Corresponding Author: Lorraine Venturato, RN, PhD Email: lventura@ucalgary.ca Journal of Applied Hermeneutics ISSN: 1927-4416 February 10, 2021 ©The Author(s) 2021 Book Review Towards an Ecology of Nursing Knowledge: Nursing and Humanities by Dr. Graham McCaffrey Lorraine Venturato Abstract McCaffrey, G. (2020). Nursing and humanities. Routledge. (pp. 127, $63.95 CAD, Hardcover) Nursing and Humanities by Dr. Graham McCaffrey explores the role of humanities in nursing knowledge, and McCaffrey makes a compelling case that humanities are an integral, though often invisible, part of nursing practice. He places nursing humanities within the sphere of health humanities and provides a cogent argument, along with examples and insights, to support the claim that the humanities offer not merely another form of knowledge to sit alongside science, but also a way to integrate the diversity of nursing knowledge into a coherent framework or ecology of nursing practice. In this respect, the book serves as an important development in understanding nursing practice and forms a possible bridge between the tensions inherent in contemporary explorations of nursing as an art and science. The book is aimed at nurses, graduate students, nurse educators and researchers, and anyone with an interest in nursing theory. Nursing and Humanities is rich with ideas and propositions, often thought-provoking and challenging in its offering of an evolution of thinking about nursing knowledge and practice. Keywords Humanities, nursing, medical humanities, health humanities Venturato Journal of Applied Hermeneutics 2021 Article 4 2 In Nursing and Humanities, McCaffrey sets out to chart the sometimes-murky waters of nursing identity and knowledge, and in particular, to argue that the humanities belong in, and make a contribution to nursing practice. In so doing, he establishes a convincing argument for nursing to move further toward reconciling our history of dichotomy and tension in understanding nursing practice. These tensions are highlighted throughout the text, exploring the art and science of nursing, flesh and spirit, mind and body, the technical and the relational, technology and materiality, theory and practice, and body work and knowledge work. As a discipline, we have moved from questions of whether nursing is an art or a science to embrace both options, recognising nursing as an art and a science. McCaffrey’s proposition throughout the text is not only that humanities have a place in the diaspora of nursing knowledge and practice, but that, as a profession, we need to move understanding beyond the inference of the “and” that, while recognising the influence of both art and science, still regard them as distinctly separate entities. For McCaffrey, the humanities offer a way forward to reconcile this separation through the development of a hybrid nursing ecology “…whose character lies precisely in its diversity, its borrowings and adaptations from other disciplines, and its constantly renewed work in caring for the health needs of others” (McCaffrey, 2020, p. 116). The book is aimed at a diverse audience, including educators, graduate students, nurses, and researchers, as well as those interested in nursing theory. It is not always an easy read, but it is compelling and provocative. McCaffrey has divided the book into three sections, with the first two chapters addressing the history and application of humanities in nursing, while differentiating medical humanities and nursing humanities, and making a case for health humanities as an interdisciplinary space within which nursing has a unique voice and identity. The second section (chapters three to five) unpack and extend some of the theoretical positions on the nature of nursing practice and the place of humanities. Here, McCaffrey argues against the traditional dichotomous views of nursing knowledge and practice that divided nursing into art and science, technical and relational, and instead sets out a case for nursing (like other practice disciplines) as “…human activity that is consistent with both scientific explanation and cultural meaning-making” (McCaffrey, 2020, p. 4). Chapters six, seven, and eight comprise the third section as a series of individual essays on applications and implications of various ways of thinking about nursing and humanities. These include the concept of pharmakon in thinking about health humanities as having effects in much the same ways as drug therapy effects; the place of prose and poetry in highlighting and making sense of nursing practice; and the application of Buddhist thought in mental health nursing. The final chapter (chapter 9) looks to the future and argues that technological increases and post-human possibilities serve to highlight rather than negate the need for health humanities. Exploring Nursing and Humanities Throughout Nursing and Humanities, McCaffrey argues that humanities have a role, not just in making sense and identifying what matters in nursing practice, but also in shaping how we think about nursing as a discipline. As a human activity, nursing is focused on the rich world of humans, health, and bodies, and such activity moves from cells to systems, from individuals to communities, and from technological skill to skillful relating, in often seamless ways. McCaffrey explores these rich nuances through the following chapters. Venturato Journal of Applied Hermeneutics 2021 Article 4 3 Chapter 1 introduces the current context of the humanities in nursing, and teases out the differences in definitions, historic roots, and contemporary positions of medical humanities, nursing humanities, healthcare humanities, and humanities from a disciplinary and interdisciplinary perspective. McCaffrey highlights the different place occupied by the humanities in medicine and nursing and explores the humanities as a stand-alone disciple. He also makes a case for the use of the term “health humanities”, as a broad and inclusive term that facilitates the involvement of professional and non-professional groups (for e.g., unpaid caregivers), as well as the inclusion of art and humanities as therapy. McCaffrey also highlights the invisibility of humanities in nursing as an example of the close connection between nursing and humanities, so much so that many aspects of practice (for e.g., patient narratives) are often not recognised or considered as humanities but rather core elements of nursing practice. Chapter 2 considers the place of humanities in nursing education and research through history, philosophy, and aesthetics. This chapter serves to highlight the difficulties in drawing a clear boundary around nursing humanities through unpacking the idea of nursing as an art and science. Here, McCaffrey highlights the challenge of categorising or dichotomizing nursing practice and suggests that humanities play to the art of nursing and represent an attempt to make visible and express the human and relational aspects of nursing. Chapter 3 addresses the challenging question “what is nursing?” and considers historical and cultural mediating factors rooted in institutions, but also in the debates that seek out the heart of nursing – namely the role of caring, compassion, and empathy in nursing. This chapter highlights the multiple tensions that shape and frame the way nursing is understood – between the scientific and relational, between theory and practice, and between education and practice. McCaffrey highlights the link between humanism and nursing and suggests a way forward – a possibility for humanism to bridge humanities and nursing. Chapter 4 explores further these polarised views of nursing in relation to the rise of science and rationalism, as well as looking at some of ways that seek to restore balance and that recognise humanities and that support a “rich mixture of knowledge and practice” (McCaffrey, 2020, p. 50). McCaffrey explores pluralistic ideas of balance and blending using atlas and maps examples, cooking and recipe examples, and interpretation examples to explain nursing as a mixed practice. He argues that irreconcilable and competing paradigms of thought are largely unhelpful, while the multiplicity of ways of knowing in nursing means that various ways of knowing (including poetry and literature, history, and philosophy) are essential to understanding nursing in its fullness. McCaffrey argues for a preciseness “in how we use both science and humanities in the mixture of nursing” (McCaffrey, 2020, p. 59). Chapter 5 tackles the divide between science and humanities, which McCaffrey argues falls short in practice disciplines like nursing, teaching, social work, law, and medicine. Here McCaffrey posits that practice disciplines exist in a shared space of relational and scientific knowledge and he takes as his starting point the world of experience. This chapter goes on to explore the ways that science and philosophy come together in ideas about human experience that make sense for nursing and that help identify the place for humanities in nursing. This argument builds through exploration of Richard Kearney’s Carnal Hermeneutics, Damasio’s brain, body culture link, and Varela, Thompson, and Rosch’s enactivism, as well as a discussion Venturato Journal of Applied Hermeneutics 2021 Article 4 4 on negative plasticity and trauma through the lens of experience and mental health. Using Kearney’s Carnal Hermeneutics, McCaffrey positions nursing in the realm of the physical, and the body and senses as material to interpretation in nursing with its focus on “physical bodies in physical spaces” (McCaffrey, 2020, p. 62). Damasio’s work supports a brain-body link that aligns with carnal hermeneutics, from its view of the brain from cells, to systems, to functioning in a way that highlights the interaction between biology and culture. For McCaffrey, enactivism serves to round out this discussion. An enactive approach to cognition is based on an embodied and related circularity between biology, cognition, and social and cultural factors that focuses on making sense of experience in interaction with the environment. McCaffrey argues that nursing must be “scientifically informed, but culturally active” (p. 60), and that this mandate requires knowledge from both science and humanities. Indeed, he places nursing practice as engaged in negotiating the gap between biology, science, and experience and in “shuttling back and forth between objective and subjective, flash and culture, history and story” (McCaffrey, 2020, p. 69). In Chapter 6, McCaffrey returns to consideration of empathy and compassion, this time in relation to the claim that the humanities foster empathy among students and health care professionals. McCaffrey uses the metaphor of the pharmakon, which is associated with drugs and medication, but which can also be interpreted as a substance or movement towards difference, to make the case for considering the arts and humanities as a mind-body altering substances (McCaffrey, 2020, p. 74). As a consequence, arts and humanities may have positive, negative, or no effect, in much the same way that medications and drugs may produce similar effects on the body. McCaffrey continues his thoughts on nursing and humanities in Chapter 7, through consideration of creative writing, and, in particular, poetry and prose, and the role of story-telling and communication in bringing various aspects of nursing practice to life. Here McCaffrey explores different genres and uses of prose and poetry – through nursing narratives and lyric poetry – in education, reflection, and therapy. Chapter 8 draws parallels between Buddhism and nursing drawing on four Buddhist principles: 1. Begins with suffering; 2. Compassion in response to suffering; 3. Emphasis on practice; 4. Interdependency and relational/network affinity. McCaffrey argues here that the Buddhist concept of interdependence aligns well with the complexity of nursing and uses examples from mental health nursing to further explore the concept of interdependence in nursing and Buddhism. He provides an example of the historical narratives that drive mental health nursing intrinsically (nurse, asylum attendant, therapy, and custodial) and states that there is no one final master narrative and that all histories need to be considered. This raises interesting questions for nurse educators and researchers who often position from a narrative that reflects contemporary (as opposed to historical) narratives associated with best practice and evidence. The remainder of this chapter considers causes and conditions (stories), labels, and boundaries as touchpoints where Buddhist thought offers insight into understanding nursing practice. The chapter concludes by highlighting the difference between interconnection and holism, and proposes that, given the lack of clear definition in relation to the term holism, interconnectedness may be a more helpful term for nursing practice. Venturato Journal of Applied Hermeneutics 2021 Article 4 5 Chapter 9 explores the future of nursing and humanities in light of the rise of the post-human and the shifting boundary between the human and the non-human, and between the human and the technological. This shifting boundary has seen technology move from “tool manipulated by humans and into the human body itself” (McCaffrey, 2020, p.105). McCaffrey makes reference to genetics, artificial intelligence, robotics, and nanotechnology, as well as the increase in data and surveillance as increasingly shaping what it is to be human. He notes that, in light of this, “(n)ursing without the humanities is not nursing at all. It is robotics” (p.112). Conclusion McCaffrey makes a convincing argument for the place of humanities in nursing and for greater consideration and recognition of health humanities as a domain of nursing knowledge. Further, he hints at an exciting opportunity in the evolution of the ways in which we understand and think about nursing practice as an integrated practice, where diverse forms of knowledge and its varied applications come together in practice that is focused on human health, and where “(t)he future for humanities and nursing is in securing the importance of embodied, enculturated human experience when matters of health are at stake” (McCaffrey, 2020, p.112). Importantly, this work points to the range of further possible applications of health humanities. As McCaffrey points out, somewhat ironically, this is happening at a point in time when the humanities themselves are under threat from shifts in higher education that prioritise economic and employment ready education. References McCaffrey. G. (2020). Nursing humanities. Routledge.