To view dialogical nursing as it is actually experienced in the real
world, one must conceive of it as occurring in time, not simply measured
time but also time as lived by patient and nurse. Certainly both
participants are caught up in measured time and this influences their
shared world, for example, eight-hour tours of duty, a day off, surgery
scheduled at 8:00 a.m., discharge in two days, visit three times a week,
clinic appointment in 30 days. Thus, to an extent, both patient and
nurse must live by the clock and calendar.
However, equally important, or perhaps even more important, in the lived
dialogue of nursing is the participants' experience of time. Some
references were made to lived time in the section on call and response
where it was noted how the nursing dialogue unfolds over time from
moments to years. How the involved persons experience this continuity is
an individual matter.
The nurse may conceive of herself as one of many persons contributing to
a continuous stream of caring for the patient. So she will give and hear
and write and read reports, note observations, keep records. She will
carry an image of the patient in her mind continually adding to it or
changing it with each interaction or report. Sometimes, after not seeing
the patient for a time, on meeting him again she will "pick up where she
left off," treating him as if he were the same person, as if days,
months, years of living had not intervened. "Oh, it's him again." Or she
may be startled by the visible changes and resume the dialogue from that
point. Or even if change is not visible, she may be aware that it may
have occurred and try to fill in the gap.
These possibilities may be mirrored from the patient's standpoint, for
he likewise experiences continuity or lack of it in his care. And yet,
the experience must be different for him. For instance, nurses may think
of continuity of care in terms of "coverage" for a planned program of
care. So it has often been {34} claimed that "the nurse is with the
patient 24 hours a day." From the patient's point of view this is not
true. _A_ nurse may be with him but each nurse is different. The
function of nursing may be continuous, but individual nurses come and
go; the day nurse, the evening nurse, the night nurse are each unique
individuals. And the nursing dialogue as lived, intersubjective
transaction occurs between a particular nurse and a particular patient.
When we speak of a nurse and a hospitalized patient spending a day
together, we usually are referring to eight hours out of a 24-hour day.
They may both experience the spacing of this time by functions or
activities such as meal time, medicine time, visiting time. Yet the
measured minutes and hours are experienced differently by each in their
different modes of being in the situation. Nurses often express feelings
of not having enough time to give the care they want to give; of having
too many demands on their time; of trying to "make time" for patients
who ask "do you have a minute?" Patients live their time in relation to
boredom, pain, loneliness, separation, waiting. The nursing dialogue
runs its course in clock time but both nurse and patient live it in
their private times.
When the nursing dialogue is genuinely intersubjective, it has a kind of
_synchronicity_ that is evident in the nurse's being with and doing with
the patient. This kind of timing is related to the transactional
character of nursing and to its goal of nurturing the development of
human potential. It is experienced in openness, availability, and
presence, as well as in nursing care activities. The nurse feels in
harmony with the rhythm of the dialogue and, sensing the timing of its
flow, she paces her call and response to patient's ability to call and
respond in that moment. So, as a nurse, you may find yourself almost
unconsciously or intuitively waiting, holding back, anticipating, urging
the patient. This kind of synchronization or timing is intersubjective
for the clues or reasons for encouraging or waiting are not found solely
in the patient's behavior nor only in the nurse's knowledge or
experience. "Good" or "right" timing somehow involves the "between." It
implies that nurse and patient share not only clock time but private,
lived time.