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

"The aim of methodology … is to invite speculation from science and practicality from philosophy … to help us understand in the broadest possible terms, not the products of scientific inquiry, but the process itself."[3]

The above quotation expresses the spirit in which this presentation is offered. Positivistic science aims at objectivity and its results are viewed as scientific facts. Nursing practice has been understood by many as an implementation of such theoretical facts. Considering my and other nurses' implementation of such facts it is apparent that in these endeavors nurses come to know much about human existence.

Philosophy is often viewed as man's contemplations, autobiographical revelations, and the values and belief systems that underlie man's actions, Can an explicit philosophy of nursing allow for more meaningful quality practice, be a resource for nurses, improve service, be available for reexamination, correction, and the forwarding of knowledge? If nursing practice is viewed as the implementation of scientific facts and what they call forth in the nursing situation related to man's condition of existence, is a heuristic science of nursing developed from this situation, by nurses, an appropriate practical professional aim?

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This presentation is my answer, a committed "Yes."

The method offered here, a phenomenological method of nursology, aims at the reality of man, how he experiences his world, or it aims at a subjective-objective state. It aims at description of the professional clinical nursing situation which in reality is subjective-objective world that occurs between subjective-objective beings. The description focuses on this between and preserves the complex mobile flow of the river of nursing to make apparent that superficial precise portrayals are only an overlay of its river bed, course, and eventual destinations.

The relevance of phenomenological nursology ranges from the formulation of nursing constructs to the creation of theoretical propositions. It is applicable to one's own clinical data and to others' clinical data, here and now, or in historical study of the literature.

This method addresses itself to the question: How can a nurse, a subjective-objective human being know self and the other and compare and complementarily synthesize these known betweens?

Basic to this method is a belief system, a philosophy about the nature of man explicitly commented on by thinkers throughout human history.

Plato said:

"I cannot be sure whether or not I see it as it really is; but we can be sure there is some such reality which it concerns us to see."[4]

Nurses are with other men in times of peak life experiences under the most intimate circumstances. We, too, can not be certain about what we come to know in our betweens. We can be sure that these realities of human experience are worthy of exploration. Our opportunities are unique, only we can describe man in the nursing situation.

In Let Us Now Praise Famous Men, James Agee voices a similar concern about the need to describe man-in-his-world and the adequacy of human description.[5] Aware of the wonders and complexities of man he considers not trying to describe worse than the inadequacy of description.

Thinkers have also acknowledged that we can come to know from others. A poem by Goethe expresses an attitude about this:

    "Somebody says: 'Of no school I am part,
    Never to living master lost my heart;
    Nor anymore can I be said
    To have learned anything from the dead.'
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    That statement—subject to appeal—
    Means: 'I'm a self-made imbecile.'"[6]

In nursing what better master than the nursing situation in which we become through our relations with others. Each human person has something unique to teach us if we can but hear.

About our inadequacies of expression, many things are, are true, "all-at-once." The law of contradiction does not apply in-the-lived-experienced-world. We each view the world through our unique histories. Wisdom is many sided truth. Wisdom cannot be expressed "all-at-once." Truths can be stated only in sequence or metaphorically. If I were supercritical of my human limitations to express "all-at-once" wisdom, I would say nothing. Jung points up the dangers of this, he says:

"I must prevent my critical powers from destroying my creativeness. I know well enough that every word I utter carries with it something of myself—of my special and unique self with its particular history and its particular world."[7]

Each nurse's uniqueness dictates then a responsibility to share her particular knowing with fellow struggling human beings. Only through each describing can there be correction and complementary synthesis to movement beyond.

The nurse's world is an experiential place for becoming influenced by each participant's "here and now" inclusive or origin, history, and hopes, fears, and alternatives of the confronting future. Positivistic science focuses on selected particulars. Henri Bergson says:

"… for us conscious beings, it is the units that matter, for we do not count extremities of intervals, we feel and live the intervals themselves."[8]

Each human participant in the nursing situation has a unique flow of consciousness which is intersubjectively influential.

So as human nurses we are limited in our ability to express the reality of our-lived worlds. Yet, also, this world depends on and demands that we, as human nurses, give it meaning, understand it in accordance with our {69} humanness. Will and Ariel Durant, historians, professionals who are forced to selectively present the world for other humans, say:

"The historian will not mourn because he can see no meaning in human existence except that which man puts into it: let it be our pride that we ourselves may put meaning into our lives, and sometimes a significance that transcends death."[9]

Humans are the only beings conscious of themselves. Nurses are human beings. As such we are capable of looking at our existence, choosing our values, giving our world meaning and of constantly transcending ourselves, or becoming more. If we value and prize our human nursing world and our human potential for consciousness and expression, we will actuate our potential and conceptualize our human nurse-world. This suggests questions to me. What do I want nursing to be? How can I influence the meaning of the term, nursing? How committed am I? What investment am I willing to make? Will I risk exploring and saying what I see in my nursing world? Am I open to knowing? How can I actuate my uniqueness to allow the realistic potential of my nursing profession to become, become ever more? Am I contributing my "nursing here and now" to nursing's history through a lasting form of expression? Of what importance is what I think or say; do I make any difference? Hermann Hesse says of each man's uniqueness:

"… every man is more than just himself; he also represents the unique, the very special and always significant and remarkable point at which the world's phenomena intersect, only once in this way and never again."[10]

Or, a nurse might say:

"… every nurse is more than just herself, she also represents the unique, the very special and always significant and remarkable point at which the nursing world's phenomena intersect, only once in this way and never again."

To me, human freedom means recognizing our unique potential, responsibility, and limitations. Our singularity as a nurse among nurses, then, confronts us with a responsibility that belongs to one else. Martin Buber, philosophical anthropologist says:

"As we become free … our responsibility must become personal and solitary."[11]

Our unlikeness to other nurses is a lonely, very person conditioned state. Only each nurse can be responsible for herself. The wonders of freedom are {70} paradoxically, "all-at-once," both a delight and a burden. In nursing it is important for us to understand freedom not as opposing or agreeing: freedom is choosing—choosing and saying "yes" to one's self.

Human endeavor between man and men in their-worlds, in this instance professional clinical nursing, if explored and described is viewed as contributing to man's human evolvement and to knowledge of the human condition and how man becomes.

Integrally all the above statements are the bases and biases of this human phenomenological method of nursology. In a phrase, I suppose what all these starting point statements say is: Nursing situations make available human existence events significantly worthy of description. Only human nurses can describe them. Humans' ability to describe reality adequately has its limits. We should describe since pridefully we humans are the only existing beings capable of giving meaning to, looking at, and expressing our consciousness. In the long run this effort could yield a nursing science.

Phase I: Preparation of the Nurse Knower For Coming to Know

This method engages the investigator as a risk taker and as a "knowing place." Risk taking necessitates decision. Decision imposes confronting ambivalence in one's self. The ambivalence of wanting to be "all-at-once" responsible and dependent. Superimposing an already accepted and acceptable structure on data is safe feeling. Approaching the situation or data openly, letting the structure emerge from it, not deciding what to look for, being willing to be surprised, give feelings of excitement, fear, and uncertainty. There exists the possibility that our humanness may include the dilemma of our not being able to perceive the messages of our data, that we will not be able to merge with it and become more. The question arises, Are we knowing places that can relate to otherness and intuitively synthesize knowledge? This process of accepting the decision to approach the unknown openly is experienced as an internal struggle and we become consciously aware of our rigidity and satisfaction with the status quo. Conforming to the usual, in this case positivism, gives a security that is not easily relinquished despite the advantages of actualizing our unique responsible freedom.

Russell's metaphorical phrase, "windows always open to the world," depicts the sought state of mind. His elaboration on this phrase gives the flavor of the process of preparing the mind. He says, "Through one's windows one sees not only the joy and beauty of the world, but also its pain and cruelty and ugliness, and the one is as well worth seeing as the other, and one must look into hell before one has any right to speak of heaven."[12] Pain, cruelty, ugliness, hell seem appropriate words to convey seeing our {71}long-cherished ideas and values, our security blankets, as only false gods. Nietzsche in speaking of confrontation of one's values said, "And now only cometh to him the great terror, the great outlook, the great sickness, the great nausea, the great seasickness."[13] So this human methodology seeks a condition of being in the investigator. The investigator must be aware of her own angular view and democratically open to giving the angular views apparent in the data, the called for representation.

The first phase of this method of research correlates well with the struggle experienced by me in clarifying my approach to patients in public health, medical-surgical, and psychiatric mental health situations. In these situations, one truly has to struggle with democratically keeping one's windows open to the world. And this is a continual process. Having experienced this struggle in clinical nursing made this approach to research valid and meaningful to me.

Preparing the mind for knowing in clinical or research endeavors may be accomplished by several means. One means is by immersing one's self in dramatic and literary works and contemplating, reflecting on, and discussing them as they relate to the knower's already known, in this case, nursing practice. In clinical or research nursing the selection of literary works to stimulate the opening of one's human view is based on their presentation, depictions, and descriptions of man's nature. In literature authors share their thoughts as men and present possible ways men may view and relate to their worlds.

Phase II: Nurse Knowing of the Other Intuitively

Bergson conceives of man knowing through a dilatation of his imagination getting inside of, into le durée, into the rhythm and mobility of the other. Living