This chapter explored the basic view of humanistic nursing as a
phenomenon in which human persons meet in a nurturing, intersubjective
transaction. Beginning with the central intuition that nursing is lived
dialogue, the examination turned to its existential source, the nursing
situation as it is lived. Reflection on actual experience clarified the
phenomena of meeting, relating, presence, and call and response as they
occur in humanistic nursing. Dialogical nursing was then reconsidered in
broader perspective as it actually evolves in the real world of men and
things in time and space.
As scientific advances multiply in the health field, nursing is swept
along in the tide. Continuous technological changes, ever increasing
specialization, emphasis in nursing education and research on scientific
methodology all have marked influence on the development of nursing.
Science (with a capital S) colors the nursing world. At every turn it
permeates the nurse's being with and {36} doing with the patient. It
offers a certain security by providing a consistent and effective
approach to some problems and questions, and, in some cases, results in
general laws to guide practice. At the same time, in the lived nursing
world the nurse experiences a reality that is not open to the scientific
approach, a reality not always verifiable through sense perception, a
reality of individuality. The uniqueness of individuality (her own as
well as the patient's) pervades the nursing dialogue.
The ever-present individual differences may be regarded as intractable
elements to be conquered for the sake of the efficiency of the system
(for example, fit the patient to the treatment program). Or they may be
valued as indicators of the inexhaustible richness of human potential to
be developed. In their daily practice, nurses are drawn toward the two
realities--the reality of the "objective" scientific world and the
reality of the "subjective-objective" lived world. This tension is lived
out in the nursing act. Doing with and being with the patient calls for
a complementary synthesis by the nurse of these two forms of human
dialogue, "I-It" and "I-Thou." Both are inherent in humanistic nursing
for it is a dialogue lived in the objective and intersubjective realms
of the real world.
In the highly complex health care system nurses experience many demands
from many directions. Their clinical judgments in daily practice must be
made within a continuous stream of decisions about priorities of
investment of their time and efforts. Sometimes, survival in the system
reduces the nurse to following the line of least resistance, that is,
responding to the immediate or to the loudest demands. However, even
with their total commitment this course of response does not guarantee
that nurses are making their greatest possible contribution to health
care. This can happen only if we are able to see demands and
opportunities in relation to our reason for being--nurturing the
well-being and more-being of persons in need.
Humanistic nursing, viewed as a lived dialogue, offers a frame of
orientation that places the center of our universe at the nurse-patient
inter subjective transaction. Insightful recognition of the lived
nursing act as the point around which all our functions revolve, could
require a Copernican revolution of orientation of some nurses. It does
provide, for all nurses, a true sense of direction that can be
actualized by each unique nurse through creative human dialogue. {37}
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