Humanistic Nursing Part 17

This necessity for a nurse's duality in her mode of being came to my awareness through comparing Gilbert' and Muller's works, studying Buber's conceptions of man, and considering them in relation to my current and past lived-experiences in the nursing-arena. In my nursing world of "I-Thou" relating reflection is called forth prior to my overt response to allow response selection concordant with my nursing purpose.

The very character of multifarious multiplicities of the nursing world undoubtedly has called for nurses to develop their human capacity for duality in their mode of being.

To make these "multifarious multiplicities" explicit I would like to offer a description of a recent, personal nursing experience. In a community psychiatric mental health psychosocial clinic, I sat across from and focused on relating with a psychiatric client. After long years of hospitalization he was now living in a community foster home and visiting the clinic three days a week. When there was no special clinic activity in progress and often even when there was, he sat by himself and played poker. He told me about his game many times, over weeks and months. He dealt out five poker hands. Each hand was dealt to a member of his family, long dead. He did not accept their deadness. One day while describing the poker games and his relatives, he intermittently expressed his fantasies which he projected on to a sweet cheerful 65-year-old community volunteer. She was somewhat deaf. His fantasies were angry. When he gestured toward her, she in a motherly way came over to him, put her arm around him, and her ear down to his mouth. It was a moment of possible client explosion. With my eyes I attempted to communicate with her. This, and the tone of the patient's voice warned her to move away. While this was occurring another patient jealous of my attentions to this patient walked up and down, and in pa.s.sing negatively commented on the religious background of the man I was sitting with. In the rear of the room a dietician was conducting a group on obesity. And all of this was set to the {111} melodious, sanguine strains of "If I Loved You" being poorly beat out on a piano about ten feet away by another volunteer accompanied in song by a few clients. Meanwhile two staff nurses were observing my part in all this since I was labeled "expert." The client did support me that day and responded to my staying with him. Much to my surprise he began playing poker with me. He dealt me out a hand. This was, at this time, a new behavior on his part. It was movement toward his potential for relating to live persons in his current world. This, again, is just one example of the multifarious multiplicities of one very common type of nursing situation.

The inference from the above is that professional artistic-scientific nurses relate in "I-Thou, I-It, all-at-once" to the specific general, critical nonconsequential, and the healthy ill. This presents a paradoxical dilemma. Nurses, as human beings, have a highly developed capacity for living "all-at-once" in and with the flow of the multifarious multiplicities of their worlds. Nurses, as human beings, like all other human beings, are limited to thinking, interpreting, and expressing conceptually only in succession.

This metaphoric synthetic construct, "all-at-once," has allowed me to better convey how I experience the health nursing situation. It also has aided my understanding of the multifarious multiplicity 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 a.n.a.lyzing, 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 (Was.h.i.+ngton, D.C.: The Catholic University of America, School of Nursing, 1973), pp. 17-27.

[2] American Nurses' a.s.sociation, Division on Psychiatric-Mental Health Nursing, _Statement on Psychiatric Nursing Practice_ (New York: American Nurses' a.s.sociation, 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 Publis.h.i.+ng 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).

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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 partic.i.p.ation 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_