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Running head: DEFINNING THE ART OF NURSING: UNDERSTANDING TECHNE 1

Defining the Art of Nursing: Understanding Techne, Theoria, and Phronesis

Teresa D. Welch

The University of Alabama

Seminar in Curriculum Leadership

AEL 695

Douglas McKnight, Ph.D.

November 30, 2013

DEFINNING THE ART OF NURSING: UNDERSTANDING TECHNE 2

Defining the Art of Nursing: Understanding Techne, Theoria, and Phronesis

Wide-spread transformative changes in the United States health care system and practice

environments will demand equally profound changes in the professional practice and educational

preparation of nurses to prepare them for this cacophony of change called health care reform

(Institute of Medicine of the National Academies and the Robert Wood Johnson Foundation

[IOM], 2011). “Nurses must learn how to assess, use, and manage knowledge, rather than trying

to pack thousands of facts into their heads, hoping to be able to retrieve them when needed”

(Stokowski, 2011, para. 7). We need to hardwire the processes that promote and sustain real

time, point of care access, to and management of knowledge in both education and nursing.

Furthermore, nurse educators need to improve the linkages between knowledge, clinical

reasoning, and professional practice as care within the hospital setting continues to grow more

diverse and complex, and nurses are required to make critical decisions that involve sicker,

frailer patients (Stokowski, 2011). Care in this setting depends upon sophisticated, life-saving

technology coupled with complex information management systems that require skill in the

analysis and synthesis of information at the point of care (Institute of Medicine of the National

Academies [IOM], 2011). “Our progress of knowledge is subject to the law of increasing

specialization and, hence, to increasing obstacles to comprehensiveness” (Gadamer, 1977, p. 10).

In the face of this dynamic environment it is crucial that entry level nurses have the

requisite competencies, and critical thinking skills to successfully navigate the complexities of

health care while at the same time meeting the demands of professional practice. Furthermore,

education should support a smooth transition from the academic environment to a host of

practice environments upon graduation (Stokowski, 2011). With these tectonic factors at play

demanding startling change, we must look to our past to provide the foundation of change and


the clarity of purpose to tie theory to practice. A firm understanding of this connection will serve

to improve practice and help rescue it from its own vagaries and perplexities (Dunne, 2009).

“Philosophy will serve us only if we surrender to it. The original problem does not remain in a

position to dictate what the terms of the conversation will be but is itself assumed into and

transformed by it” (Dunne, 2009, p. 21).

Theoria

In his analysis of Aristotle’s ethics Dunne states:

In the Nicomachean Ethics, where Aristotle speaks of the ‘self-sufficiency’ of

theory, and tells us that it is ‘loved for its own sake; for nothing arises from it apart

from the contemplating [to theoresai] while from practical activities we gain more

or less apart from the action. Theoretical knowledge, thus is conceived, was

emphatically distinguished from any knowledge which might have practical

import (Dunne, 2009, p. 238).

Theoria is beyond action yielding no product tangible or intangible; knowledge solely for

the sake of knowledge. According to Aristotle’s teachings “theoria is superior to any other. In

fact it is higher than human” (Adkins, 1978). Material goods maybe necessary for the life of

practical arête (excellence), but the theoretikos (deep contemplation) does not need material

artifacts. Artifacts may actually impede realization of theoria (Adkins, 1978). According to

Gadamer (1977) theory quite literally means “observation, simply looking on, perceiving how

things are or reveal themselves to be” independent of our own personal desires and interests: An

authentic reality without personal influence to prejudice the cognitive impressions. However, it

is prudent to acknowledge that as Kant noted in his famous work, Critique of Pure Reason,

“there is no doubt that all of our knowledge begins with experience”. This premise also holds


true for the knowledge that we possess as human beings and filters or influences all interactions

and thought. This would include the experiential knowledge of so-called practice that everyone

accumulates throughout their lifetime. Furthermore, moving beyond first-hand experience there

is that “vast wealth of knowledge which flows towards each and every human being in the

transmission of human culture”. Knowledge that is ‘subjective’ largely unverifiable and

unstable, but, nevertheless, knowledge that cannot be disregarded by science. (Gadamer, 1977).

According to Gadamer science is the highest intensification of the knowledge that guides

practice recognizing itself as pure theoria (knowledge sought for its own sake and not for its

practical significance). Furthermore, “science makes possible knowledge directed to the power

of making, a knowing mastery of nature. This is technology. And this is precisely what practice

is not. Technology is not knowledge that steadily grows with experience; it is acquired from

practice” (Gadamer, 1977, p. 4-5).

Techne

In the introduction of his book, The Enigma of Health, Gadamer (1977) made the

observation that, “everywhere it is a question of finding the right balance between our technical

capacities and the need for responsible actions and choice”( p. ix). “Aristotle used techne to

specify craft making, and not as a general reference to a body of knowledge” (Polkinghorne,

2004, p. 112). Simply put, techne is skill based knowledge that provides a rational plan of action

(Butler, 2006).

Polkinghorne provided an excellent example to demonstrate the concept of techne:

Techne is the reasoning used to develop the knowledge to bring about a desired

change, for example, transforming a lump of clay into a bowl for serving food.

The goal of the action was established before production began. The procedure


does not determine the end (telos) but comes to the task with the end (telos)

already established. Knowing what end (telos) is to be accomplished, the producer

can use techne to figure out the procedure that will transform the material into the

desired object. The actual manufacture of the object (poiesis) follows the steps that

have been worked out through techne reasoning. It is the reasoning used to

develop plans for the production of artifacts. Once a plan has been developed

through techne it can be used repeatedly on the same type of materials and will

consistently yield the same result (Polkinghorne, 2004, p. 115)

Aristotle specifically used medicine as his standard example for the transformation of the

purely practical accumulation of skill and knowledge into genuine science. According to the

teachings of Aristotle the physician grasps the universal to connect cause and effect, to

comprehend the reason why a particular form of healing meets with success and another will not.

“Techne is that knowledge which constitutes a specific and tried ability in the context of

producing things [health]” (Gadamer, 1977, p. 32).

“Techne provides the kind of knowledge possessed by an expert in one of the specialized

crafts, a person who understands the principles underlying the production of an object or state of

affairs, e.g. a house, table, a safe journey or state of being healthy" (Dunne, 2009, p. 244).

Phronesis

The concept of phronesis describes a person who knows how to live well and is

demonstrated in their behavior and actions as they interact with others within the community. It

is deeply personal in that, phronesis is reflected within the living of one’s life and characterizes

the kind of person that they are (Dunne, 2009)


According to Gadamer’s (1975) interpretation of Aristotle’s perception of phronesis, it is

the knowledge of self. This introspective knowledge cannot be learned or forgotten; it is ethical

and moral in character and, as such, it is the supreme influence on an individual’s actions. It is

obvious that skills based knowledge (techne) and theoretical knowledge (theoria, Sophia, or

episteme) are guided by the ‘self-knowledge’ (phronesis) in significant and social interactions. In

doing so, ‘self-knowledge’ embraces both the means and the ends of social action (Butler, 2006).

Phronesis is the excellence by which one deliberates well about what to do in the human realm.

It is the process of reasoning used to make the appropriate practical choices that constitute a

good life. Aristotle acknowledges that there are multiple facet’s to the ‘good life. When dealing

with the unpredictable social sciences, situations and circumstances change and are dependent

upon a myriad of influences. Phronetic decision making is more complex than Plato’s deductive

thought processes and typically does not produce the same calculated mathematical answers;

emotional and imaginative processes influence practical deliberation and the reasoning process

(Polkinghorne, 2004).

Quoting from the Nicomachean Ethics, Book 6, “VII. Wisdom is the most accurate of all

knowledge. It knows the principles, and the facts deduced from them. It is therefore, intuition

and science combined together” (Browne, 1853, Book. VI p. 65). Phronesis is the practical

wisdom that enables you to successfully foster another’s well-being. The Greeks used the word

phronesis to refer to the know-how that fosters that good; making both the moral and the

practical decisions that are required in nursing an intuitive judgment that draws from life’s

experiences (Bishop & Scudder, 2001). This experience is more than what we face in the

hospitals and clinics. It is the totality of our cumulative experiences of living and maturation

that we draw upon when we have to make these moral and practical decisions in our daily walk.


Telos

Quoting from Browne’s translation and analysis of Aristotle’s Nicomachaen Ethic’s:

Every art, system course of action, and deliberate preference, aims at some good.

Hence the good is defined ‘that which all aim at’. There are differences of ends;

namely, energies and works. The ends of the master-arts are more eligible than the

ends of those subordinate to them. This is the case, even though the end of the

master-art is an energy, and that of the subordinate art a work. II. There is some

end of human action which is desired for its own sake. It is the end of that which is

the master-science in the highest sense; i.e. the political. The political science

proved to be the chief science several reasons and examples. The knowledge of the

end useful. The subject of the ‘the end’ belongs to the moral, and the therefore to

political philosophy” (Browne, 1853, Book I p. 14)

Any literature review delving into Aristotelian ethics discusses the concept of telos.

Understanding this concept will bring clarity to the discussion of theoria and techne. Simply

translated telos means ‘end’ or ‘goal’. The significance of this concept lies within the realization

of the import it carries for the other concepts, particularly theoria. Theoria is the end in and of

itself.

“Aristotle claims that in order to determine the just distribution of a good, we have to

inquire into the telos, or purpose, of the good being distributed. The purpose of flutes is to

produce excellent music. Those who can best realize this purpose ought to have the best ones.”

(Sandel, 2009, p. 188). Restated, telos is a rational choice. The ‘rightness’ of that action is

determined by the purpose for which the action was undertaken in the first place. (Majithia,


2006). As previously quoted on the previous page, the first sentence of the Ethics tells us that

every activity aims at a certain telos.

Relevance to Nursing

Aristotle views education as a tool to improve human beings present circumstance in

their quest for livelihood, materials, or happiness. These teachings have had a profound impact

on the field of nursing, and are reflected in the concepts of techna (technology), theoria (theory),

and phronesis (profound wisdom or knowledge, and telos (the end). The fact that we mingle

with our environment in every breath is absolutely recognized in the field of nursing, in which

metabolic life is simultaneously ecological and socially interdependent (Elstad & Torjuul, 2009).

Naturally there is always application of knowledge to practice, as indicated by the very

terms ‘sciences’ (epistemai) and ‘arts’ (technai). Practice means not only the making of

whatever one can make; it is also choice and decision between possibilities. Practice always has

a relationship to a person’s ‘being’. This is reflected in the figurative expression: what are you

doing, but rather, how are you doing? Practice requires knowledge, which means that it is

obliged to treat the knowledge available at the time as complete and certain.

The Greeks transformed know-how and knowledge into a knowledge of principles and

thus demonstrable knowledge which one became aware of to enjoy for its own sake out of a

primary curiosity about the world. (Gadamer, 1977, p. 4-5). “Aristotle’s philosophy is

particularly relevant to nursing” (Elstad & Torjuul, 2009). “To Aristotle, natural processes and

human activities ultimately have the same ends, since cosmos unites nature and human society.

Good actions contribute to the supreme telos of human life, of living well through its course.

This is the basis for his distinction, much used in nursing ethics, between making (poiesis) which

is an end other than itself and action (praxis) which itself is its end” (Elstad & Torjuul, 2009).


Aristotle briefly discussed the concept of phronetic reasoning in a single book of the

Nicomachean Ethics. He focused on how to choose the best plan that would result in the correct

practical action. Aristotle, according to Polkinghorne (2004) believed that “ an agent with the

proper dispositions and developed perceptive capacity can make the right choice through the use

of deliberation” (p. 120). However, health care providers do not make single isolated choices to

be carried out. They are engaged with people that they serve over time. They continually have to

make choices about what to do next as they interact with the people. Healthcare providers act

then react upon observed responses to their actions. They engage in conversation with others

who are also involved in choosing goal-directed actions. The give and take of their person-to-

person interaction places their choices in a constantly shifting context. “Phronetic reasoning

involves more than simply deciding what to do in the beginning; practitioners have to monitor

the responses to their choices and adjust subsequent actions accordingly” (Polkinghorne, 2004, p.

120).

We can further examine the concept of phronesis through the discourses of nursing

education. Historically, there has been an educational debate within the academic and

professional bodies of nursing; the technical versus professional nurse. The associate nurse with

the two year nursing degree has been coined the ‘technical’ nurse, while the four year

baccalaureate nurse has been considered the ‘professional’ nurse (Mahaffey, 2002). All nurses

regardless of educational preparation must successfully sit for the NCLEX licensure exam. This

examination publically proclaims that it is strictly an assessment of minimal competence

(Mahaffey, 2002) (Sewell, 2007). The complexity and politics of this debate are well beyond the

bounds of this paper. It is only mentioned to demonstrate the differences found within the techne

and the phronetic.


The philosophy of nursing education and practice found within associate degree

programs focus on the requisite technical skills of the nurse rather than the theory, the

knowledge, the understanding of principles (Mahaffery, 2002). This has similarities with that of

the ancient Greek philosophers and their mode of reasoning called techne. Does techne or the

learned practical skills of nursing adequately prepare the nurse to deal with the ambiguities of

everyday nursing practice? The experienced clinical nurse would assert that while education and

knowledge are essential, they are not the only concepts vital to nursing practice. Logically it

would follow that the more knowledgeable and self-reflective the nurse, the broader the

knowledge base, the better the practice. The definition of a professional nurse would then be

someone who not only has a firm grasp of the techne through evidence based practice but who

also understands the universal and demonstrates the intuitive reasoning to pull it all together for

the betterment of the individual cared for. The art of the nursing profession lies within a

phronetic, ontological practice in which a nurse's morals, habits, and predispositions guide

practice.

You can be an expert in the technical realm but never achieve the attributes of excellence

in the art of nursing. To transcend from good/ competent to great/ excellent the nurse must

embrace and master the concepts of theoria, techne and phronesis. We must learn to find

ourselves, find our own way within this highly regulated and complex bureaucratic environment

of healthcare to be able to meet the needs of our patients (Gadamer, 1977). “Aristotelian theory

may thus provide a useful methodology for health care theorists, both in terms of looking at

practice (and its place in education) and in terms of identifying and dealing with the ethical

issues involved” (Scott, 1995, para. 3).


Conclusion

“… The social role of individuals rather than their self-understanding moves into the

foreground” (Gadamer, 1977, p. 11). This article has argued that an understanding of phronesis

and techne as the two primordial components of individual practical knowledge are vital for

researchers and practitioners… (Butler, 2006, p. 4). Aristotle’s lifework is a testament to

education and a belief that everyone should have a clear philosophy of life. A review of the

literature supports the influence of his teachings in philosophy and ethics to medical and nursing

students and indicates an increasing interest not only with duties, rights and consequences but

with the character of health care practitioners (Scott, 1995). We must continually ask ourselves

what makes for human flourishing. From this we should work for that which is good or ‘right’,

rather than that which is merely ‘correct’.

Quoting from Aristotle’s Nicomachean Ethics Book II:

Virtue being twofold, one part intellectual and the other moral, intellectual virtue has its

origin and increase for the most part from teaching; therefore it stands in need of

experience and time; but moral virtue arises from habit, whence also it has got its

name, which is only in a small degree altered (Browne, 1853, p. 33).

Nurses are taught the physical and technical skills necessary to pass the individual 'State

Boards' demonstrating minimal competence, but that does not imply nor infer that that nurse has

acquired the episteme, the techne nor the phronetic awareness to be proficient in the art of

nursing. An ‘excellent’ nurse must also be able to direct and coordinate the work of others, in all

departments, to care for the "whole" person emotionally, physically, and practically (Sewell,

2007). Technique and narrow rational technicality alone cannot address interpersonal and

relational responsibilities, discernment, and situated possibilities required by caring for persons


made vulnerable by illness and injury. Phronesis is required. Means and ends are inextricably

related in caring for the sick and ill. The clinician and the patient bend and respond to the other

so the horizons and the world are opened and reconstituted, allowing new possibilities to emerge

(Benner, Tanner, & Chelsea, 2009). Aristotelian virtue theory provides a practice-based focus

for health care ethics. Also, because of his emphasis on the character of the moral agent, and on

the importance of perception and emotion in moral decision-making, Aristotelian virtue theory

provides a useful supplement to the traditional duty-based approaches to health care ethics

analysis, which are increasingly being identified in the literature as having limits to their

application within the health care context. Given that an ethical dimension underlies much, if not

all, of nursing practice, it seems important that nurses are enabled to develop an ethical

awareness and sensitivity from early on in their initial professional education programs (Scott,

1995).

As a nurse and caregiver it is imperative to have an understanding of your own ethical

and philosophical values and viewpoints. To have that understanding and self-awareness implies

an emotional maturity that facilitates strong and effective interpersonal relationships with your

co-workers, patients and families. The ability and capacity to demonstrate a strong self-

awareness implies a high degree of emotional intelligence. We are more effective in everything

that we do when we understand ourselves, the way we think, and where our values are in relation

to others as well as our personal strengths and limitations (Gokenbach, n.d.).


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