It is easy to recognize the intrinsic interrelatedness of humanistic
nursing theory and practice and the consequent necessity for their
concurrent development. It is even quite easy to take the next steps of
valuing such development and committing oneself to the task. But then
the question arises: Where to begin?
Humanistic nursing is concerned with what is basically nursing, that is,
with the phenomenon of nursing wherever it occurs regardless of its
specialized clinical, functional, or sociocultural form. So its domain
includes any or all nursing situations. And within this domain, since
humanistic nursing is an intersubjective transaction aimed at nurturing
well-being and more-being, its "stuff" includes all possible human and
interhuman responses. To conceive of so limitless a universe for study
is at once exhilarating and overwhelming. How can one get a handle on
the nursing universe? Is it possible to envision an inclusive frame that
would allow an orderly, systematic, and hopefully productive approach to
the development of humanistic nursing?
The key is to return again to the source, to look at the phenomenon of
nursing as it occurs in real life. From this perspective, the human
situation sets the stage where nursing is lived. The major dimensions of
humanistic nursing, then, may be derived from this situation.
Existentially, man is an incarnate being always becoming in relation
with men and things in a world of time and space. The nursing situation
is a particular kind of human situation in which the interhuman relating
is purposely directed toward nurturing the well-being or more-being of a
person with perceived needs related to the health-illness quality of
living. The elements of the frame, based on this view of humanistic
nursing, would include incarnate men (patient and nurse) meeting (being
and becoming) in a goal directed (nurturing well-being and more-being)
intersubjective transaction (being with and doing with) occurring in
time and space (measured and as lived by patient and nurse) in a world
of men and things. In other words, the inexhaustible richness of lived
nursing worlds could be explored freely, imaginatively, and creatively
in any direction suggested by the dimensions of this open framework. It
allows for a variety of angular views.
For example, in terms of man as incarnate, it is certainly not new for
nurses to focus on man's bodily existence. Naturally, one of nursing's
basic concerns always has been care of people's physical needs. To view
nursing from the perspective of the human situation, however, is to see
beyond physical care, {19} beyond the categorization of man as a
biopsychosocial organism. The focus is on the person's unique being and
becoming in his situation.
Every man is inserted into the common world of men and things through
his own unique body. Through it he affects the world and the world
affects him. Through it he develops his own unique personal private
world. When a person's bodily functions change during illness _the_
world and _his_ world change for him. The nurse needs to consider how
the patient experiences his lived world. Ordinary things which nurses
simply take for granted, such as, hospital noises or odors, touching,
bathing, feeding, sleep or meal schedules, may have very different
meaning for individual patients. They may or may not be experienced as
nurturing in a particular person's lived world.
In the humanistic perspective the nurse also is viewed as a human
person, as a being in a body rather than merely as a function or a doer
of activities. Conscious recognition of this fact opens many areas for
exploration. Obviously, the nurse's actions (her being with and doing
with), that affect the patient's world, are expressed through her body.
How is nurturance communicated and actually effected through nursing
activities? From the other side, consider the nurse as being affected by
the world through her body. What depths of "nursing content" could we
fathom if we accepted the existential dictum that "the body knows?"
Would we dismiss so lightly those gems of clinical wisdom nurses
attribute disparagingly to "gut reaction," "unscientific intuition," or
"years of experience"? Would we value serious exploration and extraction
of these natural resources in the nursing world?
The framework suggests, further, the possibilities of exploring the
development of human potential, both patient's and nurse's, as it occurs
in the unique domain of nursing's intersubjective transactions. What
human resources are called forth in the shared situations during which
nurses coexperience and cosearch with patients the varied meanings of
being and becoming over the entire range of life from birth to death?
How does it occur? What is the process? What promotes well-being or
becoming more when facing life, suffering, death? For the patient? For
the nurse? What knowledge gained through the study of nursing, a
particular form of the human situation, could be contributed to the
general body of human sciences?
Finally, within this framework, all the phenomena experienced in the
nursing situation could be explored in relation to their attributes of
time and space. More specifically, from an existential perspective, the
focus would be directed toward the significance of lived time and space,
that is, time and space as experienced by the patient and/or the nurse,
and as shared intersubjectively. For example, waiting, silence,
chronicity, emergency, positioning a patient in bed, moving through
space in a wheelchair, crutchwalking, pacing, could be considered from
the standpoint of the patient's experienced space and time, or from the
nurse's, or as a shared event. Explorations of this kind could provide
valuable insights into important nursing phenomena, such as, presence,
empathy, comfort, timing. {20}
The human situation, then, is the ground within which nursing takes
form. As such, it provides a framework for approaching the study and
development of humanistic nursing. As an angular view, it holds the
focus on the basic question underlying nursing practice: Is this
particular intersubjective, transactional nursing event humanizing or
dehumanizing?