The term "all-at-once," arose within me as a construct that would
metaphorically describe the multifarious multiplicities that exist
within nursing situations. Completing my comparison of Gilbert's and
Muller's written works to grasp how they viewed the nature of
psychiatric mental health nursing I found myself mulling over and
fussing.[18] Your question is probably, mulling and fussing over what?
While I mulled over and fussed I believe I, too, was perplexed. Why was
I unsatisfied?
I had compared Gilbert's and Muller's writing styles, their conceptions
of man, approaches to nursing, nursing education, supervision, and
consultation. Their similarities and differences were noted, and how
each presented herself predominantly. Then I cited the nursing
communities they sought to influence and those in which they were while
writing. Through reviewing their bibliographies and biographies I
indicated the sources that had influenced them.
Still I mulled over, fussed, and was perplexed. I awakened in the middle
of one night in 1969 understanding what had been causing my struggle.
The "all-at-once" was my answer.
The description of single constructs and single examples originally had
felt unrelated to the reality of the nurse's world. They oversimplified
its complexity. The nature of nursing was complex. It seemed to me that
we needed, as a profession, constructs that simplified and allowed clear
communications. We, also, needed constructs that conveyed the reality
and complexity of the {110} worlds in which nurses nursed. Perhaps a
description of what "all-at-once" expressed for me would convey to
others the lived-unobservable-worlds of nurses.
Nurses relate to other man in situations of "all-at-once." The
"all-at-once" is equated by me to Buber's "I-Thou" and "I-It" occurring
simultaneously and not only in sequence as he expressed it. These two
ways that man can relate to and come to know his world and himself
demand sequential expression for clear communication. However, the
responsible authentic nurse in the nursing arena lives them
"all-at-once." Aware of the multifarious multiplicities of her responses
to another and at once to the surrounding field of action, the nurse
selects and overtly expresses her responses that actualize the purpose,
values, and potential of the artful science of professional nursing.
Awareness of the multifarious multiplicities affecting the other and the
self in the nursing arena is a component of "I-Thou" relating.
Selectively overtly expressing concordantly with the purpose, values,
and potential of nursing necessitates a looking at, which is a component
of "I-It" relating, while acting and being. Therefore both "I-Thou and
I-It" modes of being are "all-at-once."
This necessity for a nurse's duality in her mode of being came to my
awareness through comparing Gilbert' and Muller's works, studying
Buber's conceptions of man, and considering them in relation to my
current and past lived-experiences in the nursing-arena. In my nursing
world of "I-Thou" relating reflection is called forth prior to my overt
response to allow response selection concordant with my nursing purpose.
The very character of multifarious multiplicities of the nursing world
undoubtedly has called for nurses to develop their human capacity for
duality in their mode of being.
To make these "multifarious multiplicities" explicit I would like to
offer a description of a recent, personal nursing experience. In a
community psychiatric mental health psychosocial clinic, I sat across
from and focused on relating with a psychiatric client. After long years
of hospitalization he was now living in a community foster home and
visiting the clinic three days a week. When there was no special clinic
activity in progress and often even when there was, he sat by himself
and played poker. He told me about his game many times, over weeks and
months. He dealt out five poker hands. Each hand was dealt to a member
of his family, long dead. He did not accept their deadness. One day
while describing the poker games and his relatives, he intermittently
expressed his fantasies which he projected on to a sweet cheerful
65-year-old community volunteer. She was somewhat deaf. His fantasies
were angry. When he gestured toward her, she in a motherly way came over
to him, put her arm around him, and her ear down to his mouth. It was a
moment of possible client explosion. With my eyes I attempted to
communicate with her. This, and the tone of the patient's voice warned
her to move away. While this was occurring another patient jealous of my
attentions to this patient walked up and down, and in passing negatively
commented on the religious background of the man I was sitting with. In
the rear of the room a dietician was conducting a group on obesity. And
all of this was set to the {111} melodious, sanguine strains of "If I
Loved You" being poorly beat out on a piano about ten feet away by
another volunteer accompanied in song by a few clients. Meanwhile two
staff nurses were observing my part in all this since I was labeled
"expert." The client did support me that day and responded to my staying
with him. Much to my surprise he began playing poker with me. He dealt
me out a hand. This was, at this time, a new behavior on his part. It
was movement toward his potential for relating to live persons in his
current world. This, again, is just one example of the multifarious
multiplicities of one very common type of nursing situation.
The inference from the above is that professional artistic-scientific
nurses relate in "I-Thou, I-It, all-at-once" to the specific general,
critical nonconsequential, and the healthy ill. This presents a
paradoxical dilemma. Nurses, as human beings, have a highly developed
capacity for living "all-at-once" in and with the flow of the
multifarious multiplicities of their worlds. Nurses, as human beings,
like all other human beings, are limited to thinking, interpreting, and
expressing conceptually only in succession.
This metaphoric synthetic construct, "all-at-once," has allowed me to
better convey how I experience the health nursing situation. It also has
aided my understanding of the multifarious multiplicity of angular views
expressed by several professionals in responding to and describing a
similar situation. I can accept each description as truth for each
responder. Each responds with his uniqueness in the situation.
Comparing, contrasting, and complementarily synthesizing these multiple
views inclusive of their inconsistencies and contradictions, none
negating the other, allows a better understanding of man-in-his-world in
the health situation than the so frequently presented oversimplifications.
These oversimplified presentations usually deal only with what is
occurring that is important to the particular interests of the reporter.
And they are offered only after the selected material has been put
through a process of interpretation and logical sequencing to emphasize
the reporter's particular point. In such reporting the existent in the
situation labeled unimportant, unacceptable, or unrelated is not
considered. Such existents, nonetheless, may control the patients, the
families, the nurses and health professionals generally. Their control
may well be more powerful than any erudite oversimplification or its
presentation.
Humanistic nursing practice theory in asking for phenomenological
descriptions of the nurse's lived-world of experiencing proposes
authentic awareness with the self of what is existent in the situation
prior to conceptualization for dispersal. Unless nurses appreciate and
give recognition to the dynamic meaningful breadth, depth, and future
influence of their worlds the actualization of the potential thrust of
the nursing professional will never be or become.