Humanistic Nursing - Loretta T. Zderad (best books to read for knowledge TXT) 📗

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

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Part 1 THEORETICAL ROOTS

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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