Free Transforming Care: A Christian Vision of Nursing Practice by Mary Molewyk Doornbos;Ruth Groenhout;Kendra G. Hotz

in
part by the goods that are "internal to that practice." There are certain central values or goods or aims that are the main focus of nursing and that define it as a practice. Health is the most central of these, since nursing is a
health care practice that aims at the alleviation of pain; at restoring physical, psychological, and emotional functioning; at attending to the wellbeing of the whole person; and so on. While these latter aims may coincide
with physical health, they also may diverge in certain cases. A terminally ill
client, for example, is unable to achieve full physical health, but she can
certainly look to her caregivers for the alleviation of pain and for concern
for her emotional well-being.
    Care is essential to curing
and healing, for there can be
no curing without caring.
    MADELEINE M. LEININGER
    These central goods can be redefined over time. In the past, nursing
tended to think of itself as a matter of service work. Training as a nurse involved learning to change dressings and
bedpans in the hospital setting, and nursing education involved learning to carry
out physician's orders (McKenna 1997, 87).
But nursing no longer defines itself in this
way. It now defines itself as a sciencebased practice and as an independent profession, and it requires practitioners to
master knowledge of the scientific basis of
nursing practice and to internalize professional standards of behavior that
include responsibility and client advocacy (Group and Roberts 2001, 344). This is an important change in the professional self-definition of nurses,
and it involves a shift in the central goods of nursing from a more servicebased model to a science-based model of nursing, though historical studies demonstrate that nursing has never been entirely service based (Nelson
2001, 31; Lewenson 1993, 5).

    These goods, or central values, are what Maclntyre calls "internal"
goods of a practice. He calls them internal for two reasons. The first is that
they define the central identity of nursing as a practice, so that without
them it would not be nursing. The second is that they are distinctive from
other goods that might be incidentally connected to the practice but do
not define it. So nursing is a job, and it involves a salary, various benefits,
and often certain schedules for working. These are good things, and important things, but by themselves they don't identify what nursing is all
about. A nurse's salary may change as she moves from one health care system to the next, but her goals as a nurse remain focused on health. Further,
we can envision changing, say, the normal schedule nurses work without
changing their identity as nurses. But if we ask nurses to focus on the profitability of the health care system rather than on the promotion of health,
we are making a change in the nature of nursing itself and in the nature of
what it is to identify oneself as a nurse.
    This notion of the internal goods of a practice becomes more complex
when we combine it with the notion, discussed earlier, that practices have a
history. The definition of nursing that we find in Florence Nightingale is
significantly different from the definition of nursing that we find in contemporary textbooks in some ways, though her definition clearly sets the
tone for the later development of nursing (McKenna 1997, 86). This is not
so much because Nightingale somehow got nursing wrong, but rather because nursing as a practice has developed and refined its notion of what
nursing is all about to the point where it now defines itself differently than
it did, as a practice, many years ago. Presumably, as health care continues
to develop and change, nursing will continue to develop and refine the notion of what it means to be a nurse. Part of what makes it a practice (rather
than just a job) is that these revised understandings come from inside the
practice itself as those who engage in it gain a better understanding of
what its