Humanistic nursing is dialogical in the theoretical as well as the
practical realm. Just as the meaning of humanistic nursing is found in
the existential intersubjective act, that is, in the dialogue as it is
lived out by nurse and patient in the real world, so the theory of
humanistic nursing is formed, in the dialogical interplay of articulated
experiences shared by searching, abstracting, conceptualizing nurses.
The theory of humanistic nursing originates from and is continually
revitalized and refined by actual nursing experience. But each nurse, as
a unique human being, necessarily experiences the nursing dialogue and
her nursing world in a unique way. So the development of humanistic
nursing theory rests on the sharing of individual unique angular views.
And the theory as a totality will become richer, more consonant with
reality, as it represents more and more nurses' views.
So often nurses, even nurses who know that their clinical expertise grew
out of their practice, hesitate to share their nursing experiences. They
are apt to say deprecatingly, "Oh, that's _only_ my _personal_
experience." Yet that is precisely where the value lies, in the
uniqueness of human experience. Since each nurse's description of her
nursing experience is a glimpse of a real nursing world, the views
cannot justifiably be judged as right or wrong; they simply are. Once
the various views are expressed, they can be compared and contrasted,
not for the purpose of accepting some and rejecting others but rather in
the interest of clarifying each in relation to the other. Such a
dialogue of experientially based conceptualizations can result in a
complementary synthesis. The process calls for not only a true
appreciation of personal experience by each nurse but also commitment to
a collaborative effort of open sharing by a genuine community of nurses.
This view, that the development of humanistic nursing practice theory is
a dialogical process, has led to our valuing (in fact, insisting on) the
description {78} of nursing phenomena. We see phenomenological
description as a basic and essential step in theory building. Indeed,
considering the "state-of-the-art" of nursing theory development, it is
the most crucial and immediate need.
Looking back at the historical evolvement of our humanistic nursing
approach, it is obvious that we had been using and developing a
phenomenological approach for a number of years before we graced our
efforts with the impressive label, "Phenomenological Psychiatric Mental
Health Nursing," in a course offered to a group of nurses at Northport
Veterans Administration Hospital in April 1972. Although we were aware
much earlier that our interests and work were flowing in the general
stream of phenomenology, we usually refrained from using the label
because it did little to clarify our position.[1] The term has grown
less precise with the extension of its use in different disciplines and
with variations in methodology.
When we began applying the term "phenomenological" to our work, we
learned that to many persons it sounds strange, unpronounceable,
foreign; to some forbidding; to others enticing. We later coined the
title "humanistic nursing" as being more suitable for it encompasses our
general existential bent. However, this change in title does not imply
any abandonment of our phenomenological approach. The description of
nursing phenomena is as highly prized now as ever. In humanistic
nursing, phenomenological and existential currents interrelate. Having
an existential view of nursing as a living dialogue influences which
phenomena one becomes aware of, experiences, values, studies, and
describes. Reciprocally, as one discovers and struggles to describe and
develop meaningful ways of describing nursing phenomena, the lived
nursing dialogue itself will be continually perfected.
It is more precise to speak of phenomenological methods (in the plural)
rather than phenomenological method (in the singular), for, since Edmund
Husserl's original work, the approach has been used by different
disciplines. With its spread there has developed a corresponding
variation in methodology. This, in a sense, is the beauty of
phenomenology: it thrives on variety of perspective; it allows, perhaps
requires, individual creativeness; it is always open. In this spirit,
ideas are offered here with the hope of stimulating imaginative,
critical response, and further development of methodology.
This chapter considers some of the more concrete details of
phenomenological methodology as they relate to humanistic nursing. The
general approach and procedures discussed below have been used,
individually {79} and collaboratively, by Dr. Josephine Paterson and
myself with individual and groups of nurses to explore and describe
their nursing experiences. They have helped nurses in various levels and
types of nursing service to take a fresh look at their practice and make
desirable changes. We have lived through the process with graduate
students in nursing, and it has led both the students and us to new
conceptualizations and reconceptualizations of nursing phenomena. We
have found this to be a fruitful research method when applied to
clinical nursing phenomena personally experienced and/or reported in the
literature. And we are currently exploring its potentials with
interested nurses at Northport Veterans Administration Hospital.