buddhist thought and nursing: a hermeneutic exploration

Buddhist thought and nursing: a hermeneutic explorationnup_502 87..97

Graham McCaffrey* RN BA BN, Shelley Raffin-Bouchal† RN PhD andNancy J. Moules‡ RN PhD*PhD Candidate, †Associate Professor, and ‡Professor, Faculty of Nursing, University of Calgary, Calgary, AB, Canada

Abstract In this paper I lay out the ground for a creative dialogue betweenBuddhist thought and contemporary nursing. I start from the observa-tion that in tracing an arc from the existential human experience ofsuffering to finding compassionate responses to suffering in everydaypractice Buddhist thought already appears to present significant affini-ties with nursing as a practice discipline. I discuss some of the complexi-ties of entering into a cross-cultural dialogue, which is already well underway in the working out of Western forms of Buddhism, and which isbeginning to be reflected in nursing literature. I introduce philosophicalhermeneutics as a useful framework for elaborating an open and con-structive exchange. I then discuss key Mahayana Buddhist concepts ofemptiness and two truths that lead to a dynamic and open way ofunderstanding reality and responding in the world. I turn to examplesof original texts to give a flavour of the varied and distinctive forms ofliterature in the Buddhist tradition. This is intended partly to keep thereader alert to cultural difference (from a Western standpoint, that is)while exploring the creative potential of Buddhist thought. Hermeneu-tics again provides a framework for interpretation. This paper estab-lishes a philosophical ground for a critical and creative dialogue betweenBuddhist thought and nursing.

Keywords: Buddhism, Zen, nursing, hermeneutics.

Introduction

Buddhist thought has clear affinities with nursing andthere is enormous potential in dialogue between thetwo. In this paper, I explore concepts from Buddhistphilosophy that will lead to soundly based perspec-tives on nursing practice. Buddhist thought begins

Correspondence: Mr Graham McCaffrey, PhD Candidate,

Faculty of Nursing, University of Calgary, Professional Faculties

Building, 2500 University Drive NW, Calgary, AB, Canada

T2N 1N4. Tel.: +1 403 289 0572; fax: +1 403 220 9361; e-mail:

[email protected]

Originalarticle

87© 2012 Blackwell Publishing Ltd

Nursing Philosophy (2012), 13, pp. 87–97

with the human experience of suffering and arcsthrough epistemological and ontological understand-ings of the origins of suffering to practical and ethicalresponses to suffering. This arc between suffering andresponsiveness is in itself sufficient to show whynurses might be interested in Buddhist thought.There are innumerable points at which elements inthe Buddhist tradition might be brought to bear onthe concerns of nursing within this vast overarchingstructure. Buddhism, after all, is a complex anddiverse 2500-year tradition that has developed acrossAsian cultures from India to Japan and from Tibet toThailand (Faure, 2004). In the present paper, I willfocus on the central Mahayana Buddhist concept ofsunyata, or emptiness, since it has such profoundimplications in a philosophical discussion ofBuddhism.

The discussion is in three parts.After a brief reviewof existing literature, I first address the complicationsof bringing to bear an Asian tradition of thought in aWestern context, putting the question of Buddhismand nursing in relation to a developing Western Bud-dhism. I also use hermeneutics, as a philosophy ofdialogue, as a way of establishing a ground for cross-cultural exploration. Second, I discuss the concept ofsunyata, which is related to the Buddhist view of theinterconnectedness of phenomena and to the distinc-tive notion of ‘two truths’. In the third part of thepaper, I explore some of the possible implications ofthese concepts for contemporary nursing. I focus onthree themes of interconnection, compassion andpractice, using a hermeneutic approach to originaltexts.

Buddhism and nursingliterature review

There is a small but diverse literature emergingaround themes of Buddhism and nursing. Whereasthe purpose of some papers is to give informationabout Buddhist traditions and practices for caregivers(Smith-Stoner, 2003, 2005, 2006), the present focus ison the work of nurse scholars who have suggestedways in which Buddhist philosophy can be usefullybrought to bear on questions in nursing itself.Rodgers & Yen (2002) offered an overview of affini-

ties between Buddhist philosophy and nursing with aparticular focus on the concept of suffering. Sitzman(2002) described similarities between Watson’s theoryof caring and the Buddhist concept of interdepen-dence. Rich (2007) considered how Buddhist commu-nitarian ethics could be relevant to addressing thephenomenon of horizontal violence among nurses.Bruce (2007) discussed the awareness of time in end-of-life care, using the Buddhist concept of dependentorigination to elaborate an approach to care that isless reliant on linear time and more responsive to thedying person’s sense of time.

There is an important related subgroup of litera-ture about mindfulness both as a state of awareness inthe present and as a set of practices to cultivate suchawareness. It has been discussed in the context ofmental health nursing (Hirst, 2003; Campbell, 2009).There is an extensive multidisciplinary literatureabout theory, practice, and research based on the pro-grammatic adaptation of mindfulness practices intoMindfulness-Based Stress Reduction (Kabat-Zinn,1990; Didonna, 2009). In this paper I build on theexisting literature by exploring Buddhist thoughtfrom a philosophical perspective and bringing ittowards nursing practice.

Part I: How do we thinkWestern Buddhism?

There are risks in trying to engage with another cul-tural tradition of thought. At one extreme, if it isrendered too alien or too exotic, then it may be anobject of fascination but is scarcely useful because ithas no relevance to everyday concerns. If it is ren-dered too familiar, at the other extreme, then itbecomes superfluous since it will merely be a new wayof expressing established ideas. In the case of Bud-dhism and Western thought, one impetus for explor-ing their engagement from a nursing perspective issimply that it is a dialogue that is already happeningin the wider culture. In the past 50 years, Asian teach-ers have come to the West, introducing Buddhistthought and practice to North Americans and Euro-peans. There are now first and second generations ofWesterners who have themselves become teachers,most commonly in the Zen, Tibetan, and Theravadan

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© 2012 Blackwell Publishing LtdNursing Philosophy (2012), 13, pp. 87–97

traditions. A cursory browse in the spirituality sectionof a bookshop will reveal English translations ofancient texts, modern commentaries on earlier texts,contemporary interpretations of Buddhist teachings,mediation manuals, and books applying Buddhistprinciples to areas of life from parenting to golf.Theseare all expression of an emergent Western Buddhism,and what this can or should look like is hotly debated.This has a specific application when it comes tophilosophy. Edelglass & Garfield (2009) in their intro-duction to a book of readings in ‘Buddhist philoso-phy’ noted that the term itself ‘raises questionsconcerning the nature of philosophy and how oneought to pursue cross-cultural interpretation’ (p. 8).One complication is that Asian traditions of Buddhistthought have not historically worked within the samekind of disciplinary divisions that have emerged in theWest. It is difficult to maintain a focus on Buddhistphilosophy without addressing questions that, inconventional Western terms, would more properlybelong under the headings of psychology, or ethics,or religion.This hybridity (seen from the point of viewof Western expectations of disciplinary definition)perhaps lends itself to nursing, as a discipline that haslong debated its self-definition. Crucially, again fornursing in particular, this multidimensional nature ofBuddhist thought includes, and indeed always returnsto, questions of practice of how to live in the world.

It is in turn both a challenge in working in the spaceof Western Buddhism, and one of the reasons for itsvalue since it suggests new possibilities of alignmentsof ideas. Faure (2004), a scholar of Buddhism, used theterm Buddhist thought rather than philosophy, tobetter encompass this plurality. He put forward oneapproach to joining the discourse between Westernand Buddhist thought. He proposed regarding themas ‘distinct forms of rationality that, given a chance,might interact with each other’ (p. 6).

One way of holding these differences and attrac-tions open, and keeping them in play is by recourseto hermeneutics. There are a number of reasons forapplying hermeneutics as a means of mediation inthis cross-cultural exploration. One is historical.Heidegger, who was one of the formative thinkers of20th century hermeneutic philosophy, worked closelywith Japanese students and took a close interest in

Zen Buddhist thought (Froese, 2006). One of his stu-dents, Keiji Nishitani (1982) wrote a major workaddressing what he saw as the problem of nihility inmid-20th century Western philosophy from thestandpoint of the Buddhist conception of emptiness.Gadamer (2003, 2004), who developed a philo-sophical hermeneutics following Heidegger, alsoexpressed a degree of openness towards Eastern phi-losophy. Although it was not a theme he developed,nonetheless his emphasis on dialogic play and theidea of fusion of horizons provide a structure for acurious, self-reflective engagement between philo-sophical worldviews.

The principles of philosophical hermeneutics arehelpful in negotiating the phenomenon of WesternBuddhism, not least in resisting the error that Bud-dhism is one trans-cultural object to be explained. Forexample,Wright (1998), in a penetrating discussion ofZen literature, drew on Gadamerian hermeneutics toread back through the Romantic assumptions that heidentified as permeating previous Western readings ofZen. Mindful of the historicity of his own interpreta-tion, he wondered of the contemporary Western curi-osity about Zen, ‘what is the meaning of “our” askingat precisely this point in our history? Why are weinterested, and what is the point of the modernWestern engagement with Buddhism?’ (p. 215). It isprecisely this reflexivity, and willingness to keepvariant readings of tradition in play that characterizeboth hermeneutics and Zen.

Part II: Emptiness/openness

Nagarjuna (probably 2nd century ce), an Indian Bud-dhist philosopher, developed the argument that allphenomena are interdependent and empty of essencethat centred on the concept of sunyata, a Sanskritword usually translated as emptiness (Garfield, 2009).He refuted charges that this could only lead to nihil-ism with a philosophy of two truths. ‘Just as the con-ventional truth about phenomena is made up by theirinterdependence, their ultimate truth is their empti-ness’ (p. 27). However, the term ‘ultimate truth’ issomewhat misleading in that it does not denote thetrue reality hidden behind the everyday world of illu-sion; rather, the two truths are to be understood as

Buddhist Thought and Nursing 89


coextensive.This has a soteriological meaning in Bud-dhist practice, since it is posited that emptiness canonly be realized through direct experience, hence thepath of intensive meditation practice according tovarious traditions in Tibet, China, Japan and so on. Inthis way, Nagarjuna fully accepted that we have tocontend with everyday reality while arguing that it isat the same time ultimately empty of essence. Theperspective of two truths creates a radically dynamicview of reality, which is always between appearanceand emptiness (Note this is more subtle than isallowed for in the distorted view sometimes seen inWestern discourse that Buddhism says that reality isnothing but an illusion and is therefore nihilist). Theconsequence of sunyata is an embrace of experience,not a rejection of it. In one translation of Nagarjuna’swork, McCagney (1997) used the word ‘openness’rather than the more common emptiness for sunyata.She did this in order to convey this sense of prolifer-ating potentiality in the Mahayana view of reality.This kind of radical contingency has a correlate insome postmodern thought, e.g. in Caputo’s (1987)writing about ‘the flux’.

Faure put the idea of two truths at the centre of hisaccount of how Buddhist and Western discoursesmight inform each other.He pointed out that Buddhistrationality operates differently from our more familiarexpectation of linear logic. In contrast to the Aristote-lian either/or of A; not A, Buddhist thought employs atetralemma, or fourfold relation of A; B; both A and B;neither A nor B. Consider, e.g. the concepts art andscience as applied to nursing. An approach of art orscience permits one kind of argument; an approach ofart; science; both art and science; neither art norscience permits another kind. One of the distinctiveaspects of this dialectic is that each term is sufficient initself, both transcended and not transcended.

The significance of this model of ‘two truths’ thatare not arranged sequentially or in a hierarchy but areco-extensive is that it establishes at a philosophicallevel the continual troubling of duality. This has theeffect of prompting a questioning of the dichotomieswe tend to set up, expecting an answer according toAristotelian logic in which A is separate from non-A.The concept of two truths itself, e.g. is of necessityexpressed as an intellectual concept, but it takes on

meaning only through practice, in the continual expe-rience of the world as consisting of separate elementsthat are also interconnected in complex and dynamicways. The tetralemma and two truths keep one off-balance, although it may be more helpful to think ofoff-balance in this case as the continuous motion ofbalancing and falling forward in walking, creating notentropy but mobility. The thrust into practice andmobility of response are one with the philosophicalassumption of openness. Theory and practice arefluid, interpenetrating and co-extensive, not separatedand sequential. This relation between concept andpractice brings the discussion back to nursing, andhow Buddhist thought may be deeply effective inaddressing nursing practice.

Part III:Textual examples

In this section, I attempt to approach aspects ofnursing through a hermeneutic reading of Buddhisttexts. I have adopted this approach partly to give aflavour of Buddhist writing, which rarely fits a con-ventional philosophical style, for the reasons dis-cussed in Part I. It is nonetheless important to readoriginal texts in order to stay awake to the differencesand openings between traditions. Hermeneuticscomes into play here as an approach to textual inter-pretation that invites us to open to possibilities ofunderstanding and self-understanding through enter-ing into dialogue with the address of the other(Davey, 2006). Hermeneutic reading is a dynamicengagement with texts, a reading for what the text hasto tell us about ourselves, on the premises both thatwe are already participants in certain traditions andways of seeing, and that when we open to dialogue wepermit the play and plasticity of understanding tobecome known through the possibility of new insights(Gadamer, 2004). My reading of the texts that followis my reading as a nurse, reading for what the texts cantell me about nursing. The point is not to discoverwhat Buddhism means, or to establish a history ofBuddhism, but to let the words from this other (froma Western perspective) tradition with its cross-cultural, 2500-year-old life of investigation of thehuman condition speak to our contemporary predica-ment as nurses in the 21st century. Glenn Wallis



(2007), a contemporary translator of early Buddhisttexts, quoted Gadamer’s (2004) idea of the dialecticalart of questioning as helpful in finding a way toapproach these missives from other cultures (again, ifthe reader, like me, is starting from a Western back-ground), and other times:

As the art of asking questions, dialectic proves its value

because only the person who knows how to ask questions is

able to persist in his questioning, which involves being able

to preserve his orientation toward openness.The art of ques-

tioning is the art of questioning ever further – i.e., the art of

thinking. It is called dialectic because it is the art of conduct-

ing a real dialogue. (Gadamer, p. 276)

Thus, the text extracts are pertinent to the affinitiesbetween nursing and Buddhist thought. The particu-lar interpretations I offer are one answer to the ques-tion I have asked of the texts, and as such theyrepresent only one movement of this dialectic. Myselection of texts, and my interpretations of them areintended to substantiate the presence and usefulnessof the affinities I have identified between nursing andBuddhist thought, not to suppose that there is a finalformula, let alone claim to have discovered it. At thesame time, I use examples from nursing literaturesparingly, recognizing that there are extensive litera-tures dedicated to each of the affinities under discus-sion. There is a work just beginning of introducingnursing to Buddhist thought, and a work of introduc-ing Buddhist thought to nursing; this paper, for now, isa word in the latter work.

Interbeing: Indra’s net

The contemporary Vietnamese Zen Buddhist teacher,Thich Nhat Hanh (2006, p. 81), has written oftenabout what he has called ‘interbeing’. This is a way ofpresenting the view of interdependence of phenom-ena that supports the dynamic openness of the twotruths philosophy. He has used the ancient Buddhistimage of Indra’s net as a metaphor for this way ofseeing:

Indra’s net is a vast, cosmic lattice that contains precious

jewels wherever the threads cross. There are millions of

jewels strung together to make the net, and each jewel has

many facets. When you look at any facet of any one jewel,

you can see all the other jewels reflected in it (. . . .), in

Indra’s net the one is present in the all, and the all is present

in the one. This wonderful image was used in Buddhism to

illustrate the principle of interdependence and interpenetra-

tion. (pp. 81–82)

This translates into the recognition that everything inour everyday world is dependent on other factors, sothat:

. . . we see a teapot as a single, independent object. But if we

look deeply enough into the teapot, we will see that it con-

tains many phenomena – earth, water, fire, air, space, and

time – and we will realize that in fact the entire universe has

come together to make this teapot. That is the interdepen-

dent nature of the teapot. (p. 82)

The principle of interbeing has use for nursingwhenever we consider nursing as a relational practice.We act in relationship with patients, family members,other nurses, professionals in other disciplines, thephysical environment, the tools and materials we use,the networks of policies and regulations that affect us,our own past, our bodies, our thoughts and feelings.The simple task of giving a medication occurs at thelevel of an ordinary interaction between nurse andpatient, but among other connections, it invokes ascientific worldview in which the drug was designedand tested, an economic system in which it was manu-factured and sold, the body and mind of the patient aschemistry and individual consciousness. The dynamicview of reality that is suggested by interbeing isradically contingent. Thich Nhat Hanh quoted theBuddha, ‘This is, because that is’ (Hanh 2006, p. 82). Inthis view of things, everything is as it appears – theteapot is a teapot – and nothing is as it seems – theteapot is a wave in the ocean of being. This does notleave us lost in the midst of the world, but onlyobliged to act, since that is what happens whatever wedo. Interrelationship is openness because situationsare always in movement. Bergum & Dossetor (2005)took up the language of interdependence in thecontext of relational ethics:

The relational ethic is a web, and the major feature of this

web is interdependence (which holds dependence and

independence equally valuable). Interdependence is the



relationship of being true to ourselves and open to the other,

committed to ourselves as individuals as well as ourselves as

environment – connections between people, institutions,

agencies and other structures. (p. 181)

Interbeing is also pertinent to the nurse–patientrelationship, which has long been identified as centralto nursing practice, particularly in mental health.Barker and Buchanan-Barker (2009) identifiednursing as an ‘interpersonal process, involving theestablishment and development of complex relation-ships between nurses and the people in their care’ (p.16), recognizing both the team context of nursing andthe intrapersonal complexity of the nurse. The factthat these authors in 2009 cited Peplau (1952) in thispassage indicates the huge and enduring influence ofher interpersonal theory of nursing. Peplau (WernerO’Toole & Rouslin Welt, 1994) was always aware ofthe contexts in which nursing care took place, extend-ing networks of relationship beyond the nurse–patient relational dyad. She discussed not only theplanned structures of therapeutic milieus but also ‘theneglected area [of] this unstructured, informal com-ponent of milieu, which is the most important andcomplex dimension of milieu’ (p. 77).

The viewpoint of interbeing supports this strand ofnursing tradition, which arguably always has tore-assert itself against institutional (and human) ten-dencies towards simplicity and fixity of understand-ing.The perspective of interbeing is a reminder that tothink relationally is to think inter-relationally. Eachinteraction between an individual nurse and an indi-vidual patient is richly contextualized, contingent, andimplicated in dynamic processes of knowledge,power, and emotion. Interbeing also goes beyond it,however, since the underlying assumption of empti-ness points to the contingency of ‘nurse’ and ‘patient’roles and identities as well as their relatedness. Thisdoes not mean that one is, or can be, instantaneouslyaware of all the connections that are operating in eachmoment, or that one second guesses what it is to be anurse while nursing (or perhaps one does, some-times). Practice is bringing attention to what is appro-priate to the situation, or as Dogen wrote, ‘as one sideis illumined, the other is darkened’ (Kim, 2004, p. 66).The perspective of interbeing does, however, imply

that nursing practice can never be fully known, sincethere are immanent possibilities in a situation that wedo not choose. It also implies openness to seeking outnew possibilities of not quite trusting in our own‘experience’ that tells us that all options have beenexhausted.

Compassion:The Lotus Sutra (Reeves, 2008)

If living beings suffer adversity

And are oppressed by countless pains,

The power of the wonderful wisdom of the Cry Regarder

Will liberate them from the world’s suffering.

Perfect in divine powers,

Practicing wisdom of skillful means everywhere,

Throughout the universe there is no place

Where he does not appear (p. 378).

The Lotus Sutra was probably compiled around the2nd century ce, originally in Sanskrit although theearliest known versions are themselves translationsinto Chinese, dating back to the 3rd century ce(Reeves, 2008). The two verses above are a very smallextract from a longer text. Even in these few lines,there is a taste of the hyperbolic language typical ofwritings from Mahayana Buddhism (Harrison, 2010,p. 87).

Leaving aside questions of history and literarystyle, the core of this section is an account of compas-sion, as a response to the suffering. The ‘Regarder ofthe Cries of the World’ (Reeves, 2008, p. 371) is apersonalized representation of compassion as a figurewho first notices suffering, without discrimination,and then attends to it in an appropriate manner. Thisnon-discriminatory freedom of response is againpredicated on the view of reality as dynamic andopen. It is the movement of responsiveness, hereexpressed symbolically, that is so pertinent to nursing.Compassion in nursing at its best is not merely anattitude or intention, but an enacted response to suf-fering, accurately aligned with actual need. The atten-tiveness and responsiveness of compassion appear inanother text, this time from the Zen tradition, in anexchange between two Zen masters. ‘Yunyan askedDaowu, “What does the Bodhisattva of Great Com-passion do with so many hands and eyes?” Daowu



said,“It’s like someone reaching back for the pillow atnight.” ’ (Cleary, 1988, p. 229). The Bodhisattva ofGreat Compassion in this extract is the same figure asthe Cry Regarder, and was traditionally pictured with1000 eyes and hands to represent his or her (thegender changes across traditions too) inclusive andnon-discriminating capacity for compassion. Daowu’sresponse is a beautiful and compact image of thenaturalness of enacted compassion. In spite of theexotic imagery (perhaps to those of us not brought upin these traditions), these images of compassionateaction are not given in order to leave us in awe of aperfect compassion, and thereby separated from it. Itis quite the opposite; these texts can be understood asinvitations to the practice of compassion. The every-day image of reaching for the pillow reminds us thatwe are already in the world and responding to circum-stances. The question then is always one of how bestto respond. If nursing is a caring practice, then asnurses we have already taken on an intention to care,to exercise compassion however we may understandthat. In this way we have already accepted the invita-tion of the universal human possibility of compassion.This principle is again seen in the language of rela-tional ethics, which identifies the need to act in con-crete situations and relationships in ways that addressthe specific circumstances (Bergum & Dossetor,2005).

What sometimes gets missed about Buddhism,when it is romanticized and washed out in theWestern imagination, is that it is a highly practical wayof seeing, well aware of the wiles and snags of humanlife. The Tibetan Buddhist teacher Chögyam Trungpacoined the term ‘idiot compassion’ (Chödrön, 2005, p.118) to caution against well-meaning niceness or self-abasement being mistaken for acting effectively in theworld for the benefit of oneself and others. Thishealthy pragmatism again speaks to nurses, who arewell aware of the need to make difficult decisions, toknow when ‘no’ is more therapeutic than ‘yes’.

A key phrase in these verses is ‘skillful means’(Reeves, 2008, p. 378), which points to the many dif-ferent forms that compassionate response might take.Thich Nhat Hanh (2008, p. 170), in a contemporarycommentary on the Lotus Sutra, wrote that ‘if thesituation requires the presence of [the Cry Regarder],

she will be there in the most useful form in order toalleviate the suffering’. The idea of form followingneed fits with the multiplicity of nursing roles andspecializations, as well as with the repertoire of skillsand interventions that nurses acquire through educa-tion and practice.

All these components of compassion, the attentive-ness to need, the responsiveness, the appropriatenessof a particular response are present in Benner’s(1984) description of the expert nurse in an emer-gency situation.

Nurses are most continually present on units and are most

often aware of the total picture. Expert nurses often noted

how they are aware of the rest of the staff, the total picture

of patient needs, and the resources available to them. They

are the overseers of the total picture; they are aware of and

use the layers of available resources. (p. 113)

The link between compassion and expertise is prac-tice. Benner’s description of the expert nurse, which Ihave used here as an illustration of compassion asattentiveness-responsiveness, carries the inferencethat such behaviour does not just happen by itself.This leads to the affinity between nursing and Bud-dhist traditions on the ground of practice.

Practice: Dogen’s Instruction for the Tenzo[head cook]

One of the axioms of nursing is that it is a practicediscipline. When a term becomes widely assumed andtaken for granted, it starts to slip away from us, unno-ticed in plain sight like a comfortable pair of shoes.Words start to accrue qualifiers in order to reintro-duce differentiation, jump start meaning, or to remindus of their presence. Thus, we have practice that canbe advanced, it can be the best, or bad (or malpractice– the legalistic sting of that Latin prefix) – is there aworst practice, the evil twin of best practice? If clinicalpractice is the epicentre of nursing, then what kind ofpractice is it that I am engaged in writing this? Theone thing we are unable to do – we would not evenwant to try – is to get rid of practice. The followingextract lets us take the step back, as the Zen sayinggoes, in order to see practice from another angle.



The 13th century Zen teacher, Eihei Dogen, put thepractice of sitting meditation at the centre of Zenactivity. To this day, the invitation to attend to one’sexistence in the present moment in the silence ofmeditation is the hallmark of Zen practice. Dogen,however, also deployed meditation as a kind of tem-plate for understanding how the activities of everydaylife are also practice. In terms of the two truths, prac-tice necessarily takes place among the exigencies ofthe world of conventional perception, and yet is aniterative embodiment of the possibility of realizedemptiness. Dogen particularly addressed the day-to-day realities of monastic life, and the exigencies ofpeople living together in ‘just institutions’ to useRicoeur’s (1992, p. 194) phrase. Zen Buddhism is apractice both of meditation and of how one lives(Tanahashi, 1985; Rizzetto, 2005).

This is clear from Dogen’s text ‘Instruction for theTenzo [head cook]’ (Tanahashi, 1985) which, amongother things, is a detailed practical guide to runningan institutional kitchen. It is also a description ofpractical, purposeful activity as reflection and expres-sion of how we live. ‘When you wash rice andprepare vegetables, you must do it with your ownhands, and with your own eyes, making sincere effort.Do not be idle even for a moment. Do not be carefulabout one thing and careless about another’ (Tana-hashi, 1985, p. 54). Here, Dogen stressed the vitalimportance of everyday tasks as practice, servingothers and serving oneself in the constant applicationof attention to one’s activity in the world. Thus, heenjoined the tenzo, on receiving the day’s food sup-plies to ‘take care of them as your own eyes’ (p. 54).The intent here is not to adopt an obsessive ormiserly control of resources, but to cultivate an atti-tude of attention to what one is doing; to recognizethe life and the labour that have brought food intothe kitchen, and one’s obligation towards thoseothers who are relying on the tenzo to eat and besustained. To practice is to be in the midst of thingsand to ‘discern the living contours of contingency asthey unfold from moment to moment’ (Batchelor,2000, p. 74). Practice is nowhere but in our activityand the expression of self in activity is as close as ourown eyes: ‘To penetrate this is joyful mind’ claimedDogen (Tanahashi, 1985, p. 65).

One aspect of the instruction to the tenzo is that itquestions the distinction between one sort of practiceand another. In the Zen monastic context, this meantthat although sitting meditation was considered thecore practice of Zen, everyday activities like cookingwere not only essential, but also themselves forms ofpractice. This prompts the question whether innursing some practices are considered less thanothers. There is literature that suggests that this maybe true of the documenting of nursing care. Buus(2009) found that charting limited in its scope ofexpression by institutional structures. Other authorsreported that it was treated as a secondary activity,resulting in rote, fragmented reporting (Martin &Street, 2003; Fourie, McDonald, Connor, & Bartlett,2005).We may see it as a post hoc account of the day’spractice, or as an external legal obligation, rather thanas a practice in itself and as the expression of ourindividual contribution to the team practice of carefor a patient. It is a challenge to bring a full attentionto all our activities. Dogen’s account of practicing apractical, purposeful activity like cooking a meal toschedule for a large number of people points out thatpractice is not only a matter of what we do, but howwe do it.

Practice does not come naturally. That is why it iscalled practice. As any athlete or musician or indeedcook knows, practice implies repetition, doing thesame, or rather nearly the same thing over and over. Itis in the ‘nearly’ that repetition unfolds over time aschange. The philosopher John Caputo (1987) distin-guished two kinds of repetition. The first, which heassociated with Husserl, he termed a repetition ofrecollection in which we get to know better what wealready know. The second, which he took fromKierkegaard, is a repetition forward which ‘beginswith the situatedness in which one finds oneself’ andis ‘the freedom to actualize possibilities’ (p. 30). Theexploration of repetition is essential in keeping usgrounded in the reality that practice is not only activ-ity but also continual activity. In coming back dayafter day, to our chosen field of practice, in this casenursing, it is easy to let repetition become only recol-lection, the automatic and comfortable carrying out ofwell-known tasks with all the satisfaction of compe-tency that that entails. The trick is let ourselves notice



the cracks that are always there in the facade of ourcompetence, the cracks of the nearly and the notquite, the displacement from yesterday to today, thefact that the borderline patient you are admitting forthe sixth time is not the same person as before, andnor are you. As Leonard Cohen (1992) put it, ‘there isa crack in everything, that’s how the light gets in’. It isuncomfortable to practice forwards, to try to remainopen to the possible cracks in our competence, butwhen we try to learn to look for the cracks, we mightjust see some light.

A note on mindfulness practice

Actualization of bringing attention to everydayactions and interactions is found in the practice ofmindfulness. ‘Mindfulness is being present with ourexperience as it is unfolding: knowing what we aredoing while we are doing it – simply being or doing,open to the present moment’ (Campbell, 2009, p. 384).It is both a way of being aware, and the intentionalpractice of cultivating such awareness. Meditation hasbeen central to Buddhist practice since its inceptionand in recent years techniques of mindfulness havebeen presented without the philosophical context ofBuddhism, following the work of Jon Kabat-Zinn(1990). Mindfulness has found a place as a therapeuticpractice for a number of clinical populations in themental health field including those suffering fromdepression, anxiety, addictive behaviours, post-traumatic stress disorder, and psychosis (Didonna,2009). More importantly in the present context, mind-fulness is also a practice that is being recognized asuseful to clinicians in cultivating empathetic listening(Walsh, 2008).

Mindful reflective listening involves listening reflectively to

our biases as they are manifested in our efforts to under-

stand. Like clouds moving across the sky, these presupposi-

tions can be noticed, accepted without judgment, and

allowed to pass again from view (back to the background)

for an expanded perspective on ourselves and on the client

who sits before us. (p. 82)

The practice of mindful awareness in the presentcan support reflective listening by allowing one to beless swayed by one’s own thoughts and need to reply

and more able to keep open a space of attention towhat the other person has to say. In this way, there isa direct interchange already going on between Bud-dhist and modern healthcare practices, with potentialfor further investigation.

Conclusion

There is an emerging Western Buddhism that is bothancient and modern. It is ancient insofar as theseideas new to the Western world have been in use andunder discussion in Asia since around the 6th centurybce. It is modern not only because Buddhist practiceand studies have expanded enormously in the Westsince the mid-20th century, but also because this is anew kind of cultural encounter. Western culture isheir to its own ways of thinking and seeing that havealso evolved over millennia in which we are bound tofind our own interpretations of Buddhist tradition.Additionally, modern communications allow usaccess to a vast range of Buddhist literature fromacross centuries and different cultures (just as fast astranslators from Pali, Sanskrit, Japanese, Chinese,Tibetan and so on make them available to us Englishreaders) so that Buddhism appears to us quite differ-ently than it has to people who for centuries havelived in societies where it was a part of the socialfabric. My use of texts in this exploration reflectsthese circumstances. I have drawn eclectically fromBuddhist writings readily available in English trans-lation, but have deliberately chosen extracts that Ibelieve have something to say to nurses. One of myassumptions is that nursing breathes the same air asthe culture of which it is part. It is worthwhile fornurses to listen to voices in the culture and to makeresponse. As nurses, and for the sake of sustaining theethical, compassionate practice of nursing, we havean opening to enter into the cross-cultural possibili-ties for new and fruitful understandings in thismeeting of Western and Buddhist traditions ofthought. Dale Wright (1998), a contemporary reli-gious scholar, has written on the Zen tradition from ahermeneutic standpoint, elegantly expressing itsunique perspective:

[This is, perhaps,] the greatest theoretical strength of the

Buddhist tradition. In the wake of the doctrines of no-self,



impermanence, dependent origination, and emptiness,

human beings could easily be understood in flexible and

non-essentialist terms, as capable of differentiated possibili-

ties. (p. 214)

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