Humanistic Nursing



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Humanistic Nursing

Copyright (C) 2007 by Josephine Paterson and Loretta Zderad.

Humanistic Nursing

(Meta-theoretical Essays on Practice)

by Josephine Paterson and Loretta Zderad

Copyright (C) 2007 by Josephine Paterson and Loretta Zderad all rights reserved except as follows. This e-text may be freely copied for academic and scholarly work with the copyright notice clearly affixed to all copies. No commercial use may be made of any part of the text without the express permission of the copyright holders.

This e-text version of the classic text "Humanistic Nursing" is made available with the kind permission of the authors and copyright holders, Josephine Paterson and Loretta Zderad. The book was originally written to define the Humanistic Nursing Theory which presented a way for each nurse to become-more as a person and to extend that becoming-more to the community of nurses in which he or she practices. The offering of this book in the "free" e-text format reiterates the continuing contribution of these two nurses long after their retirement from practice. It is their hope that nurses everywhere will take their vision for nursing and expand on it and integrate it into their nursing practice. At the request of the authors this e-text version is complete with the original 1976 Front Matter.

Susan Kleiman

For more information or questions about the subject of Humanistic nursing or this e-text you may contact Professor Susan Kleiman, PhD, RN, CS, NPP at: susank@humanistic-nursing.com. Alternatively you may visit the web site: www.humanistic-nursing.com. The Humanistic Nursing Inquiry web site provides context for the major initiatives of humanistic nursing, which celebrate the enduring and immutable ideals of Humanism that give us insight into the fundamental truths of being in the world of nurses, patients, families, colleagues, and students.

FOREWORD to the 1976 Edition

These essays will evoke different reactions from different readers. "Well, I know that," for example, may be the reaction of a beginner in nursing; "I wouldn't have said it that way but I knew that is really nursing." "Since they've given us a methodology," perhaps from one more experienced in nursing; "I'll give it a try." Others with still more or different kinds of experience may respond, "It's about time nurses put that into words; it's about time."

Timely as these essays are I would prefer not to use up the foreword with a listing of the crises, the "eco-spasms," and scientific triumphs that would document their timeliness. It is my pleasure, rather, to use this opportunity to relate the six elements of my own reaction:

Nursing has a solitariness until we find it has many companions in philosophy, science, and art. It has a steadiness about its pace yet holds a potential for flights to higher elevations. It is constantly changing yet has an enduring component of permanence. Good is the word we use every day; our vision, however, is of excellence. Its tasks often have the appearance of homeliness until we glimpse that kind of beauty that is humanness. Nursing even sings very softly because our ears are attuned to "a different drummer."

Lilyan Weymouth, R.N., M.S. Northampton, Massachusetts October 1975

PREFACE to the 1976 Edition

Out of necessity nursing, as a profession, reflects the qualities of the culture in which it exists. In our culture for the past quarter of a century nursing has been assailed with rapid economic, technological, shortage- abundance, changing scenes' vicissitudes. In the individual nurse these arouse turmoil and uncertainty. These cultural stirrings inflame that part of the nurse's spirit capable of chaotic conflict and doubt. Often she questions her professional identity. ''Just what is a nurse?" Her nurse colleagues, other professionals, and nonprofessionals freely, directly and indirectly-on television, in the theater, through the news media and the literature-pummel her with their multitudinous varied views.

As searching, wondering, reflecting, relating microcosms within this perplexing health nursing world for longer than a quarter of a century, we present this book. Descriptively we view the chapters as hard-wrung, philosophical foundations, synthesized extracts from our lived experiences. These metatheoretical essays on practice present an existential alternative approach for a professional nurse's knowing and becoming.

These conceptualized existents are available because Miss Marguerite L. Burt, formerly Chief of Nursing Service, Northport, N.Y. Veterans Administration Hospital called them forth from us. These chapters are our response to her call. In 1972 Miss Burt requested us to develop a course for the professional nursing staff at Northport V.A.H. This book has evolved from the original presentations offered to the ten participants in the first course. While we taught and worked with five subsequent groups, we learned and continually revised and clarified our conceptualizations. The course is entitled Humanistic Nursing.

Fifty-three nurses have been involved in this course. Interest, appreciation, wonderment, effort, and investment characteristically depict their response. They convey that the humanistic nursing practice theory reflects what nursing means to them. Their hungry approach to the suggested readings has both surprised and pleased us. Our amazement persists over the participants' ability to concentratedly discuss abstract theory and concrete nursing practice for weekly day-long sessions over six-to nine-month periods. Presently requests to participate in the next humanistic nursing course are mounting from nurses both within and outside the Northport complex.

The course, the theory, and this book are the fruits of our individual and collaborative efforts. While sharing seminar responsibility for graduate students in 1960, we began to dialogically and -dialectically struggle with professional and /clinical nursing issues. Discussing and searchingly questioning ourselves and our students became a value. Through conveying, struggling for clarification, openness to honest argument, we grew in our awareness that each was moved beyond her beginning thoughts. Through reflection we have come to view, describe, and distinguish our dialogues as struggles with, and not against, others' ideas. Differences in response are valued for what they can tell us of our chosen area-nursing. So dialectical dialogue has gradually become our predominant teaching method. We convey our ideas, are open to others' questions, struggle to clarify and really communicate, and question ourselves, and others. In the process of the humanistic nursing course, using this methodology, which is deliberate and, yet, natural and authentic for us, we and our professional nursing staff students have learned and become more human, more questioning, more clinical, and just, more.

We value our moreness. Appreciating and valuing the effects of our actualizing selves as human beings, we must attest to our existential modes of nurse being; our inner mandate is: share. Hence, Humanistic Nursing has come into being.

To find the meaning of nursing we have returned "to the thing itself," to the phenomenon of nursing as it occurs in the everyday world. Our reflections on nursing as a lived experience flowed into the realm of metanursing. Obviously, these thoughts are only a beginning. They are offered in the hope of stimulating response and further development. Dialogue may be difficult at first because humanistic nursing represents one of our discipline's less articulated streams. Yet, it is a stream traceable to nursing's foundation and, as such, is related to nursing's artistic, scientific, and technological currents. It is not being, cannot be, developed in opposition to them.

Science and art are forms of human responses to the human situation. They are valued in genuine humanism. Thus, the humanistic nursing approach does not reject advances in nursing technology, but rather it tries to increase their value by viewing their use within the perspective of the development of human potential. The same holds true for scientific, artistic, and clinical developments in nursing practice. They are the necessary means through which and in which humanistic nursing (a being and doing) is experienced and developed.

At this time when serious concern is being expressed about the survival of nursing as a profession, humanistic nursing offers a note of optimism. By examining the values underlying practice, it focuses on the meaning and means of nursing's particular' mode of interhuman caring. It increases respect for that caring as a means of human development. Nurses have the privilege of being with persons who are experiencing all the varied meanings of incarnate being with men and things in time and space in the entire range from birth to death. They not only have the opportunity to co-experience and co-search with patients the meaning of life, suffering, and death, but in the process they may become and help others become more-more human.

Beyond this, the humanistic nursing approach respects nursing experience as a source of wisdom. By describing and conceptualizing the phenomena experienced in nursing situations, nurses could contribute to the development of nursing as a discipline. Even more, they could add to the knowledge of man.

Humanistic nursing, then, is neither a break with nor a repetition of nursing's past. It is neither a rejection of nor a satisfaction with nursing's present. Rather it is an awakening to the possibilities of shaping our nursing world here and now and for the future.

Thanks to Miss Marguerite L. Burt are in order for she provoked our conceptualizations of our lived nursing worlds. Dr. Frederick H. Wescoe, while Chief of Nursing Service, Northport, N.Y., VAH administratively facilitated the time and the means for our compiling these materials into a manuscript. Past nursing students challenged and grappled with our ideas and theirs insisting always on our forwarding our thinking. Our consultants, Miss Lilyan Weymouth and Miss Rose Godbout, were marvelous resources and counselors.

Immediately we are most grateful to the participants in the six humanistic nursing courses taught here at the Northport VAH. As nurses, they received and accepted our expressed ideas to the extent of testing them in the fires of their real lived nursing practice settings. While struggling with our ideas and us, they gave to us. They were supportive, loving, and truly present with us in the community of nurses at Northport, VAH. Miss Sue McCann, clinical nurse specialist, one of our first course participants, has read and reviewed our materials. More than this Miss McCann has been a counselor, resource person, and a dependable friend in our humanistic nursing effort of the last three years. We hope our chapters give back to others, at least just a part of what we have received from them in our travels in the nursing world.

J.G.P L.T.Z.

[Transcriber's Note: to the 1988 Edition

Italic text has been marked as text. Bold text has been marked as ~text~. Obvious punctuation errors in the original have been corrected. Other corrections are noted at the end of the text. The original page numbers have been retained, e.g. {1} marks the start of page 1 in the original text.]

HUMANISTIC NURSING



Josephine G. Paterson, DNSc, RN Loretta T. Zderad, PhD, RN

PREFACE


Somewhere there's a child a crying Somewhere there's a child a crying Somewhere there's a child a crying Crying for freedom in South Africa.[1]

But until someone hears the cry and responds, the child will continue to suffer the oppression of the current South African regime; and the world will continue to be less than it could be. To cry aloud when there seems no chance of being heard, belies a hope--perhaps an inherently human trait--that someone, somewhere, somehow will hear that cry and respond to it.

This same hope, that someone would hear and respond, allowed existential psychologist Viktor Frankl to survive the systematic torture and degradation in Nazi death camps. As Frankl and others sought their way, they found meaning and salvation "through love and in love;" and by choosing to believe that "life still waited for him, that a human being waited for his return."[2]

There is power in the call of one person and the potential response of another; and incredible power when the potential response becomes real. There is the power for each person to change as she becomes more than she was before the dialogue. There is the power to transcend the situation as two people engage the events that are whirling around them and together try to make sense of their worlds and find a meaning to their existence. When the call and response between two people is as honest as it can be, there is the revolutionary power which the poet Muriel Rukeyser speaks of:

What would happen if one woman told the truth about her life? The world would split open.[3]

{iv}


The call and response of an authentic dialogue between a nurse and patient has great power--the power to change the lived experiences of both patient and nurse, to change the situation, to change the world. It is the same authenticity we search for in relationships with our friends and lovers. The person who really listens to what we are saying, who really tries to understand our lived experiences of the world and who asks the same from us. When found, it brings the same exhilarating feeling of self-affirmation and the comforting feeling of well-being.

For, if as holistic beings we are the implicate order explicating itself, as suggested by Bohm[4] and Newman[5] among others, then the responsibilities of those who would help (e.g., nurses) include making sense out of the chaos that can occur as illness disrupts past order and as the ever-present threat of non-being disrupts all order. When we are successful in helping patients and their loved ones make sense of their lives by bringing meaning to them, we make sense of and bring meaning to our own.

And when we help create meaning, it is easier to remember why we chose nursing and why we continue to choose it despite what an underpaid and undervalued job it has become in today's marketplace. These are the moments when by a look or a word or a touch, the patient lets us know that he understands what is happening to him, what his choices are, and what he is going to do; that he knows we know; and that each knows that the other knows. When we get past our science and theories, our technical prowess, our titles and positions of influence, it is this shared moment of authenticity--between patient and nurse--that makes us smile and allows us to move forward in our own life projects.

Nurse educators who seek such authentic exchanges with their students enjoy similar moments. The same can be said of deans of schools of nursing, administrators of delivery systems, executives and staff of nursing and professional organizations, and colleagues on a research project. It is the authentic dialogue between people that makes any activity worthwhile regardless of whether or not it is called successful by others.

When Josephine G. Paterson and Loretta T. Zderad first published their book Humanistic Nursing in 1976, society was in the midst of the new women's movement and nurses were going through the phase of assertiveness training, dressing for success, and learning to play the games that mother never taught us. Since then, nurses have moved into many sectors of society and have held power as we have never held it before. We have proved ourselves as politicians, administrators, researchers, and writers. We have refined our abilities to assess, diagnose, treat, and evaluate. We've raised money and balanced budgets. We've networked, organized, and formed coalitions.

Yet, individually we are uneasy and collectively we are unable to articulate a vision clear enough so that others will join us. This re-issue of Paterson and {v} Zderad's classic work will help to remind us of another way of developing our power. Perhaps we can, once again, look for and call for authentic dialogue with our patients, our students, and our colleagues. Paterson and Zderad are clear in their method: discuss, question, convey, clarify, argue, and reflect. They remind us of our uniqueness and our commonality. They tell us that it is necessary to do with and be with each other in order for any one of us to grow. They help us celebrate the power of our choices.

Is it ironic and fortunate that Humanistic Nursing should be re-issued now when it is needed even more than it was during the late 1970s? Then, humanitarianism was in vogue. Now, it is under attack as a secular religion.

Today, the technocratic imperative infiltrates an ever-increasing number of our lived experiences; and it becomes more difficult to ignore or dismiss Habermas's analysis that all interests have become technical rather than human.[6] As health care becomes increasingly commercial the profound experiences of living and dying are discussed in terms of profit and loss. Life itself is the focus of public debates about whether surrogacy involves a whole baby being bought and sold or only half of a baby, since one half already "belongs" to the natural father and so he cannot buy what he already owns.

We have many choices before us: to adopt the values of commerce and redesign health care systems accordingly; to accept competition as the modus operandi or insist on other measures for people in need; to decide who will be cared for, who won't, who will pay, and how much?

Perhaps it is time for us to turn away from the exchange between buyers and sellers, providers and consumers; and turn back to an exchange between two people trying to understand the space they share. Perhaps it is time for a shared dialogue with patients for whom the questions are most vital? Perhaps we need to hear their call and respond authentically. Perhaps they need to hear ours? For only then, as Paterson and Zderad have made quite clear, will our lived experiences in health care have any real meaning.

Patricia Moccia PHD, RN Associate Professor and Chair Department of Nursing Education Teachers College Columbia University

FOOTNOTES:

[1] Azanian Freedom Song. Lyrics by Otis Williams, music by Bernice Johnson Reagon. Washington, DC: Songtalk Publishing Co., 1982.

[2] Frankl, Viktor. Man's Search For Meaning. Boston: Beacon Press, 1959.

[3] Rukeyser, Muriel. "Kathe Kollwitz," in By a Woman Writ, ed. Joan Goulianos. New York: Bobbs Merrill, 1973, p. 374.

[4] Bohm, David. Wholeness and the Implicate Order. London: Ark, 1980.

[5] Newman, Margaret. Health As Expanding Consciousness. St. Louis: C. V. Mosby Company, 1986.

[6] Habermas, Jurgen. Knowledge and Human Interest, (trans. J. Shapiro.) Boston: Beacon Press, 1971.

CONTENTS

PART ONE


THEORETICAL ROOTS 1

1 Humanistic Nursing Practice Theory 3 2 Foundations of Humanistic Nursing 11 3 Humanistic Nursing: A Lived Dialogue 21 4 Phenomenon of Community 37

PART TWO

METHODOLOGY--A PROCESS OF BEING 49

5 Toward a Responsible Free Research Nurse in the Health Arena 51 6 The Logic of a Phenomenological Methodology 65 7 A Phenomenological Approach to Humanistic Nursing Theory 77 8 Humanistic Nursing and Art 85 9 A Heuristic Culmination 95

Appendix 113 Glossary 121 Bibliography 123 Index 127

{1}

Part 1


THEORETICAL ROOTS

{2} {3}


1

HUMANISTIC NURSING PRACTICE THEORY

Substantively this chapter introduces two aspects of the humanistic nursing practice theory: first, what this theory proposes and, second, how the proposals of the theory evolved.

Concisely, humanistic nursing practice theory proposes that nurses consciously and deliberately approach nursing as an existential experience. Then, they reflect on the experience and phenomenologically describe the calls they receive, their responses, and what they come to know from their presence in the nursing situation. It is believed that compilation and complementary syntheses of these phenomenological descriptions over time will build and make explicit a science of nursing.

HUMANISTIC NURSING: ITS MEANING

Nursing is an experience lived between human beings. Each nursing situation reciprocally evokes and affects the expression and manifestations of these human beings' capacity for and condition of existence. In a nurse this implies a responsibility for the condition of herself or being. The term "humanistic nursing" was selected thoughtfully to designate this theoretical pursuit to reaffirm and floodlight this responsible characteristic as fundamentally inherent to all artful-scientific nursing. Humanistic nursing embraces more than a benevolent technically competent subject-object one-way relationship guided by a nurse in behalf of another. Rather it dictates that nursing is a responsible searching, transactional relationship whose meaningfulness demands conceptualization founded on a nurse's existential awareness of self and of the other. {4}

EXISTENTIAL EXPERIENCE

Uniqueness--Otherness

Existential experience infers human awareness of the self and of otherness. It calls for a recognition of each man as existing singularly in-his-situation and struggling and striving with his fellows for survival and becoming, for confirmation of his existence and understanding of its meaning.

Martin Buber, philosophical anthropologist and rabbi, expressed artfully this uniqueness, struggle, and potential of each man. He said:

"Sent forth from the natural domain of species into the hazard of the solitary category, [man] surrounded by the air of a chaos which came into being with him, secretly and bashfully he watches for a Yes which allows him to be and which can come to him only from one human person to another."[1]

With such uniqueness of each human being as a given, an assumed fact, only each person can describe or choose the evolvement of the project which is himself-in-his situation. This awesome and lonely human capacity for choice and novel evolvement presents both hope and fear as regards the unfolding of human "moreness." Uniqueness is a universal capacity of the human species. So, "all-at-once," while each man is unique; paradoxically, he is also like his fellows. His very uniqueness is a characteristic of his commonality with all other men.

Authenticity--Experiencing

In humanistic nursing existential awareness calls for an authenticity with one's self. As a visionary aim, such authenticity, self-in-touchness, is more than what usually is termed intellectual awareness. Auditory, olfactory, oral, visual, tactile, kinesthetic, and visceral responses are involved and each can convey unique meaning to man's consciousness. In-touchness with these sensations and our responses informs us about our quality of being, our thereness, our degree of presence with others. The kind of "between" we live with others depends on both our degree of awareness and the meaning we attribute to this awareness. This awareness, reflected on, sometimes shared with a responsible other for reality testing, offers us opportunity for broadening our meaning base, for becoming more--more in accord with our potential for humanness.

Perhaps a statement made by Dr. Gene Phillips, professor of education at Boston University, will clarify the importance I attach to each nurse becoming as much as she can be. He said, "The more mature we are the less it is necessary for us to exclude." Presently I would paraphrase this statement {5} and say, the more of ourselves we do not have to exclude, the more of the other we can be open to. Our self-awareness, in-touchness, self-acceptance, actualization of our potential allows us to share with others so they can become in relationship with us.

In this kind of existential relating, presence with another, a nurse is confronted with man as singular in his own peculiar angular, biased, or shaded reality. It becomes apparent that each has his very own lived world. So one might describe human existence as man-world as some refer to man as mind-body, using a hyphen rather than "and." Man's universal species commonality and peculiar perplexing noncommonality, has this manness, affect and constantly interplay with one another. This arena of interplay is complicated further by man's capacity for nondeterminedness, his ability for envisioning and considering a variety of alternatives and choosing selectively. Often these alternatives are experienced as contradictory and inconsistent. Humanistic nursing calls forth in the nurse the struggle of recognizing the complexity of men's relating in the nursing world as "just how man is" and his nature, his human condition, as searching, experiencing, and an unfolding becoming.



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