For the process of nursing to be truly humanistic it must bear out, that
is, be a lived expression of, the nurse's recognition and valuing of
nursing as an opportunity for the development of the human person. To
this end, humanistic nursing process echoes existential themes related
to a person's becoming through choice and intersubjectivity.
Existentially speaking, man is his choices. This does not mean that a
man can be anything he chooses. Naturally, each individual is unique,
having his own particular potentials and limitations. Nor is this view a
denial of the forces of unconscious motivation and habit. It does not
imply that all of a person's actions result from totally conscious
deliberations. By saying, "I am my choices," I mean I am this here and
now person because in my past life I took particular paths in preference
to others; of the possibilities open to me, I actualized certain ones.
In this sense, I am my history, I am what I am, what I have become. But
I am also what I am not, what I have not become. I am a nurse, this
unique here and now nurse with particular experience, knowledge, skills,
and values; without other experience, knowledge, skills, and values.
Through self-reflection I know that I have changed, I have experienced
growth from within. I know myself as a being capable of becoming more,
capable of actualizing my possibilities, my self. So I am my choices not
only in terms of my past but also in regard to my future, my
possibilities.
Man is an individual being necessarily related to other men in time and
space. As every man is beholden to other men for his birth and
development, interdependence is inherent in the human situation. In this
sense, human existence is coexistence. The deeper significance of this
truth has been recognized and elucidated by many thinkers, especially
those in the existential stream. Over {16} and over, their writings
reveal the paradoxical tension of being human: each man is, at once,
independent, a unique individual and interdependent, a necessarily
related being. As Wilfrid Desan says, referring to man as subsistent
relation, "He is towards-the-other but he is not-the-other."[1]
Furthermore, as Martin Buber and Gabriel Marcel maintain, it is actually
through his relations with other men that a man becomes, that his unique
individuality is actualized. To know myself as "individual" is to
experience myself as this particular unique here-and-now person and
other than that there-and-now person. Or in other words, to know myself
as me is to see myself in relation to and distant from other selves. As
Buber so beautifully states, "It is from one man to another that the
heavenly bread of self-being is passed."[2]
Logically, it follows that the possibility for self-confirmation exists
in any intersubjective situation. However, in everyday life this
self-confirmation is experienced to different degrees or on different
levels in interhuman relating. Since both persons are independent
subjects acting with their human capacity for disclosing or enclosing
themselves, there is no guarantee that the availability and presence
necessary for a genuine confirming encounter will come forth. Presence,
the gift of one's self, cannot be seized or called forth by demand, it
can only be given freely and be invoked or evoked.
Since man becomes more through his choices and the aim of nursing is to
help man toward well-being or more-being, the humanistic nursing effort
is directed toward increasing the possibilities of making responsible
choices. Such choice involves, in the first place, an openness to and an
awareness of one's own situation. A choice is a response to possibility.
Therefore, one must first recognize that possibilities or alternatives
exist. This openness to options is experienced as a freedom to choose as
well as a freedom from the bonds of habit and stereotyped response, from
routine, from the veils of the obvious. It means getting in touch with
one's experience, one's subjective-objective world. As one becomes more
acutely aware of his personal freedom of choice, there arises
concurrently an awareness of the quality of choice, of the
responsibility that is always implied in the freedom. Then follows
reflective consideration of one's unique situation with its possible
alternatives and an examination of the values inherent in them. Finally,
the act of choosing is expressed in a response to the situation with a
willingness to accept the responsibility for its foreseeable
consequences. Through this experience the person becomes aware of
himself as an individual. As a subject choosing freely and responsibly,
he knows himself as distinct from and yet related to others.
Nursing, being an intersubjective transaction, presents an occasion for
both persons, patient and nurse, to experience the process of making
responsible choices. Through living this process in nursing situations,
the nurse develops her own potential for responsible choosing. The
satisfaction, often in the form {17} of a sense of vitality and
strength, that is felt in making responsible competent professional
judgments reinforces the habit. In personally coming to experientially
appreciate the growth promoting character of responsible choosing, the
nurse may more readily recognize the value of such experiences for any
person, including the one currently labeled "patient." The humanistic
nurse, therefore, is alert to opportunities for the patient to exercise
his freedom of choice within the limits of safe and sound practice. She
is constantly assessing his capabilities and needs and encourages his
maximum participation in his own health care program. Through
coexperiencing and supporting the process in the patient's experience
from his point of view, the nurse nurtures his human potential for
responsible choosing. Both patient and nurse become more through making
responsible choices in the intersubjective, transactional nursing
situation.