The meaning of humanistic nursing is found in the human act itself, that
is, in the phenomenon of nursing as it is experienced in the everyday
world. Therefore, the interrelated practical and theoretical development
of humanistic nursing is dependent on nurses experiencing,
conceptualizing, and sharing their unique angular views of their unique
lived nursing worlds. An open framework suggesting dimensions for such
exploration was derived from a consideration of the phenomenon of
nursing within its basic context, namely, the human situation. The
elements of this humanistic nursing framework 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 (as measured and
as lived by patient and nurse) in a world of men and things.
The framework offers a little security by providing some reference
points for the exploration. However, what is gained in clarity by
conceptual abstraction is lost from the flavor of the actual experience.
Like a weather map that statically represents major factors and currents
in their interrelatedness, the framework discloses a nexus of elements.
But it is as far from the real phenomenon of nursing with its pains and
suffering and comforting and joys and hopes as the weather map is from
real weather with its wind and rain and heat and cold. This chapter is
concerned with the same basic framework of humanistic nursing but seen
in an enlivened form. To inspirit its constructs the search must return
again to the existential source, to the nursing situation as it is
lived.
When I reflect on an act of mine (no matter how simple or complex) that
I can unhesitatingly label "nursing," I become aware of it as
goal-directed (nurturing) being with and doing with another. The
intersubjective or interhuman element, "the between," runs through
nursing interactions like an underground stream conveying the nutrients
of healing and growth. In everyday practice, we are usually so involved
with the immediate demands of our "being with and {22} doing with" the
patient that we do not focus on the overshadowed plane of "the between."
However, occasionally, in beautiful moments, the interhuman currents are
so strong that they flood our conscious awareness. Such rare and
rewarding moments of mutual presence remind us of the elusive
ever-present "between."
>From these epiphanic episodes in our personal nursing experience, we
have certain and immediate knowledge of intersubjectivity. Through our
experience, too, we know that both humanizing and dehumanizing effects
can result from human interactions. Therefore, it is essential for the
development of humanistic nursing to explore and describe its
intersubjective character.
Although many nurses have agreed in principle about the importance of
this work, they also have expressed the feelings of frustration and
discouragement attending it. There are real difficulties involved in
attempting to describe something so real yet so nebulous as "the
between." The descriptions must be derived from our own real nursing
experiences. This means that we must develop habits of conscious
awareness of experience, of recall, and of reflection. Then we must
struggle with our language finding the words in our physically and
technologically oriented vocabularies, perhaps even creating terms, to
convey the substance and flavor of the experience of intersubjectivity.
Furthermore, description of the intersubjective quality of nursing is
difficult because of its peculiar pervasiveness. Whether it is
consciously recognized or not, it is part of every nursing transaction.
However, to consider and explore intersubjectivity solely as a component
or constituent of nursing, even a necessarily inherent or an essential
one, would be to see it out of true perspective. The "between" is more
than a factor or facet of nursing; it is the basic relation in which and
through which nursing can occur. So the question remains. How can our
experiences, our angular views, our glimpses of this foundation, this
necessary means of nursing, be conceptualized and shared?
Once while reflecting on the nature of nursing against a background of
notions about intersubjectivity drawn from experience and literature and
testing them against my own real life experiences of nursing, I suddenly
saw that _nursing itself is a particular form of human dialogue_. This
insight occurred to me with clarity, conviction, and all the force of a
brand new idea. It was so obvious, so distinct, so simple, so clearly a
central intuition that could illuminate the phenomenon of nursing from
within. I experienced the idea as fresh and excitingly full of promise.
Yet, when I said it out loud, "Nursing is dialogue," the words seemed
too meager to convey the true meaning of the idea and its real
significance. There was, furthermore, an annoying shadow of familiarity
lurking about it. It was almost as if I had expressed something similar
previously. At first, I hesitated to share this insight with others for
fear they would extinguish it by saying, "of course, everyone knows
that," or "I've heard you say something like that before." Still, I
experienced it as an idea I _had_ to express. Moved by the pressure of
feelings of responsibility and desire to share, in 1973 I wrote a paper,
"The Dialogue Called Nursing." {23}
In retrospect, that paper has the marks of a hesitant beginning,
restrained by cautious statements and supposedly protective references
to existential literature. Dissatisfaction with it prompted further
rethinking and revision. Searching through my files during this process,
I found, to my great surprise, some notes on the dialogic nature of
nursing written by myself three and six years previously. In fact, a
three-year-old note contained the very title, "Dialogue Called Nursing"!
Now, how is it possible to grasp a truth and then "forget" that one
knows it and later meet and grasp the old truth again as new? The
difference in these experiences of knowing, for me at least in this
case, is that now I know as if from the inside out that nursing is
dialogical. The idea seems to have sprouted out of the lived phenomenon,
to have broken forth from the ground of experience, as opposed to having
been concluded in my earlier "intellectual," "theoretical," or
"philosophical" ponderings. But how did the earlier idea, the conclusion
that nursing is dialogical, become a live option for me? Why did it
appeal to me? How did it come to make sense in the first place if not
because of my experience?
The concept and the actual experience revitalize each other. Perhaps
this is the value of an existentially grounded insight; it has a kind of
durability resulting from its continuous rejuvenation by the interplay
of experiencing and conceptualizing. Some old ideas are always new. In
this spirit, this chapter looks again at humanistic nursing as lived
dialogue.