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

"… an absolute can only be given in an intuition, while all the rest has to go with analysis."

"… from intuition one can pass on to analysis, but not from analysis to intuition."

"… fixed concepts can be extracted by our thought from the mobile reality; but there is not means whatever of reconstituting with the fixity of concepts the mobility of the real."[14]

The known, clinical nursing practice, gave meaning to the above for me. Over the years in nursing conferences I had been told my grasp of nursing situations was intuitive. Most times this was offered rather disparagingly although the nursing outcomes were most times successful. Along with having {72} the attribute of intuition assigned to me persons often asked, "Why are you so fascinated with other persons' situations?" Together these relate to Dewey's view of intuition. He views intuition as a mulling over of conditions and a mental synthesis that results in true judgments since the controlling standards are intelligent selection, estimation, and problem solution.[15] In nursing practice research knowing the other and how he experiences and views his world is viewed as the problem.

Knowing intuitively, as described by Bergson, is comparable to Buber's considerations of man's necessary mode of becoming through "I-Thou" relation. The criteria Buber describes as characteristic for "I-Thou" relation are subscribed to in my approach to nursing practice and in this human or phenomenological nursology approach.[16] Buber held as prerequisite for intuitive type knowing of the other, or imagining the real of his potential for being, a knower, and "I," capable of distance from the other, able to see the other as a unique other, one who turns to the other, makes his being present to the other, and allows the other presence. The knowing, "I," in this case the nurse, responds to the other's uniqueness, does not superimpose, maintains a capacity for surprise and question, and is with the other, as opposed to "seeming to be." This kind of relating cannot be superimposed on a nurse clinician or researcher. It must be personally responsibly chosen and invested in.

The approach then of the second phase of this method and of the transactional phase of nursing when nurses are in the arena with others is the same. This method proposes that to study nursing from outside the arena for purposes of objectivity bursts asunder the very nature of nursing practice. The studier is a part of that which is being studied. Observations interpreted from outside the situation could be classified only as projections.

Phase III: Nurse Knowing the Other Scientifically

Bergson believes man knows incompletely through standing outside the thing to be known, metaphorically walking around it, and observing it. This analytical process, this viewing of a thing's many aspects, he conceives as the habitual function of positive science. This is the third phase of this phenomenological nursology method. Bergson says:

"… analysis multiplies endlessly the points of view … to complete the ever incomplete representation."

     "All analysis is thus a translation, a development into
     symbols, a representation taken from successive points of
     view."

     "Analysis … is the operation which reduces the object to
     elements already known, that is, common to that object and to
     others."[17]

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So phenomenological nursology proposes that after the studier has experienced the other intuitively and absolutely, the experience be conceptualized and expressed in accordance with the nurse's human potential. Humanly we can express only sequentially while our actual experienced lived worlds flow in an "all-at-once" fashion. Our words are known symbols and categories used to convey the experience and thus deny the uniqueness of each realized experience.

Buber's description of man's "I-It" way of relating to the world is in agreement with Bergson. He conveys the necessity of this kind of relating by man to his world; and despite its lacks proposes that man prize his analytical ability. Like Bergson, Buber views knowing as a movement from intuition to analysis, and not the other way around. Buber sees knowledge expressed or science created through the knowing "I" transcending itself, recollecting, reflecting on, and experiencing its past "I-Thou" relation as an "It." This is man being conscious of, looking at, himself and that which he has taken in, merged with, made part of himself. This is the time when he mulls over, analyzes, sorts out, compares, contrasts, relates, interprets, gives a name to, and categorizes.

The third phase of this methodology is the same as that phase of clinical nursing practice in which the nurse, removed from the nursing arena, replays and reflects on this area and transcribes her angular view of it. In this reflective state the nurse analyzes, considers relationships between components, synthesizes themes or patterns, and then conceptualizes or symbolically interprets a sequential view of this past lived reality. The challenge of communicating a lived nursing reality demands authenticity with the self and rigorous effort in the selection of words, phrases, and precise grammar.

Phase IV: Nurse Complementarily Synthesizing Known Others

In this phase of the methodology the nurse researcher, the knower, compares and synthesizes multiple known realities. Buber says of comparison:

"The act of contrasting, carried out properly and adequately, leads to the grasp of the principle."[18]

In this comparison and synthesis the "I" of the researcher assumes the position of the knowing place. The knower, like an interpreter, allows dialogue between the multiple known realities. These realities are unknowable to each other directly. The knower interprets, sorts, and classifies.

In the human knowing place discovered differences in similar realities do not compete, one does not negate the other. Each can be true, present, "all-at-once." Differences can make visible the greater realities of each. Desan, the philosopher, says of this kind of synthesis:

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"… a synthetic view where two or more positions are seen to illuminate and to transfigure one another through their mutual presence."[19]

The knower alert to an aspect present in a single reality can question the other reality on this aspect. This aspect may be present in both, more blatant in one than in another. Its forms may be different or modified in each. It may be totally absent in one. Differences found may arouse or bring to consciousness other questions to ask of the data. This oscillating, dialectical process continues throughout reflection on the multiple realities. This indirect dialogue is recorded by the investigator as the complementary synthesis.

This synthesis is more than additive because it allows mutual representation and the illumination of one reality by another.

The fourth phase of this research methodology is like that phase of clinical nursing in which a nurse compares and synthesizes the similarities and differences of like nursing situations and arrives at an expanded view.

Phase V: Succession Within the Nurse From the Many to the Paradoxical
One

This phase of phenomenological nursology is highly probable if not absolutely necessary. Desan says:

     "Truth emerges in and through the relational operation. For the
     way of paradox is the way of truth."[20]

The investigator may struggle with the multiplicity of views now consciously part of and within herself. Again Desan:

     "… this unrest "is" the mind of man, reaching its center….
     From this center the splendor of multiplicity is visible."[21]

The researcher, mulling over and considering the relationships between the multiple views, insightfully corrects and expands her own angular view. This is not a right-wrong type of correction. Such correction would amount only to an ongoing eternal recurrence of a frustrating nature. Rather this correction takes the form of ever more inclusiveness. Struggling with the communion of the different ideas the knower takes an intuitive leap, through and yet beyond these ideas, into a greater understanding. She then may come up with a conception or abstraction that is inclusive of and beyond the multiplicities and contradictions.

This inclusive conception or abstraction is an expression of the investigator in her here and now, with the old truths and the novel truths, none obliterated.

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The fifth phase of this phenomenological nursology method can be equated to that phase of clinical professional nursing in which the nurse propels nursing knowledge forward. In this phase a nurse struggling with the mutual communion of multiple nursing situations arrives at a conception that is meaningful to the many or to all. From the specific concrete ideas of the many situations she moves through dilemma to resolution which is nursing expressed abstractly in units or as a whole, as one.

Experiential knowledge of nursing, years in which I came to know self and the other while implementing scientific facts, allowed me as a knower to recognize the relevance of this philosophical nursology method. This method does not aim at conventionality. Rather it strives to meaningfully augment and share conceptualized nurse-world realities.

[1] Josephine G. Paterson, "Echo into Tomorrow: A Mental Health Psychiatric Philosophical Conceptualization of Nursing" D.N.Sc. dissertation, Boston University, 1969.

[2] Josephine G. Paterson "From a Philosophy of Clinical Nursing to a Method of Nursology," Nursing Research, Vol. XX (March-April, 1971), pp. 143-146.

[3] Abraham Kaplan, Conduct of Inquiry (San Francisco: Chandler Publishing Co., 1964), p. 23.

[4] Plato, The Republic, trans. Francis MacDonald Cornford (New York: Oxford University Press, 1945), p. 45.

[5] James Agee, Let Us Now Praise Famous Men (New York: Ballantine Books, 1939), pp. 91-102.

[6] Johann Wolfgang von Goethe, "On Originality." In Great Writings of Goethe, ed. Stephen Spender (New York: Mentor Press, 1958), p. 45.

[7] C. G. Jung, Modern Man in Search of a Soul, trans. W. S. Dell and Cary F. Baynes (New York: Harcourt, Brace and World, 1933), p. 118.

[8] Henri Bergson, "Time in the History of Western Philosophy," in Philosophy in the Twentieth Century, ed. William Barrett and Henry D. Aiken (New York: Random House, 1962), p. 252.

[9] Will Durant and Ariel Durant, Lessons of History (New York: Simon and Schuster, 1968), p. 102.

[10] Hermann Hesse, Demian, trans. Michael Roloff and Michael Lebeck (New York: Harper & Row, 1965), p. 4.

[11] Martin Buber, Between Man and Man, trans. Ronald Gregor Smith (Boston: Beacon Press, 1955), p. 93.

[12] Bertrand Russell, The Autobiography of Bertrand Russell, 1914-1944 (Boston: Little, Brown and Co., 1968), p. 97.

[13] Frederick Nietzsche "Thus Spake Zarathustra," trans. Thomas Common, in The Philosophy of Nietzsche (New York: Random House, 1927), p. 239.

[14] Henri Bergson, "An Introduction to Metaphysics," in Philosophy in the Twentieth Century, ed. William Barrett and Henry D. Aiken (New York: Random House, 1962), pp. 303-331.

[15] John Dewey, How We Think (Boston: D. C. Heath & Co., Publishers, 1910), p. 105.

[16] Martin Buber, "Distance and Relation," trans. Ronald Gregor Smith, in The Knowledge of Man, ed. Maurice Friedman. (New York: Harper & Row, Publishers, 1965), pp. 60-82.

[17] Bergson, "An Introduction to Metaphysics," pp. 303-331.

[18] Martin Buber, I and Thou, 2nd ed., trans. Ronald Gregor Smith, (New York: Charles Scribner's Sons, 1958). pp. 3-34.

[19] W. D. Desan, Planetary Man (New York: The Macmillan Company, 1972), p. 77.

[20] Ibid.

[21] Ibid., p. 80.

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7

Humanistic nursing is dialogical in the theoretical as well as the practical realm. Just as the meaning of humanistic nursing is found in the existential intersubjective act, that is, in the dialogue as it is lived out by nurse and patient in the real world, so the theory of humanistic nursing is formed, in the dialogical interplay of articulated experiences shared by searching, abstracting, conceptualizing nurses.

The theory of humanistic nursing originates from and is continually revitalized and refined by actual nursing experience. But each nurse, as a unique human being, necessarily experiences the nursing dialogue and her nursing world in a unique way. So the development of humanistic nursing theory rests on the sharing of individual unique angular views. And the theory as a totality will become richer, more consonant with reality, as it represents more and more nurses' views.

So often nurses, even nurses who know that their clinical expertise grew out of their practice, hesitate to share their nursing experiences. They are apt to say deprecatingly, "Oh, that's only my personal experience." Yet that is precisely where the value lies, in the uniqueness of human experience. Since