and moral reasoning to uphold dignity. A nurse’s experience illustrates this: during an encounter with a patient diagnosed with appendicitis the nurse recognized signs of an acute surgical condition. A referral made directly to a surgeon led to a life-saving intervention, but excluded the attending physician. While the outcome was favorable, the nurse realized that acting solely on empirical knowledge without ethical collaboration created division. This moment emphasizes that sound nursing practice must balance knowledge with ethical responsibility4. Science guides actions, while ethics ensures that actions are just.
Despite essential contributions, nursing continues to be undervalued and misunderstood. Nurses often find their relational and holistic work dismissed, overshadowed by task-based functions and medical hierarchies. Media portrayals of nurses as passive or subservient perpetuate a narrative that disempowers the profession¹. In addition, gender-based stereotypes contribute to this invisibility. Male nurses are often perceived as more competent, not due to skill, but due to societal bias. This dynamic undermines the professional identity of all nurses, particularly women, who form the majority of the workforce.
Competence is not gendered; it is demonstrated through knowledge, compassion, and clinical judgment. To dismantle these barriers, nurses must first empower themselves. True empowerment involves three elements: supportive work environments, belief in one’s power, and recognition of the unique strength found in relational care5. Empowered nurses influence patient outcomes, reshape public perceptions, and drive system-wide change. Nurses are advocators of themselves and their patients. Empowerment is embracing the full scope of four patterns of knowing: empirical, aesthetic, ethical, and personal6. These ways of knowing must coexist and guide every decision made by a nurse. A nurse caring for a pediatric patient in respiratory distress illustrates this point when repeated medical orders failed to improve the child’s condition, she trusted her assessment and relational understanding to advocate for a change in treatment. This advocacy, rooted in both knowledge and empathy, led to the child’s recovery placing nursing at its finest.
Health is not merely the absence of disease. As Roy’s Adaptation Model reminds us, individuals can thrive even amidst illness when supported by a nurturing environment and effective nursing interventions7. A person with chronic heart disease may still function and find joy because of adaptive strategies and a holistic care approach. Nurses, by manipulating the stimuli around the patient rather than the patient themselves, promote this positive interaction with the environment. Leading modern healthcare requires nurses to ground their leadership in holistic knowing. Effective transformational leaders are those who model Carper’s patterns of knowing embracing evidence, intuition, ethics, and relationships. According to Stetler et al., transformational nurse leaders demonstrate strategic, functional, and cross-cutting behaviors by engaging, educating, intervening, inspiring, and advocating8. These are the qualities nurses must cultivate within themselves and each other.
CALL TO ACTION
In an increasingly complex and impersonal healthcare landscape, nurses are called to reclaim their full professional identity by integrating knowledge, compassion, and ethical purpose. This paper urges nurses to rise above stereotypes, challenge institutional and societal biases, and assert their visibility as autonomous professionals. Holistic, evidence-based, and morally grounded care must define every patient encounter, reflecting the unique strength of nursing at the intersection of science and humanity. It is by fostering mentorship, education, and collaborative leadership that nurses can empower one another, transform the profession from within, and drive systemic change. United in purpose and guided by integrity, nurses must lead boldly toward a more just, human centered future in healthcare.
CONCLUSION
Nursing is a profession grounded in science, elevated by ethics, and committed to respect human dignity, but the vital role of nurses is overlooked. It is time to move beyond stereotypes, media misrepresentations, and institutional hierarchies and to reclaim the visibility, voice, and a redefined professional identity. Practice must be grounded with philosophical reflection, integrating the four patterns of knowing, and embracing our leadership roles reshaping what it means to be a nurse. Nurses are to be empowered with knowledge, compassion, moral, courage, enabling them to be more than caregivers and to serve as advocates, change agents, and leaders in holistic healing.
REFERENCES
1. Falk-Rafael AR. Empowerment as a Process of Evolving Consciousness: A Model of Empowered Caring. Adv Nurs Sci. 2001;24(1):1–16. [PubMed] [Full Text] [DOI]
2. Aydelotte MK. The Changing Image of the Nurse. Image: J Nurs Scholars. 1987;19(4):213–4. [Full Text] [DOI]
3. Weaver K, Olson JK. Understanding paradigms used for nursing research. J Adv Nurs. 2006;53(4):459–69. [PubMed] [Full Text] [DOI]
4. Johnstone MJ. Bioethics: a nursing perspective. 6e ed. Chatswood: Elsevier; 2016. 434 p. [Full Text]
5. Manojlovich M. Power and empowerment in nursing: looking backward to inform the future. Online J Issues Nurs. 2007;12(1):2. [PubMed] [Full Text] [DOI]
6. Carper B. Fundamental patterns of knowing in nursing. Adv Nurs Sci. 1978; 1(10):13-23. [PubMed] [Full Text] [DOI]
7. Roy C, Andrews HA, editors. The Roy adaptation model: the definitive statement. Rev. ed of: Essentials of the Roy adaptation model. Norwalk, Conn.: Appleton & Lange; 1991. 472 p. [Full Text]
8. Stetler CB, Ritchie JA, Rycroft‐Malone J, Charns MP. Leadership for evidence‐based practice: strategic and functional behaviors for institutionalizing EBP. Worldviews Evid Based Nurs. 2014;11(4):219–26. [PubMed] [Full Text] [DOI]