The act of nursing involves a meeting of human persons. As was noted
above, it is a special or particular kind of meeting because it is
purposeful. Both patient and nurse have a goal or expectation in mind.
The inter subjective transaction, therefore, has meaning for them; the
event is experienced in light of their goal(s). Or in other words, the
living human act of nursing is formed by its purpose. Its
goal-directedness colors the attributes and process of the nursing
dialogue.
When a nurse and patient come together in a nursing situation, their
meeting may be expected or planned by one or both or it may be
unexpected by one or both. In any case, the goal or purpose of nursing
holds. Even in a spontaneous interaction where they have met only by
chance, in a health care facility or any place where one is identified
as patient and the other as nurse, there is an implicit expectation that
the nurse will extend herself in a helpful way if the patient needs
assistance. If the meeting is planned or expected, this factor
influences the dialogue. Each comes with feelings aroused by
anticipation of the event, for example anxiety, fear, dread, hope,
pleasure, waiting, impatience, dependence, hostility, responsibility.
Another factor experienced in their meeting is the amount of choice or
control either nurse or patient had over their coming together. In
today's complex health care systems, a nurse may be assigned to care for
a particular patient, or for persons in an area or unit, or may be
called into service through a registry, {25} or may be approached
directly by a patient. From the other side, the patient also experiences
varying degrees of control over his meetings with nurses depending on
the system in which the health care is offered, his location, his
financial means, and so forth. So when a patient and nurse do meet in a
given instance, each comes to the situation bearing remnants of feeling
of having caused or not having caused this encounter with this
particular individual. (Of course, even in the most de-individualized
systems the nurse and/or patient can still control their meetings to
some extent, for example, avoidance by the nurse being too busy or
avoidance by the patient feigning sleep.)
The patient and the nurse are two unique individuals meeting for a
purpose. In the existential sense, each of these persons is his choice,
each is his history. Each comes to meet the other with all that he is
and all that he is not at this moment in this place. Each comes as a
particular incarnate being. Each is a specific being in a specific body
through which he affects the other and the world and through which he is
affected by them. This nurse who uses her eyes, ears, nose, hands, her
body, this way here and now meets this patient whose body in this
condition serves him this way here and now.
Furthermore, both the patient and the nurse have the human capacity for
disclosing or enclosing themselves. So they have some control over the
quality of their meeting by choosing how and how much to be open with
and to be open to the other. Their openness is influenced by their views
of the purpose of the meeting. In general, the patient expects to
receive help and the nurse expects to give it. However, their views may
differ on the precise need and the kind of help to be given.
Also, although the nurse and the patient have the same goal, that is,
well-being and more-being, they have different modes of being in the
shared situation. One's purpose is to nurture; the other's is to be
nurtured. This difference in the perspectives from which they approach
the meeting is reflected in the kind and degree of their openness to
each other.
In describing their experiences nurses often have revealed that they are
open to patients in a certain way. This is evident when nurse and
patient meet. The nurse may have prior knowledge of the patient, perhaps
even an image of him drawn from case history, charts, tour of duty
reports, and so forth; or she may meet him as a total stranger. But when
they come together, the nurse sees "the patient as a whole." This global
apprehension is not experienced as an additive summation but rather as a
gestalt. It may result in a very clear "picture" of the patient's
condition with nursing action initiated almost before the picture
registers in full conscious awareness. Or the perception may be
imprecise yet strong that "something is wrong." From these experiences
one may infer that a nurse's openness involves being open to what is and
to what is not in the patient's state of being as weighed against some
notion (or standard) of what "ought" to be, with the intention of doing
something about the difference. Thus, the nurse is open-as-a-helper to
the patient. This kind of openness is a quality that characterizes the
humanistic nursing dialogue. Of course, every nurse-patient meeting
differs, for each participant comes to the situation as the {26} unique
individual he is, with his own expectations and capacities for giving
and taking help.
When these factors are considered in terms of an actual personal nursing
experience (for instance, the example recalled above by the reader),
they highlight a tension in the lived nursing world. The meeting through
which the nursing dialogue is initiated and consequently is possible is,
to a certain extent, out of the nurse's control. She is assigned to
approach or she approaches the patient in terms of her function. In this
sense, "the nurse" is synonymous with the function "nursing." Yet she
experiences each meeting as herself--a unique individual person, this
here-and-now being in this body responding in this situation. She is at
once a replaceable cog in a wheel of an incomprehensibly complex system
and a unique human being sharing most intimately in another's search for
the meanings of suffering, living, dying. Can these two world views be
reconciled? How can they be lived in the nursing dialogue?