Relational Nursing Leadership

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RELATIONAL NURSING LEADERSHIP: A PHILOSOPHICAL INQUIRY
by
REBECCA LYNNE BRYANT
B.S.N., Mississippi University for Women, 1981
M.S.N., University of Mississippi, 1983
A thesis submitted to the

Faculty o f the Graduate School of the
University o f Colorado in partial fulfillment of
the requirements for the degree of
Doctor of Philosophy
School of Nursing
1999
Reproduced with permission o f the copyright owner. Further reproduction prohibited without permission.
UMI Number: 9 9 4 2 4 8 8
Copyright 1999 by
Bryant, Rebecca Lynne
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This thesis for the Doctor o f Philosophy degree by
Rebecca Lynne Bryant
has been approved for the
School of Nursing
By
Sally Gadow
A
Jurate Sakalys
lally Phillips
it
Joan K. Magilvy
Mark Yarborough
Date 99
Bryant, Rebecca Lynne (Ph.D., Nursing)
Relational Nursing Leadership: A Philosophical Inquiry
Thesis directed by Professor Sally Gadow
This postmodern philosophical inquiry developed out of a concern for the moral
conflict experienced by nurses in the organizational practice environment. Of particular
interest was the kind of nursing leadership that would facilitate congruence between
nursing's moral intent and nursing practice. Caring, as the moral intent o f nursing, was
affirmed as central to both the philosophical and leadership purposes of nursing.
The study was framed by three questions: a) What are the conflicting
assumptions related to nursing's moral intent and philosophical perspective? b) How does
relational philosophy sustain a generative tension in the presence o f diverse nursing
perspectives? c) How might nursing leaders embody relational philosophy specifically in
the practice environment?
The method o f deconstruction/reconstruction was applied to dichotomies among
nursing's moral intent, philosophy, theory/science, and practice. That process consisted
of five steps: a) identify dichotomous assumptions, b) expose those assumptions as
historical constructs, c) examine for consistency with nursing's moral intent, d) reveal
how dichotomies function to oppress, and e) reconstruct new concepts that do not oppress
and open possibilities for newly created meanings.
The study was situated in the context of nursing debate over the pluralism of
philosophical perspectives and controversies related to the ethic o f care. Relational
philosophy was explored as a philosophical perspective congruent with the moral intent
o f nursing. Nursing leadership history as a contextual grounding for cultural assumptions
about leadership was elaborated. Relational leadership was presented as an alternative
possibility, reflective o f relational philosophy that is based on caring in contrast to
dominance. Leading was defined as the interpersonal process whereby each nurse,
regardless of organizational position or power, practices with moral integrity in the
context of a caring community o f meaning created with other nurses.
Five dimensions of relational nursing leadership included: questioning,
reflection, authorship, dialogue, and community. It was proposed that relational
leadership, where nurses hold themselves and each other accountable for seeking moral
integrity in morally conflicted practice environments, could strengthen the discipline of
nursing's efforts to enact an ethic of care. Case exemplars from nursing practice,
education, research, and administration were included to illustrate relational leadership.
The form and content o f this abstract are approved. I recommend its publication.
Faculty member in charge of thesis
V
TABLE OF CONTENTS
CHAPTER
I. NURSING LEADERSHIP AS AN EXPRESSION OF NURSING

NURSING PHILOSOPHY 1
Nursing's Moral Intent 1
The Role of Nursing Leadership 2
Multiple Nursing Philosophical Perspectives 4
Conflicts in Nursing Practice 6
Foundational Premises of the Study 8
Research Questions 9
Conceptual Framework: Philosophical Perspectives 9
The Relationship Between Philosophy and Leadership 12
Method: Postmodern Philosophical Inquiry 13
Organization of the Study 16
Summary 17
H. THE HISTORICAL CONSTRUCTION OF NURSING

PHILOSOPHICAL AND THEORETICAL PERSPECTIVES 18
Pre-Theoretical Definitions o f Nursing 18
The Emerging Dichotomy Between Nursing Philosophy

and Theory 21
The Emergence of New Conceptual Models 23
Nursing's Return to the Philosophical Perspectives of the

Discipline 25
Postmodern Debate Over Philosophies of Nursing 28
Debate Over the Ethic o f Care 30
vi
Summary 33
m. RELATIONAL PHILOSOPHY: ONTOLOGY, EPISTEMOLOGY,

AND ETHICS 34
Definitions o f Ontology, Epistemology, and Ethics 34
Philosophical Context 35
Metaphysical Philosophy 35
Objectivism 35
Subjectivism 36
Hermeneutic Philosophy 39
Relational Philosophy 41
Relational Ontology 42
Relational Epistemology 45
Relational Ethics 47
Relationship 48
Lived Experience 48
Vulnerability 48
Intersubjective Knowing 48
Created Meaning 48
Uncertainty 49
Summary 49
IV. HISTORICAL AND CULTURAL FOUNDATIONS OF LEADERSHIP 51
Foundations o f Nursing Leadership 52
Premodem Foundations of Leadership: The Dominator Model 52
Modem Foundations of Leadership: The Mechanistic Model 56
vii
Historical Development of Nursing Leadership 58
Contemporary Leadership Models in Nursing 61
Summary 63
V. LEADERSHIP IN THE CONTEXT OF RELATIONAL PHILOSOPHY 65
Postmodern Concepts of Leadership 65
The Ethic of Care 65
Servant Leadership 66
Spiritual Leadership 72
Relational Leadership 74
Relationship 75
Lived Experience 77
Vulnerability 78
Intersubjective Knowing 78
Created Meaning 79
Uncertainty 80
The Home Within 81
Relational Leadership in the Practice o f Nursing 83
Current Nursing Leadership: The Conflict Between Doing

Business and Practicing Nursing 83
Attempts to Resolve the Conflict: Empowered Caring 85
Relational Leading and Nursing Moral Integrity: Living in the

Conflict 87
Moral Authorship 87
The Values of Relational Nursing Leadership 88
viii
Dimensions of Relational Nursing Leadership 89
Questioning 89
Reflection 91
Authorship 92
Dialogue 93
Community 94
Summary 95
VI. RELATIONAL NURSING LEADERSHIP IN THE CONTEXT OF

NURSING PRACTICE, EDUCATION, RESEARCH, AND
ADMINISTRATION 98
Exemplar in the Context of Nursing Education 98
Exemplar in the Context of Nursing Research 101
Exemplar in the Context o f Nursing Administration 104
Summary 106
VII. CONCLUSIONS AND IMPLICATIONS FOR FURTHER STUDY 107
Study Summary 107
Conclusions , 108
Implications for Future Studies 109
REFERENCES 110
1
CHAPTER I
NURSING LEADERSHIP AS AN EXPRESSION OF NURSING PHILOSOPHY
Nursing’s Moral Intent
Nursing, as a practice discipline, enacts a societal role by participating in the
human health/illness experience (Donaldson & Crowley, 1978; Newman, Sime,
Corcoran-Peny, 1991; Schlotfeldt, 1994). To choose the role o f nurse is to choose an
expression of being that embodies beliefs regarding the meaning o f the human
health/illness experience, the nature o f caring, and the nature of the relationship between
the nurse and the patient (Newman, et al., 1991). Newman et aL (1991) developed a
focus statement for the discipline o f nursing linking health and caring, two concepts
consistently central to nursing: "nursing is the study of caring in the human health
experience" (p. 3).
The caring relationship between the nurse and the patient is the vehicle through
which nursing is practiced. Newman (1990) posed a question, which she argued is
essential to the discipline: "what is the quality o f relationship that makes it possible for
the nurse and patient to connect in a transforming way?" (p. 234). Donaldson and
Crowley argued that the humanistic value orientation of nursing has prompted nurses to
seek "knowledge of the basis of human choices and o f methods for fostering individual
independence...rather than knowledge of interventions that control and directly
manipulate the person per se into a societally determined state o f health" (p. 117).
The social construction of nursing has created ethical expectations of the nurse-
patient relationship (Schlotfeldt, 1994). Study o f the discipline o f nursing encompasses
the origins of societal expectations, the moral intent of nursing, and the philosophical
perspectives upon which nursing is based (Bishop & Scudder, 1990; Kikuchi &
Simmons, 1992; Polifroni & Welch, 1999). Theories and practices of nursing emerge in
a non-linear fashion against developing philosophical thought (Jacox & Webster, 1986).
2
The philosophical beliefs of a discipline constitute its moral intent, or purpose for
existence, as well as its ontology (nature of being), epistemology (nature of knowing),
and ethics (nature of doing) (Carper, 1978; Silva, Sorrell, & Sorrell, 1995).
The moral intent of a practice discipline guides how it will use its knowledge and
skills to fulfill its societal commitment. Bishop and Scudder (1997) referred to this moral
intent as the "essential moral sense" of nursing (p. 83). The moral sense, or moral intent,
of nursing is reflective o f nursing as a way o f being (Watson, 1995). In describing the
practice o f nursing, Bishop and Scudder clarified "a practice exists only in practitioners
who appropriate these ways of being in ways that are appropriate to their own being and
those of the persons for whom they care" (p. 84).
Nursing has historically placed more emphasis on epistemology, in terms of
philosophy, than on ontology (Meleis, 1986; Silva et aL, 1995). A current shift in nursing
emphasis is on the ontological assumptions that direct nursing practice, education, and
research. Silva et al. (1995) observed that "nurses have begun to raise ontological
questions regarding the nature and meaning of their own and their clients' realities and
beings" (p. 3).
A practice discipline, such as nursing, engaged with a moral intent must have a
foundational philosophy from which to reflect upon the integrity between practice actions
and the moral intent. Donaldson and Crowley (1978) argued:
The need for philosophical, historical, and similar types o f enquiry within
the discipline o f nursing is crucial not only in terms o f providing the
knowledge base for professional preparation but also for the development
of the discipline. It must be remembered that the discipline is defined by
social relevance and value orientations rather than by empirical truths.
Thus, the discipline and profession must be continually re-evaluated in
terms of society needs and scientific discoveries" (p. 118).
The Role of Nursing Leadership
Traditionally, leaders emerge within a discipline to articulate its philosophy and
moral intent and inspire its members to practice in consonance with it. Thus, the
3
philosophical reflective framework of a discipline is embodied in its leaders. However,

Schlofeldt (1992) posed the following questions:
Why then, after over a century o f nursing's existence as an
institutionalized field of essential human service, during which many
nursing leaders have aimed and claimed to be preparing professionals, is it
necessary to discuss the question of who holds responsibility for
answering nursing's philosophical questions? And after more than 3
decades of preparing rapidly increasing numbers o f nursing scholars, why
have those nursing scholars not already addressed and found acceptable
answers to nursing's most important philosophical questions? (p. 98).
Watson (1981) addressed the conflicts in nursing between the origins of
disciplinary ideas about the nature o f nursing established by early nursing leaders
(Nightingale, 1860; Henderson, 1966; Krueter, 1957; Hall, 1964) and the ensuing pursuit
of professionalism via the logical positivist approach to philosophy of science. She
noted:
somewhere in the midst of these strong opposing external forces nursing
lost sight of its nursing leaders’ call for research aimed fundamentally at
the solution of human health problems. Such leaders...were advocates of
an integrated approach to scientific study that would capitalize on
nursing's richness and complexity and not separate practice from research,
the art from the science, the "doing" o f nursing from the "knowing," the
psychological from the physical, and theory from clinical care (p. 282).
Nursing leadership has typically been taught, as has nursing, in terms of behaviors
rather than philosophy. The emphasis tends to be on what the nurse or nurse leader does
(skills, behaviors, interventions) to accomplish organizational or disciplinary goals rather
than who the nurse or nurse leader is in relation to the world (basic assumptions, beliefs,
values). It has been common to embody leadership in an external source of authority that
acts toward others, much like the unilateral nurse-toward-patient relationship.
Leadership literature increasingly addresses the question o f who the leader is as
much as what the leader does (Arrien, 1993, Bolman & Deal, 1995, Covey, 1989, Cox &
Liesse, 1996, Eisler & Loye, 1990, Greenleaf 1998, Levy, 1998, Senge, 1990, Shipka,
1997, Wheatley, 1994). The nurse leader in the nursing practice setting is in a pivotal
4
position to integrate the philosophy of the discipline with the manner in which the
discipline is practiced (Curtain, 1997, Curtain, 1998, Klakovich, 1994, Koemer, 1996,
Nyberg, 1998).
Multiple Nursing Philosophical Perspectives
Philosophy of science based on a logical positivist approach to theory and
knowledge development has been the predominant approach in nursing for the past three
to four decades (Watson, 1981). The assumptions of logical positivism, also referred to
as the received view, include "standards of logic, formalization, objectivity, falsity, truth,
observational and operational terms, laws, predictions, and reductionism" (p. 282). The
assumptions of this philosophical approach have been identified by nursing scholars as
incommensurate with the values o f the discipline including: the irreducible nature of
human existence, human self-determination, individual uniqueness, relativism, and the
nurse/patient relationship (Munhall, 1982). Munhall (1982) posed the question: "are
nursing philosophy and nursing research vis-a-vis the scientific method ideologically and
philosophically opposed?" (p. 582).
Both Munhall (1982) and Watson (1981) identified dichotomies that have
emerged in nursing as a result of conflicting values between nursing philosophy and
nursing research/theory development. These dichotomies included "doing versus
knowing, caring versus curing, nursing practice versus nursing theory, subjective versus
objective" (Watson, 1981, p. 283) and "uniqueness versus generalizations, relativism
versus categorization, holism versus reductionism, organismic versus mechanistic"
(Munhall, 1982, p. 583).
Nursing scholars have argued that the practice of nursing is the focal point for the
development of nursing philosophy, theory, education, and research (Peplau, 1969; Ellis,
1969; Donaldson & Crowley, 1978; Benner, 1984; Meleis, 1986). However, nursing, and
thus, nursing practice, is defined differently based on the assumptions of the nurse
scholar.
5
Newman, Sime, and Corcoran-Perry (1991) identified three world-views based on

differing philosophical perspectives that inform nursing research and subsequently,
nursing practice. These three perspectives are the particulate-deterministic perspective,
the interactive-integrative perspective, and the unitary-transformative perspective. They
described how caring, for example, would be conceptualized in each perspective. In the
particulate-deterministic perspective, caring could be "studied as a therapeutic
intervention affecting patients' health in terms of measurable responses" (p. 4). The
interactive-integrative perspective would incorporate the "specific contexts" of the caring
interaction, but would still be based on "probabilistic predictability" (p. 4). The unitary-
transformative perspective would view caring as "a unitary-transformative process of
mutuality and creative unfolding" (p. 4).
Newman et al. (1991) as well as other scholars (Kim, 1993; Wolfer, 1993)
advocated multiple perspectives for research and theory within the discipline. However,
Newman et aL urged that " a unitary-transformative perspective is essential for full
explication of the discipline" (p. 5). Newman (1997) later argued that "in our efforts to
try to create unity within the discipline, we have overlooked the incommensurable
paradigms existing under the rubric of nursing" (p. 37). She proposed that we break with
approaches that focus on "power, manipulation, and control" and bring together our
"focus, philosophy, and theory" into a coherent praxis.
Newman described that praxis in this way:
The nature of nursing is a dynamic, relational process, and to understand it
we must engage in the experience of it. We must study the process o f our
relationships with clients from within, as part of the process. We are
embedded in what we want to study. We cannot step outside the process,
the nature o f reality is not outside ourselves (p. 37).
6
Conflicts in Nursing Practice

Society makes a determination as to the level o f trust that can be placed in a
discipline based on the perceived consistency between the discipline's moral commitment
and its actions. Nursing has historically held a trustworthy place in society in terms of
the perceived aims of nursing care. Nursing has consistently been a voice for health care
as an interpersonal relationship. However, conflicting assumptions among nursing
philosophy, theory, and nursing practice environments have made difficult for nurses to
practice from a philosophical foundation o f relational intersubjectivity (Benner &
Wrubel, 1989; Fry, 1988; MacPherson, 1989; Ray, 1989; Uris, 1993).
Nursing dichotomies are realized in the nursing practice environment in at least
two ways. First, the gap between nursing philosophy/theory and practice, and second, the
nursing practice environment in which organizational and leadership approaches are
primarily designed around the organizational translation of the received view, the
bureaucracy.(Aiken, 1995; Conant, 1967; Ellis, 1969; Nyberg, 1998; Uris, 1993).
Therefore, nurses experience schisms not only between nursing philosophy and practice,
but between how the practice environment is structured by current nursing leadership
approaches and nursing philosophy.
The practice of nursing in the organizational setting is a daily walk among at least
four often disparate worlds: the world of the patient, the world o f medicine, the world
of the organization, and the world o f nursing. These worlds are more than likely in
conflict. The dominant world of medicine has been pre-empted by a new power, the
power of business. The discipline o f nursing, based on a unitary-transformative paradigm
(Watson, 1995) that values caring-healing, intersubjectivity, interpersonal nurturance,
holism, and the integrity o f the human/environmental field, is practiced in settings that
have become the territory o f stockholders, investors, and for-profit business executives.
The result in health care organizations is a cacophony o f ideologies. Forces for
maximization of profit work side by side with complementary forces in support of
7
technological cure, body part replacement, and preconceptual engineering. Purportedly

representing an increasingly sophisticated "consumer", patient advocates seek increased
personal choice and control for patients as a way of humanizing the organization.
Industrial ideologies seek to infuse health care organizations with continuous
improvement principles which have been successfully applied to the manufacture of
inanimate things.
Nursing, as a professional discipline experiencing this daily dissonance, can take
several paths. Current organizations, such as hospitals, can be abandoned as impossibly
incommensurate with the values o f the discipline. That option requires nursing to create
a new environment in which to practice nursing. The interdependence among the health
care disciplines, requirements for technology, and resource utilization constraints,
particularly for illness care, make this an unrealistic option. More importantly, we
abandon patients at their most vulnerable juncture between life and death to remain
within the walls o f the organization.
Along a different path, we can acquiesce to the current system of care, in which
we are sustained by knowing the organization will survive another day to provide
inadequate care in a morally impoverished system. That option does not abandon our
patients and their families in the physical sense but does require that we abandon or at
least dull ourselves to what we espouse health and nursing to be.
A third option is neither abandonment, nor acquiescence. That option requires
that nurses act with moral intention in practice environments by integrating a relational
philosophy of nursing with the way in which nursing - and nursing leadership - is
practiced. The integrity of joining a philosophy o f being with the action aspects of
nursing must be maintained continually through reflection. That process is what I will
describe as leading or leadership. Leading will be used as the term to indicate the process
aspect of seeking moral integrity, while leadership will be used to describe an embodied
caring relationship among nurses that incorporates and enhances the leading process.
8
Reflection upon the consistency between the philosophy of nursing and the way in
which nursing is practiced involves a dialectic among several perspectives. The nurse
looks within to uncover personal core assumptions about reality, health, illness, and the
relationship between the nurse and the patient. The nurse looks to the nursing discipline
to find consistently communicated disciplinary assumptions related to existence. The
nurse engages with other nurses to understand their assumptions about the nature of
reality. Finally, the nurse looks at the practice organization to determine what basic
assumptions are revealed by the organizational environment.
If the discipline o f nursing has a moral intent based on philosophical assumptions
related to ontology (being/existence), epistemology (knowledge), and ethics (action), and
if that moral intent is to be realized in the practice of each nurse, then what is an
appropriate philosophy for nursing and how does that philosophy translate into nursing
leadership in the practice setting?
In this study I will examine relational philosophy as a reflective ftamework for
nursing. In addition, I will propose that the practice discipline of nursing, based on a
relational philosophy, requires an approach to leadership that is different from traditional
conceptualizations involving organizational roles, hierarchies, and power structures. I
will propose relational leading as a process in which each nurse, regardless of
organizational position or power, practices with moral integrity in the context of a caring
community o f meaning created with other nurses.
Foundational Premises of the Study
There were five foundational premises for this study.
1. The moral intent o f nursing is the interpersonal caring relationship in the human
health/illness experience.
2. Each interpersonal relationship, as well as the actions and meanings that arise out
of that relationship, is embedded in a web o f relationships (Newman, 1997).
9
3. Connectedness in webs of relationships can create a caring community of

meaning.
4. Relational philosophy is an appropriate reflective vehicle for the discipline o f
nursing.
5. Leading is the interpersonal process whereby each nurse, regardless of
organizational position or power, practices with moral integrity in the context of a
caring community o f meaning created with other nurses.
Research Questions
The study was a postmodern philosophic inquiry to propose a philosophical
position in response to the following questions:
1. What are the conflicting assumptions in nursing related to nursing's moral intent
and philosophical perspective?
2. How does relational philosophy sustain a generative tension in the presence of
diverse nursing perspectives?
3. How might nursing leaders embody relational philosophy specifically in the
nursing practice environment?
Conceptual Framework: Philosophical Perspectives
The term philosophy can be used in two different ways. Both are relevant here.
Philosophy can be used to describe an integrated network o f assumptions, beliefs, and
values that guide decision-making and behavioral choices (Woolf, 1976).
In the second usage, philosophy, as an academic discipline, asks questions about
what it means to live a life, to be in the world, and about the nature of what is real
(Solomon & Higgins, 1997). Philosophical thinking is not static, but indicative o f the
Zeitgeist or "spirit o f the times" in a given era (Solomon & Higgins, 1997, p. ix).
Philosophical thinking leads to specific questions, for example, about the nature of matter
and forces in the universe.
Knowledge for itself is central to the work o f basic disciplines such as physics,
10
biology, mathematics, and chemistry (Donaldson & Crowley, 1978; Schwab, 1968;
Shermis, 1962). Disciplines that involve primarily human interpersonal expression, such
as nursing, psychology, or education, ask questions about our relationship to each other,
as well as basic knowledge questions. The primary purpose for existence o f the practice
disciplines, or professions, is a specific relationship with other humans and the generation
of knowledge used in that relationship (Donaldson & Crowley, 1978; Styles, 1982).
Characteristics o f professions noted by Styles (1982) included "service commitment,
ethical behavior, a particular expertise, a particular body o f scientific knowledge,
extensive university education, the spirit and form of collegiality, and autonomy in
setting standards of education and practice" (p. 47).
Nursing is based upon interpersonal relationship (Gadow, 1980; King, 1981;
Orlando, 1961; Paterson & Zderad, 1976; Peplau, 1997; Watson, 1989; Wiedenbach,
1963). Nursing has acquired, incorporated and applied scientific knowledge into
relationship that is central to the discipline. Through the development of nursing toward
professional status, the central nature o f relationship as the reason for the existence o f the
discipline has sometimes gotten buried in the quest for scientific knowledge (Newman,
1997; Watson, 1995). The advances that have been made in human well-being through
the acquisition o f empirical knowledge are valuable assets to nursing. However, the
value of the intangible intersubjectivity between a nurse and a patient can be undermined
by an overemphasis on scientific method.
Complete understanding is always just out of our reach. The instant that
empirical knowledge is applied to a relationship between humans, it is changed by virtue
of human interaction with it. Laudan (1977) argued:
Realizing this dilemma, some philosophers have sought to link scientific
rationality and truth in a different way - by suggesting that although our
present theories are neither true nor probable, they are closer
approximations to the truth than their predecessors. However, even these
accounts are flawed because...no one has been able even to say what it
would mean to be "closer to the truth" let alone offer criteria for
11
determining how we could assess such proximity" (pp. 125-126).

We ask our questions and seek our answers within structured frameworks in order to limit
what we seek, so that our minds may engage with knowledge in a series o f layers that we
can contemplate and synthesize. But knowledge o f any kind is always embedded in more
knowledge and in a web of relationships.
This study is based on the premise that nursing exists because of an interpersonal
relationship that grows out of human experiences related to health and illness and the
requirements presented to us by our being in the world (the intrapersonal relationship).
That interpersonal relationship is conceptualized for the purposes o f this study as the
vehicle for nursing's moral intent: caring.
The foundation of the discipline o f nursing must be a philosophical perspective
that holds the caring relationship central in practice, education, and research. Newman et
al. (1991) stressed that "the tasks of nursing inquiry will be to examine and explicate the
meaning of caring in the human health experience to ascertain the adequacy of this focus
for the discipline, and to examine the philosophic and scientific questions provoked by
the focus statement" (p. 3).
This study is designed to examine the relational philosophical perspective and the
process of relational leading as a vehicle for realizing caring more folly in nursing
practice. A philosophical perspective should not be a static icon against which nursing is
measured. This would not allow the discipline to remain flexible and would be
inconsistent with the complex nature o f humans and of the universe in which we are
engaged. The philosophical perspective should serve as a reflective vehicle with which
to engage the contexts and questions o f nursing in an unending dialogue.
A philosophy that is dialogical in nature provides the inspirational energy that
infuses a discipline with a sense of purpose, a moral intent. Ongoing reflection guiding
behavioral choices helps members o f a discipline to practice with moral integrity.
12
The moral intent is the philosophical perspective, the behavioral choices are the practice
or doing.
Since nursing is practiced primarily in the organizational setting, a differentiation
should be made between the intent of an organization which is formed around a structural
system of getting a particular type of work done (Wren, 1972; Aldridge, 1979; Greenleafj
1998) and the intent of a practice discipline with a moral commitment to society.
Nursing as a relationship-based discipline must have a moral intent that honors first the
commitment to the relationship and secondarily the intent o f the organization (Ray,
1989).
In the absence of leadership to maintain the dialogue between the philosophy of
the discipline and its practice environment, a discipline runs the risk o f inconsistency,
fragmentation, and loss of generative and regenerative power. The powerful forces of
control within health care organizations sometimes appear to run counter to the
philosophy of nursing (Uris, 1993). There are times when nursing, in the absence of
leaders who can infuse the reflective approach into interpersonal and organizational
settings, risks losing its power to create contexts for the healing and health of patients,
families, and communities. Nursing must continue to examine foundational assumptions
related to nursing practice and leadership and reflect upon their consistency with the
moral intent o f nursing as a caring interpersonal relationship.
The Relationship Between Philosophy and Leadership
How do philosophy and leadership relate to each other? Why is it relevant to
philosophical thinking to explore the notion o f leadership? Two premises help to clarify
why I am exploring leadership in the context o f philosophy. First, the members of a
group, such as a discipline, ought to be defined by their philosophical aims rather than
their actions (Gadow, 1980) and second, integrity is a congruence between philosophical
aims and actions (Cashman, 1998). To reiterate, relational leading is practicing with
moral integrity in the context of a caring community o f meaning created with others.
13
These premises underlie the exploration of leadership within a relational philosophical

perspective.
Cashman (1998) defined integrity as "total congruence between who we are and
what we do" (p. 122). This exploration of leadership starts with who the leader is, how
he or she defines self and reality; in other words: the nature o f being. Cashman
described personal mastery as a pathway to leadership: "personal mastery is the ongoing
commitment to unfolding and authentically expressing who we are" (p. 31).
The reason that leadership and philosophy must be explored simultaneously is
that they are essential to each other. One cannot be lived without the other. Philosophy
becomes a sterile cognitive process unless it is lived through integrity between thinking,
believing, valuing, and doing. And since I have characterized leaders as expressing this
integrity, then leadership is the necessary vehicle for embodied philosophy. Chinn
referred to this process as praxis. She defined praxis as "values made visible through
deliberate action" (Chinn, 1995, p. 3). The intent of this study is to explicate the
relational philosophy and values o f nursing and to associate a non-traditional definition of
leading with the actions that make those values visible.
Method; Postmodern Philosophical Inquiry
Philosophical inquiry from the postmodern perspective is an approach wherein
conceptualizations of a phenomenon that have been constructed based on modem
assumptions about rational objectivity and immutable truth are deconstructed and
questioned (Lather, 1991; Norris, 1991; Rodgers, 1991). One o f the approaches used in
postmodern inquiry is deconstruction. Deconstruction had its origins in the work of
Derrida (1976) and Foucault (1972) who read and interpreted texts for the implicit
knowledge and power relationships within them.
Deconstruction is the process o f dismantling assumed truths, not for the purpose
o f negating them entirely, but to prevent assumptions from becoming ideologies so
confining that one is unable to view reality from any other perspective. Spivak (1989)
14
described deconstruction: "rather than an exposure of error, deconstruction is a 'way o f

thinking...about the danger of what is powerful and useful....You deconstructively
critique something which is so useful to you that you cannot speak another way' " (pp.
135,151).
The goal of deconstruction is to emancipate thinking from the constrictions or
oppressions imposed by historical legacy, thereby providing an opportunity for new
meanings and new knowledge to occur. Caputo (1987) described the goal of
deconstruction as "neither unitary wholeness nor dialectical resolution. The goal is to
keep things in process, to disrupt, to keep the system in play, to set up procedures to
continuously demystify the realities we create, to fight the tendency for our categories to
congeal" (p. 236).
Postmodern philosophical inquiry using deconstruction involves an examination
of the historical and situational contexts of the construction o f interest. Power
differentials and their consequences for what is judged to be acceptable knowledge are
questioned. Language is considered constitutive o f personal meaning in context, rather
than a representation o f truth that is absolute.
Postmodernism in nursing is manifested in current nursing debate over the
philosophical basis of the discipline. Watson (1995a, p. 60) believed that multiple
worldviews in nursing are consistent with "broader cultural, philosophical
transdisciplinary shifts occurring worldwide among the public and academicians alike."
Postmodern philosophical thinking moves out of the certainty o f complete objectivity or
complete subjectivity into the uncertainty o f a continuous dialogue between the two
perspectives. Thus, postmodern philosophical inquiry in nursing is designed to examine
assumptions related to phenomena o f interest to nursing and re-evaluate those
assumptions as constructions that were made in historical, power, and hermeneutic
contexts.
Watson (1995) recommended reconstruction in order to counter "the down,
15
despairing side o f human deconstruction" (p. 474). She argued:

So, while we can know acknowledge that the center cannot hold, can we
create, recreate, cocreate a new center and a new form o f human
experience and knowledge with will lead humanity toward
emancipation....recognizing all knowledge is constructed as a human
endeavor; returning to the context rather than the abstract voice o f theory,
authority; celebrating ambiguity and pluralism for its openness and
possibilities; questioning all truth statements and assumptions; noting that
nothing is fixed, but evolving and fallible - endlessly self-revising and
self-reflecting" (pp. 474-476).
One of the most prevalent aspects of modem thinking that comes into question
during the process o f deconstruction is the existence o f dichotomies. The modem
approach o f science in identifying mutually exclusive categories inevitably results in
dichotomies that seem irreconcilable. The process of deconstruction brings those
presumed mutually exclusive dichotomies into question, allowing for the possibility o f a
reconstructed meaning that is more inclusive. The reconstructed meaning is contingent
and contextual, but provides a resting place in the ongoing process of
deconstruction/reconstruction. Grosz (1989) recommended reconstruction as a step in the
process of deconstruction to "create a more fluid and less coercive conceptual
organization of terms which transcends a binary logic by simultaneously being both and
neither of the binary terms" (p. xv).
Dichotomies and conflicting assumptions of interest for this study were: a)
nursing philosophical perspectives and nursing theory/science, b) nursing's moral intent
o f interpersonal caring and the nature of nursing practice environments, and c) nursing
leadership as an external source of authority and individual nursing
autonomy/empowerment. The purpose in exploring these dichotomies, through the use
of deconstruction and reconstruction, was to identify possible alternative conceptions that
embrace both terms in the dichotomy, yet remain true to the contingent and ambiguous
nature of assigned meaning.
16
The procedure for deconstruction consisted o f several steps:
1. Identify assumptions and basic beliefs related to the dichotomies of interest.
2. Expose the dichotomous assumptions as historical constructions.
3. Examine the consistency o f each term in the dichotomy with the moral intent of
nursing.
4. Show how the dichotomous thinking functions to oppress.
3. Reconstruct a new concept that does not oppress and opens possibilities for new
created meanings.
Schlotfeldt (1994) argued that
it will be only through philosophical inquiry that the dimensions of
nursing's discipline will be determined and thereafter, that its several
intellectual components will continue to be advanced through systematic
inquiry. Nursing practice and education will then be continuously
improved, systematic inquiry of several kinds will then be accelerated and
knowledge advanced, the world's population increasingly will be well
served by nurses, and nursing will attain universal acclaim as a learned
health profession and a scholarly academic discipline (p. 73).
Organization of the Study
The organization of the study reflects the logical evolution of conceptualizations
o f relational philosophy, relational leadership, and relational nursing leadership. Chapter
II will review selected nursing literature that addresses conflicting assumptions and
dichotomies in nursing's philosophical and theoretical legacy, especially in regard to
pluralism and the ethic of care. Chapter III will explore relational philosophy as a
potential restructured philosophical perspective consistent with the consistently expressed
moral intent o f nursing. The three major components o f a philosophy (ontology,
epistemology, and ethics) will be used as a means to structure the discussion of relational
philosophy. Chapter IV will examine pre-modem and modem foundations o f leadership
and their parallel translation in nursing leadership. Chapter V will examine postmodern
approaches to leadership. A concept of relational leadership and specifically, relational
nursing leadership will be described as a reconstructed concept. Chapter VI will contain
17
exemplars to illustrate the concept of relational nursing leadership in various settings.

Chapter VII will be a conclusion o f the study and a review of the researcher's process.
Summary
In this chapter I identified philosophical, theoretical and practice conflicts and
dichotomies in the discipline of nursing. The purpose o f this study is articulate a
relational philosophy as a reconstructed foundation for the practice o f nursing and
nursing leadership. I will use the process of deconstruction to examine historical contexts
o f the development o f philosophical, theoretical, and leadership perspectives. I will
explicate a process of relational leading in which each nurse, regardless o f organizational
position or power, practices with moral integrity in the context o f a caring community of
meaning created with other nurses.
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CHAPTER II
THE HISTORICAL CONSTRUCTION OF NURSING PHILOSOPHICAL
AND THEORETICAL PERSPECTIVES
The purpose o f this chapter will be to expose conflicting assumptions related to
nursing philosophy, theoiy/science, and practice. The initial steps in the process o f
deconstruction will be to identify dichotomies which emerged in nursing within historical
context and to examine the consistency of those dichotomous constructions with the
moral intent o f nursing. In addition, deconstruction is intended to illuminate how
dichotomous thinking functioned to oppress, or limit the discipline, in terms of its moral
intent.
The chapter will be divided into five sections. In the first section, pre-theoretical
definitions of nursing will be reviewed, revealing nursing's legacy o f emphasis on the
caring nurse-patient relationship. The second section will reveal the emerging dichotomy
between nursing philosophy and nursing theory, specifically, as a result of nursing's
pursuit o f the logical positivist approach to science. The third section will explore the
way in which nursing scholars began to question the ontological and epistemological
consistency o f nursing theories and research with the moral intent of the discipline,
interpersonal caring. Nursing scholars began to demonstrate how these dichotomies have
oppressed nursing in the full realization of its moral intent. A review o f the
conceptual/theoretical frameworks of these scholars will be included. The fourth section
demonstrates nursing's return to its philosophical roots. Nurse scholars in this section
began to re-explore the philosophical dimensions of nursing. The fifth section reveals the
debate over the issue of philosophical pluralism and the final section includes scholarly
debate over the value of the ethic of care and the ability o f nursing to enact that ethic in
the practice setting.
19
Pre-Theoretical Definitions of Nursing

A legacy of relational philosophy in nursing can be found in early domain
definitions of nursing. Nursing has been a long term advocate of human health and well
being as realized through a relationship between the nurse and the patient that is not just
instrumental in nature, but forms an environment o f caring that is as healing to the patient
as is the interventions that the nurse performs.
Donaldson and Crowley (1978) observed that since "at least the time o f
Nightingale, there has been a remarkable consistency in the recurrent themes that nurse
scholars use to explain what they conceive to be the essence or the core o f nursing" (p.
113). Early domain definitions of nursing emphasized the caring actions o f the nurse to
minister to the patient, expressing the ethics of service and nurturance, and established
the nurse-patient relationship as central to nursing (Gunter, 1962; Hall, 1964; Henderson,
1966; Johnson, 1959; Kreuter, 1957; Vaillot, 1966; Wiedenbach, 1963).
Kreuter (1957) described "good nursing care" as the ministrations of the nurse
that are a "means to obtain intimate understanding and knowledge of the person." (p.
144). She indicated a belief that to be human was to be vulnerable and deserving of
intimate understanding and knowing through ministration and protection from another
(namely, the nurse).
Gunter (1962) defined nursing care as "the provision o f personal care in a
relationship of being 'with' the patient as he experiences illness The nurse makes her
contribution to the patient in an interpersonal relationship" (p. 5). She borrowed from
Rogers' (1951) work on client-centered therapy to describe the patient's capacity for self-
understanding and self-reorganization and the need for the nurse to respect and
understand that capacity while establishing a relationship o f unconditional positive
regard.
Wiedenbach (1963) stated that a philosophy o f nursing was to be found in the
beliefs held by the nurse "in relation to the gift of life, to the patient under her care" (p.
20
55). She believed that the nurse's philosophy as to the gift of life served as a foundation
for nursing's purpose: to "meet the need the individual is experiencing as a need-for-
help" (p. 55).
Hall (1964) referred to nursing's ethical stance toward the self-determination of
humans. She argued that "it is impossible to nurse any more o f a person than that person
allows us to see" and that "only as the nurse is able to let the patient be himselfj can he
find himself and his way out of the difficulty. ...The nurse recognizes that the power to
heal lies in the patient and not in her" (p. 153). Thus, Hall implied a philosophical belief
that to be human is to control what others see in us, to be responsible for finding one's
way out of difficulty, and to have within us the power to heal and that the essence of
nursing is to facilitate that process.
Henderson (1966) defined nursing as an assistive process to help another person
regain independence. She described the nurse as "temporarily the consciousness o f the
unconscious, the love of life for the suicidal, the leg of the amputee, the eyes o f the newly
blind, a mean of locomotion for the infant, knowledge and confidence for the young
mother..." (p. 63). Her definition of nursing indicated a belief that one human (the nurse)
can enter into relationship with another (the patient) to temporarily meet needs that the
other is unable to meet alone.
Vaillot (1966) observed that the therapeutic use o f self by the nurse implies a
"belief that it is possible for two persons to share one another's emotional experiences, to
communicate with each other, not only verbally but beyond the conceptual level" (p.
500). She referred to the "committed" nurse who is able to give of herself, not because of
some learned technique, but because of a "way of life, which finds expression in all her
activities, professional and otherwise" (pp. 500-501). Vaillot believed that the philosophy
of existentialism would unify and support the knowledge base and practice of nursing.
She stressed that "existentialism studies the individual (or the existent) in the concrete
actuality of his existence" (p. 502). Vaillot characterized the human experience o f being
21
as openness to all of the joys and pain o f existence, including ultimate responsibility and
accountability for one's actions. She applied these beliefs to the nurse as well as the
patient, recognizing the opportunities nurses have to develop mature values. She argued:
"if in order to be, the nurse is to assume an unmitigated responsibility for her acts, to use
her freedom to the utmost, the same is true for the patient. No human being can ever be
excused from the full exercise of his onerous freedom, not even when he is incapacitated,
or suffering..." (p. 505).
These pre-theoretical examples o f nursing scholarship demonstrate the history of
nursing's ontological concern with the vulnerable and relational nature o f human
existence. Nurse scholars from this period articulated the paradoxical nature of human
existence as being autonomous, responsible, and self-determined, with an innate power to
heal, yet vulnerable, relational, and, at times, in need of help. In addition, they described
the nurse-patient relationship as the vehicle through which the caring actions of the nurse
assist the person experiencing health-related needs toward independence. In the next
section, the emergence of a dichotomy between this early philosophical thinking and
developing nursing theory will be revealed.
The Emerging Dichotomy Between Nursing Philosophy and Theory
In conjunction with nursing entering the academic setting, nursing scholars began
to construct nursing theory. The dichotomy or schism between nursing philosophy and
developing nursing theory became increasingly apparent as nursing theorists embraced
the scientific method and Received View of science (Watson, 1981). According to
Watson, "a set of false dichotomies has been established that makes many facets of
nursing incompatible" (p. 284).
Abdellah (1969) advocated a separation between the art o f nursing, which she
termed the "intuitive and technical skills and also the more supportive aspects o f musing"
and the science o f nursing, which she asserted "concerns itself with scientific truths" (pp.
391-392). She recommended that all nursing concepts be operationally defined and
22
"expressed in observable and quantifiable terms" (p. 391).

Dickoff and James (1968) contended that nursing theory must be "situation-
producing" (p. 105). They believed this prescriptive level o f theory to be the highest
level of empirical knowing. They listed three "essential ingredients o f situation-
producing theory: 1) goal-content specified as aim for activity; 2) prescriptions for
activity to realize the goal-content; and 3) a survey list to serve as a supplement to present
prescription and as preparation for future prescription..." (p. 105).
Jacox (1974) and Hardy (1973) advocated the logical empiricist approach for
developing nursing science/theory as the discovery of truths. Methods o f formal logic,
including the development o f concepts, propositions, and theorems were recommended.
Chinn and Jacobs (1978) defined theory as "an internally consistent body of relational
statements about phenomena which is useful for prediction and control" (p. 360).
Nursing scholars began to attempt to isolate the phenomena of interest to
nursing's domain. Yura and Torres (1975), as a result o f a National League for Nursing
survey, identified man (sic), society, health, and nursing as nursing's major concepts.
Fawcett (1984), substituting person for man, described these concepts as encompassing a
metaparadigm for nursing.
Several conceptual models were developed in nursing including: Johnson's
(1980) Behavioral System Model, King's (1981) Open Systems Model, Levine's (1973)
Conservation Model, Neuman's (1982) Systems Model, Orem's (1980) Self-Care Model,
and Roy's (1984) Adaptation Model. Silva and Rothbart (1984) noted that the initial
version of many o f these conceptual models were "essentially devoid of any explicit
linkage to philosophy of science" (p. 299). In addition, they observed that, during the
1980s,
23
several of these nurse theorists, in an attempt to bring their works more in

line with what the nurse metatheorists of the mid-1970s were espousing
(logical empiricism), revised their works to explicitly identify such
elements as concepts and propositions that are inherent in the orthodox
viewpoint (p. 300).
In the next section, new conceptual models that were developed in reaction to the existing
empirical approaches will be examined.
The Emergence of New Conceptual Models
Silva and Rothbart reported that there was a "relatively stable commitment to
logical empiricism" into the 1980s. However, they identified trends reflective o f nurses'
difficulty in reconciling the tenets of logical empiricism with the nature and philosophy
of nursing. Nurse authors began to incorporate the work o f Kuhn (1970,1977) and
Laudan (1977) as a means of explaining the conflict between traditional and newer
philosophies of science. Traditional philosophies of science, such as logical positivism,
were designed to explicate the activities of science with the goal o f theoretical reduction
and ultimate truth (Nagel, 1961); whereas newer philosophies o f science, such as
historicism were designed to understand the activities o f scientists in historical context
and to promote the ability of science to solve actual problems.
Nursing's continued dissatisfaction with the dichotomies between nursing
philosophy and nursing theory was revealed in new conceptual frameworks developed by
Paterson and Zderad ((1976) and Parse (1981). Voices emerged for the irreducible and
relational nature of humans (Gadow, 1980; Newman, 1986; Rogers, 1986; Watson,
1985). Silva and Rothbart (1984) noted that nursing began to shift to qualitative methods
of conducting research and to suggest alternatives to the Received View o f science
(Munhall, 1982; Oiler, 1982; Omery, 1983). Watson (1981) observed
These views suggest a new research tradition that can provide nursing
with the scientific and social freedom and openness to solve both
conceptual and empirical problems. It is an alternative to the Received
View and permits nursing to return to the richness and complexities
inherent in its social and scientific roots and goals. It may not be totally
explanatory, predictive, or directly testable (p. 285).
24
Watson's (1985) theory of human caring held that human caring is the "moral
ideal" of nursing. The value system which she advocated for nursing included the
following beliefs: that humans (1) possess a universal spirit to be treated with respect
and awe, (2) are part o f a central mysterious cosmic unity, (3) are souls deserving of
protection and reverence, with rights to self-control, autonomy, and freedom o f choice,
and (4) possess the capability of self-healing. Watson believed that the gentleness and
dignity with which a nurse treats a patient must first be extended to self. She asserted
that "the human can progress to higher levels of consciousness by finding meaning and
harmony in existence through the use o f the mind" (p. 223).
Rogers (1986) proposed that "unitary human beings are specified to be irreducible
wholes. A whole cannot be understood when it is reduced to its particulars" (p. 4). She
believed that "seeing the world from this viewpoint requires a new synthesis, a creative
leap, and the inculcation of new attitudes and values" (p. 8). However, she did not
explicate what those values were. Because Rogers' conceptual schema did not allow for
the fragmentation of humans, a different way of thinking about the study o f nursing was
required. Cowling (1986) identified three ways of thinking which he believed
encompassed Rogers' definition of human existence. These ways o f thinking give
guidance as to the philosophical underpinnings o f Rogers' work: (1) existentialism
(human experience as unique, knowledge as experiential), (2) ecological thinking
(wherein patterning replaces cause and effect), and (3) dialectical thinking (process
oriented and dynamic) (Cowling, 1986, p. 68).
Newman (1986) characterized human life as a "network o f consciousness " in an
irreducible pattern with the environment (p. 33). The implied philosophy in Newman's
(1986) definition of human would be the respect for the unique, yet relational nature of
each human pattern. Newman (1986) stated that "pattern recognition is the heart of
human interaction. It is basic to responding to the individuality o f another person and
25
therefore basic to the health professional's effective use of self in therapeutic interaction"
(p. 18).
These frameworks and theories of nursing were an attempt to expose and
reconcile the oppression of nursing's moral intent by strictly defining nursing and nursing
science in terms o f an empirical approach. In the next section, the return to philosophical
discussion of nursing's ontology, epistemology, and ethics are reviewed.
Nursing's Return to the Philosophical Perspectives of the Discipline
Gadow (1980) addressed the need for a philosophical basis for nursing's domain
definitions:
if nursing is distinguished by its philosophy o f care and not by its care
functions, and if nurses themselves formulate that philosophy, they
transcend a particular concept of nursing only in order to realize a more
developed concept, an ideal: a philosophy which unifies and enhances the
experience o f the individuals involved rather than devaluing and alienating
that experience (p. 41).
Gadow proposed the concept of existential advocacy based "upon the principle
that freedom of self-determination is the most fundamental and valuable human right" (p.
43) She defined a system of beliefs in action. The role of the nurse, based on the
philosophical stance of existentialism, is to enter into relationship with the patient with
the intent of assisting him or her to gain meaning from the illness experience.
In later work, Gadow (1994,1995,1995a, 1996, 1999) explored relational
narrative as a process o f intersubjectivity between nurses and patients wherein safety
within the vulnerability and uncertainty of life can be found. The sharing o f one's story
and the rewriting of new narratives when the old ones have lost their meaning is what
happens between nurses and patients to create new meaning. This is the moral intent of
nursing.
According to Gadow (1999), the intent is not teleological in nature, wherein
nursing as an agent o f care moves others toward a goal o f health and actualization. On
the contrary, nursing, in the context of a relational narrative, is based in the ambiguity o f
26
an uncertain present and future. Although we can imagine possibilities for future health
or healing, Gadow would not have us sacrifice the meaning made in the vulnerability of
present uncertainty for the certainty o f a predicted outcome.
McIntyre (1995) critiqued the focus statement developed by Newman, Sime, and
Corcoran-Perry (1991) which included the identification of multiple perspectives for
nursing ontology and epistemology. She suggested that additional clarity as to the
relationship between philosophy and science would have helped to differentiate among
the three paradigms. McIntyre referred to Kikuchi and Simmons (1992) who argued that
"in attempting to move beyond traditional scientific methods (objective verifiable
knowledge), nurse researchers have not held squarely in view the kind o f questions that
science is capable of answering and have unwittingly moved into the realm of questions
that only philosophy can answer" (p. 6).
Silva, Sorrell, and Sorrell (1995) critiqued Carper's (1978) work on nurses' ways
of knowing and indicated that a philosophical shift is occurring within the discipline
toward "ways o f being." With respect to ethical being (answering the question, "what
ought I to be morally") versus ethical knowing ("how do I come to know what I morally
ought to do?"), Silva et al. discussed the Aristotelian concepts of virtue and virtuous acts
and the nurse's response to a sense of conscience, but did not answer the question in
terms of nurses' beliefs about human life (p. 4).
Aroskar (1995) proposed that nursing is a moral community guided by certain
ethical principles which include "respect for persons" as the "most fundamental" o f the
ethical principles (p. 136). This respect, as described by Aroskar (1995), requires that
"each individual should be treated as unique, as equal to every other individual, and as a
responsible moral agent" (p. 136). Aroskar (1995), unlike other nursing authors, adds
that respect for persons has a major characteristic in addition to autonomy -
"consideration of the individual as a member of the human community with obligations
toothers" (p. 136).
27
Reed (1995) called for the use of a philosophy o f nursing to "explicate the
metanarratives of (the) discipline" (p. 76). She defined nursing philosophy as "a
statement of foundational and universal assumptions, beliefs, and principles about the
nature of knowledge and truth (epistemology) and the nature o f the entities represented in
the metaparadigm (i.e., nursing practice and human healing processes [ontology])" (p.
76). Reed discussed three major philosophic schemes: mechanistic (human as machine),
organismic (human as interrelated parts making a whole, active on environment), and
developmental-contextual (human embedded in context that is dynamic). She stressed
that what it means to be human is to be more than a body "inscribed by context" and
encouraged nurses to carry on the Nightingale belief that humans possess innate abilities
for healing (p. 82). Reed believed-that nursing can be differentiated from other
disciplines by its values and philosophical orientations including "self-reflection,
personal autonomy, innate developmental potential, connections between truth and life,
emancipatory practice and research, and chaos as opportunity" (p. 82).
Fawcett's (1996) recent work indicated that she has maintained her "value-free"
stance for the past decade. Her statement that a metaparadigm should be "perspective-
neutral" implied the value-free perspective o f science that is perceived by some nursing
scholars to be inconsistent with nursing's philosophy o f what it means to be human (p.
94).
Cody (1996) questioned the plausibility of Fawcett's perspective-neutral stance.
He referred to nursing's "traditions" and stated that the "uncompromising respect for
human dignity and the uniqueness of each client or the practice of caring for persons
through sustained attentive presence" are uniquely associated with nursing (p. 99). Cody
proposed that nursing focus on how nursing values are lived in response to the people we
serve (praxis). He urged "let us talk of how we live our traditions and incarnate our
values and beliefs about nursing in an ongoing disciplinary dialogue that weaves together
divergent traditions in a rainbow-like discipline that encompasses many views" (p. 99).
28
In a later work, Cody (1997) reiterated his belief that nursing is moving toward
praxis. He observed "the ontology, epistemology, and formal research and practice
methods o f the discipline clearly show movement toward a vision of nursing as a human
science preeminently concerned with the lived experience o f health and quality o f life in
situation, regarding the human as a unitary, self-interpreting free agent, and practicing
through a loving presence" (p. 66).
The writings of nursing scholars emphasizing the philosophical nature of nursing
remain consistent with a relational, contextual definition of nursing, including the moral
intent o f caring. The next section explicate the debate in nursing over philosophical
pluralism, particularly in response to postmodern thinking.
Postmodern Debate Over Philosophies of Nursing
Philosophical debate in nursing has centered around issues of the ontology,
epistemology and ethics of nursing as a discipline. Nursing has deemed it necessary to
predict the health outcomes of patients. We have an evolving nursing science based on
the prediction and control model o f knowing. We study evidence upon which to base our
practice and devise theories to explain our domain and to give us structure by which to
practice (Stetler, BrunelL, Giuliano, Morsi, Prince, & Newell-Stokes, 1998). Watson
(1995) referred to this approach as Paradigm I Science, or the Particulate-Deterministic
Perspective; "health and healing phenomena in this model would be reduced and
dichotomized in terms of characteristics that could be studied as explicit therapeutic
interventions with measurable outcomes. ...human caring would be reduced to a
technique or technology" (p. 66).
In addition, nursing finds it necessary to understand the subjective, experiential
aspects o f the patient experience. We have developed ways o f studying subjectivity
through phenomenology, hermeneutics, aesthetics and other qualitative designs. Watson
referred to this Paradigm II as the Interactive-Integrative Perspective. "This model calls
forth methods and processes of inquiry that acknowledge relationship, mutuality o f nurse
29
and patient, reciprocity, intuition, receptivity, presence, connection within a specific

context of meaning and consciousness" (p. 68).
A recent turn to postmodernism has facilitated a new phase in nursing
philosophical thought which calls upon us to look critically at our assumptions and
reconsider some o f the approaches that we have used. Watson described postmodernism
in nursing:
It is time to acknowledge that the dominant modem science model for
pursuing research and inquiry related to questions posed by human
phenomena o f interest to alternative medicine no longer holds. The
dominant approach is critiqued from all sides; claims o f prediction and
truth are being continuously challenged and must be reconsidered within
an expanding postmodern context of meaning and human experiences—a
context that invites diversity o f inquiry and views o f science that are
congruent with human caring-healing processes and experiences (p. 65).
All three o f these approaches to understanding and being in the world can be
considered valid. The philosophies underlying our objective science, subjective
exploration, and postmodern criticism are all important perspectives in nursing. That
philosophical pluralism, however, is not without controversy.
Gadow (1999) argued that there is room for a dialectical layering o f philosophical
approaches in a discipline as rich as nursing. She proposed that objectivism,
subjectivism, and postmodernism be regarded "not as successive stages in the
profession's advance, but as possibilities coexisting in an ethically vital practice" (p. 13).
Newman (1997), on the other hand, worried that we have "incommensurable
paradigms existing under the rubric o f nursing" (p. 37). In recounting her own journey of
discovering the inconsistencies between her philosophy and her approaches to acquisition
o f knowledge, Newman asked questions that arise from a postmodern critique o f
accepted truths. She admitted "finally, seeing that these ways were not working, I let go
o f the research expectations of objectivity and control and allowed the tenets of my
theory to guide the methods of study" (p. 35). She argued for a consistent approach to
nursing philosophy and scholarship that gives us a "ring of coherence", urging that "it is
30
time to break with a paradigm of heahh that focuses on power, manipulation, and control
and move to one o f reflective, compassionate consciousness" (p. 37).
Reed (1993) contended that nursing should move beyond the pluralism of
multiple worldviews to one metanarrative o f unity in diversity in order to avoid the
potential fragmentation attributed to postmodern thought. She believed that advocating a
coexistence o f diverse ontologies, values, and goals would inhibit the growth o f the
discipline. The "neomodem" metanarrative that she referred to as "an external corrective
o f choice" would serve as a basis against which nursing practice and science could be
evaluated (p. 78). She argued that the metanarrative should be an open and dynamic
philosophy, but not as open as postmodern pluralism.
Other nursing authors have agreed that the postmodern approach of critically
questioning assumed truths and turning to individual, contextual experience as our source
o f knowledge will weaken, if not annihilate, the discipline. Kermode and Brown (1996)
vehemently argued that an emphasis on postmodern nursing by Watson (1995) was
unfounded and extreme, further risking the marginalization of the nursing profession:
there is evidence that medicalised health care is becoming more and more
influenced by the grand narratives of capitalism and of science. For
nurses to pretend that this is not the case will result in their continuing and
increasing marginalisation. Encouraging nurses who are disenchanted
with competing with the powerful vested interests in the field of health
care and health research to use this as an excuse to remain on the margins
is a far greater threat to nursing than a failure to embrace postmodernism
(p. 381).
How is this dilemma of unity versus diversity to be reconciled? Some nursing
scholars urge a single philosophy for the discipline of nursing that is essentially
postmodern in approach. Others believe that there is room in the discipline for multiple
views. Yet another approach is a metanarrative against which all views, modem and
postmodern, can be measured. Finally, there is the argument that nursing will become
marginalized and more oppressed by forces o f power, control, and competition should it
embrace a postmodern approach. In the midst of the postmodern debate over
31
philosophical pluralism, nursing continues to debate the value and feasibility o f caring as
the moral intent and guiding ethic of nursing.
Debate Over the Ethic of Care
Morse, Solberg, Neander, Bottorff, and Johnson (1990) analyzed the concept of
caring as a human trait, a moral imperative, an affect, an interpersonal relationship, and a
therapeutic intervention. Morse et al. (1990) pointed out that caring as a moral ideal is
not a set of actions, but a belief in the "adherence to the commitment o f maintaining the
individual's dignity or integrity" (p. 5). They discussed the implications o f caring as a
moral imperative in a society that does not necessarily share nursing's value system,
acknowledging that "the environment in which nurses work must facilitate and support
caring" (p. 5).
Fry (1988) observed that the ethic of care in the nursing practice environment was
at risk for survival due to shortages and time constraints placed upon nurses. She argued
that the realization of the ethic of care requires:
the opportunity to see persons as having certain duties and rights, in a
nonhypothetical manner, within health care delivery; and the continued
potential for reciprocity and mutuality within the nurse/patient
relationship. This means that values held important to nursing must have
opportunity to be realized and fostered in health care and that nurses and
patients must have ample time to connect... (p. 48).
Uris (1993) conducted as postmodern critical inquiry of "the silencing of nurses'
moral stories by the pervasive presence of a patriarchy that does not value caring as a
basic way o f being, knowing, and doing" (p. 1). After critically analyzing the stories of
the seven nurses who were co-researchers for the study, Uris identified several
constraints to nurses' interest in caring relationships and connection with others:
bureaucracies, nurse-physician relationships, nurse administrators' lack of support,
gender, the law, physical environment, nursing education, and autonomy. Uris
concluded:
32
Lack of acknowledgment o f co-researchers' caring interests resulted in co

researchers feeling as if they were mad or hallucinating. But their sense of
madness was found not to be purely moral madness on which the study
was premised. The madness stemmed from the interrelated set of beliefs
with the analytic-empirical paradigm o f epistemology perhaps having the
greatest effect on the silencing of caring interests" (p. 385).
Uris recommended a "holographic diffusion o f caring" as a means of infusing the
organizational nursing practice environment with caring as a moral ideal (p. 358-359).
Many scholars have embraced caring as the moral ideal o f nursing (Benner &
Wrubel, 1989, Watson, 1989, Boykin & Schoenhofer, 1993, Gaut, 1983, Leininger, 1986,
Ray, 1982). Others have argued that caring, as the essence o f nursing, places nurses at
risk for further oppression and moral marginalization (Pinch, 1996, Crigger, 1997).
Critics o f an ethic of care consistently cite self-sacrifice and its accompanying
exploitation, loss of personal integrity, lack of reciprocity in caring, risk of dominance by
the caring person, and the difficulties with extending care beyond the scope of a nurse-
patient dyad.
Several authors have responded to these challenges (Carse & Nelson, 1996,
Rafael, 1996, Gastmans, de Casterle, & Schotsmans, 1998). An ethic o f care need not
entail the loss of moral integrity on the part of the nurse, because the ethic extends not
only toward the patient with whom the nurse is in relationship, but values the nurse as
well. This is consistent with a relational ethic involving inherent reciprocity wherein we
make choices based on mutual benefit.
An ethic of care does require that the nurse develop clarity about personal moral
integrity and seek ways to receive care outside o f the nurse-patient relationship. As
observed by Carse and Nelson (1996), "the care giver-recipient dyad rarely exists in
isolation from other relationships; the care giver is generally nested in a cluster of
relationships from which she in turn can draw care" (p. 22). This caring for self by
nurses was reiterated by Gastmans et al. (1998):
33
the orientation of their energies toward the patient is only possible if they
have received and continue to receive the chance to develop themselves.
....Nurses must care for themselves in order to be able to care for the
patient. Caring for the patient therefore implies that nurses take their own
autonomy seriously (p. 50).
The extension of care toward selfj as well as patient, prevents the problems of self-
sacrifice and loss of moral integrity on the part of the nurse.
In order to wrestle with the issue o f the scope o f the ethic o f care, which is
grounded in the particular experience o f those in the caring relationship, Carse and
Nelson (1996) proposed a differentiation between "caring about" and "caring for" others
(p. 29). We decide, through our moral perspective on the world, what merits caring
about. However, our application of moral skill in caring for is a more concrete and
situational application of our actions to what we care about. Rather than the blindness of
traditional justice ethics to the particulars o f difference, "the ethic o f care challenges us to
resist the human tendency to remain blind and unconcerned about what is unfamiliar or
more relationally and personally distant and to develop a sensitivity to differences in
perspective and need as a demand o f justice" [emphasis in the original] (p. 30).
Summary
The purpose o f this chapter was to expose contradictory assumptions in nursing
related to nursing's philosophical, theoretical, scientific, and practice perspectives. The
writings of a broad range o f nursing scholars revealed that nursing continues to grapple
with the issue o f diversity in the discipline. It is apparent that nursing does not have
consensus about philosophical approaches, nor even about the core tenets of those
philosophies, the most prevalent o f which is an ethic o f care. In the next chapter, I will
step outside of strictly nursing philosophical perspectives and examine two general
approaches to philosophy: metaphysical and hermeneutic. Nursing philosophy has
evolved from these approaches. I will propose relational philosophy as a reconstruction
that could serve as a unifying narrative for the diversity in nursing.
34
CHAPTER ID
RELATIONAL PHILOSOPHY: ONTOLOGY, EPISTEMOLOGY, AND ETHICS
A review of philosophical thinking reveals the intensity of our search as humans
for understanding our world. According to Solomon and Higgins (1997) "the story o f
philosophy is the history o f humanity's self-awareness and wonder with the world. It is,
in short, collective and individual passion for wisdom" (p. ix).
In this chapter, two basic approaches to philosophy will be reviewed:
metaphysical and hermeneutic. Although the focus for this study is relational philosophy,
which is a hermeneutic approach, the explication o f metaphysical philosophy helps the
reader to more clearly differentiate between the two ways of thinking about the nature of
existence. Within the metaphysical approach, two forms of absolutes - objectivism and
subjectivism - will be examined. In contrast to metaphysics, the hermeneutic approach
will be exemplified in the work of Merleau-Ponty, who emphasized our inherent
relational being in the world. These two philosophical approaches will provide the
background for a description of the ontology, epistemology and ethics of relational
philosophy. The ethics section, in particular, will explicate the values o f relational
philosophy: relationship, lived experience, vulnerability, intersubjective knowing,
created meaning, and uncertainty.
Definitions of Ontology. Epistemology. and Ethics
Definitions of ontology, epistemology, and ethics are included to clarify the
meaning o f their use in this chapter. Ontology is defined as "the assumptions about
existence underlying any conceptual scheme or any theory or systems of ideas" (Flew,
1979, p. 256). Epistemology is "the branch of philosophy concerned with the theory of
knowledge. Traditionally, central issues in epistemology are the nature and derivation o f
knowledge, the scope o f knowledge, and the reliability o f claims to knowledge" (Flew,
1979, p. 109).
Ethics is described by Flew in terms of the layperson and the philosopher. The
35
lay term for ethics is an actual body of applied beliefs by "which a particular group or
community decides to regulate its behavior - to distinguish what is legitimate or
acceptable in pursuit o f their aims from what is not" (p. 112). In this sense, ethics is a
practical guide to behavior. In the more philosophical sense, ethics can be described as
"an investigation into the fundamental principles and basic concepts that are or ought to
be found in a given field o f human thought and activity. Being a branch of philosophy it
is a theoretical study" (p. 112). The intent o f this study is to examine the ethics o f
relational philosophy not only in a theoretical manner, but to apply them within the
specific context of nursing. As Flew observed, "where philosophical 'ethics' does
correspond to lay 'ethics' is in its subject-matter; it is just those systems that are intended
to guide the lives o f men qua men that are scrutinized by moral philosophers" (pp. 112-
113).
Philosophical Context
Metaphysical Philosophy
The metaphysical philosopher is interested in absolutes. Within a metaphysical
paradigm there are believed to be universal truths, one true, unmoving center of the world
(Flew, 1979). The metaphysical paradigm is one o f certainty, or at least the search for
certainty. The allure o f certainty has been the basis o f most religious and scientific
thinking over the past several centuries. Certainty means that all that is known to us can
be understood in terms o f one basic entity. However, even the search for certainty has
resulted in at least two different perspectives on the one basic reality: objectivism and
subjectivism.
Objectivism. One perspective, objectivism, is the belief that the world can be
reduced to its material manifestations. We can systematically study the matter o f the
universe in sufficient depth, detachment, and under sufficient control to understand its
mechanical workings. The world and our bodies are machines. In the objective
paradigm the world (including other humans) is outside o f us, displayed before us,
36
waiting to be known. We stand before it and can place ourselves, through our methods,
even farther from it, in order to know it. As a result of this world view, starting with
Galileo, who proposed that all of nature be studied in terms of the properties o f matter,
and Bacon, who advocated his scientific method as a means to control the natural world,
there have been remarkable scientific and technological achievements (Capra, 1982).
The accomplishments o f science within the objective point of view are accompanied by a
dark side when the desire for prediction and control results in events such as the
destruction of the environment or whole communities o f people.
Descartes, considered the founder o f modem philosophy, was inspired by the
views o f Galileo and Bacon. A mathematical genius, Descartes argued that all o f the
material world could be reduced to mathematical certainty, emphasizing the primacy of
human consciousness, or mind, in understanding the world through the process of
analysis and deduction. With his famous cogito ergo sum (I think, therefore I am), he
established a fundamental split between mind and matter. He believed that the
mechanisms that we call the world, including our bodies, were set in motion by god.
Subsequent scientific and philosophical thinking began to focus on the notion o f absolute
consciousness without specific reference to god. And therein lay the dilemma that
resulted in the development of the second form o f philosophical certainty, subjectivism.
Subjectivism. For subjectivism the supreme truth and reality is consciousness. It
is from consciousness that the human, as an amalgam o f body and mind, controls and
directs the events of a world that still remains separated into minds and bodies, subjects
and objects. The absolute has now shifted from matter to mind. The field of study
becomes consciousness. Philosophers and scientists seek to understand how
consciousness directs the body and makes decisions. Humans, because of our level o f
sentience, are still believed to be in control of a world displayed before our
consciousness.
Even among subjectivists differences are found regarding the absolute as
37
consciousness. For some philosophers, such as Hegel, consciousness exists in the form
o f an all-encompassing absolute. Hegel's concept of Geist places humans within the
larger context of a Universal Spirit. The idea of an Absolute is accompanied by the
existence of an ultimate plan or pattern. Experience becomes the accomplishment o f that
pattern. Hegel espoused a universal purpose and meaning for the existence of humans as
a species. That telos is "community, a ’brotherhood' of mutual human love, differing
from state and society only in its lack o f finitude in space and time" (Solomon, 1987, p.
68).
Humans, according to Hegel, can access reality through the rational mind.
Knowing and reality exist in relationship to each other. What can be known, in objective
form, exists. However, the existence o f the known in human consciousness is known
only through the dialectical relationship between objectivity and consciousness. The
dialectic moves "from mere consciousness of objects to self-consciousness to the notion
of Reason, that our activities are as essential to the object of knowledge as the object is to
our knowledge" (Solomon, 1987, p. 23).
Another form o f subjective philosophy arose in response to Hegel's system.
Existentialist thought, starting with Kierkegaard, emphasized the existence and
consciousness o f the individual. Whereas Hegelian philosophy ascribed an ultimate
design to the universe within which humans live out a life with a rational purpose to
fulfill, the existentialist point o f view is that each human has the freedom to design the
self, rationally or irrationally. There is no preexisting code or authority for correct
choices. What is connoted as a terrible freedom exists for persons, bearing the weight of
conscious choice, to create a life and a meaning for that life. Suffering and pain are
inevitable aspects o f life. The freedom to choose is an inescapable aspect o f human
consciousness sometimes ignored by humans in an attempt to deny personal
accountability in the creation o f reality. This kind of freedom indeed can be a burden.
For existentialism, reason is employed in only a limited way by humans in
38
response to experience in order to give meaning and structure to that experience. The
existentialist believes that through fully engaging in the world of action and experience,
humans come to experience more of self and develop enhanced awareness of self in
relation to the world. Rather than a stance o f withdrawal from the world to observe and
rationally deduce, existentialists embrace experience and fully engage in situations that
allow them, through self-reflection, emotion, and intuition, to come to know themselves
and the world more fully. The emphasis in existentialism remains on individual
subjectivity and control.
In Sartre's existentialist view, individual existence provides experiential evidence
of the universal - a universal that exists only for that moment and within that experience
in time. In contrast to Hegel, who believed that history could enlighten us about
universal themes that make evident the purpose for human existence, Sartre believed that
history was simply the totality o f opportunities that a specific human being had
encountered as the background for individual choices. For Sartre, human existence is
inextricably tied to freedom o f choice. This onerous freedom produces the painfulness of
shame when one is perceived by the other as an unfree object and the painfiilness of
isolation when the other is perceived as the only free subject. The freedom to choose
one's life purpose or goal is what sets each individual apart.
Sartre believed that an ethic of personal freedom, while accessible to all, is not
embraced by all. Persons choose a moral stance in the world and create a meaning for
their existence in response to the existence o f others. The consciousness o f self-choices
being influenced by other-choices results in actions chosen not only for the self but for
others as well: "if...existence precedes essence, and if we grant that we exist and fashion
our image at one and the same time, the image is valid for everybody and for our whole
age. Thus, our responsibility is much greater than we might have supposed, because it
involves all mankind” (Sartre, 1957, p. 17). Anguish results from the constant tension
between the freedom to choose actions and the reflection on behaviors perceived through
39
the subjectivity o f others.

The existentialist perspective of persons choosing to live authentically with
integrity between behaviors and intentions lends itself to the question, how can we
recognize, given our own subjectivity, the authentic life? Can authenticity and its pursuit
be reconstructed through the scientific, methodologically rigorous study of the human
condition? And if the authentic life is lived by making choices that can be universally
applied, have we not come full circle to Hegel's notion of the Absolute? Do we hope to
make a contribution to a collective knowledge o f humans through reflection upon the
experiences o f others and the placement of that experience within the context of our
personal reflection on our own experience? Is this then deemed knowledge of the
existent individual or o f the universal human condition? These types of questions have
resulted in philosophical thinking that has moved beyond both objective and subjective
certainty, instead emphasizing contextual meanings as constructed, not immutable, truths.
Constructed truths are contingent interpretations - the focus o f hermeneutics.
Hermeneutic Philosophy
Hermeneutic philosophy represents a break from the certainty of both objectivist
and subjectivist metaphysical philosophy (Gadamer, 1976). According to hermeneutics,
we live and understand in context. There is no objective place from which we might
interpret the world and other people. There is no immobile center of truth; the center
moves. Reality and meaning are constructed in the tension created by the struggle to
find certainty in a continuously reconfiguring and ambiguous world. This struggle is
perceived in hermeneutic philosophy to be the essence o f life, a desirable openness within
which we move between our subjectness and objectness in a continuous dialectic.
Rather than trying to reduce reality to a unified grand theory, hermeneutics
embraces imaginative, emotional, and poetic methods of expression along with reason,
reflection and analysis as ways o f interpreting reality. The resulting notions of the world
are situated and engaged with lived experience. Perspectives o f reality become diverse
40
and expansive. Any resulting theories are viewed with an attitude of irony and humility.
Into this type of inquiry fell those philosophers who reinterpret, dialectically or
metaphorically, our assumptions about the nature of reality, thereby expanding our
perspective on the world (Dilthey, 1976; Gadamer, 1976; Merleau-Ponty, 1962;
Heidegger, 1962; Schleiermacher, 1977;) .
An exemplar of hermeneutic philosophy, Merleau-Ponty challenged both
metaphysical perspectives, objectivism and subjectivism. Although classified in the
realm o f existentialist philosophy, Merleau-Ponty was critical o f existentialist thought
that proposed an individual content-free consciousness as the center of human reality. He
emphasized an embodied existence, an incarnate subjectivity that is the primordial basis
of human reality. He shared with existentialist philosophers a commitment to philosophy
grounded in concrete, actual lived experience and insisted that "truth comes into being in
our concrete co-existence with others and cannot be severed from language and history"
(Langer, 1989, p. ix).
In Phenomenology o f Perception. Merleau-Ponty systematically carried the reader
through a series o f arguments against empiricist and intellectualist points o f view.
Beginning with the empiricist objectivist notion o f the body as object, he presented a
perspective o f our bodies as situated expressions of our being-in-the-world. He argued
that "bodily existence is not reducible to the laws of mechanistic physiology but is itself
imbued with meaning by our being-in-the-world. Consequently, it is not a question of
joining a soul to a mechanistic object, as Descartes tried to do, but of recognizing the
dialectical movement of our existence" (Langer, 1989, p. 34).
Merleau-Ponty then turned to the notion of the primacy of consciousness, the
intellectualist perspective on reality. The discipline o f psychology, for example, has been
primarily based on intellectualist subjectivist philosophy. For an intellectualist
philosophy, reality is consciousness. All material manifestations, behaviors, and
experiences are the result o f consciousness acting upon and perceiving matter, including
41
the body. However, as Merleau-Ponty argued, attempts to separate our bodies from our
consciousness and to study ourselves from outside ourselves cannot succeed. We are both
the subject and the object o f our study, a perceiving presence that lives through our
bodies. Psychologists are "the subject and object o f their own study and this equivocal
status o f being both observer and observed obliged them to rediscover the lived
relationships underlying and anterior to any subject-object differentiation." (Langer,
1989, p. 38)
Merleau-Ponty emphasized repeatedly that the body, consciousness, and the
world are inseparable. We cannot stand outside of our existence in order to observe and
understand it. We cannot stand outside o f the existence of others with whom we are
situated in context because we exist in a primordial world of relation to each other. Our
incarnate subjectivity in a situated existence is where we discover and create meaning for
our lives. Our existence is open and ambiguous, a continuously reconfiguring reality that
always includes others. Echoing the ideas o f Dewey, Merleau-Ponty maintained that the
self is inherently relational because its a priori context is the social world.
The hold on the world which others have - and which they are - enriches
me by enabling me to achieve a more comprehensive view o f the world
than is offered by my own hold alone. Far from being mutually exclusive,
these multiple modes of being-in-the world are internally related and form
a social world. ...the social world is not a 'sum o f objects' but a 'permanent
field' with which we are in contact by the simple feet o f existing, prior to
any objectification or judgment about it [italics added] (Langer, 1989, p.
104).
Relational Philosophy
In his philosophy o f internal relations, Merleau-Ponty expressed the basis for my
exploration o f relational philosophy: an ambiguous field of interwoven existences that
form the world to which our perception opens. In the following sections I explore the
ontology, epistemology and ethics o f a philosophy o f relation. I have chosen these forms
o f philosophical discourse because they provide a useful vehicle within which I can think
about a philosophy o f relation, not only for my life questions, but fi>r those that I ask
42
because I am a nurse. I find that the more I search, the more I find that my life questions
and my nursing questions are the same. I do not make any assumptions as to the
completeness of this framework. As a matter of feet, I can state with confidence that
completeness is not my goal, nor is comprehensiveness. I seek to add my voice to those
who see the world from the perspective o f relation. Using ontology, epistemology, and
ethics makes this voice more recognizable.
Relational Ontology
Ontology is an attempt to describe what is considered most real. When I ask
ontological questions, I am attempting to get to the core o f it all, to the most knowable
beginning place in my world. I imagine that from this place I might be able to interpret
my world, to associate meaning with what I perceive. The assignment of meaning is the
expression o f a manifestation o f ontology. Whether consciously or subconsciously, we
reveal what we consider real through that to which we assign significance or meaning.
Relational ontology can be defined as the general belief that all existence is
relational and the specific belief that humans are inherently relational beings. We are
internally related to other subjectivities; perception is intersubjectivity. Individual
subjectivity is not a separation o f mind and body but a subject-body, one integral being o f
consciousness and perceptive existence living in the world, weaving in and out with other
beings. The condition o f a relational world exists prior to our ability to reflect upon it or
apply our mental faculties to it. Merleau-Ponty observed that the desire to step out o f the
intersubjective relational world and to employ reason, structure, or analogy to
characterize reality is gradually acquired throughout our development and is usually
prompted by an awareness of our own subjectivity or of our bodies as objects. This
awareness, which takes us out o f pure presence in our experiences into the role o f
observer o f our bodies, thoughts, or experiences, represents what he would refer to as a
break-down in the intersubjective world.
It is important in discussing a relational philosophy to differentiate between
43
relation and relationship. Relation exists a priori. It is the nature of being, whether we
are conscious of it or not. Relation exists for us as does our ability to breathe,
unconsciously. Relation describes our ontology. Relationship is a conscious and often
cultivated reciprocity between beings (human or nonhuman) or even within a being.
Relationship is relation made manifest. Relationship may be entered into by chance or by
choice.
The foundational assumption of relational ontology is that the nature of being is
relation. There is no being that is not relational The world exists to us and we exist to it
in a web o f reciprocity. Merleau-Ponty (1962) described one example o f the relational
nature of being: "Between my consciousness and my body as I experience it, between
this phenomenal body of mine and that of another as I see it from the outside, there exists
an internal relation which causes the other to appear as the completion o f the system" (p.
352). According to Merleau-Ponty, to be in relation, to be open and ambiguous is the
very essence of being human and alive.
In the world o f experience, we come out of our pure relational stance to step back,
be conscious of ourselves in relation, objectify and name our experiences. In giving
language or thought to being in relation, we attempt to communicate in our world.
However, we can never fully express the nature of being in relation. When we use our
mental capacities to describe and categorize our experience, we can never be certain that
we have fully captured it. As Merleau-Ponty (1962) observed, "I am never quite at one
with myself' (p. 347).
Relational ontology presents us with a paradox: on one hand, a world of relation
that exists before we exist, exists within us, and through which others permeate our
being; on the other hand, an abstracted world o f experience through which we give
language and form to what we perceive, yet never quite capture a certain reality. We
move between the two perspectives as part of our human reality. This is the ambiguity of
relational ontology.
44
Because relational ontology describes a reality that is open and ambiguous,

constantly changing and reconfiguring, and because we come into this world of relation
as open and ambiguous beings, we are vulnerable. Vulnerability has commonly been
construed in a negative sense, as being open to harm, damage or pain, and thus a state to
be alleviated. In describing it as an aspect of relational ontology, I propose that
vulnerability is valuable in that it is inherent to life. To be vulnerable is to be open,
permeable, capable of change in both positive and negative ways, with both painful and
joyous results. For the purposes of this philosophical position, vulnerability is described
as openness to change.
Vulnerability does not infer that something is missing, that we are less than what
we could be. Consciousness o f vulnerability can be a valuable manifestation that life is
being fully embraced. Each person encounters his or her own vulnerability and through a
continuous dialectic between our presence in the world and our perception of it, we can
make meaning and assign value in our lives. This process is always contextual and
embedded. Being completely objective and impartial, standing outside oneself or the
world, is not possible in relational ontology. No matter how small or how large our
perspective, the window through which we view the world, we cannot escape being in
relation.
Another paradox manifests itself. We cannot escape being in relation, yet we
seem to stand alone in our thoughts and the inferiority we experience. Are we connected
or not? Merleau-Ponty (1962) argued that
the other is not shut up inside my perspective of the world, because this
perspective itself has no definite limits, because it slips spontaneously into
the other's, and because both are brought together in the one single world
in which we all participate as anonymous subjects of perception (p. 353).
This is the existence of intersubjectivity that is fundamental to a relational reality. We
perceive ourselves and our experiences as unique, but only because we exist in the world
45
through our bodies, which provide us with a horizon or background from which to
perceive.
Description o f an ontology o f relation means that the nature o f relational being
has been interpreted, conceptualized, and given categorization. It is fundamental to this
philosophical standpoint to remember that any time we seek to use language, metaphor,
or concepts for the purposes of communication we have placed limits around what exists.
Ambiguity is as inherent as relation. A philosophy of relation not only embraces this
notion, but holds it as the essence o f what constitutes life and freedom itself. It is the
movement between structure and fluidity, certainty and ambiguity, relation and
relationship that allows us to be most fully alive, most frilly who we are, and to most
fully engage in what seems to be paradox or duality, but in essence is as necessary as
breathing out is to breathing in. We cannot stand purely in the world o f relation and not
ever use reason and structure to carry out the necessities o f living, nor can we stand
purely in the realm o f structure (certainty and objectivity), lest we become so rigid that
there is no room for life, for the spirit of movement that is life.
Relational Epistemologv
Epistemology is the branch of philosophy that deals with knowledge, its nature,
origin, and scope. Questions arise such as: how do we know what we know? and how
do we know what we know is true? Within a philosophy o f relation claims to knowledge
are situated in context. Knowledge is viewed as neither wholly empirical and sense
driven, nor wholly a priori in the world of subjectivity. Knowledge is a relational
phenomenon. We come to know through our experience as incarnate subjectivities
perceiving and interpreting in a world of sentient and non-sentient beings. We come to
know other subjectivities because we see in the other something o f ourselves that is
embedded in the web of life. Much of what we know fades immediately into past
experience, only recalled as memory with labeling assigned to it. Our knowledge is
never necessarily reflective o f the full presence as experienced at that moment.
46
We acquire knowledge of facts through sensory and cognitive experiences. These

abstractions that we call facts help us to structure the world, to find boundaries within
which to act. Facts are necessary to the action aspect o f our existence. However, in a
relational epistemology, facts - no matter how empirically driven, how objectively sense-
evident - are simply a metaphor for what we have been present with, yet can never fully
represent to each other, or even to ourselves, without some descriptor, some language,
some visual representation - a painting, a poem, an essay, a logarithm. In a relational
epistemology, knowing occurs in relation and relationship. We come to know through
relation: relation within our bodies, relation to nature and non-sentient beings, and
relation to other subjectivities. We express our knowledge in relationship: through
language and other forms o f communication.
According to an epistemology o f relation, we have a fuller understanding o f the
universe in which we are embedded when we come to know the relational context.
Contextual, embedded, situational knowledge allows space for the assignment of value,
the creation of meaning that is the essence o f relational existence.
Epistemology of relation underscores the essential nature of self-knowledge in
coming to know another. The more knowledge one has of one's self and the more one
moves toward the consciousness of one's own vulnerability, the more access one has to
the subjectivity o f another. In turn, one remains vulnerable to be known by the other, and
therein to learn more through the reciprocal subjectivity of another. There is a sort o f
humility in this type of knowing that emanates from the realization that there is always
more to learn, more to the mystery, the freedom to choose the life without certainty.
Epistemology can be explored in terms of power. It has been said that knowledge
is power. Humans have philosophized that we are superior due to our level of
consciousness, our ability to acquire knowledge, to act on our knowledge and make new
functional relationships from what we learn. With the advent of the scientific method, we
have made our primary goal the acquisition o f empirical knowledge that results in the
47
power to predict and control the world. The philosophical basis o f this thinking is that
we are obligated by virtue o f our privileged existence to use the power we acquire
through knowledge to understand and improve the world.
A philosophy o f relation places knowledge in a different light. The emphasis in
relational epistemology is the process rather than the power o f knowing. Knowing is the
process o f creating new knowledge intersubjectively and contextually, resulting in new
meanings and new value assignments to support and sustain an inherently relational
world. Power is defined as generative and regenerative energy. Rather than power-over
(power to control), a relational epistemology defines knowing and knowledge as "power
with", power to come to understand and experience more fully the world around us. This
is a peaceful power, not a controlling power. Eisler (1987) described this power as "a
means of advancing one's own development without at the same time having to limit the
development of others" (p. 193). Chinn (1995) defined power as "the energy from which
action arises" (p. 8). In contrast to power-over which often results in an emphasis on who
has power, power-with places value on "the capacity to be in harmony with others and
with the earth, to join others in directing your collective energies toward a future you
seek together" (p. 8). This is an abundance perspective. There is enough knowledge and
power for all: we do not have to hoard or compete for it.
Relational Ethics
Ethics is the branch o f philosophy that explores the basic beliefs and values that
govern our decisions and behaviors. How do beliefs about a relational nature of being
correspond with beliefs and values that result in actions? In Chapter I, I described
integrity as a synchrony between being and doing. What would synchrony between
relational ontology, epistemology, and ethics look like? According to the ontology and
epistemology I have described, existence is relational, we are embedded in a relational
world, and a contextual perspective is inherent to knowledge and perception. We come
to know others through intersubjectivity; we dwell in "consummate reciprocity"
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(Merleau-Ponty, 1962, p. 354). Awareness o f the ambiguous, dialectical, and

contextually embedded essence o f our existence can provide us with a sense of purpose in
becoming more fully present and vulnerable in our lives, more engaged with our world.
Six ethical corollaries follow for those o f us who embrace this philosophical perspective.
I describe them below as values and develop them further in the context o f relational
leadership in Chapter IV.
Relationship. If we believe that reality is inherently relational, then we value
relationship as a manifestation o f the nature of being. We value processes that support
and sustain relationships. We honor and revere the simple act o f being with another as a
manifestation of our relational being.
Lived Experience. If we believe that reality is perceived contextually and
perspectivally, then we value our own lived experience as well as that of others. We
value becoming part o f the lived experience o f others (including their environment, their
family, etc.). We, by virtue o f our inherently relational being, become experiential
context for others as they become context for us.
Vulnerability. If we believe that vulnerability is a manifestation of life and
reflects the openness o f a relational way of being, then we value our own vulnerability
and that o f others. We allow ourselves to be vulnerable in relationship with others and
attempt to provide a safe place for them to experience and value their own vulnerability.
Intersubjective Knowing. If we believe that intersubjective knowing is not only
possible, but of benefit to both beings involved, then we value experiential inquiry as a
means of gaining knowledge and understanding o f our world. We value knowledge that
is gained through a process o f openness between knower and known, wherein both are
vulnerable to change.
Created Meaning. If we believe that the process o f making meaning is creative
and expansive, then we value and support this process. We participate in this process to
develop tentative constructions and saturate them with our experience. We demonstrate
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the inseparability o f our benefit from that of others by creating meaning with them and by
creating contexts that are mutually meaningful.
Uncertainty. If we believe that meaning is constructed and contingent, then we
value the uncertainty and ambiguity that makes new meanings possible. We demonstrate
respect for the human desire for certainty and employ it when it is necessary. However,
we avoid the tyranny o f certainty that no longer serves its purpose. We embrace
ambiguity and make it safe for ourselves and others to be uncertain because only in the
space that ambiguity provides can new meanings be created.
Summary
The purpose o f this chapter was to describe the ontology, epistemology and ethics
of relational philosophy. The philosophical context from which relational philosophy
emerged was examined. Metaphysical and hermeneutic philosophy were described. It
was observed that metaphysical philosophy is based on a belief that reality can be
described in terms o f either objective or subjective certainty. Hermeneutic philosophy,
using Merleau-Ponty as an exemplar, was contrasted with metaphysical philosophy in its
emphasis on uncertainty and constructed meaning.
Against this review of philosophical thought, the ontology, epistemology, and
ethics of relational philosophy were defined. Relational ontology is the general belief
that all existence is relational and that humans are inherently relational beings, existing as
integral subject-bodies. Relational epistemology is coming to know in relation and
relationship: within our bodies, to nature and non-sentient beings, and to other
subjectivities. Knowledge is expressed in relationship, creating power-with, rather than
power-over. Relational ethics were described as six values consistent with the ontology
and epistemology o f relational philosophy: relationship, lived experience, vulnerability,
intersubjective knowing, created meaning, and uncertainty.
In the next chapter, the concept of leadership will be explored in the context of
relational philosophy. In the milieu o f postmodern philosophical inquiry, premodem
50
(dominator) and modern (mechanistic) foundations o f leadership will be described.

Conflicts among dominance, instrumental reason, and caring will be highlighted.
Nursing leadership approaches which paralleled cultural trends will be identified.
Postmodern exemplars o f leadership that move beyond the dominant and mechanistic
foundations of previous leadership approaches will be reviewed. A relational leadership
approach that is not located in a designated role within a hierarchical structure will be
proposed.
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CHAPTER IV
HISTORICAL AND CULTURAL FOUNDATIONS OF LEADERSHIP
In this chapter I will explore the historical development of leadership approaches
in a broad cultural context and specifically in the discipline of nursing. In keeping with
the postmodern nature of this inquiry, the very existence o f a quality, state, or process
called leadership is called into question. The postmodern approach o f deconstructing
assumptions that have been accepted as truths allows us to envision new possibilities for
finding safety in the ambiguous tension between our desire for certainty (usually
provided by structure) and our desire for freedom (sometimes equated with lack of
structure). Relational philosophy inhabits this place o f tension.
A postmodern approach to understanding leadership is to deconstruct the
meanings that have been assigned to leadership and look at them in a new way. Gadow
(1999) described postmodern deconstruction in this way: "every form o f order becomes a
target for deconstruction, from the social, sexual, and political to the epistemological and
metaphysical, but none is as inimical to postmodern ethics as the hermeneutic order, the
modem hierarchy o f meanings" (p. 10). Meanings of leadership are the focus o f inquiry
in this chapter.
In a postmodern philosophical inquiry the ethics of a discipline are also examined
within its sociocultural and historical contexts. As Reverby (1987) emphasized: "caring
is not just a subjective and material experience, it is also a historically created one.
Particular circumstances, ideologies, and power relations thus create conditions under
which caring can occur, the forms it will take, and the consequences it will have for those
who do it" (p. 202). An examination o f nursing leadership, in the context o f the socially
constructed practice environments in which it occurs, manifests another dimension of
nursing's struggle with the ethic o f care.
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Foundations of Nursing Leadership

If a philosophy of nursing and its ethic o f care are embodied in nursing
leadership, then what kind of leadership is required? Which way do we lead and whom
do we follow? Do we take the poetic road less traveled at the cost of our destination as a
discipline? And even if we believe that the joy is in the journey, will we abandon our
patients who are by necessity traveling on the main thoroughfare? These are the
dilemmas o f leadership that we see reflected in our history as a profession.
The development of nursing leadership closely parallels cultural models of
leadership. Historically, leadership was defined metaphysically, in terms of the absolute,
either objectively or subjectively (Galton, 1870; Woods, 1913; Wiggam, 1931). Bennis
and Nanus (1985) referred to this as the "Great Man" theory: "leadership skills were
once thought a matter o f birth. Leaders were bom, not made, summoned to their calling
through some unfathomable process" (p. 5). Because leadership represents a relationship
among humans, the way in which humans have set up their relationships to each other,
particularly in the context of power, dominance, and control (in contrast with
generativity, partnership, and vulnerability) informs how leadership is carried out.
Contemporary literature is replete with catchphrases and how-to books on
leadership. For the purposes o f this exploration, I have chosen to limit my inquiry to
sources which I believe provide a more comprehensive perspective on the philosophies
that serve as foundations upon which leadership is defined. I group these philosophical
foundations into three categories: premodem (based on beliefs about natural superiority);
modem (based on faith in instrumental reason); and postmodern (based on relational
ethics).
Premodern Foundations of Leadership; The.Dominator Model
Relationships among people and their basic beliefs about those relationships make
up the philosophical foundation upon which leadership is built. Eisler (1987), in her
book The Chalice & The Blade, brought together findings from the natural and social
53
sciences, new findings on the nature of change in the universe, and feminist theory in a
comprehensive examination of social and cultural dynamics that have shaped our view of
reality and power in relationships. Eisler demonstrated, through extensive examination
starting with pre-historical data and moving through the development of religious and
secular ideologies, the prevailing hegemony o f the dominator model. My intent in
exploring Eisler's review of cultural development is to demonstrate the link between the
dominator model and our deeply entrenched ideas o f what leadership should be.
Her work challenged assumptions related to the nature o f relationships between
men and women, the nature o f competition, and the use o f force. Through the use of
archeological findings and other historical data, Eisler examined cultures that predate
most o f recorded history. Through this work she identified cultures that were neither
patriarchal nor matriarchal, but instead organized themselves around a linking or
partnership model of social order, in which neither gender dominated the other, but males
and females worked together in nonhierarchical, generative, peacefill structures.
The people's reverence for generative power within partnership models, or what
Eisler termed gylanic (gy for female, 1for linking, and an for male) societies, is
symbolized by the chalice. Cultures that functioned in a partnership model tended to
make significant contributions to the human ability to produce art, beauty, learning, and
life-producing results, such as agriculture. These were typically societies characterized
by abundance, without a necessity for competition for goods or hoarding o f material
possessions. In contrast, reverence for the power to take life and to establish domination,
what she termed the dominator model, is symbolized by the Blade. These warring
societies were the precursors to the established cultures we live in today, wherein
hierarchy, dominance of some groups over others, competition, and the concept o f power
as a possession prevail.
Through a reexamination o f archeological and pre-historical data, Eisler
discovered that approximately five thousand years ago a dramatic social shift occurred
54
when linking or partnering societies were obliterated by warring tribes, using the power
of the blade to destroy and to obtain power through violence and suppression of females
and weaker males. The result has been a 5000-year span of cultural development in
which power-over, competition, male dominance, and hierarchy have become so
entrenched in every facet of social behavior that any other option is almost invisible to
our consciousness.
The social systems that developed from the use o f dominance and violence are
foundational to the issues we deal with today in hierarchically organized competitive
businesses. In contrast to those who believe inherent gender differences are the cause o f
issues o f dominance and control, Eisler identified the social structures created by the use
o f dominance as the problem. She argued:
the underlying problem is not men as a sex. The root o f the problem lies
in a social system in which the power of the Blade is idealized—in which
both men and women are taught to equate true masculinity with violence
and dominance and to see men who do not conform to this ideal as too
soft' or 'effeminate"' (Eisler, 1987, p. xviii).
Eisler stressed that "the way we structure the most fundamental o f all human relations has
a profound effect on every one of our institutions, on our values, and...on the direction of
our cultural evolution, particularly whether it will be peaceful or warlike" (p. xix).
Challenges to androcracy, or the domination of male-oriented values, have
occurred throughout history in all cultures and in many different forms. Eisler proposed:
the rebellions first of burghers, workers, and peasants (Marx's bourgeoisie
and proletariat), and later o f black slaves, colonials, ami women are also
part of this still evolving movement to replace androcracy with gylany.
For all these mass rebellions were and are fundamentally against a system
in which ranking is the primary principle of social organization, (p. 169).
The postmodern phase of questioning the assumptions upon which beliefs about reality,
science, and social structure are based is consistent with this type of rebellion.
In order to thoroughly explore our notions o f leadership and what it means to lead
other humans, we question the basic structures we have created and the way they shape
55
our ideas about leadership. Eisler turned to feminism as a major source for reshaping our
perspectives on social organization through questioning, persistently, the current social
order. She referred to feminist scholarship as internally consistent in "applying principles
such as equality and freedom to all humanity—not just its male half" (p. 169).
Eisler believed that cultural transformation is possible, that men and women in the
twentieth century have begun to seek a new model of relating that is more generative and
peaceful. She cited the work of feminist scholars who have introduced new conceptions
of power among humans and between humans and the natural world: "power as
affiliation" (p. 193). This new view o f power is being carried into every realm of human
social organization to question assumptions related to a dominator model. A shift to a
partnership society is dramatic and difficult for us to conceptualize. However, Eisler
challenged: "if we free ourselves from the prevailing models of reality, it is evident that
there is another logical alternative: that there can be societies in which difference is not
necessarily equated with inferiority or superiority" (p. xvii). In addition, she pointed out
that major technological and social changes have all begun with ideas. It is these ideas
that are widening the crack in a foundation for leadership made up o f dominance,
competition, and control
Eisler described the cultural transformation from a dominator to a partnership
model for society:
The transformation from a dominator to a partnership society would
obviously bring with it a shift in our technological direction: from the use
o f advanced technology for destruction and domination to its use for
sustaining and enhancing human life. At the same time, the wastefulness
and overconsumption that now robs those in need would also begin to
wane. For as many social commentators have observed, at the core of our
Western complex o f overconsumption and waste lies the feet that we are
culturally obsessed with getting, buying, building—and wasting—things, as
a substitute for the satisfactory emotional relationships that are denied us
by the child-raising styles and the values o f adults in the present system (p.
196).
The core theme that will coalesce a partnership model of society, politically,
56
economically, and socially is as yet undetermined. Eisler pointed out that the shift to a
partnership society entails placing an increased value upon caring and caring behaviors.
She observed: "as this caring labor—the life sustaining labor o f nurturing, helping, and
loving others—is fully integrated into the economic mainstream, we will see a
fundamental economic and political transformation" (p. 197).
To summarize the dominator model, premodem conceptions o f leadership were
based on the mysterious presence o f an ability within some persons, usually men, to
envision a future and to inspire and motivate others toward this envisioned future. This
visionary leader was thought to be chosen by the gods, also male, to show others the way
of truth. This notion of leadership was often attached to the use o f dominance and force
to accomplish the leader's desired aims.
Modern Foundations of Leadership; The Mechanistic Model
Modem conceptions o f leadership emanate from mechanistic philosophy about
the nature of human reality. Based on a philosophy o f the universe as a machine,
organizations are machines with people as the mechanisms (Taylor, 1911). Bureaucracies
were designed with a mechanistic philosophy as their basis (Weber, 1947). The
bureaucratic organization is designed for efficiency, productivity, and standardization.
Human needs are sublimated to the goals o f the organization. Rules, policies, and
standards are established in order to maintain the control and power o f those at the top of
the hierarchical structure. Work and personal life are to be completely segregated and
creativity is not encouraged.
Relationships among people in the bureaucratic organization are strictly
instrumental in nature, the purpose o f which is to meet the ends o f the organization.
Socially constructed gender differences are typically played out in the hierarchy in terms
of role assignment. Men are thought to be more rational, impartial, and decisive. These
value driven assumptions, in addition to the privileged role of some men in society
(particularly white males), are lived out in hierarchical role assignments, domination, and
57
the suppression o f more characteristically female values considered to be passive,

emotional, and uncontrolled.
In this machine, the leader sets the cogs in motion. The leader has power over the
others in the machine and conversely, is dominated by someone more powerful. The
leader is expected to create an inspiring vision to which the others in the organization will
conform, since the leader knows the correct way o f doing work. Organizational theories
of leadership developed around making the bureaucracy run most efficiently.
In the 1950s and 1960s, scholars in motivation, organizational, and leadership
theory discovered the worker (Maslow, 1954; Herzberg, 1960; McGregor, 1960; Fiedler,
1967; Hersey & Blanchard, 1969). Concepts of organizational behavior began to shift
toward attending to the personal needs of the workers in the organization. What were
termed leadership theories, but were primarily management theories still designed to
achieve the ends o f the organization, were developed. Much attention was paid to what
motivated workers, what helped them to achieve satisfaction in the work setting, how
leaders should behave in response to various management contexts, and how workers
could be empowered by leaders.
At the same time, and continuing into the present, the women’s movement
engendered feminist scholarship which began to question the foundation upon which
leadership theories are based (Lugones & Spelman, 1983; Fraser, 1987; Young, 1990).
Much of contemporary leadership thought revolves around the notion o f the re
distribution of power to those who are powerless, thereby making them empowered.
However, a careful examination o f much of the new empowerment and value-oriented
emphasis in leadership literature reveals that these approaches continue to leave the basic
structures of dominance, competition, hierarchy, and power-over in place (Young, 1990).
The question remains: if the philosophic foundation of mechanism and instrumental
reason does not change, can the structures, such as leadership, built upon it fundamentally
change?
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Young (1990) criticized the notion of distribution o f power as the determining

factor for a more participative societal structure. Using a postmodern critical theory
approach, she maintained that social justice does not consist of trying to redistribute
power. First, she argued that power is not a possession to be distributed:
common though it is, bringing power under the logic of distribution, I
suggest, misconstrues the meaning of power. Conceptualizing power in
distributive terms means implicitly or explicitly conceiving power as a
kind o f stuff possessed by individual agents in greater or lesser amounts.
From this perspective a power structure or power relations will be
described as a pattern of the distribution o f this stuff (p. 31).
Young conceptualized power as a relationship among people, rather than an entity
that could be distributed differently. For power to exist within a person or group, there is
a supportive web of other persons who enable the power; further reinforcing that power is
a social construction and occurs as a process, rather than an entity. Young quotes
Foucault (1980) who asserted that "power is employed and exercised through a net-like
organization. And not only do individuals circulate between its threads; they are always
in the position o f simultaneously undergoing and exercising their power" (p. 98). In this
context, power is a process supported by those involved, rather than an entity that can be
handed over because the leader believes that others should have more power.
Modem leadership approaches have attempted to account for the human factor of
organized work primarily through the redistribution o f power and attempts to motivate
workers through identifying what satisfies them. However, these approaches have left
the modem foundation of leadership (a mechanistic philosophy based on instrumental
reason) intact.
Historical Development of Nursing Leadership
From nursing's history o f whores, witches, healers, and scholars, we ranked
ourselves around prevailing western notions o f "a good woman" (Reverby, 1987, p.
202). The good women in nursing became the leaders. Bowing to a social structure that
was already woven, we used our power to replicate that structure in our work. Sick
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people and nurses were collected together into hospitals, instead of remaining in their
homes, and with the dawn of professional nursing, attributed to Nightingale, nursing
became an organized profession.
Nightingale ranked nurses according to their social status. Those who fit
societally accepted norms became leaders (Klakovich, 1994) and perpetuated the norms
in a hierarchical system that simultaneously oppressed them and made them powerful.
Reverby (1987) observed: "nursing from its very beginnings created a female hierarchy
in which sisterhood was difficult to achieve when different class-based assumptions
about behavior and work collided" (p. 200).
As nursing moved into the scientific management era of bureaucracies in the
1930s and 1940s, we brought with us our history of class and gender issues and added to
it the rules, standardization, and mechanistic approach o f the industrial era (Nyberg,
1998). Working primarily in these hierarchies established the acquiescence o f nursing to
external sources of control, leadership, and power. Caring within the bureaucratic
organization was enmeshed in conformity to procedures and policies. Particularity was
sacrificed.
This scientific approach to management made the work controlled and predictable
because the workers were interchangeable. Interchangeable workers were easily
dominated because they were dispensable. Nyberg (1998) reminded readers of the
current viability of bureaucracies:
Why spend so much time describing an old organizational model?
Because in nursing and health care, it has not gone away. Oh we make
change after change, thinking that we are moving in the right direction.
Then, along comes the Joint Commission of Accreditation of Health Care
Organizations, and we drag out the policy and procedure books, we brush
off the organizational chart, and we present ourselves as the perfect
bureaucracy (pp. 42-43).
If nurses' caring is based strictly on a societal assumption about the obligation o f
women to care for others, then nurses simply carry out this duty in an unquestioning
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manner, and hierarchical and mechanistic structures organize that duty more efficiently.
According to Reverby (1987) "trained nursing began as an occupation based on the duty
to care. Neither ethical dilemmas nor questions of role were anticipated because it was
assumed that duty would make such conflicts impossible" (p. 202). This is consistent
with philosophies of certainty, wherein an unquestioned obligation is the source of
work/responsibility/choice. Gadow (1999) called this condition immersion, a form of
ethical and societal certainty that allows no reflection.
The strength of immersion as an ethical approach is the solidarity it
achieves. Nurses and patients sharing an unquestioned view o f die good
are united in their attempt to realize that good. Difference in interpretation
may arise between individuals, but the foundational unity that grounds
their values prevents differences from becoming divisive (p. 5).
The perception of caring as a duty, even though it should have provided for
ethical certainty, was, as Reverby (1987) pointed out, "never that simple... there was
continual conflict among physicians, nurses, and other providers over appropriate care,
and thus the role o f the nurse. Caring always requires individual flexibility and
judgment. But their unbending adherence to rules earned nurses opprobrium" (p. 202).
Conflict and dissatisfaction continued to exist alongside marked changes and
growth in the nursing profession. As nursing moved through the teams of the 1940s and
1950s to primary nursing of the 1960s, nursing leadership, in concert with the human
relations movement in organizations, discovered the value of increased decision making
by the bedside nurse. However, the fundamental organization as hierarchy remained.
Klakovich (1994) noted that "primary nursing was an initial attempt to align nursing
practice with professional nursing values. However, the centralized and hierarchical
decision-making structures conflicted philosophically and operationally with the primary
nursing model" (p. 46). The practice of nursing remained in hierarchical bureaucracies as
nurses continued to designate leaders to create practice environments consistent with the
values of the discipline. By the 1980s nursing leaders were in executive positions in
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organizational hierarchies. In terms o f success in the cultural hierarchy, nursing had

made it to the top.
The 1980s and 1990s introduced competition and increased financial strain in
health care. Many o f the changes in nursing structure were often driven more by the
needs o f the organization in terms o f competitive power than by needs o f the nursing
staff. Decentralization, though intended to drive decision-making down into lower layers
of organizations, was often more about decreasing management overhead. Shared
governance models, intended to increase nurse participation in decision-making related to
practice, were often not authentically implemented, leaving nurses more disillusioned
with nursing leadership. Nyberg (1998) observed,
it is very difficult to maintain participative models when the decisions you
are asked to make will negatively affect the participants. As health care as
a whole recoils from participative decision making to a stronger
bureaucracy, it is hard for nursing not to do the same (p. 222).
Contemporary Leadership Models in Nursing
Just as other social structures call for new approaches to leadership, the discipline
of nursing continues to seek different models o f leadership that move beyond
redistribution o f power in the form of professional autonomy. On one hand, the interest
in new forms of leadership is driven by the desire to maintain the viability o f a business-
oriented competitive health care system. On the other hand, the search for alternatives is
consistent with the postmodern turn toward questioning hierarchies and other forms of
dominance and control Nursing continues to seek ways to more fully incorporate an
ethic of care into clinical practice and leadership.
Rost (1994) recommended a post-industrial paradigm for nursing leadership based
on a relationship between leaders and collaborators (instead o f followers). He believed
that leadership is defined by the involvement of both leaders and collaborators in a
relationship wherein they use only noncoercion to influence each other. Leaders and
collaborators make significant changes that reflect their mutual purposes.
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The postindustrial megaparadigm will focus on collaboration, active

participation, common good, pluralism, client orientation, and consensus
building. ....In the new paradigm, leadership is not about governance or
management/administration. It is about change leaders and
collaborators form a relationship to change a group, organization, or
society (in Nyberg, 1998, p. 223).
Klakovich (1994) called for a new kind o f nursing leadership which she termed
connective leadership: "flexible networks to replace hierarchies, empowered workers
who make their own decisions, and the acceptance o f loving and caring as legitimate
workplace motivators" (p. 49). Connective leadership for nursing is derived from the
research ofLipman-Blumen (1992) as a strategy for bringing people together in
connection with their "tasks and visions, to one another, to the immediate group and the
larger network, empowering others and instilling confidence" (p. 187). Klakovich
described behavioral strategies used by the leader to make connections among various
disciplines and interests in the organization.
Porter-O'Grady (1997), an advocate o f shared governance and participative
decision making in nursing, proposed a concept o f quantum leadership. He described
quantum reality as "that which emerges when the viewer 'sees' reality as a set of
relationships expressed at varying and continuously changing levels of complexity" (p.
16). The evolution of the knowledge worker as less easily controlled by bureaucracies is
the motivating force for this type of leader. Knowledge workers own control of
processes in unstructured work settings, and the locus o f decision-making power is at the
point of service. In an age of chaotic instability, the leader serves to connect people with
information. Behaviors of the quantum leader include "mentoring, creating, sharing,
facilitating, integrating, and coordinating people, resources, and processes toward the
outcomes that exemplify the purposes o f the system" (p. 20).
Curtain (1997) advocated a transformational leadership model wherein leaders
"convert followers into leaders and may convert leaders into moral agents" (p. 7).
Transformational leaders, through modeling their own integrity, inspire commitment and
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trust in followers and help people to envision goals "worthy of human effort" (p. 7).
Recently, Curtain (1998) emphasized the moral nature o f nursing. She urged that nurses
"need a moral community to sustain them,” and that leadership consists o f "building
moral communities in our workplaces and neighborhoods, in our homes and churches, in
our countries and our world” (p. 5). She expressed concern over the value conflict
between the moral ideals of nursing practice and the business ideals of nursing
workplaces. Instead of embracing the values of competition, profit, and controlled
access, she argued that nursing needs moral leadership to guide service;
only when the choice to serve undergirds the moral formation of the leader
will hierarchical power be used to serve the community rather than the
self. ...leadership exists when people no longer allow themselves to be
victims o f circumstances, and start creating new circumstances (p. 6).
The preceding examples manifest nursing's search for non-hierarchical,
collaborative approaches for nursing leadership. I echo Curtain's concern that nursing, as
a morally defined discipline, needs a moral community within which to enact an ethic of
care. In the following chapters I will develop the position that leadership based on a
relational philosophy can facilitate that moral community in nursing.
Summary
Philosophical debate in nursing has centered around the issues of multiple versus
unified philosophical perspectives and the risks and benefits of embracing an ethic of
care as the essence o f nursing. Although a relational philosophy that includes
interpersonal caring is consistent with the moral intent o f nursing, scholars disagree about
how nurses should practice an ethic o f care. Some critics worry that nursing will become
increasingly marginalized if the discipline shifts toward a perspective that is inconsistent
with the current models o f capitalism and science. Other scholars believe that a shift in
nursing away from these models is consistent with a wide spread multidisciplinary trend
toward a more relational philosophy o f practice.
Nursing's philosophy o f practice is reflected in its concepts o f leadership. The
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history o f nursing leadership, particularly in practice settings, parallels the historical

patterns o f leadership in western culture. Nursing continues to struggle with how to enact
the values of the discipline in a practice setting that is organized around different values.
Most nursing leadership literature focuses on leadership within an organization rather
than a discipline. Leading a hierarchical organization inevitably comes into conflict with
the contextual meaning of practicing an ethic of care. Leading an organization is
typically about generalization, the common good, movement toward goals and visions,
change, motivation, and often, but not always, standardization in order to gain control
Contemporary nursing leadership literature recommends moving away from hierarchy
and dominance models toward models o f connective, collaborative, and transformational
leadership.
I contend that nursing has not yet developed a concept of leadership that promotes
integrity between its philosophy and practice. In Chapter V, I will develop a concept of
relational leadership and more specifically, relational nursing leadership, that is
consistent with a relational philosophy.
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CHAPTER V
LEADERSHIP IN THE CONTEXT OF RELATIONAL PHILOSOPHY
The purpose o f this chapter is to explore postmodern concepts o f leadership
outside the discipline o f nursing and within the discipline o f nursing. This will provide a
background for the development of relational leadership and the specific application of
that leadership approach to the discipline of nursing..
Postmodern Concepts of Leadership
The Ethic of Care
The ethic of interpersonal caring in the context of relational philosophy is
grounded in the recognition that attitudes and actions that support mutual growth and
sustain both humans and the environment are expressions of our ontology. Noddings
(1984) described caring relationships as the basis of reality and stressed that caring for
others includes caring for oneself. Mayerofif (1971) wrote o f this ethic o f care: "instead
of trying to dominate and possess the other, I want it to grow in its own right, or, as we
sometimes say, to be itself, and I feel the other's growth as bound up with my own sense
of identity" (p. 6). Merleau-Ponty pointed out that our inherence in the world as
embodied subjectivity in relation with others can and should be applied concretely in our
moral and ethical behavior:
...morality cannot consist in the private adherence to a system of
values....Thus we cannot remain indifferent to the aspect in which our acts
appear to others....It is the very demand of rationality which imposes on us
the need to act in such a way that our action cannot be considered by
others as an act o f aggression but, on the contrary, as generously meeting
the other in the very particularity o f a given situation....Just as fire
perception of a thing opens me up to being...the perception of the other
founds morality...(Langer, 1989, pp. 154-155).
This is the essence of the ethic o f care. It is valuing and living a nonaggressive,
noncompetitive, generative stance in the world. When we harm or destroy the
environment or others, we ultimately harm or destroy ourselves. What is destructive to
others is destructive to ourselves. In this context, caring becomes more than an affect,
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more than a duty. It becomes both a self-sustaining, enhancing way of being in the world
and other-enhancing, which are essentially the same, mutually beneficial
Caring is situated in ethical context and is a way o f being that is reflective of
relational philosophy. Caring is embodied in actions. In a postmodern approach to
caring, actions would not be teleological in nature, aiming toward some greater end, but
ends in themselves, based in the context o f the present. In relational philosophy ends are
simply created meanings, constructions that evolve out of a daily, moment by moment
self-and-other-dialogue that makes up existence.
What does a construction called leadership look like when based upon a relational
philosophical foundation? In the next two sections, I will describe two examples from
contemporary leadership literature that incorporate some aspects of an ethic o f care:
servant leadership and spiritual leadership. In addition, I will describe what I believe to
be inconsistencies of these two approaches with relational leadership. In the final section
o f the chapter I propose a concept o f relational leadership that embodies caring more
frilly than either servant or spiritual leadership.
Servant Leadership
Greenleaf (1998), a management development executive for AT&T, began
writing about a concept he termed "leader as servant" after his retirement from AT&T in
1970. For the next 20 years, until his death in 1990, he continued to write about this
concept. Recent attention to and interest in his work is evidenced in a 1998 collection o f
his essays entitled The Power of Servant Leadership.
Central to the concept of servant as leader is Greenleafs use o f the term servant
and the manner in which it is combined with leader. Spears (in Greenleaf 1998)
clarified: "the subject is the servant or service; the predicate is the leader. His phrase is
an application of the philosophy o f service to the practice of leadership" (p. xi). In the
following section I will explore some o f Greenleafs ideas about leadership. I will
discuss ways in which they are similar to relational philosophy and an ethic of care and
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the reasons why Greenleafs notion of leadership is different from the idea of leadership
that I am proposing.
The philosophy o f service and of a way o f being as servant is closely applicable to
an ethic of care. In a philosophy o f service, as conceptualized by Greenleaf a caring
ethic is embodied. Greenleaf (1998) makes the connection between caring and a servant
philosophy evident in his introduction to the essay entitled "Servant: Retrospect and
Prospect":
I believe that caring for persons, the more able and the less able serving
each other, is what makes a good society. Most caring was once person to
person. Now much o f it is mediated through institutions - often large,
powerful, impersonal; not always competent; sometimes corrupt. If a
better society is to be built, one more just and more caring and providing
opportunity for people to grow, the most effective and economical way
while supportive of the social order, is to raise the performance as servant
of as many institutions as possible by new voluntary regenerative forces
initiated within them by committed individuals: servants [italics added to
caring, servants italicized in original] (p. 17).
Greenleaf (1998) defined leadership as "going out ahead to show the way" (p. 31).
He believed management and administrative functions to be primarily maintenance
activities, designed to keep things running according to the current order. In contrast, a
leader uses creativity to apply his or her knowledge in a new way and is inspired by a
vision of what could be. The leader lives this powerful vision through a stance is the
world as servant; a servant in service to an idea. It is this notion of being inspirited or
inspired and inspiring others that Greenleaf advocates as the essence o f servant
leadership.
Greenleaf applied his leadership ideas to business organizations, academic
institutions, churches, and even as social commentary. He argued that disabling mind
sets were what erected barriers to people acting on their knowledge. These disabling
mind-sets tie people to convention and maintenance o f the status quo to the extent that
they are unable live in a different way. Greenleafpointed out these disabling mindsets in
some major institutions such as: businesses, universities, health care, and churches.
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He discussed the purpose that mind-sets serve in organizations and in daily life:
what if every person and every institution was 'open' in the sense o f being
free o f all inhibiting mind-sets that block action on what we know? Every
question and every situation would be faced as if nothing like it had
happened before. This would be the reformer's dream; but the world
would be in chaos. Few of us can survive without a good deal o f dogma
that prompts reflexive actions. We would not be able to act quickly in
emergencies, and moral choices that require prompt action would paralyze
us (p. 34).
In addition to mind-sets that cause excessive conformity to social construction,
Greenleaf believed that the second reason for lack o f "liberating visions" is that they are
very difficult to deliver. He believed that very few people have the requisite skills to
enact vision. These skills are "summoning a vision", the "power to articulate it
persuasively" and "the courage or the will to try" (p. 35). Greenleaf acknowledged that
part o f the problem in the delivery of an inspirational vision may rest with those hearing
the message. He argued that "seekers" or "hearers" must be available to the vision o f the
leader (36).
To understand Greenleafs notion o f leadership, it is crucial to understand that he
believed that the leader/follower relationship must be entirely voluntary. He argued
"leadership is not delegated; it is assumed. If there are sanctions to compel or induce
compliance, the process would not qualify as leadership. The only test o f leadership is
that somebody follows - voluntarily" (p. 31). The concept o f the voluntary nature o f the
leader-follower relationship serves as the basis for the skills that Greenleaf attributed to
the servant leader.
The most critical skill o f this leader is persuasion. "Such a leader is one who
ventures and takes the risks of going out ahead and showing the way and whom others
follow, voluntarily, because they are persuaded that the leader's path is the right one - for
them, probably better than they could devise for themselves" (p. 44). Greenleaf believed
that being persuaded is the "arrival at a feeling o f rightness about a belief or action
through one's own intuitive sense...." He asserted "Both leader and follower respect the
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integrity and allow the autonomy o f the other; and each encourages the other to find her
or his own intuitive confirmation o f the rightness of the belief or action" (pp. 44-45).
In order to determine if servant leadership is being enacted Greenleaf asks the
following questions: "do those being served grow as persons: do they, while being
served, become healthier, wiser, freer, more autonomous, more likely themselves to
become servants? And what is the effect on the least privileged in society; will she or he
benefit, or, at least, not be further deprived?" (p. 43). Greenleaf added in his later years
an additional characteristic: "no one will knowingly be hurt by the action, directly or
indirectly" (p. 45).
It is this later addition to his beliefs about the servant leader that Greenleaf
predicted would be most likely to deter a leader from the servant mind-set. He did not
believe that any action taken that would knowingly hurt even the smallest number of
people was appropriate as the inevitable result of conducting business. He recounted
seeing some of the most blatant abuses o f this ethic in the work of organized religion.
Even in the context a broad social commitment, such as that o f service organizations,
Greenleaf held true to the notion "the first aim o f the servant is that no one will be hurt"
(p. 46). A utilitarian ethic was not his aim.
He offered two concepts, power and competition, as key to the servant leader's
ability to offer visionary leadership. He discussed power in terms o f arrogance. He
quoted Lord Acton from the late 19th century: "power tends to corrupt and absolute
power corrupts absolutely" (p. 47). These statements reveal Greenleafs
conceptualization of power as power-over, the power to control, and its inherent risk to
ethical and moral balance. He was so convinced that power corrupts the one who wields
it, that he proposed that one never assume a role that wields power unless it is "shared
with colleagues who are equals" (p. 48).
Greenleaf assumed that the current generation of leaders would not be capable of
this dramatic shift in perspective on power, but he did believe it was possible for future
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generations o f leaders. He predicted:

if enough of today's able youngsters catch the vision o f servant-leadership
and incorporate it into their lifestyles early, the day may come, when these
people are in their prime years, that they will label, categorically, the
current commonly accepted power striving of some successful people as
pathological - because it makes for a sick society [italics in original] (p.
49).
In the same way as he questioned the notion o f power, Greenleaf questioned
cultural assumptions about the nature of competition. Emphasis on competition as
healthy and good, providing for the best and the brightest to rise to the surface, tends to
lead to winning at all cost, even the cost of hurting others. He argued:
if we are to move toward a more caring, serving society than we have
now, competition must be muted, if not eliminated. ...I believe that serving
and competing are antithetical; the stronger the urge to serve, the less the
interest in competing. The servant is importantly concerned with the
consequences of his or her actions... the servant is strong without
competing [italics in original] (p. 51).
I am cautious about using the term servant to describe a leader. Although I
support Greenleafs ideal o f service as a way o f being that promotes a more caring
society, I am concerned that a servant mind-set may continue to lend credence to a
dominator mentality by placing caring behavior in a context o f powerlessness. Are we
moving to the opposite extreme when we shift from leader as dominator to leader as
servant? I understand the paradox that Greenleaf is trying to present. And sometimes it
is paradox that shifts our thinking, by the juxtaposition o f concepts. However, I believe
the process o f relational leading is a dynamic that happens between people out of a
condition of mutual respect and a mutual search for integrity.
Just as objectivity and subjectivity appear to be philosophical opposites, yet
reflect the same notion of an absolute, both the dominator and servant notions o f
leadership, while appearing to be opposites (with servant leadership representing a radical
shift away from a power-over mentality), in reality both represent the risk o f sublimation
of one set of values to another. In addition, service to an idea, in its extreme, can result in
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crusading, rather than leading. Relational leadership is more consistent with a linking or
partnering paradigm, wherein people value each other because o f mutual benefit. Chinn
(1995) called this mutuality empowerment:
Empowerment is growth o f personal strength, power, and ability to enact
one's own will and love for self in the context of love and respect for
others. Empowerment is not self-indulgence, but rather is a form o f
strength that comes from real solidarity with and among those who seek
PEACE [Chinn's acronym]. Empowerment requires listening inwardly to
your own senses as well as listening intently and actively to others,
consciously taking in and forming strength (p. 3).
I am concerned about Greenleaf s ideas related to power. His warnings about the
danger of power as a corrupting influence are well taken, considering the prevalence of
the dominator model in our culture. However, his argument that power never be wielded
unless it is shared by equals implies the notion o f inequality, again in an either/or context-
-either one has absolute power that is corrupting, or one shares power with one's social
equals, making it less corrupting.
I submit that sharing power among socially equivalent groups simply reinforces
conditions of dominance and hierarchy. In addition, it gives substance to power,
reinforcing the idea that power is an entity that can be distributed in a more equitable
manner (Young, 1990). Instead, we can conceptualize power as a process created by a
relational web of participants based on their beliefs about the nature of relationships.
This opens up space for the kind of power which Chinn (1995) called "PEACE" Power:
the kind of power required to create and live PEACE reflects an ideals
where the focus shifts to underlying values associated with the exercise of
power, and what happens when power is used. What is valued is the
capacity to be in harmony with others and with the earth, to join with
others in directing your collective energies toward a future you seek
together (p. 8).
The result of a relational power process is more likely to be a sense of meaning for those
in community.
Greenleaf, in proposing the idea of leader as servant, began to shift thinking about
leadership away from modem conceptualizations of leaders as wielding power from a
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position of authority. However, his emphasis on leaders knowing the way, and showing
it to others through persuasion, perpetuates the myth that true leaders are endowed with a
special ability not possessed by others. The risk with this conceptualization of leadership
is lack of moral accountability on the part of followers. The second example of a
postmodern approach to leadership emphasizes the leader's accountability for his or her
spiritual grounding as a way o f finding meaning with a community o f followers.
Spiritual Leadership
Bolman and Deal (1995) explored the concept of leadership in the context of a
parable o f a leader, searching for meaning and purpose in his life and work, who seeks
the wisdom and advice o f an experienced and successful woman. Through the course of
their relationship she guides him on a journey o f understanding leadership in a new way.
In refusing to answer his questions, but only proposing more questions, she encourages
him to find his own answers. With interjections to interpret the parable, Bolman and
Deal proposed that leading should originate in the heart o f the leader. They believed that
true leadership resulted from reclaiming one's sense of the spiritual and what gives
meaning to one's life. Bolman and Deal acknowledged that current pragmatic concerns
related to technical logic, control, and competition interfere with this process.
They attempted to dispel the myth that effective leadership is the possession of
power, either in terms of competitive edge or charisma. Consistent with Young's (1990)
premise o f power as a reciprocal process among people, Bolman and Deal viewed
absence o f leadership as indicative of fragmented relationships among people. They
proposed that
effective leadership is a relationship rooted in community. Successful
leaders embody their group's most precious values and beliefs. Their
ability to lead emerges from the strength and sustenance o f those around
them. ...The spiritual journey that leaders must take, and inspire others to
take, begins with ourselves but not necessarily by ourselves [italics in
original] (pp. 56-57).
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Rooted in the clarity o f a spiritual center and committed to relationships of

meaning, the leader, in Bolman and Deal's conceptualization, leads by giving to others.
These "gifts" that the leader offers to others include: love, power, authorship, and
significance. Bolman and Deal further clarified the gifts that the leader offers to those
with whom he or she is in relationship: "the essence of leadership is not giving things or
even providing visions. It is offering oneself and one's spirit" (p. 102). Caring, or love,
is enacted through relationships in which others matter enough to us to be vulnerable to
understanding their values. They described love as an openness: "an open heart is
vulnerable. Accepting vulnerability allows us to drop our masks, meet heart to heart, and
be present for one another. We experience a sense of unity and delight in voluntary,
human exchanges that mold the 'soul o f community' " (p. 103).
Authorship was conceptualized as a gift wherein the leader creates conditions for
others to find their own answers and experience personal accountability for the results of
their actions. Power was described in the context of relationship. The leader must
balance authorship with power to realize a changed environment. "Authorship requires
autonomy. Power is the ability to influence others. ...Authorship without power is
isolating and splintering. Power without authorship can be dysfunctional and oppressive.
Each of these gifts is incomplete. Together, their impact on organizational spirit is
extraordinary" (p. 109).
Significance was discussed as the result o f rituals, ceremonies, and storytelling.
The value of these processes is to create a sense of connectedness within ourselves, with
the past, and with each other. Bolman and Deal believed that a strong sense of
community could be formed by the act of storytelling.
Bolman and Deal summarized with a call for leadership based on searching
individuals who are willing to reflect upon and learn from their own experiences, as well
as those of others. These individuals would develop communities o f meaning through
receiving the leader's gifts of love, authorship, power, and significance.
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I believe the concepts proposed by Bolman and Deal are consistent with the tenets
of relational philosophy. The major contrast between relational leadership and Bolman
and Deal's conceptualization of leadership is in their emphasis on the leader’s use of
power and authorship. There is still the implication that power and authorship,
conceptualized as gifts, can be owned by one person and given to another. Relational
leadership makes the assumption that power and narrative are processes that people
weave together, rather than entities that they give to each other.
How do these two contemporary concepts - servant leadership and spiritual
leadership - inform construction o f relational leadership? These two examples move
beyond the rhetoric of much current leadership literature, but they stop short of relational
leadership. In the following section, I characterize the construction of relational
leadership in contrast to both servant and spiritual leadership.
Relational Leadership
Relational leadership is a way o f giving voice and presence to the values of
relational philosophy, an ethic of care. Helgeson (1990), who wrote about women's ways
of weblike leadership and management, believed that it is voice, rather than vision, that is
most important for leaders. Voice is more indicative o f dialogue, the mutual sharing of
meaning. Relational leadership is fluid. It moves and shifts according to the relational
web woven by the participants. Within any relationship coexist the potential for
leadership and the potential for followership. Therefore, the role o f follower is as
important as that of leader. If a new foundation for leadership is to be established, the
philosophy and values which form that foundation must be clearly articulated. I
described a set of values reflective of an ethic of care in Chapter III. To reiterate, those
values are: (a) relationship, (b) lived experience, (c) vulnerability, (d) intersubjective
knowing, (e) created meaning, and (f) uncertainty. In the following sections, I will
describe each o f the values of a relational ethic o f care as manifested in a leader/follower
dynamic.
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Relationship. Relationships are the manifestation of our inherent relational

being. The leader/follower relational dynamic involves listening for another's story to
help make meaning o f one's own. Leader/follower relationships are voluntarily chosen.
Relationships are not entered into for the purpose o f domination or control (as can be
characteristic of hierarchies), but for the purpose o f creating and enhancing meanings.
Human beings are viewed as valuable, not because of what they produce, as in a
hierarchical organization, but because they exist. Leading takes place when one member
o f the dyad or group, by expressing a value, gives voice, through dialogue or action, to
another's unexpressed value, increasing the possibility that the followers will be more
able to express their own values, thus shifting into leading self and possibly others. Thus,
learning to lead becomes learning what has meaning within the context o f one's own life.
In relational leadership, the role o f leading moves. A prerequisite, similar to
Greenleafs seekers and hearers, is a group of people seeking integrity and trying to live
and work within their value system. The desire for integrity sets the stage for relational
leadership and is consistent with our inherent relational being and the idea o f shared
vulnerability and created meaning.
Power-with in the context o f relationships is similar to Bolman and Deal's (1995)
leader who is rooted in community through the reflection of others' values and
strengthened by relationships with others. Community captures the notion of relational
leadership context more accurately than the term organization.
Friedman (1993) contrasted communities o f place such as families,
neighborhoods, churches and schools, with communities of choice. Communities of
place are often an affiliation that we discover about ourselves, rather than choose. Even
though a person may choose an organization as professional work context, he or she may
find value conflicts inherent because of the norms o f the hierarchy. In that sense,
bureaucratic organizations are communities of place. In searching for our moral
identities, we often find ourselves needing resources and skills we derive from the
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communities we choose, such as friendships or support groups.

Communities o f choice are the most appropriate context for relational leadership,
rather than communities o f place. Where relational leadership occurs in an organization
(community o f place), it will be because a community o f choice has emerged within that
organization. Friedman (1993) described communities o f choice:
these more voluntary communities may be as deeply constitutive o f the
identities and particulars o f the individuals who participate in them as the
communities o f place so warmly invoked by communitarians. ...Perhaps it
is more illuminating to say that communities of choice foster not so much
the constitution o f subjects as their reconstitution. We seek out such
communities as contexts in which to relocate and renegotiate the various
constituents of our identities (p. 252).
Communities o f choice provide a voluntary relational context for the
leader/follower dynamic. These communities form around a search for integrity and
meaning that is found through shared experiences and common values. People seeking a
community o f meaning around living an ethic o f care while working within a conflicting
social structure, such as an organization, confront a complex moral challenge.
If we are to fully integrate caring behavior into our social/relational structures, we
must acknowledge the complexity o f living an ethic of care. Living an ethic of care is
neither a benevolent altruism toward the less fortunate, introducing the values of care
without changing the dominator model, nor a noble sacrifice o f self as servant to meet the
needs of others. We must be particularly cautious in introducing an ethic o f care in the
context of women's lives. Women have experienced the dominator model in a way that
causes many feminist scholars to question the value o f caring in this culture. Friedman
acknowledged this dilemma:
On the one hand, care is essential for the survival and development of both
individuals and their communities, and care giving is a noble endeavor as
well as being often morally requisite. On the other hand, care is
simultaneously a perilous project from women, requiring the sacrifice of
other important values, its very nobility part o f its sometimes dangerously
seductive allure. An ethic o f care, to be fully liberatory for women, must
not foil to explore and reflect this deep complexity (p. 183).
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Relational leadership helps to address this complexity through the manner in

which beliefs about caring are enacted. The relational leader recognizes that, because of
an ontological belief that reality is inherently relational, it is relationships with others that
constitute the infrastructure of the world as we know it. Because of the leader’s belief
that his or her benefit is inseparable from that o f a follower, the leader places value on
actions that support the benefit o f both leader and followers. This value of care is
enacted through caring behavior. According to Bowden (1997) "caring expresses
ethically significant ways in which we matter to each other, transforming interpersonal
relatedness into something beyond ontological necessity or brute survival" (p. 1).
This caring behavior is not defined as caring ./or, a paternalistic notion o f caring,
nor caring about, a consumerist notion of caring, but caring with another in a mutual
reverence for the generativity facilitated by authentic moral reciprocity. People are not
merely means to our ends. Relationships are ends in themselves. Being with another
matters because as inherently relational beings we derive our life from the vulnerability
we experience in relation to others. In more concrete terms, being frilly present with
another matters more, in terms o f priorities, than the pragmatic goals o f production and
outcome accomplishment.
Lived Experience. Lived experience is the central theme of relationships.
Relational leadership entails reverence for particularity and situational context. Sharing
what it is like to live my life and hearing what it is like to live your life creates between
people the fertile ground for leadership. As a leader and as a follower, one always
responds from lived subjectivity. The impartiality and objectivity implied in separating
personal from other aspects o f life, such as work, are not possible or desirable.
Utilitarian ethics assume there is a common good for all people. This mythical
common good is arrived at through impartial, objective analysis o f reality (also mythical).
As Young (1990) reminds us, "the perception o f anything like a common good can only
be an outcome o f public interaction that expresses rather than submerges particularities"
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(p. 119). In relational leadership, the leader/follower dynamic becomes part of the lived
experience for each. They become context for each other. This mutual context opens the
possibility for the formation of new meanings, a created and contingent "common good",
or the affirmation of existing meanings.
In contrast to a way o f thinking that is goal oriented on the part of the leader
(wherein an unfinished future is approached in a gradual process through the planning,
motivating, and inspiring actions of the leader), relational leadership is based squarely in
the present. It necessitates being fully present in daily lived experience. Relational
leadership is a daily, if not moment by moment, lived dialogue between what is being
experienced and responses to that experience.
Vulnerability. In telling and valuing my story and in hearing and valuing yours,
I become vulnerable to amending or even replacing my beliefs about reality.
Vulnerability does not imply moral weakness. Rather, vulnerability, in this context, is a
choice to be open and to realize that control is an illusion based on a desire for certainty.
This is the vulnerability referred to by Bolman and Deal (1995) that allows us to choose
an ethic o f care because our internal strength comes from knowing that we can remain
open to the ideas, values, and experiences of others without losing ourselves and what we
value most. In other words, we relinquish being right, and the desire to persuade or
convince others of our rightness, to the vulnerability o f being in relationship, which
carries with it the possibility of constructing new meanings from knowing and being
known by another.
Intersubiective Knowing. Knowing and being known by another occurs in the
presence of an ethic o f care and within the openness o f vulnerability. Gadow (1999)
referred to this as engagement:
the valuing o f persons requires perception of each one's uniqueness, and
perception involves engagement. In contrast to rational ethics, which
demands detachment in order not to perceive people concretely or respond
to them personally, care respect [the ethic o f care] conveys 'cherishing,
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treasuring, profoundness o f feeling' (p. 9).

Intersubjective knowing occurs across a continuum o f possibilities, ranging from
simply being present with another to intimate verbal dialogue. There is no ranking
placed on this continuum. Because we are inherently relational, there is value in each o f
the ways we relate, given the conditions of an ethic of care and vulnerability. Gadow
(1999) expressed engagement in the form of relational narrative: "narrative meaning is
communicative, the saying o f something another can understand" (p. 11) Although
Gadow speaks o f a moral dyad, specifically nurse and patient, I propose that relational
leading is what happens when one person in a group or dyad "is not silenced by their
situation, remaining able to imagine and voice an interpretation: one o f the two [in my
proposed notion, one of the group or dyad] serves as their poet" (Gadow, 1999, p. 11).
Relational leading and following involves an intersubjective dialogue that
encompasses actions and voice. The tension between rationalist certainty, where
knowledge is power, and nihilist uncertainty, perceived as powerlessness, is sustained
through dialogue between values and experiences. As observed by Chinn (1995): "as
your actions are informed by your awareness of values, your thinking and your ideas are
shaped and changed by your experiences with those actions" (p. 3). When this type of
dialogue occurs among people in voluntary relationship seeking integrity in a community
of choice, it is leadership. It is this dialogue that engages others, inspires their own
dialogue and results in followers finding their own way. There is an openness between
follower and leader that leads to greater presence and awareness, learning and growth for
both. This is relational power.
Created Meaning. Wheatley (1994) used concepts from chaos theory to describe
meaning as an attractor, or a centering force, that helps to bring order to chaotic
situations. She observed:
we instinctively reach out to leaders who work with us on creating
meaning. Those who give voice and form to our search for meaning, and
who help us make our work purposeful, are leaders we cherish, and to
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whom we return gift for gift. ....Whether we believe that we created this
meaning in a retrospective attempt to make sense of our lives, or that we
discover meaning as the preexistent creation o f a purposeful universe, it is,
at the end, only meaning that we seek. Nothing else is attractive, nothing
else has the power to cohere an entire lifetime o f activity (pp. 135-137).
Relational leadership involves communities of choice in fluid relationships o f generative
power who are able to create together a safe place within which to construct meaning.
The relational narrative between leader and follower is what allows for the
creation o f meaning. It is fundamental to this position to realize that the leadership moves
from person to person. Relational leading requires letting go of the notion o f one right
way to be. Leadership literature usually implies that the right ways to be are:
enthusiastic, committed, open to change, communicative, motivated and excited.
Creating meaning includes being vulnerable to dullness, questioning, stillness,
immobility, loss, depression, and apathy and embracing these as part of our experience.
Uncertainty. In relational philosophy any immutable certainty is an illusion, a
construction, a contingency. There can be a powerful freedom in owning what is chosen
and creating meaning from our experiences, a freedom from the constraints of making
choices because o f a law, a policy, or a leader. Provisional certainties, such as objective
knowledge, rules, goals, and plans, are necessary constructions at times. However, when
perceived as reality, they can cause us to opt for the illusion of safety in external
constructions in exchange for safety in relational vulnerability. The illusion of
impartiality that is associated with social institutions such as hierarchies, can seduce us
into a mechanistic philosophy that will be in conflict with an ethic o f care based on
particularity and ambiguity. Young (1990) warned:
however explicitly a bureaucracy formalizes rules and procedures, it still
cannot eliminate individual and subjective choices the point is not that
substantive personal values enter bureaucratic decisionmaking when they
ought not to; on the contrary, the entrance o f particular substantive values
into decisions is inevitably and properly part o f what decisionmaking is
about (p. 78).
Relational leading must by its very nature avoid the certainty of social
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constructions that are intentionally impersonal in nature. Interpersonal dialogue and

attempts to create meaning inevitably introduce uncertainty. The carapace of certain
knowledge is shattered. But it is through this uncertainty that an ethic of care can be
realized. Gadow (1999, p. 14) recommends an ethical cornerstone that can
simultaneously support a relational ethic of care and constructions o f certainty as they are
needed: "if otherwise opposing approaches can be appreciated as inseparable, they may
then be acknowledged in practice as being mutually enhancing instead of oppositional.....
a region o f existence large enough to accommodate - even encourage - diversity among
those who live there."
Consistent with Gadow, the relational leader is not searching for an ultimate telos.
Perhaps instead of going out ahead to show the way a leader gives voice to his or her own
way, a constantly reconfiguring telos. A follower, in that moment of followership which
is fluidly shifting already to leading self and giving voice, responds and the follower's
own way is enhanced. And they move that way, ever in the present, leading, following,
giving voice, creating meaning.... living.
The Home W ithin. Relational leadership is situational and contextual, as is
relational philosophy. Its characteristics and embodied being cannot be generalized.
Nor can the role of leader be situated in an absolute position. Just as truth in relational
philosophy is a moving center, the center of leadership moves fluidly among a group
seeking integrity.
I believe the notion of leadership as a powerful, charismatic, visionary quality has
allowed us to excuse ourselves from living out our values on a daily basis. We say we
lack leadership or that what we need is strong leadership. I believe we need to come to
terms with our values and seek to take action in integrity with those values. Only in
conjunction with this introspective and relational process are we prepared to look for,
hear, and respond to leadership.
Leading, in this context, becomes a way o f being in the world that is generatively
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powerful because of a continuous search to be in integrity, to embrace ambiguity and to

bring meaning, even for the moment, to an uncertain situation. The paradox of
embracing ambiguity and uncertainty, while constructing meaning, is what is lived by the
relational leader. The keys to relational leadership are that meaning is created by both
leader and follower, their meaning manifests an integrity of values and actions, the
relationship between them is voluntary, and both are vulnerable to learn and to respond
more fully to the context in which they find themselves.
Living an ethic o f care can be a risk or a safe haven. It requires vulnerability and
willingness to continuously remain in dialogue with oneself, examining each action and
experience. Caring is particularly risky for groups who have typically been oppressed or
socially constrained in some way by a culture or society, especially societies based on
competition, control, and dominance. Such societies are often patriarchal in nature,
placing women at greater risk and in conflict over the nature o f caring and beliefs about
the value of caring.
The discipline o f musing is a living example o f the conflict between caring and a
culture that does not value caring. Because nursing is primarily a female profession and
because so much of the conflict over caring has centered around socially prescribed
gender roles, living and leading in an ethic o f care, although consistent with the values o f
the discipline, often become secondary. Rather than become immersed in the gender
issues related to caring, I will focus in the next section on the conflict in musing between
leadership based on caring and leadership based on the values o f competition, hierarchy,
and control
Men and women alike are situated in a culture that does not embrace a relational
philosophical perspective, except when it is convenient. How then does a leader, in a
specific context such as nursing, imbued with gender issues, care ethic issues, and
cultural dominance and competition issues, embrace a relational philosophy and
leadership approach with any hope of integrity?
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Relational Leadership in the Practice of Nursing

Nursing is a practice discipline with a moral intent: intersubjective caring
relationships between patients and nurses that help to create meaning within the
vulnerability of health and illness. The practice of nursing, whether it be in direct patient
care, management, education, or research, primarily occurs in hierarchically organized
structures. It has been established that these structures tend to value standardization,
competition, power-over/dominance, measurable outcomes and certainty over diversity,
community, meaning, vulnerability, and ambiguity.
The purpose of this section is to describe the process of relational leadership in
the practice o f nursing. The conflicted context in which nurses and designated nursing
leaders practice will be reviewed. Nursing responses to the conflict between the values
of organizations, which serve as practice contexts, and the moral intent o f the discipline
will be examined critically.
Based on the relational philosophy developed in Chapter III and the concept of
relational leadership described in this chapter, I will conceptualize relational nursing
leadership as an approach for nurses seeking moral integrity to become moral authors in
the context of nursing practice. Their moral authorship establishes a community o f
created meaning that allows them to live safely in the ambiguities o f practice.
Dimensions of relational nursing leadership that are associated with moral authorship and
integrity will be elaborated.
Current Nursing Leadership: The Conflict Between
Doing Business and Practicing Nursing
Current nursing leadership approaches attempt to reconcile the conflict between
practicing nursing and doing business. These approaches have focused primarily on the
position of the nursing leader as a designated role in the organizational hierarchy.
Nursing leaders are encouraged to create caring practice environments and to increase the
autonomy o f nurses to make practice decisions through the redistribution o f power in the
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organization (Nyberg, 1998, Porter O'Grady, 1997). Regardless of the leader's strategies
and no matter how caring the leader's behaviors are, situating nursing leadership only in
the context of designated roles of authority in an organizational hierarchy, by definition,
creates a conflicted philosophical and moral situation.
Today's nursing leader is often expected to "play the game" o f competitive health
care that treats patients as commodities and health services as a percentage of market
share. Nursing leaders playing this game join in the fever to find measurable outcomes
that are nurse sensitive indicators of care. Nursing seeks to quantify outcomes and justify
interventions, thus competing with colleagues in other disciplines to be the most cost-
efficient provider of services. Nurses negotiate to enter into risk-sharing agreements with
managed care organizations and attempt to maximize profit for both organizations by
collaborating to control patient access to services. I offer that these tactics are founded
on a dominator model and are currently enacted in the context of a mechanistic model,
the organizational hierarchy.
A postmodern inquiry necessitates that the current contexts and assumptions of
nursing practice be re-examined, but Kermode and Brown (1996) have criticized
postmodernism for potentially removing nursing from the competitive world of health
care and thereby further marginalizing the discipline. They believe that the relativism,
ambiguity, and intersubjectivity emphasized in postmodern critique only perpetuate the
status quo of capitalistic competitive health care and science because postmodernism
does not replace the status quo with a system that is equally powerful; "rather than opting
out of the mainstream, marginalised groups need to participate to survive. Nursing
should not be tempted into writing its own postmodernist epitaph" (p. 382).
Some feminist writers agree with Kermode and Brown that the only way to
replace the patriarchy is to use its own tools to defeat it: "women must become familiar
with the patriarchal discourses, knowledges and social practices which define and
constrain them: these provide the only sources and tools against the patriarchy. Only
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through its own techniques can patriarchy be challenged and displaced" (Grosz, 1989, p.
133). This is the argument for nursing and its leaders to engage in the power processes of
the hierarchy, lest: "nurses forfeit the future to the grand narratives they refuse to
acknowledge" (Kermode & Brown, 1996, p. 383).
In order to use the tools o f the hierarchy and dominant power, nursing has
"assimilated caring" by attempting to achieve equal access to traditional sources of power
(Rafael, 1996, p. 11). Avenues to this power include nursing's pursuit o f scientific
knowledge within the positivistic paradigm and pursuit o f accepted norms of
professionalism. Rafael (1996) described ethical assimilation:
Assimilated caring has an ethical basis that is based on malestream ethics
(e.g., application of universal principles such as self-determination,
beneficence, and rights-based justice). ...Assimilated caring is not,
however, congruent with a caring ethics based on feminine virtue or a
relational ethics based on women's experience because it has assimilated
the dominant culture's devaluation o f women, their characteristics, and
their experience (p. 12).
Problems constantly arise in nursing, however, in attempting to assimilate an ethic
of care into the current structures in which nurses practice. Nyberg (1998) described the
conflict: "nurses will tell you that they believe that their actions for patients are indeed
caring, but they do not believe that the whole system is caring. In feet, they will tell you
that they must spend a great deal of energy working around the system in order to care
properly for patients" (p. 90).
Attempts to Resolve the Conflict; Empowered Caring
In an attempt to resolve the conflict between the ethic o f care and practice
contexts, nurses have explored reconstruction of the concepts of power and caring
consistent with the insistence o f other feminist writers who have acknowledged that
immersion in the tactics and strategies of the prevailing worldview will not change that
view, but strengthen it: "this is an old and primary tool o f all oppressors to keep the
oppressed occupied with the master's concerns" (Lorde, 1984, p. 113). Rafael (1996)
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wrote o f "empowered caring" as a way for nursing to move beyond prevailing

conceptualizations o f power and caring (p. 13). She advocated using traditional power
sources as a "means to an end" of reforming the health care system (p. 13). The
traditional power sources she advocated include: credentials to enhance nursing
credibility, affiliation with professional associations, research on nursing interventions,
and nursing expertise as a source of enabling power for others.
Rafael described enabling power as "based on respect for and connection with
others and nature. Rather than exerting control over others, enabling power requires their
active and equal participation" (p. 14). She argued that enabling power in conjunction
with a reconstructed notion of caring would result in empowered caring, which she
viewed as "ontology, epistemology, ethics, and praxis" (p. 15). The ontology of
empowered caring is equality in relationships, coupled with the transformative power of
the nurse-patient relationship for both the patient and the nurse. The ethic of empowered
caring is "a sense o f responsibility for others" that is "contextual and may at times be
guided by principles but not always driven by them" (p. 15). The epistemology and the
praxis o f empowered caring are informed by knowledge and clinical competence. She
believed caring occurred in a dialectical layering: "In ordered caring, power and caring
are seen as dualistic concepts. The conflict that is relieved at the level o f assimilated
caring gains power at the expense of caring values. Empowered caring represents a unity
that resolves the conflict between power and caring evident in the previous layers" (p.
16).
Rafael described a type of caring that she believed goes beyond assimilating the
moral intent of nursing within the context o f traditional power structures. She did not,
however, offer insight into how nurses might grapple with the daily moral conflicts
presented by practice contexts. Traditional sources o f power such as professional
credentialing, research, associations, and expertise do not automatically result in a sense
o f moral integrity on the part o f nurses.
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Moral integrity is not a static position, but a continuously reconfiguring sense o f

self that occurs in relationship with others. In order to consistently enact the empowered
caring that Rafael referred to, nurses need a relational leadership approach that
emphasizes nurse to nurse caring as the context in which nurse-patient caring is
embedded.
Relational Leadership and Nursing Moral Integrity: Living in the Conflict
Based on a philosophical foundation o f relational philosophy, the ontology of
nursing is a reality o f inherent relational being wherein nurses and patients share
vulnerability and uncertainty within the context of the health/illness experience (Gadow,
1995, 1995a, 1999). The nurse/patient relationship is a manifestation o f the nurse and
patient as part of each other's lived experience. They define and give meaning to each
other. The epistemology of nursing is intersubjective knowing in the context of the
health/illness experience. Nursing and patient knowledge are constructions made
meaningful by the relationship between the nurse and the patient. The ethic of nursing is
caring in the context of the health/illness experience; caring is the moral intent of nursing.
Moral Authorship
The ethic o f care challenges the nurse to engage in moral reflection and act as a
moral author in order to maintain integrity. Tappan and Brown (1991) referred to moral
authorship as the telos of moral development. Authoring one's moral narrative is
contextually defined and dynamic, in contrast to the telos o f a developmental approach to
moral integrity, in which an individual moves through progressive cognitive stages of
objective operations or principles toward an ultimate moral level. Tappan and Brown
clarified moral authorship:
An individual achieves authorship by authoring his or her own moral
story. Authoring, in this view, entails more than simply recounting a
series of events in a temporal sequence; it involves telling a stoiy;
constructing a narrative;... As such, it also entails moralizing: imbuing a
story or narrative with moral value, thereby asserting or claiming moral
authority on behalf o f an individual's own moral perspective (p. 180).
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Moral authority, according to Tappan and Brown, entails expression and

acknowledgment o f one's moral perspective, honoring that perspective, and assuming
responsibility for "acting on behalf o f one's moral perspective" (p. 180).
Authoring o f one's moral narrative, according to relational philosophy, occurs in
relationship with others. Relational leadership is a process of seeking moral integrity
through a consistency between values and actions. Moral integrity can be viewed as the
continuously reconfiguring telos of a morally imbued practice, such as nursing. Moral
authorship in this context is consistent with the tenets o f relational philosophy in that it is
relational, one remains vulnerable to the other's perspective, and meaning is created
together. Relational nursing leadership is a nurse to nurse caring community engaged in
dialogue for the purpose of moral integrity, creating meaning in the ambiguity o f practice
through moral authorship.
The Values of Relational Nursing Leadership
Relational nursing leadership is anchored in the values of relational leadership
ethics. The role o f each nurse is to lead and to follow in relationships o f caring with
others. Nurses lead each other in the context o f the daily lived experience of nursing
practice. Vulnerability is manifested in each nurse's openness to his or her own
experiences, as well as to the experiences and values o f other nurses. Intersubjective
knowing is a process among nurses wherein a continuous dialogue is maintained in the
midst o f the tension between the certainty o f paternalistic dominance in health care and
the risk o f nihilism in a completely consumerist approach. In seeking moral integrity,
each nurse becomes moral author of his or her practice in a relational context. As
relational leadership moves fluidly among nurses, they create together a community of
meaning about nursing practice that provides nurse to nurse caring. In this context,
nurses are more likely to practice according to the moral intent o f the discipline, to
experience moral integrity and to feel safety in confronting the uncertainty inherent in
health and illness.
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A nurse's sense of moral integrity is a manifestation o f self-awareness, voluntary

participation in a caring community of meaning, and personal accountability for
meanings created mutually. If nursing as a discipline embraces the values o f the ethic of
care based on relational philosophy, then most nurses will find themselves in a value
conflict. I do not believe external sources o f nursing leadership vested in positions o f
authority can resolve these value conflicts for nurses. I believe that moral integrity is a
process of leading and following that must occur within each nurse in relationship to
other nurses. In this way nurses will be moral authors and upon that foundation nurses
might make different decisions about how to participate in the health care system.
In the following section I will describe five dimensions o f relational nursing
leadership. The term dimension was deliberately chosen to indicate the kind of space we
open up for ourselves when we come to terms with ambiguity. These are not linear steps
toward the ultimate moral development of a nurse with perfect moral integrity. The
process of constituting and reconstituting moral integrity is a moving and uncertain telos.
The dimensions o f relational leadership are situationally and relationally embedded
processes that I believe help nurses to become moral authors of their own practice
narratives. These dimensions are questioning, reflection, authorship, dialogue, and
community.
Dimensions of Relational Nursing Leadership
Questioning
Within this dimension o f relational leadership, the nurse becomes conscious o f the
foundational assumptions o f the practice environment. Questions may emerge as a result
of repeated value conflicts and an internal sense of fragmentation. The nurse begins to
willingly examine the structures that serve as the context for practice: What foundation
are they built on? Is there a hierarchy? What is the basis for the hierarchy? Is the
structure goal-driven? What are the expectations related to these goals?
We cannot construct new meaning until we surface from the immediacy of
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assumed truths. According to Gadow (1999, p. 5), "immediacy is an unreflective and

uncritical certainty about the good. A certainty powerful enough to resist reflection
originates outside an individual in order to avoid being undermined by particularity." In
questioning, the particularity o f a nurse's lived experience has started to shatter the
certainties o f the practice environment.
Questioning is uncomfortable. In starting to question, a nurse begins to
experience vulnerability. Nurses often want a concrete roadmap, clear signage, to know
the destination, have the end-point clearly marked. When questions arise, nurses often
look to sources of external authority to correct the inconsistencies experienced in
practice. Simultaneously, nurses resist control over their practice from external
authorities and call for more autonomous decision-making.
The same conflicts over power are reflected in the context of the nurse's care for
the patient. Nurses espouse the values o f patient individuality and autonomy then
describe patients as noncompliant when they do not cooperate with the prescribed plan of
care. Playle and Keeley (1998) examined the ideology that serves as a foundation for
issues of non-compliance. They argued that "increased concern with non-compliance can
best be understood in terms o f historical developments of professional dominance over
health care issues. ...This ideology consists of professional beliefs about the 'appropriate'
behaviour of patients, viewing non-compliance as deviant and irrational in the light of
professional rationality" (p. 309).
Our solutions seem to have been somewhat bipolar in nature, demanding either
certainty or freedom. We have endorsed either total control o f the practice environment
through authoritarian management, or shared governance and even self-governance.
These approaches, though intended to increase nurses' satisfaction by increasing their
ability to practice according to the values of the discipline, do not seem to accomplish
that aim. What seems to be missing that keeps nursing in an either/or mentality, is a
process of nurses leading each other in the moral authorship of the discipline. This is the
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purpose o f relational leadership for nursing:

As a nurse begins to question the status quo of the practice setting and experience
the discomfort of uncertainty, he or she may opt to return to the safety of the assumptions
and structures o f the workplace, even though these assumptions are threatening the nurse
with moral disintegration. In the absence of a caring community, some nurses may
abandon their questions. This is often a prudent response to the demands of the
organization. When questioning leads instead to an acceptance of uncertainty, we move
into the reflective dimension.
Reflection
In the reflective dimension of relational nursing leadership, nurses begin to look
introspectively at what they personally value and reexamine those values in the context of
the moral intent o f nursing and the practice of nursing. This reflection is the work of
constituting and reconstituting moral integrity.
If a nurse has a willingness to come out of certainty and to embrace relational
nursing philosophy, the following self-questions can be asked in the context of the nurse's
life. These questions help nurses to begin to write a moral narrative, the aspect o f moral
authorship referred to by Tappan and Brown (1991) as "clearly expressing and
acknowledging one's own moral perspective" (p. 180).
Do I value relationship more than outcome?
Do I value being with as much as I value being towarcfi
Am I willing to be part of the lived experience o f others, to see myself as their
context and to see them as mine?
Am I willing to see myself as part of a web that weaves in power as a process?
Do I believe that I, as well as others, are responsible for their responses to their
experiences?
Am I willing to propose to others another response if I know of one?
Am I willing to be vulnerable from a centered place o f safety?
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Am I willing to change my perspective in response to knowing another?

Do I believe that knowledge is created among people, not within certain people?
Am I available to be known and to know?
Am I willing to integrate personal and professional?
Do I want to construct meaning from my experience?
Am I willing to live with uncertainty?
Am I willing to engage with others to create a meaning that we can both live
safely with in the presence o f uncertainty?
Will I look at any constructed certainty with the knowledge that it may not be
permanent?
Can I tolerate ambiguity and even feel joy in the freedom to make moral choices?
I f the nurse finds that saying yes to these questions is consistent with his or her desired
way of being in the world, then another dimension o f relational leadership is choosing to
assume authorship for moral values and actions.
Authorship
The authorship dimension is the essence of claiming moral accountability. The
nurse is willing to sign his or her name to a moral narrative. The paradoxically certain
yet ambiguous reward fer moral authorship is a sense of moral integrity. This is the
essence of relational nursing leadership. Choices and authorship never occur in objective
isolation. Choices and narrative are always a weaving together o f inherently relational
being. As defined by Carse and Nelson (1996), "integrity is not only a personal virtue, by
which one acts to protect the boundaries o f the self, but also centrally a social virtue in
that it involves standing for something to other people” [italics in original] (p. 26). The
dimension of authorship in the practice environment is embedded in the context of the
lives o f patients, families, other nurses, and other health care professionals. This internal
sense of leading self and seeking to follow and lead others with similar values, sets in
motion the relational leader/follower dynamic that I call dialogue.
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Dialogue
The dialogic dimension of relational nursing leadership is the shared context of
nursing practice. Embeddedness in intersubjectivity is a basic tenet of relational
philosophy. Intersubjectivity is manifested through dialogue. Intersubjective dialogue is
not an abstracted discourse about nursing as a discipline. It is a conversation about the
particular experience o f nurses situated in a context that is inherently ambiguous and
challenges moral integrity. The content of the dialogue will depend on the practice
context. I propose that dialogue can occur in actions, as well as in conversation among
nurses.
The values o f relational philosophy serve as a foundation for how nurses engage
in dialogue. The relationships among the nurses in this community o f choice take
priority over outcome. In other words, this is not an instrumental community (such as a
support group) to help nurses get through the difficulties of nursing. This community is
formed around a desire for present integrity, and dialogue becomes a vehicle for shared
reflection.
Each nurse's perspective is honored and is considered valuable as nurses become
vulnerable to each other. The approach recommended by Chinn (1995) is appropriate for
relational leadership as dialogue. Chinn's acronym, PEACE, represents concepts of
praxis, empowerment, awareness, consensus, and evolvement. PEACE is a process of
building communities o f generative power through several approaches.
Praxis: thoughtful reflection and action that occur in synchrony, ...values
made visible through deliberate action; Empowerment: listening intently
and actively to others, consciously taking in and forming strength;
Awareness: this means tuning in to the moment. It also means a
heightened, transcendent awareness that sees beyond the moment to the
past and the future; Consensus: an internal attitude which welcomes
differences o f opinion, and an openness to self-reflection; and
Evolvement: commitment to growth, where change and transformation
are conscious and deliberate, (pp. 2-4).
Leading self, as well as following and leading others, requires recognizing that
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what we value for ourselves, we value for others and taking conscious actions in our lives
to realize those values consistently. If we desire to live a more integrated life, then we
must engage in dialogue between what we do and what we believe. Leading is giving
voice and presence to this dialogue. Dialogue in a community o f nurses seeking moral
integrity allows space for nurses to explore together a relational integrity.
Community
As nurses begin to form relational leadership communities, they will begin to
receive more of the care that is so important to the moral integrity o f the nurse. This is
strengthening and empowering. Meaning can be created within the community.
Enacting an ethic of care requires that nurses have a source of receiving care. The
reciprocity of the nurse-patient relationship has been one of the sources o f conflict in the
ethic o f care for nursing. The argument has been made that the nurse might be exploited
by the relationship, due to the inherent inequity o f the nurse-patient relationship, in terms
of care needs. Carse and Nelson (1996) argued that we must examine our beliefs related
to an ethic of care and decide whether we advocate the "mutual, active promotion of one
another’s well-being" (p. 23). If we do, we will look to relational networks as the
embodiment of an ethic of care, not each specific relationship: "the care giver-recipient
dyad rarely exists in isolation from other relationships; the care giver is generally nested
in a cluster o f relationships from which she in turn can draw care" (p. 22). I believe that
these clusters of relationships in which a nurse can seek moral integrity and receive
caring as a way o f finding meaning in vulnerability have been lacking in the practice of
nursing.
Gastmans, et al. (1998) cautioned : "nurses can fulfill themselves by serving
someone apart from themselves. But also the opposite is truth: caring for patients
assumes that nurses care for themselves--if they are unable to care for themselves, they
are unable to care for another person" (p. 50). We expect nurses to go home and receive
care, take stress management classes, or practice yoga. Nurses need a context in which to
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rehearse the stories of their work and to make meaning in the context o f relational values.
Neither nurses nor patients are mere instruments in a teleology of improving human
health. They are individuals with passions, .pain, desires, fears, and talents. These
particularities must be honored.
Relational leadership is characterized by the nurses' ability to grapple with
uncertainty through having formed a generatively powerful caring community of
meaning. The nurses are able to stay fully present with their values and the ambiguity
inherent in enacting them. Although the ambiguity o f the present is the context o f this
leadership approach, a sense of moral integrity and meaningfulness in the present practice
of nursing can paradoxically free nurses to imagine a different future. Intent replaces
vision, because practicing in moral integrity is a particular and present-oriented
experience that one can choose to sustain. The generative power o f a community o f
nurses practicing meaningfully in the context of the moral intent o f nursing is the basis o f
relational nursing leadership.
Summary
The purpose of this chapter was to explore relational leadership and to apply it in
the context of nursing practice. Postmodern approaches to leadership were examined:
servant leadership and spiritual leadership. Both move toward relational leadership in
emphasizing characteristics in the leader such as an attitude of service, movement away
from power-over and competition, and the development o f community and meaning
among followers. However, criticism o f these approaches identified the risk of
sublimation of one set o f values to another when using service and persuasion as
leadership characteristics, and a concern over continued emphasis on the leader as owner
of the power and authorship that is given away.
Relational leadership was described as a philosophical approach that emphasizes
the role of follower equally with that o f leader in a fluid leader/follower dynamic
motivated by a desire for integrity. Values enacted through relational leadership include:
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relationship as a manifestation o f an inherent relational reality wherein caring with others

is an ethic based on mutual benefit derived from a community of meaning; lived
experience as the context for relationship wherein a present-oriented emphasis on daily
experience as a source o f meaning is priority; vulnerability as an openness to the
ambiguity inherent in reconciling personal values with experience and honoring the
experience and values o f others; intersubjective knowing as a process among participants
wherein a continuous dialogue is maintained in a tension between the alienation caused
by complete certainty or nihilism; created meaning as a construction resulting from the
fluid movement o f leadership among the participants in dialogue together; and
uncertainty as the freedom wherein meanings can be recreated as needed and safety can
be found.
The process of relational leadership is particularly applicable to communities that
are based on the professional practice o f a disciplinary value system, such as nursing.
Nursing struggles with conflicts inherent in practicing an ethic o f care within contexts
that are founded on a dominator or mechanistic view o f reality. The moral intent of
nursing is often in conflict with the business-oriented environment in which nursing is
practiced. Nurses in designated positions o f organizational authority are especially
enmeshed in the moral conflict between nursing's ethic of care and the utilitarian ethics of
business. Practicing nurses have tended to appeal to external sources o f authority, in the
traditional leadership model, to resolve moral conflicts.
One approach to the conflict between commerce and caring was for nursing to
participate in the competitive, outcome oriented business ideal, while assimilating the
ethic of care into the prevailing power structure. Another approach was to transcend
current ideas of power and caring toward a model of empowered caring, using the
traditional power sources as means to an end o f transformed health care that would be
more consistent with the ethic of care. Neither o f these approaches is sufficient for
helping nurses confront the day to day moral ambiguity o f the practice environment. A
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new kind o f leadership, grounded in the relational experience o f the practice of nursing, is
needed.
Relational leadership is proposed as an alternative to leadership situated within
the hierarchy o f organizations. Relational nursing leadership extends the values o f
relational philosophy that inform an ethic of patient care to an approach where the same
values are embodied by nurses with each other. Five dimensions o f relational nursing
leadership were described: (a) questioning as a process where the nurse challenges the
status quo and certainty is replaced by the discomfort o f vulnerability, (b) reflection as a
process through which the nurse examines personal values in the context o f disciplinary
and organizational values, (c) authorship as the nurse's willingness to embrace a moral
narrative that is personal yet authored in relationship with others, (d) dialogue as the
intersubjective process whereby nurses struggle together with living an ethic of care in
the day to day practice o f nursing, (e) community as the powerful web o f relationships
that provides a source o f caring and meaning in nursing practice for nurses who are
leading and following each other. Moral integrity is the moving telos o f relational
leadership for nurses who are willing to embrace ambiguity and its inherent freedom
because they have found safety in their relationships with their own values and with each
other.
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CHAPTER VI
RELATIONAL NURSING LEADERSHIP IN THE CONTEXT OF NURSING
PRACTICE, EDUCATION, RESEARCH, AND ADMINISTRATION
In order to more clearly explicate the concept o f relational nursing leadership, the
following exemplars were included. Each exemplar is followed by a discussion of the
dimensions of relational leadership that were or were not evident in the exemplar. These
exemplars are offered with the intention o f engaging the reader in dialogue with the
dimensions o f relational leadership.in the context o f nursing practice, education, research,
and administration. The purpose o f the exemplars, consistent with the nature of relational
leadership, is to reconstruct dichotomies into new concepts that inhabit the tension
between the dichotomies.
Three contexts that exemplify dichotomies will be included: nursing education
and practice, including the teacher versus student role; nursing research and practice,
including the researcher versus subject role; and nursing administration and practice,
including the nurse leader versus nurse follower role.
Exemplar in the Context o f Nursing Education
The first exemplar, written in the form o f a poetic narrative, is a story of an

experience o f a nursing faculty member responsible for teaching a class on leadership and
management to a group o f registered nurses returning for a Bachelor's degree. The
exemplar reveals the dichotomy that has been historically and socially constructed around
the role o f a teacher as a source of external authority.
It is a Thursday afternoon and the small class of Registered Nurses
gathers in the sterile light of a generic university classroom. As part of
their pursuit of a Bachelor's degree in Nursing, they must complete a class
in leadership and management. They are a seasoned group. With decades
o f collective experience, they have cared for the mentally ill, newborn
babies, old people dying, children dying, mothers, families, victims of
violence and their perpetrators, the conscious, the unconscious, the
traumatized, the raped, the wealthy, the poor, and those with runny noses.
They have nurtured families o f their own, often while working at two jobs
with long hours and little reward. They relentlessly pursue this thing we
call nursing. They work, they study, they love, they cry, they complain,
they laugh, they ask questions.
I am supposed to be their leader. My years of education and
experience are supposed to prepare me to teach them about what it means
to lead. My head is full of theoretical notions. My experience is full of
contradictions. The class is on stress management. Retreating to the
safety of my chalk, I ask them: what creates stress in your life? Within
minutes, the board is covered. I can find ho more space to write of the
endless hours, the lack of recognition, the system that abuses them, the
patients who do not appreciate them, the overtime, the lack o f resources,
the bitter angry environment, an environment where there is no time to eat,
drink, or meet other basic body needs.
I move to another board. Are there stressors outside o f work?
Again, I fill a board with the losses: family time, energy for relationships,
fatigue, sleeplessness, they say they have no life.
I seek balance. I ask them about the good things. They are
silenced. I ask them how they care for themselves. Only one has a voice.
We talk about saying no. We talk about boundaries and self-care
possibilities. They do not argue. Somehow,' I feel the power of unspoken
arguments hanging in the air o f the cloistered lifeless classroom. They
leave with an assignment. Do something this week to decrease the stress
in your life. Say no or say yes, but be a voice for you.
Thursday afternoon comes again. I eagerly ask them for a report.
They now have maids and walks and less time on the work schedule.
They have reported malicious doctors and stepped up their work-outs.
There is one novice in the group. She speaks of feeling violated by this
discussion. She feels we have blamed the victim. She is the victim. She
feels helpless in the face of a system that controls her. What can she do?
She left last week feeling betrayed. She needs to hear from them, not me.
Why do you do this? Why do you stay in nursing?
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Slowly, they find their voices. They speak of intimacy and respect.
They speak o f flexibility and self-determination. They speak of love and
job security. They color in the paradoxes o f nursing with their stories.
She listens to them with thirsty intensity. I speak of the values o f the
discipline. It's not enough. It is their stories that heal her. It is their
stories that connect them to each other. Together they weave a web of
power that enables them to continue to give of themselves. It is their
voices that tell her where to find leadership.
This exemplar reveals several of the dimensions o f relational leadership. The
structured content o f the course was based on traditional conceptualizations of leadership,
one o f which is recommending stress management strategies for overwhelmed and
exhausted staff nurses. This is consistent with an approach conceptualizing leadership as
an external source o f authority. The educational setting and the practice o f each o f the
nurses provides the context within which the dialogue takes place. The educational
setting is reflective o f the teacher as the leader, in position o f authority in the classroom.
The nurses in the class, including the novice, are struggling with issues in the
practice environment that constantly threaten their sense of moral integrity. Their
struggle is very individualized. They find little caring for themselves in either their
practice or home environments. A recommendation for caring is provided by the teacher.
Each nurse is expected to go away from the setting and do something individually to care
for himself o f herself. These assumptions related to caring do not confront the issue o f
disciplinary integrity, or the nurses' sense o f meaning related to nursing.
The novice acts as a relational leader in eliciting from the others their stories
about what nursing means to them. She has begun to question the status quo. She is
reflecting on the discrepancies between what she thought nursing was (interpersonal
caring) and the practice environment in which she finds herself. She is seeking moral
integrity.
Her leadership, and subsequent followership, engages them in a mutual dialogue
about the shared experience of nursing. They have each authored a personal narrative
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about -what it means to be a nurse, individually. This dialogue, wherein they lead and
follow each other from their different dimensional perspectives, becomes a shared
meaning. Their caring for each other is evident. They help the novice, as she has helped
them, to see the possibility o f moral integrity in musing.
Their dialogue is situated in the context o f their practice as nurses and their
nursing education. The two become inseparable in this relational process. For this point
in time, they transcend defining themselves in a particular role and define themselves by
what nursing means to them.
Exemplar in the Context of Nursing Research
The second exemplar, with an accompanying poetic narratives, is about the
experience of a nurse researcher who is asked to facilitate a focus group o f women who
are survivors of breast cancer. She is charged by the organization to find out their
answers to the following questions: a) were we there for you? b) what did you need?
and c) what could we have done differently? She neatly arranged the discussion into
what she perceived to be sequential categories o f their experience: prevention and
education, routine screening, diagnostics, alternatives, procedures, procedural outcomes,
and rehabilitation. She established her authority as a Master's prepared registered nurse
and Quality Manager and opened the discussion to the women.
The women in the group were of varied ages, ethnic origins, and socioeconomic
strata. She thought to herself what a nice representative sample they were. As the
discussion ensued, the researcher's self-conceptions and her conceptions o f what caring
meant to these women began to shatter. The experience was a very emotional and
insightful one for this researcher. The following poem was written by the researcher in
response to the experience:
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I've never even had a mammogram...

You are sassy, smart, and strong.
Your courage made me know that I need not worry about the
mystery of my life.
I felt your strength and somehow knew that I have it too...the
strength of women...
The coinage to go a little crazy...the audacity to say no...
The wisdom to seek sustenance from each other.
All so different - ages, colors, eyes, experiences...
All so beautiful in your complexity...
So much life in one room!
So much living to be done!
I honor you. You have helped me to honor myself.
In an attempt to communicate to the organizational administration the content of
the 90 minute discussion, wherein these women revealed with intensity and passion their
personal search for meaning in the free of cancer and loss, the researcher analyzed the
text and grouped the comments of the participants into six themes: I need answers, I
need someone to walk beside me, I need presence, I need to be in control, I need to feel
my feelings, and I need physicians and nurses.
These themes and exemplars were presented by the researcher to the
administrators of the organization (including the nursing administrator), the radiologists,
and oncological surgeons involved in the strategic planning process for a breast care
center. In presenting the information, the researcher stressed the need for a more caring
environment for these women, who perceived themselves to be on a spiritual journey.
The following poetic narrative was written by the researcher in response to her
experience o f presenting the information.
103
He asked me to listen. Professional listening. In this context, it is

called facilitation.
I listen to their stories. Shock, numbness, denial, questions. So
many questions. You aren't listening, they say. We want you to be with
us. We want you to travel this road with us. Please don't tell us that our
bodies can be repaired, like broken dolls, to look new again. We want
answers. You don't have them, they say. So we find them ourselves. You
want us to decide right away. You think we should have surgery. We
cant even hear you.
I tell him the stories. I even count the words, to be scientific; the
number o f times they pleaded for attention, one human to another. He
says these are needy women, they do not represent all o f the women. I
find my voice. I disagree with him. These are strong resourceful women.
They have taken care when we didnt. Even if just one speaks these
words, we should listen. You asked me to listen.
But I am silenced by his power. He holds the knife that cuts away
the cancer. He says what need is.
And there is an empty space where there was a breast.
In this exemplar, the nurse researcher seeks moral integrity and has the intent of
caring for the women who are survivors of breast cancer. She enters into dialogue with
them, initiating a set o f questions framed by the bureaucracy. She is acting in a
traditional role o f leader as authority. However, her dialogue with these women shatters
her sense of authority and places her in a questioning/reflective dimension.
The women lead her and lead and fellow each other as they weave her into the
web of meaning that they have created around the experience o f breast cancer. The
researcher's desire to practice nursing with integrity is heightened. She seeks to realize a
clearer sense of nursing's moral intent. The moral authorship of the women and their
leadership elicited a sense o f generative strength within the researcher that prompted her,
in turn, to seek a caring community of meaning with other nurses willing to act on the
moral intent o f nursing without the permission of the bureaucracy and to search for ways
to create a context for that caring.
The physician want empirically based results. The implication being that a larger
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sample size o f women with breast cancer would be more reliable. The nurse researcher
was able, because of the women's leadership and the leading/following context of
meaning created with other nurses, to communicate with the physician from a place of
generative power to express the moral intent o f nursing.
Each woman with breast cancer is deserving o f caring in her vulnerability and her
lived experience o f cancer. Even if only one woman had this experience with the health
care system, it would be too many. Generalizability o f experience is not nursing's aim.
The conflict between the aims o f the organization and that o f nursing was
apparent. The aim of the organization was a cost-effective program with just enough
caring to satisfy patients (if enough of them ask for it to justify the added time and
expense). The aim of nursing is a caring relationship with each patient, wherein both the
patient and the nurse are vulnerable and open to change.
The researcher, as a female, especially realized her own vulnerability to this
experience. The leadership o f these women and the creation o f a community with them
and with other nurses gave meaning to this experience and to the ambiguity presented by
the experience of breast cancer. The dichotomies between research and practice and
researcher and subject were reconstructed in a dialogue o f shared meaning.
Exemplar in the Context of Nursing Administration
The last exemplar is taken from a leadership text in nursing (Yoder-Wise, 1999).
It was chosen to demonstrate a common dilemma in the role o f nursing administration:
the design o f the health care delivery system to meet the needs of patients and nurses.
Yoder-Wise included case studies such as these in every chapter of the text. The cases
are called "A Manager's Challenge" and are always followed with the question to the
reader: "What do you think you would do if you were this manager?" (p. 3). This
particular case study was from the chapter titled "Leading and Managing" (Bleich, in
Yoder-Wise, 1999, p. 3). Although Bleich refers to the leading and following required of
each professional nurse, leadership remains defined as behaviors: "leading and managing
105
activities at the bedside, ...delegating assignments, or when serving in positions of formal

authority over a clinical department or cluster of services" (p. 3). The nurse in the
following exemplar demonstrates several assumptions common to traditional leadership
in hierarchical organizations.
As Director of Nursing, it is my responsibility to ensure that
effective clinical care is rendered to patients through the allocation of
human and material resources. In my position, I cannot oversee the care
given to each patient, but I do make use of management reports, consider
staff and physician communications, and make selective rounds to observe
the clinical practice environment. Using these management systems, I
review and attend to critical problems that require immediate attention and
examine the clinical outcomes for aggregate patient populations. This
information helps me determine whether there are opportunities to
improve or enhance methods for delivering patient care, systems such as
those for documentation, patient education, or discharge planning, with
constrained or scarce human and material resources one o f my biggest
challenges is getting adequate input from nurses and other bedside care
providers so that systems can be enhanced to increase the value of care for
patients. With high acuity and census, staff nurses do not have the time to
redesign systems, or they are overwhelmed by the responsibility for
suggesting changes in a turbulent work environment. Yet I need staff
input and buy-in (p. 3).
This designated nurse leader assumes that she is ultimately responsible for
effective clinical care, which by her definition is measured by the clinical outcomes of
aggregates. Her problem-oriented method of dealing with critical problems is through
management systems. She assumes these management systems will allow her to improve
care methods and the systems built around those methods.
Her primary concern is scarcity, a characteristic o f organizational/bureaucratic
thinking. She views nurses as human resources and communicates her assumptions about
their involvement in the practice environment. The nurses are viewed as instruments of
the organization to provide care and to give input, when asked, for the purpose of
enhancing the system of work. The increased value o f care for the patients seems
secondary. The need for staff input and buy-in is expressed as a personal need related to
her position within the organization.
106
All o f these factors serve to reinforce the dichotomy between this nurse,
designated as leader, and the nurses she has designated as staff. This type o f approach is
so entrenched in practice environments that it is difficult to conceptualize anything
different. Therefore, the following scenario will be speculative in nature. It is intended
to begin the process of deconstruction.
What if the nurses, each in their own way and within their own sense o f time,
began to seek meaning and moral integrity within their practice? What if in doing that,
nurses began to question the systems that hierarchically organize work and decided to
author together a new narrative for practice with caring for each other as a context for
caring for patients? What if the central question in their patient/nurse community o f
caring was how can we relate to each other in a way that helps each of us make meaning
of this experience? What if their dialogue together was situated in that practice context
and they returned to that dialogue, even in the face of vulnerability, each time the
dichotomies o f practicing in an organization (financial constraints, managed care, nurse-
physician issues) arose? What if systems were not designed (objectively with
interchangeable nurses and procedures), but created in the context o f a specific caring
community? Would this nurse administrator have the same concerns? The answers to
these questions would perhaps be an expression of relational leadership that would
reconstruct the dichotomy between a nurse leader and a nurse follower.
Summary
These exemplars served to further explicate the dichotomies present in the
discipline o f nursing and how they can oppress nursing's moral intent of interpersonal
caring in the health/illness experience. In addition, they demonstrate the poetic, non
linear, uncertain, and inherently relational nature o f relational philosophy and leadership.
In the final chapter, I will draw conclusions about the study and recommend other
studies that might build upon this work. I will describe my own journey through this
process of philosophical inquiry.
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CHAPTER VII
CONCLUSIONS AND IMPLICATIONS FOR FURTHER STUDY
Study Summary
This study developed out of a concern for the moral conflict experienced by
nurses in the organizational practice environment. If nursing is to be defined by its
philosophical aims, then how could nurses practice in concert with these aims? What
kind of leadership would be required to facilitate nurses' moral integrity? Caring, as the
moral intent of nursing, was proposed as central to both the philosophical and the
leadership purposes of nursing.
Postmodern philosophical inquiry, designed to examine historical contexts, power
relationships, and constructed meanings, was the approach used for the study. A process
of deconstruction/reconstruction was applied to dichotomies among nursing's moral
intent, philosophy, theory/science, and practice. The study was framed by three
questions: a) What are the conflicting assumptions in nursing related to nursing's moral
intent and philosophical perspective? b) How does relational philosophy sustain a
generative tension in the presence o f diverse nursing perspectives? c) How might nursing
leaders embody relational philosophy specifically in the nursing practice environment?
The study was situated in the context of nursing debate over the pluralism of
philosophical perspectives and controversies related to the ethic of care. Discussion of
philosophical thinking, specifically relational philosophy, followed.
Because of my emphasis on leadership, I then explored assumptions about
leadership from the philosophical perspective of dominance. Nursing leadership history
as a contextual grounding for these assumptions was elaborated. I presented relational
leadership as an alternative possibility, reflective o f relational philosophy that is based on
caring in contrast to dominance. Finally, I proposed a concept of relational nursing
leadership that has its basis in a leader/follower dynamic that is shared among a
community of nurses seeking moral integrity.
108
The context for this inquiry was the nursing practice environment. Although the
intent of the study was primarily directed toward the organizational clinical practice
setting, I believe that relational nursing leadership has implications for nursing education
and research, as well. The same kinds o f moral conflicts occur in both nursing
educational and research contexts: dominance versus caring, knowledge as power-over
rather than power-with, and meaning as certainty rather than construction. Relational
nursing leadership could be applied between nursing faculty and students, among
communities o f nursing scholars or researchers, and between nurse researchers and
research participants. Exemplars were included to illustrate the possibilities in the
application of relational leadership.
Conclusions
I believe that the moral integrity o f the discipline o f nursing is the foundation of
nursing's generative power. I have concluded that through relational leadership, where
nurses hold themselves and each other accountable for seeking moral integrity in morally
conflicted practice environments, the discipline of nursing can strengthen, not
marginalize, its efforts to enact an ethic o f care.
My process of conducting this postmodern philosophical inquiry resulted in my
own personal deconstruction of what I believed this study would be. I expected to
somehow generate a new version of leading which would be more easily translatable to
the current contexts of nursing leadership. What I have done is conclude that leadership
has nothing to do with position or authority vested by external sources. Leading is a
search for integrity and is equally about following. Because leading cannot be found
solely in an external source, nor solely within the self in isolation, it is relational And
because the philosophy which I found myself most drawn to and believe to be most
consistent with the essence o f nursing, is relational the fit is synergistic.
The current study, describing a relational approach to nursing leadership, was
significantly informed by the work o f Gadow (1980,1994,1995,1995a, 1996,1999). It
109
extends the work o f Gadow, regarding the nurse-patient relational narrative, in several
ways. First, the concept of relational leadership moves beyond the dyad o f the nurse and
patient described by Gadow to communities of nurses. Second, the caring relationship is
extended to the nurse as a vulnerable member of the relationship who seeks to create
meaning in his or her experience as a nurse. Third, the concept o f relational leadership
elicits a context in which the ideal o f relational nursing as an ongoing narrative between
the patient and nurse can be realized. Finally, the concept o f relational leadership makes
explicit the need for a an environment that is a community o f choice and meaning in
which both nurses and patients can feel the safety to embrace ambiguity - the patient of
his or her illness/health experience, and the nurse of the practice environment and the role
o f being a nurse.
Implications for Future Studies
Studies based on relational philosophy and relational leadership will be inherently
non-linear and ambiguous in nature. The lived experience o f nurses attempting to create
a caring community o f meaning should be studied. This may be an existing community
or one that is sought as part of a participative study. These studies could be conducted in
clinical practice, research, or educational settings. Further studies of specific ways in
which nurses collaboratively express moral integrity through caring practice
environments would be beneficial The lived experience o f patients in these settings
would be of importance to illuminate. Further philosophical inquiry specifically
deconstructing and reconstructing assumptions in nursing education and research would
extend this inquiry. The appropriateness and fit of relational philosophy and relational
leadership should always remain open to question in the spirit o f postmodernism's
challenge to ideology.
110
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I. NURSING LEADERSHIP AS AN EXPRESSION OF NURSING

Nursing's Moral Intent 1

The Role of Nursing Leadership 2

Multiple Nursing Philosophical Perspectives 4

Conflicts in Nursing Practice 6

Foundational Premises of the Study 8

Conceptual Framework: Philosophical Perspectives 9

The Relationship Between Philosophy and Leadership 12

Method: Postmodern Philosophical Inquiry 13

Organization of the Study 16

H. THE HISTORICAL CONSTRUCTION OF NURSING

Pre-Theoretical Definitions o f Nursing 18

The Emerging Dichotomy Between Nursing Philosophy

The Emergence of New Conceptual Models 23

Nursing's Return to the Philosophical Perspectives of the

Postmodern Debate Over Philosophies of Nursing 28

Debate Over the Ethic o f Care 30

m. RELATIONAL PHILOSOPHY: ONTOLOGY, EPISTEMOLOGY,

Definitions o f Ontology, Epistemology, and Ethics 34

IV. HISTORICAL AND CULTURAL FOUNDATIONS OF LEADERSHIP 51

Foundations o f Nursing Leadership 52

Premodem Foundations of Leadership: The Dominator Model 52

Modem Foundations of Leadership: The Mechanistic Model 56

Historical Development of Nursing Leadership 58

Contemporary Leadership Models in Nursing 61

V. LEADERSHIP IN THE CONTEXT OF RELATIONAL PHILOSOPHY 65

Postmodern Concepts of Leadership 65

The Ethic of Care 65

The Home Within 81

Relational Leadership in the Practice o f Nursing 83

Current Nursing Leadership: The Conflict Between Doing

Attempts to Resolve the Conflict: Empowered Caring 85

Relational Leading and Nursing Moral Integrity: Living in the

The Values of Relational Nursing Leadership 88

Dimensions of Relational Nursing Leadership 89

VI. RELATIONAL NURSING LEADERSHIP IN THE CONTEXT OF

Exemplar in the Context of Nursing Education 98

Exemplar in the Context of Nursing Research 101

Exemplar in the Context o f Nursing Administration 104

VII. CONCLUSIONS AND IMPLICATIONS FOR FURTHER STUDY 107

Study Summary 107

Implications for Future Studies 109

philosophical reflective framework of a discipline is embodied in its leaders. However,

Newman, Sime, and Corcoran-Perry (1991) identified three world-views based on

Conflicts in Nursing Practice

technological cure, body part replacement, and preconceptual engineering. Purportedly

3. Connectedness in webs of relationships can create a caring community of

determining how we could assess such proximity" (pp. 125-126).

These premises underlie the exploration of leadership within a relational philosophical

described deconstruction: "rather than an exposure of error, deconstruction is a 'way o f

Lack of acknowledgment o f co-researchers' caring interests resulted in co