Foundation of Humanistic Nursing Theory
Logic of Phenomenological Methodology
THEORETICAL ROOTS
Foundations of Nursing Practice
Chapter Two
Foundations of Nursing Practice
"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 ."(Paterson & Zderad, p. 11) The phenomenon of nursing comes in infinite forms with factors such as situation, culture, age, medical condition, and need for assistance.
Well-Being and More-Being: That nursing is tied to the health-illness quality of man is obvious. How it is related is not so easily determined. Dr. Paterson relates that the term "health" is an essential component of the equation from the broadest definition of well-health to the narrowest such as dying. Nursing is integral to this continuum. "Nursing, then, as a human response, implies the valuing of some human potential beyond the narrow concept of health taken as absence of disease. Nursing's concern is not merely with a person's well-being but with his more-being, with helping him become more as humanly possible in his particular life situation." (P & Z, p. 12) Nursing then assists the person to be greater than the total sum of all parts.
Human Potential: Humaneness is essential for nurses. When nurses are thanked for this quality in what they do, a large part of them are surprised. Those nurses not displaying humaneness are usually criticized. To view that all nursing acts are "overflowing of the milk of human kindness" (P & Z, p. 12) is in error, as nursing acts and nursing deeds contain all the human potential of anger, pain, meanness, frustration, as well as, joy, happiness, and caring. Thus, nursing acts can contain all responses that all humans experience.
Intersubjective Transaction: The nursing act occurs between at least two persons. The nurse does and the receiver receives and responds to the nursing or nurturance. The acts of both create an intersubjective transaction, a relationship if only for a moment. This is the "between" that has meaning to both. This is an essential dimension beyond science. "It is a quality of being that is expressed in the doing." (P & Z, p. 13)
Being and Doing: Nursing involves both being and doing and these are so interrelated that one does not exist without the other. Much of the description of nursing is focused on the doing half. The "doing" half can be examined, held up for example and talked about. The "being" half of the equation is much more ephemeral and less apparent for scrutiny, but the mere "presence" of the nurse is just as valuable. It is "just being there," to be an active presence. An example may be that of sitting by the bedside during the dying process.
Authentic Commitment: Nursing that is directed toward the human potential, "that is, an active presence with the whole of the nurse's being. This involved presence is personal and professional." (P & Z, p. 15) The personal commitment in each nurse is unique. The nurse brings to the interaction his or her unique presence with the professional commitment that the interaction is goal directed. This goal directed act is held to industry standards. While the perfect goal is to have a positive interactive transaction, in actual practice, this may not be the case. Humanistic nursing occurs along a continuum with degrees of genuine presence.
Process-Choice and Intersubjectivity: Dr. Paterson writes about how we are the sum of our choices. For some the paths chosen for us and only a narrow opportunity exists for choices. Human existence is also coexistence. Humans are also as they are because of the choices they did not make. "Presence, the gift of one's self, cannot be seized or called forth by demand, it can only be given freely and be invoked or evoked." (P & Z, p. 16) To do so means that alternatives or other possibilities exist with choice being a response to any number of possibilities. This freedom of choice or "free agency" exists to varying degrees in any situation. The humanistic nurse then is self-aware of this free agency and makes responsible choices at the same time recognizing the other person also has this free agency and directs opportunities to give voice to the other person's choice within safe practice parameters.
Theory and Practice: Theory and practice are intertwined. Practice gives rise to theory which in turn leads back to practice. Nursing interactions build upon themselves with each experience lending in turn to the next nursing act. This leads to an accumulation of nursing wisdom, both within the individual and the whole of nursing.
Framework-The Human Situation: Paterson & Zderad ask "where to begin?" The domain of nursing is any and all nursing situations and covers all areas including specialty practice areas. An open framework is necessary to encompass the wide variations of nursing situations, the uniqueness of the nurse and the uniqueness of the one being nursed. "To view nursing from the perspective of the human situation, however, is to see beyond physical care, beyond the categorization of man as a biopsychosocial organism....In the humanistic perspective the nurse also is viewed a human person, as a being in a body rather than merely as a function or doer of activities". (P & Z, p. 19)
The elements of the frame then include "incarnate men (patient and nurse), meeting (being and becoming), in a goal directed (nurturing well-being and more-being) intersubjective transaction (being with and doing with) occurring in time and space (measured and as lived by patient and nurse) in a world of men and things." (P & Z, p. 18) This framework allows for the possibilities of exploring the human potential and incorporated within this framework is all the nursing phenomena experienced that can be explored in relationship to time and space. So, where to begin is answered with an open framework looking into all the possible dimensions of humanistic nursing. This transaction needs description and articulation which in turn is incorporated back into theory.
