1. Purnell, Marguerite J. MS, RN

Article Content

The caring intention of nurses may be the most important health care resource ever to have been hidden in plain view. Despite the fact that intentionality is the major dynamic that guides nursing practice, few individuals understand the vast implications that the concept holds for nursing. Intentionality, an ordinary word with extraordinary meanings, is generally unexamined in nursing. The meaning of intentionality, however, is profoundly bound up in the caring relationship between the nurse and the one nursed.


The purpose of this issue is to focus attention on intentionality as integral to caring nursing practice and as the dynamic that guides, shapes, and affirms practice. This issue also is created to stimulate discourse into the nature, quality, characteristics, and expression of intentionality in nursing, with a view toward generating future inquiry and evidence for change.


Understanding that what affects nurses also directly affects nursing practice and patient outcomes invites us to seriously ask, "What is intentionality in nursing? What influence does intentionality bring to bear on practice? What influences nursing intention? How does nursing intention influence quality and outcomes of care?" And further, "How does nursing intention affect the profit of health care institutions?"


When nurses reminisce about their lives, the statement "I always wanted to be a nurse" weaves its way into narratives with startling regularity. Many nurses even remember with clarity the occasion when they first "knew," at perhaps the tender age of 6 or 7 years, they were going to be nurses, and, further, many nurses remember exactly what they said and did at the time. Manifest at such a young age, embodied intentionality to care for others is both a mystery and wonder. Nurses themselves often say that they have always "had something," "felt a calling," or alternately "just knew" they were going to be nurses.


Readers are invited to reminisce and ask themselves: "Why do I nurse, and why do I continue to nurse? How does my intention to nurse affect my practice, and what is the effect on my patient care when I am continually under stress? What is my intention to nurse in the future?"


With the shortage of nurses worldwide, the spotlight of attention is focused on nurses, not only by employers and a concerned public, but by nurses themselves. The connection between the professional and personal well-being of the nurse, quality of care, quality of patient outcomes, and, consequently, net institutional profit, is a challenge that no longer can be ignored. This issue is a beginning response to that challenge.


A maze of different understandings about intentionality is represented in the combined literature of nursing and other disciplines. Even a cursory review is daunting: Multitudes of definitions and descriptions exist that are rooted deep in psychology, philosophy, religion, and other areas of study. Within these branches of knowledge themselves, extremes of opinion further complicate understanding. It is no small wonder that nurse scholars and researchers have shied away from consistent inquiry about the intention of nurses!


Nursing, to quote the army adage, has "adopted, adapted, and utilized" knowledge grounded in the philosophies of other disciplines in order to carve out its own territory. The knowledge base of nursing thus includes an amalgam of nursing theories, individual perspectives, and worldviews that originate from non-nursing disciplines and professions.


The concept of intentionality is similarly represented in the nursing literature. In light of this embedded influence from other disciplines, the same questions that have plagued other conceptual understandings adopted by nursing must also be raised about intentionality. Which description of intentionality is the "right" one? Is one description of intentionality more acceptable than another? How can we know which description to follow in our understanding?


The collection of articles contained in this groundbreaking issue begins to address these questions. The intention of the author was to provide a constellation of views that represents the diversity and spectrum of thought concerning intentionality. Each contributor possesses unique insights as to the nature, quality, expression, and essence of intentionality, and these are richly revealed in the articles. As such, this collection of articles presents the issue as more than the sum of its parts; rather, it constitutes a dynamic whole where the intentionality of each author is joined in confluence and in creative extension beyond the limits of the printed page.


The creative aspect of this issue was born out in an unexpected serendipitous finding: Individually, and ultimately as one, each author described intentionality as "connectedness "! From out of the array of vastly different conceptual understandings arose one common theme: the connectedness of relationship. Perhaps this chiasmic joining of understanding should not be surprising, since the ancient Latin root of the word "intention" means to reach or stretch out toward. 1 Thus, from the collective understandings of this issue itself arises a way in which to understand intentionality in nursing.


Negotiating a way through the conceptual descriptions of intentionality represented in the nursing literature becomes easier when it is understood that perspectives fall naturally into three very broad, overlapping categories. These categories may be easily remembered as the vernacular, the philosophical/psychological, and the holistic/universal view and generally indicate the stance from which the conceptual viewpoint is derived. As a guide to understanding and to provide a coherent picture of the whole, each article in this issue is discussed relative to these categories.


The first category, the vernacular, the one most frequently used, encompasses the everyday use by nurses of the words "intentionality," "intention," and "intent." The meanings of these words are easily understood in their ability to be substituted by words such as "plan," "aim," "purpose," and "goal."


Lowe's article, arising from the wisdom of Native American life-ways, represents this first category. Lowe addresses a question that looms large among peoples of different global cultures. How does one translate concepts from one language or culture to another when no direct, word-for-word equivalents exist? Through the use of the vernacular understanding of nursing intention, Lowe uniquely guides the reader into an emic understanding of connectedness, the core concept of the intentionality of Native American nurses. In "Balance and Harmony through Connectedness: The Intentionality of Native American Nurses," Lowe discusses the culturally sensitive practices of nurses as they connect with clients in ways that are unique to Native Americans and are in balance and harmony with the universe.


Also representative of this first category, Engebretson's article "Hands-on: The Persistent Metaphor in Nursing" steps back more than 100 years in history to trace the importance of the hands in connection with the intent to heal. Although the concept of intentionality is couched in plain language, the meaning of the word changes significantly. Intentionality becomes value-laden and rich when used to denote original healing therapies and, in particular, touch therapies. This article, then, also may be understood as representative of the category holistic/universal, as discussed below.


The second category, philosophical/psychological, comprises understandings that are a combination of concepts arising from other disciplines of knowledge. These concepts range from the philosophical stances of Cartesian mind-body dualism, to reductive theories of action intention, and to understandings from cognitive and developmental psychology. Intentionality is generally understood as being a mental, conscious state that can be further reduced to parts. Within each stance is represented a range of thought from the reductive theories of action intention to the theories of psychology that consider the broader spectrum of intentionality.


It is important for readers to note that Husserlian phenomenology, which is included this category, utilizes a distinctly different understanding of the concept of intentionality. The use of this conceptual understanding is described as a technical use and is specifically employed in phenomenologic research. The meaning ascribed by this technical use of intentionality is "aboutness," or the framework in which reality is situated. The technical meaning of this word contrasts vividly with the plain understanding conveyed by the vernacular.


As an example of this second category, Ugarriza's article "Intentionality: Applications within Selected Theories of Nursing" stretches horizons of thought. She compares Newman's tri-part categorization of nursing with Lewis' five-level psychological model of developmental levels of intentionality. Ugarriza deftly reaches into each level and shows the interrelatedness of nursing theories with each aspect of the model. Readers will easily understand the ease with which nursing has adopted various aspects of knowledge from other disciplines and incorporated them into its own holistic knowledge base.


The third broad category, holistic/universal, reflects holism and unitary perspectives and includes knowledge from diverse global spiritual beliefs. Intentionality in this broad category is understood as consciousness, focused consciousness, and energy. Expressions of intentionality are represented in the use of prayer, healing through the use of body energies, and energy that is expressed teleologically as healing energy.


In "Intentionality and Caring-Healing Consciousness: A Practice of Transpersonal Nursing," Watson offers new connections between caring-healing and practice; between the noetic sciences of the mind and transpersonal caring theory. Intentionality, consciousness, and universal energy-field become part of the caring moment. As described in this article, the term "intentionality" is value-laden and used to denote unique understandings about an individual's conscious living in the world and about transcendent aspects of being and becoming.


Schoenhofer's article "Choosing Personhood: Intentionality and the Theory of Nursing as Caring" also explores living out the meaning of life. Schoenhofer selects aspects of psychological theories that enhance the understanding of personhood and weaves them into the holistic premise of the theory Nursing as Caring. The meaning of the word "intention" is derived through the connectedness of relationship within the nursing situation.


As readers pause to reflect on the possibilities inherent in understanding the caring intention of nurses, there can be little doubt that the concept of intentionality as the major dynamic underlying, guiding, and focusing the practice of nurses has profound implications for nursing.


Each article is an invitation for readers to continue this journey. The acknowledgment, illumination, and study of caring intention may forge a new era in nursing that enhances the well-being of both patient and nurse in ways that are yet unimagined. Cutting-edge knowledge will be caring-edge knowledge that is guided explicitly by the intentionality of nurses. With this vision for the future, our brief journey again returns to the original question, "What is intentionality in nursing?"




1. Morris W, ed. The American Heritage Dictionary of the English Language. Boston: Houghton Mifflin; 1981. [Context Link]