RESEARCH ARTICLE ANALYSIS Written Assignment

Received: 19 March 2018 | Revised: 1 November 2018 | Accepted: 11 December 2018 DOI: 10.1002/nop2.239

R E S E A R C H A R T I C L E

Thoughts of creation and the discipline of nursing

Margareth Kristoffersen

Department of Care and Ethics, Faculty of

Health Sciences, University of Stavanger,

Stavanger, Norway

Correspondence

Margareth Kristoffersen, Department of

Care and Ethics, Faculty of Health Sciences,

University of Stavanger, Stavanger, Norway.

Email: [email protected]

Funding information

The study was funded by the University of

Stavanger.

1 | I N T R O D U C T I O N

This study's point of departure is an interest in highlighting thoughts

of creation as a significant fundamental of the nursing discipline by

exploring the philosophy in relation to experiences of everyday nurs‐

ing care. The discipline has as a goal to be of relevance to nurses,

implying that nursing knowledge is seen as useful in understanding

human health processes and facilitating care for the patient (Griffin,

1980; Risjord, 2010).

Philosophical inquiry has been one important contributor to under‐

standing fundamentals or philosophical premises underlying the nurs‐

ing discipline and the pursuit of excellence in nursing care (Meleis, 2018;

Risjord, 2010). Until the late 1950s, use of the term “nursing discipline”

was rare, but from that time onwards, describing nursing knowledge

as science‐based emerged in nursing literature (Meleis, 2018; Risjord,

2010). Particularly since the 1980s, different positions have been put

forward and debates still revolve around questions such as what con‐

stitutes nursing as a discipline (Alligood, 2014a, 2014b). These ques‐

tions are influenced by political, societal and socio‐economic factors in

general (Yeo, 2014) and by philosophy of science in particular (Bluhm,

2014; Meleis, 2018; Risjord, 2010). It has been stated that nursing

knowledge must be a solidly argued set of philosophical statements

(Butcher, 2004; Risjord, 2010; Uys & Smit, 1994).

At least in the Western countries, nursing knowledge has been

influenced by thoughts of creation from its beginning in the middle of

the 19th century (Alvsvåg, 2000; Birkelund, 2001; Martinsen, 1984,

2001; Sydnes, 2001) and the philosophy has provided pertinent con‐

tributions to the nursing discipline (Delmar, 2006, 2012; Geary &

Cone, 2012; Levy‐Malmberg, Eriksson, & Lindholm, 2008; Martinsen,

1996; Wolf & Bailey, 2013). The contributions are pertinent particu‐

larly because thoughts of creation address fundamental questions

revolving around life, that is what is life and a human being?, what is

of value or of importance in life?, and what is good? (Alvsvåg, 2000;

Pesut, 2008). Various life phenomena such as relationality or inter‐

dependence, love and trust are emphasized and regarded as given

life conditions (Delmar, 2006, 2012; Levy Malmberg et al., 2008;

Martinsen, 1996; Thorkildsen, Eriksson, & Råholm, 2013). Human

beings’ dignity has also been connected to a given position in life,

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,

provided the original work is properly cited.

© 2019 The Authors. Nursing Open published by John Wiley & Sons Ltd.

566 | wileyonlinelibrary.com/journal/nop2

Nursing Open. 2019;6:566–573.

Abstract

Aim: The aim is to highlight thoughts of creation as a significant fundamental of the

nursing discipline. This is achieved by exploring thoughts of creation in relation to

everyday nursing care.

Design: This study, based on a hermeneutical approach, provides reused data drawn

from a larger Norwegian empirical study.

Method: A second thematic analysis was conducted. Data in the original study con‐

sisted of qualitative interviews and qualitative follow‐up interviews with 13 nurses.

The research context was the primary and secondary somatic and psychiatric health

service, inside as well as outside institutions.

Results: Three themes emerged: (a) Life as greater than a human being; (b) creational

powers attributed to the human being; and (c) understanding life as basically good.

Thus, thoughts of creation in terms of philosophical underpinnings seem to gain

backing from nurses’ experiences of everyday nursing care and it can be argued that

it adds elements that enrich nursing care.

| KRISTOFFERSEN 567

originating from thoughts of creation and described as an indestruc‐

tible human value (Edlund, Lindwall, von Post, & Lindström, 2013).

Considering various life phenomena as given incorporates that

they are related to life and not solely to human beings or are of

human beings’ own making (Hansen, 1996, 1999). Thoughts of cre‐

ation thereby offer a complementary perspective on other philo‐

sophical perspectives linked to the nursing discipline, for example,

virtue ethics (Sellman, 2000, 2011). Virtue ethics emphasizes the

nurse's internal goods (Tyreman, 2011), such as personal values,

skills and knowledge, or the moral character of the nurse, as being

integral to and defining nursing care (Newham, 2015). Such a per‐

spective interprets life in a restricted manner by underestimating

the fact that life can be seen as created. It represents a view which

will never be fully supported, as creational powers in life also influ‐

ence the created world (Hansen, 1996, 1999).

As described in this study, thoughts of creation represent univer‐

sal human or philosophical perspectives having their origin in very

old oriental oral traditions (Hansen, 1996, 1999; Løgstrup, 1995,

1997; Martinsen, 2012) and do not primarily represent a Christian or

theological idea of creation. The philosophy has influenced culture,

society and community for decades and basically represents human

and universal statements about thoughts of creation which are pos‐

sible to relate to each human being (Henriksen, 2014). However, at

least in the Western countries, thoughts of creation are best known

as they are written in the Bible, more precisely, as an account of

creation in Genesis in The Old Testament (Geary & Cone, 2012;

Hansen, 1999). Pointing out the significance of standing against such

a background is in line with Tyreman (2011), who has emphasized the

importance of bringing into focus external goods, such as culture,

society and community as a background nurses are representing and

from which they gain their identity.

It may then be important to highlight thoughts of creation in the

nursing discipline by exploring them in conjunction with experiences

of everyday nursing care. There seems to be little documentation of

how the philosophy can be linked to such experiences despite nurs‐

ing literature having thoughts of creation connected to the disci‐

pline. This indicates a need for more in‐depth understanding of what

is claimed to be a shortcoming. An argument for this is that beneath

the surface, nurses’ everyday experiences may be linked to aspects

in the philosophy, even though these are rarely discussed. Central

aspects of the philosophy can support and advance everyday nurs‐

ing care. Bringing thoughts of creation into focus by drawing on

experiences from nursing practice may be one way of vitalizing the

philosophy as a fundamental of the nursing discipline. Nevertheless,

it is through what can be said about the philosophy that such an

understanding is provided. This study aims to highlight thoughts of

creation as a significant fundamental of the nursing discipline.

2 | B A C K G R O U N D

Although there is no clarity regarding what the term “creation”

exactly comprises, in this study it is described as based on a

thought‐motive called “primeval‐history” (Hansen, 1999). The

thought‐motive incorporates that creation can be understood as a

universal phenomenon and common to all mankind (Hansen, 1999;

Løgstrup, 1995). Creation is consequently a phenomenon that goes

on in the created world and that life itself tells us about (Hansen,

1999). This means that creation goes on in life itself, here and now

and at any given moment we are alive and live. Another way of

stating this is to say that the thought‐motive of creation does not

portray the created world as something that was cre‐ ated once

upon a time in the distant past—the created world is not created

once and for all. Thus, the thought‐motive makes it possible to

consider creation as an understandable phenomenon (Hansen,

1999).

Here, it is worth noting that creation and describing life as “cre‐

ated” does not mean excluding the fact that all the created has a

standing in itself (Henriksen, 2014, p. 109). The thought‐motive of

creation implies that the human being has the capacity to be a co‐

creator (Hansen, 1996; Henriksen, 2014). Henriksen underlines the

importance of this when he says that the human being for the most

part is not immediately given, but its shape and character are so‐

cially constructed (2014, p. 43). This involves the human being as not

being seen as created once, as creating involves constantly doing

something new to meet what the human being needs (Hansen, 1996;

Henriksen, 2014).

Emphasizing the assumption that creation is often characterized

by the term “gift” means that life is understood as “given” (Hansen,

1996, 1999). Løgstrup (1995) states that human beings by themselves

have never caused their own life; on the contrary, life has been given

to us and is an ongoing gift. Life is essentially given to us as some‐

thing good, implying that the created world gives rise to a pleasure

simply because it is created and alive. Although life can be seen as

a precious gift and thus, not as a subordinate good, it is important

to point out that the thought of creation does not exclude the fact

that life can change and become bad when boundlessness occurs in

life or humanity (Hansen, 1996; Henriksen, 2014; Løgstrup, 1997).

Boundlessness can be described as taking responsibility to the point

of having no limits and in the worst case, leads to encroachment

(Løgstrup, 1997). This incorporates that thoughts of creation do not

include considering everything in life as equal.

Furthermore, thoughts of creation open up for an understanding of

life as being given by a creational power, which is possible to describe

as creator of the world, meaning a power in and beyond human be‐

ings’ experiences (Henriksen, 2014). In this study, creational powers in

life are described as a force which is something more than the created,

even extending beyond it. Extending beyond involves staying behind

the created as creator, implying being hidden or having no empirical

reality that is similar to anything in the created world (Henriksen, 2014,

p. 20). Such a power can be called a divine or God (Hansen, 1999). A

creational power in life can also be described as metaphysical. Løgstrup

(1995) claims that this implies widening understanding of the power

by closely connecting it to life as such. Foss (2005) clarifies that such

an extension involves creational power being understood as life itself;

thus, it is more loosely connected to the divine or God. This means that

568 | KRISTOFFERSEN

a divine affirmation of the creature can also be more loosely connected

to a divine or God.

Extending beyond the created also involves the power being dis‐

tinct, unlike or different from the created because the created is always

visible and alive on earth (Henriksen, 2014). Importantly, this distinc‐

tion does not exclude a close relation to the created world. Løgstrup

(1995) states that such a power influences the created world. It pro‐

motes life and diversity in life by creating order and coherence and it

maintains and is involved in each moment the created world is alive,

implying that the created world is “willed.” Being “willed” means hav‐

ing a central place in the created world, which again gives the human

being dignity and integrity (Henriksen, 2014). The power is perceived as

a basic condition to keep “nothingness” away from the created and this

matches the fact that whatever exists perishes and comes to an end.

3 | M E T H O D

3.1 | Design

This study is a second analysis using a hermeneutical approach

(Lindberg, Österberg, & Hörberg, 2016). It is based on a research

question concerning data derived from a previous, larger Norwegian

empirical study which used a hermeneutical research design (Taylor,

1999) with the aim of interpreting what is of significance for remain‐

ing in nursing practice (Kristoffersen, 2013). Data in that empirical

study inspired to carry out a second analysis, with the intention of

exploring the significance of thoughts of creation in relation to how

nurses expressed experiences of everyday nursing care. It was a more

in‐depth understanding of the empirical data in light of thoughts of

creation that had emerged as a matter of interest (Heaton, 2004) and

using that philosophy to understand the data further was considered

as valuable (Lindberg et al., 2016).

3.2 | Sample and participants

The sample in the larger original study was based on non‐prob‐

ability method (Kristoffersen, 2013). Participants’ selection cri‐

teria were a minimum of 2 years’ nursing experience and full or

almost full‐time work. There were 13 participants aged between

26–62 years (median 51 years), with varying work experience in

the primary and secondary somatic and mental health service,

from inside as well as outside institutions. Their work experience

ranged from 2–40 years. Many of the participants had worked

10 years or more on the same ward and were in full or almost

full‐time employment.

3.3 | Data collection

The larger original study was conducted with the aid of qualitative

interviews and qualitative follow‐up interviews (in all 27 interviews)

(Kvale & Brinkman, 2009; Silverman, 2006). Qualitative follow‐up

interviews were used to deepen the already collected data about

day‐to‐day experiences of caring for patients. In the interviews, the

participants were asked to freely describe what is of significance for

remaining in nursing practice.

In this second study, data were collected from transcripts of

qualitative interviews in the larger original study. The transcripts

were read again to identify the parts of the empirical material con‐

sidered as the most suitable to explore thoughts of creation in rela‐

tion to how nurses expressed experiences of everyday nursing care,

along with an endeavour to comprehensively understand these ex‐

pressions (Heaton, 2004).

3.4 | Ethical consideration

The reused data are drawn from an original empirical study approved

by the Norwegian Center for Research Data (Kristoffersen, 2013).

Information was given, and consent obtained from the participants.

The reused data was limited and anonymized, so the participants

were not contacted again.

3.5 | Analysis

Data analysis in the larger original study was based on a phenom‐

enological hermeneutic approach. The different steps in the analysis

were narrative reading, different thematic readings and a compre‐

hensive understanding (Lindseth & Norberg, 2004).

The second data analysis was inspired by some methodological

support principles (Lindberg et al., 2016). It was performed by read‐

ing the reused part of the empirical data to gain a general structure

of the material and find new patterns of meanings. In the next step, a

philosophical examination was performed whereby the data and the

philosophical texts were read again (Lindberg et al., 2016). The read‐

ing involved conducting the analysis process of exploration with an

open attitude to get an understanding of data in relation to thoughts

of creation, implying a process of deep reflection (Lindberg et al.,

2016). The analytical strategy was to openly question the material,

asking, for example, what the data tells about creation and creational

powers in life in relation to experiences of everyday nursing care and

how thoughts of creation can shed light on the experiences. Also,

in the reused data, it was considered what appeared to be obvious

and what appeared to be more latent meaning structures. A more

in‐depth understanding of the data emerged (Lindberg et al., 2016),

resulting in descriptions of three themes.

3.6 | Trustworthiness

The trustworthiness of this study is considered a strength (Lincoln

& Guba, 1985), as the reused data demonstrates everyday nursing

experiences and was considered as relevant in interpreting central

aspects of thoughts of creation. This implies that the data can be

seen as suitable (Heaton, 2004). It can also be seen as a strength that

the original empirical study used phenomenological philosophy as

one theoretical perspective (Kristoffersen, 2013). Furthermore, the

interpretation of the data has been conducted with openness and re‐

flection (Lindberg et al., 2016). Nevertheless, there is still a risk that

| KRISTOFFERSEN 569

an interpretation of experiences of nursing care on a comprehensive

level implies an over‐interpretation of the reused data. To delimit

that risk, alternative interpretations in light of thoughts of creation

were discussed in the research group until consensus was reached.

This indicates that the analysis was performed in such a way that the

study's findings were found to be credible (Lincoln & Guba, 1985).

It is relevant to point out possible limitations linked to reusing

data to explore thoughts of creation in relation to nursing experi‐

ences. One could view such an exploration as superfluous because

it was a deductively inspired analysis. Another critical aspect is how

well the reused data fit the present study's aim (Heaton, 2004).

The data may be considered limited because it was translated from

Norwegian to English and thereby loses some of the naturally occur‐

ring richness in daily language.

4 | F I N D I N G S

By exploring thoughts of creation in relation to how nurses expressed

experiences of everyday nursing care, three themes emerged: (a) Life

as greater than a human being; (b) creational powers attributed to

the human being; and (c) understanding life as basically good.

4.1 | Life as greater than a human being

The data shows that the nurses used words such as “something

divine, a spirituality, something unifying in life” (1) or “‘the one’ up

there” (2) when they talked about life related to everyday nursing

care. Even though these words were not connected to a specific re‐

ligion, they can be understood as a description of creational powers

in life and more precisely, as articulations of phenomena in life that

cannot be verified in the same way as the created world. It is there‐

fore interesting to hear how one nurse went on to explain:

Even though I can’t always understand life, I believe

there is a meaning to life. I try to believe that the

meaning of life must be good, both for myself and oth‐

ers. There must be something good and meaningful in

this life and not solely coincidences and meaningless‐

ness. I believe there is a God behind life and in life and

that I’m quite small and understand very little of it.

(3)

The expression “I believe there is a God behind life and in life” il‐

lustrates how creational powers were described as phenomena that

were experienced as something greater than the human being, imply‐

ing going beyond and staying behind life. This is also evident from the

nurse's comment: “I believe there is a meaning to life.” Interpreting cre‐

ational powers as something greater than the human being involves

there being a difference in relation to the created world. This difference

may be connected to a capability to create life and keep nothingness

from life. Being in a relationship to such powers can provide a feeling of

being in a close relation and not standing alone in nursing care. It seems

to contribute to what makes life worth living and strengthens the hope

that life will be good. This could be important when life is experienced

as difficult to understand, particularly in terms of the patients and their

life conditions. Comments such as “I can't always understand life” and

“I'm quite small and understand very little of it” can be seen as an ex‐

pression of how the nurse experienced not having absolute control in

life, that is that life was not experienced as anthropogenic and thus, it

was not solely the responsibility of nurses to decide what should live or

die. This means that life presents itself in everyday nursing care in ways

that the nurses were not directly able to change. In turn, neither nurses

nor patients have full control in everyday nursing care. By saying “I try

to believe” the nurse demonstrated her openness to uncertainty re‐

lated to incidents in life, although at the same time, striving to achieve

control related to nursing care seemed to be important. Another nurse

said more concretely that: "I can do my best, but then I can't do more as

we are only human beings"(4).

4.2 | Creational powers attributed to the

human being

The data demonstrates how the essence of the patient cared for in

nursing care was understood. One nurse said:

A creational power in the human being separates us

from other living beings, meaning we all have cre‐

ational powers. It is a power which, as a core, is pos‐

sible to extract from ourselves and also poke out of

others. The most important prerequisite to be able to

work with patients may be that all human beings have

such a power in themselves. (5)

Here, it is possible to discern how the nurse attributed creational

powers to the human being. The nurse described “creational power” as

something “in” the human being, implying that the powers are under‐

stood as an embodied quality. This quality “separates” human beings

from “other living beings.” Considering creational powers in the human

being can be understood as the way the nurse recognized the patient's

dignity and integrity, meaning that the patient has human value.

Further, a prerequisite for the nurse's work with patients may be

confidence in life's renewal processes. Extracting “a core from our‐

selves” and “poke” it “out of others” can be seen as expressing how

the nurse articulated confidence in life by having an openness to the

new, that is that which is different to now. Pointing this out is pos‐

sible because creation is described as essentially related to a future

that may imply change and an expansion of present life conditions.

In other words, life's renewal processes might be helpful, particularly

because they can bring a sense of something new to be created in

the patient's life conditions—something new that may also be good

and thus, worth “poking out.” Additionally, the nurse's comment

demonstrates how she wanted to contribute to this kind of well‐

being. This interpretation involves considering the nurse as co‐cre‐

ator of a continued creation. Thus, extracting creational powers out

of oneself as a nurse and poking such a core out of the patient can

570 | KRISTOFFERSEN

be understood as an articulation of how the nurse realized being a

co‐creator in everyday nursing care, implying that the nurse has such

a capability. Put otherwise, confidence in life's renewal processes

can require of the nurse to “ride on the bright moments” by rousing

the patient's spark of enthusiasm (6).

4.3 | Understanding life as basically good

The data demonstrates that understanding life as basically good

does not mean ruling out the bad. One nurse said:

I have expectations of life, like “that’s life” and so

when bad things happen I can confront and endure it.

Experiencing bad things does not imply a disaster—it

hurts and is uncomfortable—but that’s life right now

and you get through that phase. We will encounter

good things again, or life calms down. That’s how life

is: good and bad. (7)

This quote can be understood as an expression of how the nurse

integrated different nursing experiences which appear as contrasts

to each other in a whole. Here, one could point out that describing

life as both “good and bad” demonstrates the nurse did not see the

good as completely incompatible with an understanding of life as

less good or bad. More concretely, having “expectations of life, like

‘that's life’” contributed to confronting life as it is. An experience of

how everything in life belongs to life and consequently that the good

and the bad in life do not stand apart seemed to stimulate the nurse's

capacity to meet life as it really is “right now,” implying helping the

patient when “bad things” in life hurt to “get through that phase.” In

other words, it can be perceived as an expression of how life essen‐

tially understood as “given” inspired the nurse simply because life

is created and will give “good things again”. Another nurse said the

following about how understanding life as basically good inspired

everyday nursing care:

The bad things of today is possible to solve because

we have managed things like this before. When our

hard work promotes life and the patient gets a better

day, it gives a pleasure as there has been a movement

from the bad to the good. (8)

Additionally, the data demonstrate that proximity to patients and

their life conditions means nurses are particularly exposed to all facets

of life. One nurse stated:

Life itself is a challenge and it’s pretty tough. But we

will be more whole human beings if we live the life we

have been given and meet the challenges we get. (3)

Here, it is possible to see how the nurse's experiences of bad things

in life did not necessarily include wishing that such things had never

happened or in the worst case, seeing them as a curse. An experience

described as being “more whole human beings” seems to emerge be‐

cause life understood as “good” stands its ground. This means that

the nurse's experiences of the good in life can be understood as one

contributor to remaining in life and moving forward, implying that bad

experiences, at least over time, can be changed to something less bad.

The nurse nevertheless pointed out a prerequisite for such a change:

to “live the life we have been given.” Importantly, the data can also be

perceived as an expression of how the nurse understood the human

being as a subject in one's own life, meaning that the good and bad in

life also depend on psychological or emotional aspects. Emphasizing

this related to nursing care might imply having access to these inner

realms to promote being a subject in one's own life, either as a nurse

or a patient.

5 | D I S C U S S I O N

The study's overall aim was to highlight thoughts of creation as a

significant fundamental of the nursing discipline by exploring them

in relation to experiences of everyday nursing care.

The findings have demonstrated how the nurses experienced life

as greater than a human being. They talked about creational pow‐

ers as being greater than a human being, meaning that life presents

itself in everyday nursing care in ways that the nurses were not di‐

rectly able to change, that is in terms of the patients and their life

conditions. Explicating an insight that acknowledges that, as human

beings, we do not have full control related to life and death can con‐

tribute to clarifying the limitation of human beings’ power in relation

to life, as powers exist which can be understood as extending be‐

yond the human (Hansen, 1996; Løgstrup, 1995). This means that

nurses cannot prevail over life itself, as life is greater than a human

quality; the world is created and whatsoever exists perishes and

ends. Such an insight can illuminate everyday nursing experiences,

particularly when nursing care requires recognizing nurses’ expe‐

riences of how they, as professionals, can be limited in relation to

patients’ nursing care. Although limitations of human powers exist

in relation to how life presents itself, the insight does not exclude

that a nurse can help a patient and that relieving suffering makes a

difference (Thorkildsen et al., 2013). It is emphasized that nursing

care should be considered as related to serving life and helping the

patient to live (Kristoffersen & Friberg, 2015).

The study's findings have also demonstrated how the nurses

attributed creational powers to the human being, thus empha‐

sizing the worth of the patient cared for. Thoughts of creation

contribute to focusing on the dignity of a human being, as therein

lies divine affirmation of the creature (Hansen, 1996; Henriksen,

2014). The philosophy highlights that the human being is created

and consequently given as something good, understood as one

embodied quality and the human being can thus be received as

something worthy. This is also underlined by Edlund et al. (2013),

who describe human worth as an absolute worth, meaning a last‐

ing and inviolable dignity which originates from thoughts of cre‐

ation. It is nonetheless important to state that the human being

| KRISTOFFERSEN 571

has a standing in itself and a capacity to be a co‐creator in life,

implying that the view does not stipulate that human beings are

unable to determine and shape their lives in relation to the future

(Hansen, 1996; Henriksen, 2014). On the contrary, it contributes

to focusing on opportunities in life. Another way of stating this is

to say that receiving life as a “gift” has an impact: giving something

in return for what is given by taking care of the created world, that

is the patient and thereby contributing to a continued creation of

life (Henriksen, 2014).

It was an important finding how nurses used their capacity to

be a co‐creator. By extracting creational powers out of oneself as a

nurse and poking such a core out of the patient, the nurses thereby

contributed to realizing their lives’ renewal processes and promot‐

ing the patients’ dignity. This involves nurses saying a new “word”

or giving a new “message” to the patient when needed—a finding

in line with previous research. Edlund et al. (2013) have pointed

out that human beings have been given a unique position in the

created world and have an obligation to serve life, meaning a free‐

dom given to them by creation and thus, a choice regarding how

to relate to a situation. It has been documented that preserving

the patients’ dignity revolves more concretely around allocating

time to the patient, inviting the patient to participate and shielding

the patient's body (Valeberg, Liodden, Grimsmo, & Lindwall, 2018).

Previous research has also documented that psychological or emo‐

tional aspects are interwoven in the nurse's actions and decisions

(Nortvedt, 2014). The nurses’ character might then motivate them

to realize nursing care for the patient's best (Newham, 2015) and

values such as beneficence inspire nurses to promote patients’

well‐being and avoid harm to patients (Holm, 2001; Newham,

2015; Nortvedt, Hem, & Skirbekk, 2011; Sellman, 2000, 2011).

Moreover, the study's findings indicate how everyday nursing

care was connected to an understanding of life as basically good. The

good and the bad were nonetheless intertwined related to everyday

nursing experiences. A similar observation is also demonstrated in a

previous study (Kristoffersen, Friberg, & Brinchmann, 2016). By tak‐

ing into consideration that everything in life is a part of life, thoughts

of creation provides a view of life understood as both good and bad,

implying that the bad is necessary in life, although never so much as

the good (Hansen, 1996; Henriksen, 2014; Løgstrup, 1995, 1997).

Rather, the good and the bad are seen as contrasts and mutually

dependent on each other, despite being qualitatively different. The

point here is that the bad is necessary in life, but nonetheless never

so much as the good (Henriksen, 2014). The nurses’ experiences

can therefore be used to support the significance of including an

openness to life, where everything in life is not understood as equal.

Adding insight into how the good and the bad in life are intertwined

and do not stand apart can strengthens nurses’ capability to meet all

facets of the patient's life as it is experienced in nursing care.

5.1 | Implications

It is relevant to consider some issues connected to thoughts of crea‐

tion in relation to the nursing discipline as the study's findings point

to thoughts of creation as significant nursing knowledge. As a funda‐

mental, the philosophy becomes a valuable tool, providing a human

and universal perspective to the nursing discipline. This can be argued

as central aspects of the philosophy seem to be manifested in nurs‐

ing practice. Thoughts of creation in terms of philosophical under‐

pinnings have gained backing from nurses’ experiences of everyday

nursing care and such experiences can be important simply because

they are expressed by nurses as nursing experiences and appear to

nurses as part of life. This indicates that the philosophy which has in‐

fluenced culture, society and community for decades (Hansen, 1996,

1999; Henriksen, 2014) might also be useful to nurses in understand‐

ing human health processes and facilitating care for the patient.

More specifically, the philosophy is a valuable tool, providing

a supplementary view of life to other philosophical perspectives

linked to the nursing discipline as these perspectives interpret life in

a restricted manner by underestimating the fact that life can be seen

as created (Newham, 2015; Sellman, 2000, 2011; Tyreman, 2011).

The philosophy is a supplementary tool, adding elements that enrich

the nursing discipline. It provides avenues for thinking differently

largely because central aspects of the philosophy add insight on how

life presents itself as greater than human beings, creational powers

is attributed to the human being and life is understood as basically

good (Hansen, 1996, 1999; Henriksen, 2014). Previous nursing re‐

search points to the importance of standing against a background

which addresses questions revolving around what is life and a human

being (Alvsvåg, 2000; Delmar, 2006, 2012; Levy Malmberg et al.,

2008; Martinsen, 1996; Pesut, 2008).

On the other side, when considered as an ideology, the philos‐

ophy can be understood as evolving into a kind of fixed structure.

It can be argued that this may generally be problematic in that it

involves understanding life as narrow, a notion that might be used as

an infringement or, in the worst case, a reason for abuse (Løgstrup,

1997). This implies a risk of switching to an ideology which deter‐

mines what is right or wrong ethos (Hussey, 2009). Linked to every‐

day nursing care, such a switch could happen if the practical reality

of nursing demands nurses to adhere, accept and favour thoughts of

creation as a condition of being a nurse or of delivering high‐qual‐

ity nursing care. This may, however, be an impossible scenario to

support. Instead, it is important to emphasize that the philosophy is

disputed and can be criticized for not having concepts with a clear

definition (Hansen, 1996; Løgstrup, 1995). Delineating what counts

as such thoughts are dependent on context. Consequently, they can

be weakened by other philosophical perspectives such as core vir‐

tues (Sellman, 2000, 2011), ethical guidelines and principle‐based

ethical theory (Nortvedt, 2001, 2014). The nursing discipline should

therefore not neglect to base nursing care on ethical guidelines and

principle‐based ethical theory and values, such as non‐maleficence.

Nonetheless, there is a distinction between seeing nursing as depen‐

dent on thoughts of creation and seeing the philosophy as comple‐

mentary to other perspectives influencing the nursing discipline. As

a supplementary tool, thoughts of creation can offer central aspects

and thereby enrich nursing knowledge, even though these aspects

are not concepts with a clear definition (Swinton & Pattison, 2010).

572 | KRISTOFFERSEN

Additionally, thoughts of creation have religious undertones,

which might make it difficult to gain significant popularity in nursing

care. It is not unproblematic to introduce the philosophy, implying

that it can create difficulties which can be hard to overcome. It is

nevertheless important to do so, for the following reasons. Firstly,

it introduces a view whereby life is not solely understood as anthro‐

pogenic or having its origin there, meaning that life is not given by

human beings themselves (Hansen, 1996, 1999). Another argument

is that connecting thoughts of creation more loosely to a divinity or

God allows religious and non‐religious perspectives to be equated.

These perspectives have at all times mutually influenced each other

(Løgstrup, 1997), implying that each life phenomenon and context

that is open for a religious interpretation can also be interpreted as

non‐religious. It can be argued that framing in this way is relevant

to the fact that Western countries have more or less lost a religious

perspective on life, while a more non‐religious perspective has sur‐

faced (Henriksen, 2014). Moreover, taking into consideration that

there might exist great diversity among religious ideas today, it is

important to emphasize that thoughts of creation are human and

universal statements moving beyond distinctions between religion,

philosophy and science (Hansen, 1999; Hussey, 2009; Paley, 2008).

6 | C O N C L U S I O N

Highlighting thoughts of creation as evident in the nursing discipline

may be of relevance in illuminating how life presents itself in every‐

day nursing care and what it basically revolves around, that is how

creation goes on in life here and now, implying that it is important to

be present at any single moment in caring for the patient. Although

the nurse's power related to life and death can be experienced as

limited, he or she has a capacity to be a co‐creator of a continued

creation, where the good and bad can be intertwined in everyday

nursing care. Additionally, thoughts of creation provide a language

which can bring nurses’ experiences into perspective, giving them

depth and nuance. The added value could be that the philosophy

provides a vehicle for describing aspects that nurses might find most

difficult to be aware of and grasp last of all. This raises further ques‐

tions of how thoughts of creation can enrich everyday nursing care

and contribute to future development of nursing knowledge.

ACKNOWLEDG EMENTS

The author wishes to thank the nurses who made it possible to carry

out the empirical study drawn on in this study. I also thank Professor

Febe Friberg for having supported me and contributing her thoughts

on formulating the manuscript. She has given valuable comments on

earlier draft.

CONFLIC T OF INTEREST

The author declare that there are no conflicts of interest with regard

to this study.

ORCID

Margareth Kristoffersen https://orcid.org/0000‐0002‐0800‐1169

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How to cite this article: Kristoffersen M. Thoughts of

creation and the discipline of nursing. Nursing Open.

2019;6:566–573. https://doi.org/10.1002/nop2.239