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

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.

Moreness—Choice

How can a nurse let herself know her human responses and the breadth and depth of the possibilities called forth by the other? How can she be, search, experience, become in an accord with the calls and responses of her lived nursing world? It is a chosen, deliberate life-long process. The process itself is generative. One experience opens the door for the next. In humanistic nursing practice theory we call this kind of experiencing authentic, genuine, or "letting be what is." It is man conscious of himself, not necessarily acting out, but aware of his human responses to his world and their meanings to him. This quality of personal authenticity allows one's responsible chosen actions to be based in human knowledge rather than human defensiveness. Man is a knowing place. From education and living experience one assumes an initial innate force in human beingness that moves man to come to know his own and others' angular views of the world. Humanistic nursing is concerned with these angular views, these differences being viewed by nurses responsibly and as realities that are beyond the negative-positive, good-evil standard of judgement. Or, for example, nursing is concerned with how this particular man, with his particular history, experiences being labeled with this general diagnosis and being admitted, discharged, and living out his life with his condition as he views it in-his-world.

Man has the inherent capacity to respond to other man as other man. Only each unique nurse faced with the chaos of her alternatives in a situation can then choose either to relate or not to relate and how to relate in-her-nursing-world to others. Choosing to and how to relate or respond cannot be superimposed on man from the outside by another. A person, to a degree, can be coerced to behave outwardly in a certain way. For example, physically, in a spatial {6} sense, a nurse can be ordered into parallel existence with another. Being existentially and genuinely present with another is different. This human mode of being is chosen and controlled by the self. It takes responsible self-ordering that can arise only in the spirit of one's own disciplined being.

Value—Nonvalue

To offer genuine presence to others, a belief must exist within a person that such presence is of value and makes a difference in a situation. If it is a value for a nurse, it will be offered in her nursing situation. Libraries, concrete buildings bursting with words of great thinkers, support the value of genuine presence and authentic dialogue between persons. Consider the literary works that have conveyed or reflected this message throughout the existence of intellectual man. Plato, Rousseau, Goethe, Proust, Nietzsche, Whitehead, Jung, May, Frankl, Hesse, de Chardin, Bergson, Marcel and Buber effortlessly come to mind.

Many nurses are genuine presences in the nursing situation. Some have tried to share their experiences; some have not. And, there are those who are not genuine presences in the nursing situation. One wonders if this has influenced the distinctions nurses have made over the years with certainty when considering their nurse contemporaries. Often one hears, "she is a good nurse, a natural." These positive critics are often up against it when asked, "why, how, what?" Descriptive literary conceptualizations of nursing that reflect this quality of nurse-being (presence, intersubjectiveness) call for nurses willing to search out and bring to awareness, the mysteries of their commonplace, their familiar, and to appreciate the unique ideas, values, and meanings fundamental to their practice. Conceptualization of these qualities by practicing nurses is basic and necessary to the development of a science and an actualized profession of nursing.

PHENOMENOLOGICAL DESCRIPTION

Phenomenology directs us to the study of the "thing itself." The existential literature, descriptions of what man has come to know and understand in his experience, has evolved from the use of the phenomenological approach. In the humanistic nursing practice theory the "thing itself" is the existentially experienced nursing situation. Both phenomenology and existentialism value experience, man's capacities for surprise and knowing, and honor the evolving of the "new."

What Does Humanistic Nursing Practice Theory Ask the Nurse to Describe?

Nurses experience with other human beings peak life events: creation, birth, winning, nothingness, losing, separation, death. Their "I-Thou" empathetic {7} relations with persons during these actual lived experiences and their own experiential-educational histories make "the between" of the nursing situation unique. Through in-touchness with self, authentic awareness and reflection on such experiences the human nurse comes to know. Humanistic nursing practice theory asks that the nurse describe what she comes to know: (1) the nurse's unique perspective and responses, (2) the other's knowable responses, and (3) the reciprocal call and response, the between, as they occur in the nursing situation.

Why Does Humanistic Nursing Practice Theory Ask That Existential Nursing
Experience Be Described Phenomenologically?

There are many reasons. Philosophically and fundamentally the reason relates to how humanistic nursing perceives the purpose and aim of nursing. It views nursing as the ability to struggle with other man through peak experiences related to health and suffering in which the participants in the nursing situation are and become in accordance with their human potential. So, like Elie Wiesel, the novelist, who states in One Generation After that he writes to attest to events of human existence and to come to understand, humanistic nursing proposes that human forms of existence in nursing situations need attestation and that through describing, nurses will understand better and relate to man as man is. Thus the profession of nursing's service contribution to the community of man will ever become more.

The reasons for phenomenologically describing nursing are complex, interinfluential, and their ramifications are far reaching. Sequentially, the study and description of human phenomena presented in nursing situations will affect (1) the quality of the nursing situation, (2) man's general knowledge of the variation in human capacity for beingness, and (3) the development and form of the evolvement of nursing theory and science.

How Can Nurses Begin to Describe Humanistic Nursing Phenomenologically?

The process of how to describe nursing events entails deliberate responsible, conscious, aware, nonjudgmental existence of the nurse in the nursing situation followed by disciplined authentic reflection and description.

There are obvious common lived human experiences which if considered and wondered about, can advance a nurse's ability for phenomenological description. These experiences are easily cited, yet not easily plumbed. Often experiences such as anger, frustration, waiting, apathy, confusion, perplexity, questioning, surprise, conflict, headache, crying, laughing, joy are quickly theoretically and analytically interpreted, labeled, and dismissed. Examining, reexamining, mulling over, brooding on, and fussing with the situational context of these experiences as nonlabeled, raw human lived data can yield {8} knowledge. Knowledge of the nurse's and her other's unique human existence in their on-going struggle becomes explicit. Superficial treatment of such human clues results in nonfulfillment of the realistic human possibilities of artful-scientific professional knowing and nursing.

Words are the major tools of phenomenological description. They are limited by our human ability to express, and yet they are the best tools we have for expressing the human condition. The novelist James Agee, in Let Us Now Praise Famous Men, says that though man or human relatedness never could be described perfectly it would be the greater crime not to try. This, too, is a basic premise of the humanistic nursing practice theory.

The words we use to describe and discuss this theory are easy words, everyday English words. We all know them. We, at times, narrow a word's meaning or make it more specific. Some problem is presented by words we are accustomed to using and hearing. Habit and our human fallibility can promote only superficial comprehension. Thoughtful awareness of the meaning of these same sequentially expressed words can convey the complexity of the never completely fathomable "all-at-onceness" of lived existence. This theory is expressed in terms like "existence confirming," "striving," "becoming," "relation," and "reflection." We intend such words to express the grasp with acceptance and recognition of human limitations while awesomely pondering the open-ended scope of each man's potential.

In time, with disciplined authentic reflective description, themes common and significant to nursing situations become apparent. They are then available for compilation, complementary synthesis, and on-going refinement. A nursing resource bank accrues: Not a bank that offers a map of how and what to do but rather one that further stimulates nurses' exploration and understanding.

THE EVOLVEMENT OF HUMANISTIC NURSING PRACTICE THEORY

Since 1960 Loretta T. Zderad and myself in dialogue, together, and with groups of nurses in graduate schools and in nursing service situations have reflected on, explored, and questioned our own and others' nursing situational experiences. Over this period we have come to value and appreciate the meaningfulness of these situations to man's existence. This constantly augmented our feelings of responsibility for contributing to these situations beneficially. Therefore, we looked at them for their tractability to research methodology. Their loadedness with variations, changes, uncontrollables, and our negative feelings about the implications of viewing human beings as predictable left the strict scientism of positivistic method wanting at this stage of man's knowing. We saw objectivity in nursing situations or our questions, nursing questions, in the realm of needing to now how man experienced his existence. This objectivity, or man's real lived reality paradoxically is subjectively ridden, man-world.

The existential literature dealt with substantive themes encountered in nursing experiences. As I previously stated this literature evolves from a phenomenological {9} approach to studying being and existence. This approach to studying, describing, and developing an artistic science of nursing became Dr. Zderad's and my long-sought haven. All along existentialism and phenomenology had been ours 'and many nurses' "what" and "how." Now we had labels that were acceptable and reputable to many—most of all to ourselves.

FOOTNOTES:

[1] Martin Buber, "Distance and Relation," trans. Ronald Gregor Smith, in The Knowledge of Man, ed. Maurice Friedman (New York: Harper & Row, Publishers, 1965), p. 71.

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FOUNDATIONS OF HUMANISTIC NURSING

Nursing is a response to the human situation. It comes into being under certain conditions—one human being needs a kind of help and another gives it. The meaning of nursing as a living human act is in the act itself. To understand it, therefore, it is necessary to consider nursing as an existent, a phenomenon occurring in the real world.

THE PHENOMENON OF NURSING

The phenomenon of nursing appears in many forms in the real lived world. It varies with the age of the patient, the pathology or disability, the kind and degree of help needed, the duration of the need for help, the patient's location and his potential for obtaining and using help, and the nurse's perception of the need and her capacities for responding to it. Nursing varies also in relation to the sociocultural context in which it occurs. Being one element in an evolving complex system of health care, nursing is continuously appearing in new specialized forms. As professionals, we are accustomed to viewing nursing as we practice it within these specialty contexts—for example, pediatric, medical, rehabilitation, intensive care, long-term care, community. There seems to be no end to the proliferation of diversifications. Even the attempts of practitioners to combine specialties give rise to new specialties, such as, community mental health nursing and child psychiatric nursing.

So it is difficult to focus on the phenomenon of nursing as an entity without having one's view colored by a particular clinical, functional, or societal context. Yet, if we can "bracket" (hold in abeyance) these adjectival labels and the preconceived viewpoints they signify, we can consider the thing itself, the act of nursing in its most simple and general appearance. {12}

Well-Being and More-Being

In this most basic sense, then, disregarding the particular specialized forms in which it appears, the nursing act