Humanistic Nursing by Loretta T. Zderad (good short books TXT) 📕

Then there is adolescence with all its moodiness, questions, fears, and experimenting related to adult modes of being. The moods are a mystery and the questions often unanswerable or the answers contradictory. Norman Kiell in The Universal Experience of Adolescence says that as adults we forget the intensity, turmoil, and concretes of this period and that perhaps we have to.[7] Yet, it is not possible that the instability and discomfort of spirit lived in adolescence does not leave its ingrained tracing as part of our eternal presents.

When the focus of our responsibility shifts from play to work, during these early years of becoming, depends on our particular circumstances and abilities. For most persons there is a tipping of the balance between these. Hopefully neither extreme is the master. Fortunately, in many instances, as the child's work as been to play; the adult's work world, his world of responsibility is lived, experienced by him, to an extent as play—it gives satisfaction and pleasure.

{44}

Some adults select another and are chosen by this other for a sharing of their worlds. Some go it alone. Some procreate new beings; some create in other ways; some give-take and exist; some just lean. These last appear to be, and yet to not be, "all-at-once."

Buber perceives man becoming more through his human capacity to relate to other being in all forms from the materialistic to the spiritual in "I-Thou," "I-It," and "We" ways.[8] Gestation, with the closeness of mother and child, has left man with an ingrained knowing of the experience of closeness. Thus, throughout man's life his condition of existence is affected by and desires relationship with and closeness to other being. The closeness of the conditions of gestation is never again possible, hence existential loneliness. Yet because of this prenatal experience Buber conceives of man as born with a "Thou"—another—before he is conscious of himself, his "I." With growing consciousness he sorts out his "I" from his "Thou." You can see the late infant doing, acting through, this separation. During this growing phase, often to the care-taking adult's frustration, he repeatedly, intensely, and excitedly throws his toys or bottle out of the crib, carriage, or playpen. Often he runs away from his "Thou," his parental security source, to a safe distance with intense awareness of what he is doing. While internalizing these and subsequent "Thous" as part of his "I," his knowing place, paradoxically, he sorts out who he is, and who and what is other than himself. So with ever more relationship, ever more experience, he becomes ever more the person he has the human capacity to be. He becomes more through his relations with others, never the same as these others, though he does internalize these others as part of himself.

Buber describes "I-Thou" relating, man merging with otherness, as always necessitating an "I," a man, capable of recognizing self as at a distance, apart from otherness. Therefore, his "I-Thou" relating, a merging of beings, is not like the psychological defense, unconscious identification. Buber's "I-Thou" relating emphasizes awareness of each being's uniqueness without a superimposing, or a deciding about the other without a knowing. Such relating is a turning to the other, offering the other authentic presence, allowing the authentic presence of the other with the self, and maintaining one's capacity to question. It is not then identification or an idealization of the other. Within this mysterious happening of "I-Thou" relating, when both participants are human, each becomes more. Buber refers to the event of this merging of otherness, of man with other being, as "the between." Humanistic nursing is concerned with "the between" of nurses and their others. Their others, the {45} microcosms of their communities, would be patients, patients' families, professional colleagues, and other health service personnel.

Buber describes man's ability to come to know and relate in "I-It" as man looking back, reflecting on his past "I-Thou" relations. Looking back these "I-Thou" relations are viewed as an object to be known, as "It". "I-It" relating allows man to interpret, categorize, and accrue scientific knowledge.

Finally man relates with others as "We." This permits the phenomenon of community and of adult unique contribution. So man becomes through relating with family, others, and community, like Hesse's onion or a being who actively moves toward ever more integuments, qualities, threads, and complexity.[9] Many unique contradictory type beings, then, have influenced the becoming of each individual human person. In a sense each unique person might be viewed as a community of the beings with whom he has meaningfully related in struggle and/or complementariness. In fact Buber talks of thinking man as a dialogue of internalized "Thous."

If each man can be likened to a community of his internalized "Thous," logically think of the outcome of many men struggling together supposedly for a common purpose. Since time began, man in community has been experienced by man as chaotic. Thus Plato wrote The Republic.[10] This presentation depicted an impossible scheme for developing an ideal community. As a classic, The Republic continues to be a thought provoking thesis. Its antiquity makes one realize that this desire to control, our continued concern with genetic planning, is a part of the very nature of man. And yet, considering man's ever existing recognition of the chaos of community how naive we often behave, for example, enraged at experiencing another communication break.

Plato envisioned regulating and controlling almost every dimension of the individual's existence in accordance with his particular potential for development to fulfill the needs of his ideally conceptualized community. Today Heinlein, a science fiction novelist, still writes of breeding for longevity in man, as we breed animal stock for the greatest amount of meat and profit.[11] Giving Plato his due, he recognized at the end of his book concern and doubt as to whether men so carefully mated and reared would fulfill their designated responsibilities. He wondered if things could, would, or would not go in accordance with his plan. He then logically indicated the process and kinds of community deteriorations which could ensue. Plato had a concept of an ideal community, of ideal types of necessary men, and of ideal male-female breeding relationships. He viewed our present-style family as one that saps the {46} strength of community and does not support this concept. He conceived of communal living more like the communal living of our present-day communes. However, Plato's communes would have been regulated by the plan as he conceived it. Existence in these communes was to be predetermined and very determined.

Nursing, though not generally the ruling force of this type of planning, certainly is involved in control measures analogous to Plato's. Nurses do influence who gets the hospital bed and who does not, who gets the specialized treatment and equipment, who is discharged and when, and what goes into the education and planning for post-hospital health care. Also, how do our biases influence our teaching regarding family? Innuendoes are frequent in the areas of birth control, abortion, and family size. So nurses can make a difference regarding community thought, purpose, and action.

Nietzsche put forth a concept of community of a more indefinite nature than Plato's.[12] Two major themes dominated the nature of community in his conception: (1) the legitimate purpose of community was the total support of its elite men and (2) the criterion for determining the elite was to be based on those who selected their own values with a "will" to say, "yes" to life. He referred to his elite as supermen. He questioned the realization of such a community because of the preponderance of conforming nonquestioning mediocre men. This complacent majority fearful of the different or strange would subdue the possibility of his supermen. Nietzsche did not seem to trust man; he spoke of him as "human, all too human." Unlike Plato, Nietzsche viewed "good" and "evil" as arising from a common source. Man in his humanness, Nietzsche felt, denied his animal heritage and animal qualities. Recognition of these, of one's Dionysian nature, as a source of both "good" and "evil" was necessary for becoming superman.

To me it is wondrous to ponder my own conscious purposefulness and unconscious purposelessness, my quality of force as a member of the nursing and health communities, viewed through the deep extensive conceptualized thought Nietzsche bequeathed. I offhand consider our communities as egalitarian, part of a larger egalitarian society. Are they really? Does the citizen affect the quality of organizational structure in accordance with his existential needs while in our commonplace—the health-nursing world? Whose values set and direct on this stage of life? Do I, nurse, search out the values on which I want to base my nursing practice? Do I look for direction and values from others? Did I take on values during my initial nursing experience—values never to be reexamined?

Within the nursing community are there nurses eagerly noncomplacent and desirous of looking at, of sharing their explorations, and of determining and choosing the values that they want to underlie their nursing practice? {47} Would supernurses be allowed to be the mediocre many? Who would determine the elite of the nursing community? Could supernurses survive without approval of their being different? Would they be strengthened by the fruits of suffering in their struggle within the profession? Would these fruits of suffering contribute constructively to the strengthening of the nursing community?

Buber, like Nietzsche, sees man-in-community with possibilities for evolving, being, and becoming more. Buber trusts each man as a unique potential involved in an ongoing struggle with his fellows directed toward a center.[13] His nonstatic, nonselected community where men become in and through ongoing struggle with each other expresses the reality of my nursing world. Who would expect a community without struggle if they accepted each man as his history inclusive of antecedents that go back to beginnings of man's consciousness and of anticipations that go forth into this man's notions of eternity? Considering the complexity of each man's being and becoming, it is surprising that we come to understand each other in community at all, rather than the reverse.

How can we hope for a sustained thereness, presences of nurses with other man (patients, patients' families, professional colleagues, and other health service personnel) as "We" in an ongoing struggle of community considering their multitudinous differences? Norman Cousins, in Who Speaks for Man, comments on man's inability to respond affirmatively to those he experiences as different from himself.[14] For the human community to progress he suggests federation. A unity in which differences would be valued as promoting thought, human evolvement, and community advancement. Cousins gives examples of man's inhumanity to man based on differences viewed as nonvalues. The prevalence of this latter view of differences is very evident in our commonplace health-nursing world. Can nurses and other health care maintainers look at the ways they respond to differences consciously, and can they deliberately choose to be open to responding to them as valuable? Can we conceive of there being value in that which we see as "not right," "untrue," "wrong?"

The ability to be there, to stay involved in community with my fellows, is a problem worthy of concern to me as a nurse. How do I stay in an existential way with my contemporaries, patients, patients' families when their values in reality are so different from my own? How do I go beyond a negative judgmental to a prizing attitude that would open the possibility of seeing strengths in others' views perhaps lost, discarded, or never previously existent in my own? Nonsuperimposing of my own value system through recognizing and bracketing it is a difficult professional goal. And yet, a goal that if coupled with the courage for personal existence, could sustain me in the health-nursing community. {48}

So for a health-nursing community to truly be actualized each nurse would prepare to be all it was possible for her to be as a nurse. Then, through exploration there would be a recognition of the reality of the existent community. Over time a merger of the values of the nurse and of the existing community would be reflected as moreness in each. The nurse would be more through her relation with the community; the community would be more through its relation with the nurse. Each would make an important difference in the other. The macrocosm, the community, would reflect the nurse's quality of presence. The microcosm, the nurse, would reflect the presence of the community with her. Each unique man becomes in community through communication with other uniquely different men.

[1] Plato, The Republic, trans. Francis MacDonald Cornford (New York: Oxford University Press, 1945).

[2] Wilfrid Desan, Planetary Man (New York: The Macmillan Company, 1972).

[3] John Hersey, A Single Pebble (New York: Alfred A. Knopf, 1956), p. 18.

[4] Hermann Hesse, Steppenwolf (New York: Holt, Rinehart and Winston, 1966), p. 60.

[5] Gabriel Marcel, Homo Viator (New York: Harper & Row, Publishers, Harper Torchbooks, 1962), p. 121.

[6] Teilhard de Chardin, The Phenomenon of Man