The dialogue lived between nurse and patient is affected by their
numerous other interhuman relationships. For a nurse to be genuinely
with a patient involves her coexperiencing his world with him. His
family, friends, and significant others are a very real part of this
world whether they are physically present or distant. So to be open to
the patient is to be open to him as a person necessarily related to
other men.
Furthermore, in caring for a patient the nurse relates to him not only
as an individual patient but also as one in a group of patients. The
group may be physically present (for example, in a ward, in an intensive
care unit, in a {32} waiting room, in a dining room, in a therapeutic
group) or they may be present in the nurse's mind (for example, while
caring for one she may think "I have three more patients to visit," "so
and so needs his medication in five minutes," "I promised so and so I'd
get back to him," "three other patients are waiting to be fed"). Even
when the nurse is responsible for only one patient, she often views him
in relation to other patients she has nursed.
The nurse herself also functions within complex networks of interhuman
relationships that affect the nursing dialogue. As health care becomes
more specialized, more groups of health care workers arise and the
various groups become more diversified. So the nurse's intersubjective
transactions with her patients occur within an intra- and
interdisciplinary milieu of constantly changing personnel, functions,
and roles. While her own role is expanding, extending, deepening,
broadening, becoming more specialized, she must relate with others
undergoing similar change. And here again, as with the patients so with
her colleagues, the nurse is constantly faced with the possibility and
necessity of relating to others in terms of their functions and as
persons.
Finally, it should be recognized that while it is easy and common to
think of "the nurse" as synonymous with the function "nursing," in real
life the nurse is a human being necessarily related to others. She
learns to focus on those present in her here and now work situation. But
she too is her history and brings to her work world all that she is and
all that she is not including her past experienced and future
anticipated interhuman relationships. So each nurse affects her peopled
nursing world and is affected by it in her own unique way.
>From the other side, the patient also enters into the nursing dialogue
with his various networks of interhuman relationships. How he
experiences his relationships with his family and significant others,
with the patient groups of which he becomes a part in different degrees,
with members of various disciplines and health services groups, with
"the" nurse and "his" nurse, all influence the lived nursing dialogue.
It is always colored by the patient's current mode of interpersonal
relating. Of course, the current mode reflects his past, for example,
learned habits of response, and his future, for example, concerns about
anticipated changes in interpersonal relationships due to the effects of
his illness. In some cases, the intersubjective behavior itself becomes
the focus of the nursing dialogue as the area of the patient's greatest
needs in attaining well-being and more-being.