Humanistic Nursing, Loretta T. Zderad [ebook reader for comics .txt] 📗

of angular views expressed by several professionals in responding to and describing a similar situation. I can accept each description as truth for each responder. Each responds with his uniqueness in the situation. Comparing, contrasting, and complementarily synthesizing these multiple views inclusive of their inconsistencies and contradictions, none negating the other, allows a better understanding of man-in-his-world in the health situation than the so frequently presented oversimplifications. These oversimplified presentations usually deal only with what is occurring that is important to the particular interests of the reporter. And they are offered only after the selected material has been put through a process of interpretation and logical sequencing to emphasize the reporter's particular point. In such reporting the existent in the situation labeled unimportant, unacceptable, or unrelated is not considered. Such existents, nonetheless, may control the patients, the families, the nurses and health professionals generally. Their control may well be more powerful than any erudite oversimplification or its presentation.

Humanistic nursing practice theory in asking for phenomenological descriptions of the nurse's lived-world of experiencing proposes authentic awareness with the self of what is existent in the situation prior to conceptualization for dispersal. Unless nurses appreciate and give recognition to the dynamic meaningful breadth, depth, and future influence of their worlds the actualization of the potential thrust of the nursing professional will never be or become.

A THEORY OF NURSING

A human nurse nurses through a clinical process of "I-Thou, I-It, all-at-once to comfort." {112}

"I-Thou" is a coming to know the other and the self in relation, intuitively.

"I-It" is an authentic analyzing, synthesizing, and interpreting of the
"I-Thou" relation through reflection.

The "all-at-once" symbolizes the multifarious multiplicities of extremes (incommensurables, criticals, nonconsequentials, contradictions, and inconsistencies) as metaphorically representative of what exists in the nurse's world.

"Comfort" is a state valued by a nurse as an aim in which a person is free to be and become, controlling and planning his own destiny, in accordance with his potential at a particular time in a particular situation.

FOOTNOTES:

[1] Josephine G. Paterson, "A Perspective on Teaching Nursing: How Concepts Become," in A Conceptual Approach to the Teaching of Nursing in Baccalaureate Programs, a report of a project directed by Rose M. Herrera (Washington, D.C.: The Catholic University of America, School of Nursing, 1973), pp. 17-27.

[2] American Nurses' Association, Division on Psychiatric-Mental Health Nursing, Statement on Psychiatric Nursing Practice (New York: American Nurses' Association, 1967), p. IV.

[3] Plutarch, "Contentment," in Gateway to the Great Books, Vol. 10, Philosophical Essays (Chicago: Encyclopaedia Britannica, 1963), p. 265.

[4] Viktor E. Frankl, From Death-Camp to Existentialism (Boston: Beacon Press, 1961), p. 103.

[5] Ibid., p. 110.

[6] Bertrand Russell, The Autobiography of Bertrand Russell (Boston: Little, Brown and Company, 1968) and An Outline of Philosophy (Cleveland: The World Publishing Company, 1967).

[7] Frederick Nietzsche, "Beyond Good and Evil," trans. Helen Zimmern, in The Philosophy of Nietzsche (New York: The Modern Library, 1927) and "Thus Spake Zarathustra," trans. Thomas Common, in The Philosophy of Nietzsche (New York: The Modern Library, 1927).

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

[9] Karl Popper, Conjectures and Refutations (New York: Basic Books, Publishers, 1963).

[10] John Dewey, The Knowing and the Known (Boston: The Beacon Press, 1949) and "The Process of Thought from How We Think," in Gateway to the Great Books, ed. Robert W. Hutchins, et al. (Chicago: Encyclopaedia Britannica, 1963).

[11] Martin Buber, Between Man and Man, trans. Ronald Gregor Smith (Boston: Beacon Press, 1955); I and Thou, 2nd ed., trans. Ronald Gregor Smith (New York: Charles Scribner's Sons, 1958); The Knowledge of Man, ed. Maurice Friedman (New York: Harper & Row, Publishers, 1965).

[12] Henri Bergson, "Introduction to Metaphysics," in Philosophy in the
Twentieth Century, Vol. III, ed. William Barrett and Henry D. Aiken
(New York: Random House, 1962) and "Time in the History of Western
Philosophy," in Philosophy in the Twentieth Century, Vol. III, ed.
William Barrett and Henry D. Aiken (New York: Random House, 1962).

[13] Norman Cousins, Who Speaks for Man (New York: The Macmillan Company, 1953).

[14] Pierre Teilhard de Chardin, Letters from a Traveler, (New York: Harper & Row, Publishers, 1962) and The Phenomenon of Man (New York: Harper Torchbooks, Harper & Row, Publishers, 1961).

[15] Nietzsche, The Philosophy of Nietzsche, p. 441.

[16] Buber, The Knowledge of Man, Appendix, p. 168.

[17] Wilfrid Desan, Planetary Man (New York: The Macmillan Company, 1972), p. 77.

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

{113}

APPENDIX NURSE BEHAVIORS EXTRACTED FROM CLINICAL DATA

In pursuing the idea of conceptualizing comfort as a proper aim of psychiatric nursing I extracted 12 nurse behaviors from my clinical data that were used repeatedly to increase patient comfort. I quantified these behaviors for two months. The following are a list of these behaviors with a representative example of all but the first. The first was too general and continuous for example.

1. I focused on recognizing patients by name, being certain I was correct about their names, and using their names often and appropriately. I also introduced myself. Names were viewed as supportive to the internalization of personal feelings of dignity and worth.

2. I interpreted, taught, and gave as much honest information as I could about patients' situations when it was sought or when puzzlement was apparent. This was based on the belief that it was their life, and choice was their prerogative since they were their own projects.

Examples

(a) While drinking coffee with a few patients at the dining room table suddenly we could hear Sidney, in his customary way, wailing, moaning, and muttering in another room. It is a sad sound. I was about to get up and go to him as I often do, when Arthur, who was sitting next to me, face working, and tense posture-wise, aggravatedly said, "Sidney doesn't have to do that, he should control himself, the rest of us control ourselves." I said, "When others express how miserable they feel, it sometimes arouses our own feelings about our misery." This was an attempt to provoke 32-year-old Arthur to work on his own {114} feelings of misery and to deter his projection of anger at himself out onto Sidney. Arthur looked at me sharply, like he had gotten the message, and agreed by relaxedly nodding his head.

(b) Alice, diagnosed as manic depressive, has been depressed. This depression dates from her going out to a department store and asking for a job. She was hired for a five-day-a-week job. This was done on her own. Later her readiness for a five-day-a-week job and her participation in the unit were questioned. Then Alice became depressed.

Alice was sitting in the dayroom. I sat down next to her. She looked very sad, her eyelids as well as her mouth, drooped. Her mouth worked as if she wanted to talk, but she was quiet. I asked her about her job decision. She said that she had not taken it. I said, "You look so sad that I feel like holding your hand." Her hands were in her coat pockets, but she looked at me and smiled weakly. I said, "Sometimes a conflict of wanting to do two things at once in the present and not being able to can bring up the feelings of a past very much more important similar experience." Alice just shook her head up and down and looked at me. Alice is in her mid-forties. Later I was walking down the hall to leave saying goodbyes to various people. Alice came out of a side room, put both her hands out to me, and said, "goodbye and thank you." In a previous contact Alice had discussed her suicidal thoughts with me.

3. I verbalized my acceptance of patients' expressions of feelings with explanations of why I experienced these feelings of acceptance when I could do this authentically and appropriately.

Example

I met a new patient at coffee. Later she was the only patient in the dayroom when I went in. She had not spoken at coffee. Now she sat very stiffly in her chair. I sat down next to her and reintroduced myself. She looked scared but told me her name. Her shifting eyes reminded me of a cornered animal. She blurted out, "I don't believe I've met you." It was like she had said, "go away." I smiled at her and said, "We were introduced at coffee, but with so many new people it's hard to remember." Conversation continued to be tense. At one point Marion bolted from her chair toward the door. I thought she was going to leave. I stayed in my chair. She went to the fish bowl in the corner. We continued to talk about the fish. Marion came back and sat down a few seats away from me. I said that I felt I'd been asking her an awful lot of questions but that I was only trying to get to know her. Marion seemed to relax in her chair and gave a great deal of information about herself in a strange stiff sort of way often inserting a word that did not have meaning for me. I encouraged, supported and showed my interest. Finally she said that she {115} had been admitted to McLean in her third year of nurses' training just before her psychiatric experience. She had been in therapy there, one-to-one for a couple of years. I teased her about knowing the ropes, yet giving me a difficult time. This was an attempt to increase her feelings of adequacy by bringing out the similarities of the old situation which she knew and this new situation. For the first time she really grinned at me, almost laughed. Marion is in her early thirties.

4. When verbalizations of acceptance were not appropriate, I acted out this acceptance by my behavior of staying with or doing for when appropriate.

Example

Mary is a middle-aged patient who, on her first days in the unit, was liberally gobbling her food with alertness for only more to be had. Her only rather loud, irrelevant, smiling expression was about her daughter who was a go-go dancer, had three children, and whom she had visited twice by bus in California. This day she approached me and asked if I would file her nails. I said that I would but asked if she knew if there was a file in the unit. Another patient offered his. We sat down and I filed. The patient poured out a life story full of misery. This was a side of this patient that I had not perceived. I listened, nodded, and filed. The story started in the 1930s about her husband and mother-in-law's behavior; their marital separation; his being killed in World War II; their two children; their son, now thirty, was born with cerebral palsy, is blind and mute, and has been institutionalized since eleven months old; their daughter's husband left her with three children after fourteen years of marriage. I silently wondered what old feeling might have been aroused in her by her daughter's marital separation. Her daughter is so busy that she is unable to write regularly. She has told Mary not to worry if she doesn't hear from her. Mary then expressed concern over not receiving her usual letter this week from her mother, whom she visits. Mary had tried to reach her by phone and would again. I inquired if her mother lived alone. Yes, but next to relatives. She then related the drastic physical problems of a relative. I felt the sadness of this woman as she talked and empathized with the tough time she had had.

5. I expressed purposely, to burst asunder negative self concepts, my authentic human tender feelings for patients when appropriate and acceptable.

Example

I was sitting in a rather large group of patients in the dayroom. A casual conversation ensued about Thanksgiving as it had been and Christmas as it might be. There was talk of having been at home and plans for being at home. I