HUMANISTIC NURSINGTHEORY Theorists: Josephine

Paterson and Loretta Zderad

BACKGROUND OF THEORISTS

Dr Paterson Mastered in Public Health Nursing, completed Doctor of nursing science degree at Boston University – dissertation on comfort.

Dr Zderad Mastered in Psychiatry, Doctorate at Georgetown University in philosophy with dissertation on Empathy.

Met in the 1950’s while working at Catholic University, where their task was to create a new program that would include Psychiatric and Community Health components as part of the graduate program.

Friendship that has lasted over 35years.

Shared experiences, ideas and insight to form a concept that evolved into the Formal Theory of Humanistic Nursing.

Josephine G. Paterson and Loretta T. Zderad first published their book Humanistic Nursing in 1976.

Their initial commitment to creativity conceptualize nursing constructs developed into “Nursology”, a phenomenological approach to studying nursing as an existential experience.

“Human experience”

MAJOR CONCEPTS• Humanistic nursing theory is ‘Multidimensional ’ and it is an ‘Interactive Theory’.

• In Humanistic nursing theory the components identified as humans are the patient (can refer to the person, family, community ) and the nurse.

Person who sends call for help is the patient

Person who recognizes . and responds to the call

is the nurse

• ”Dialogue’’ which provides methadological bridge between theory and practice•Dialogue – Nurturing of ‘wellbeing’ and ‘morebeing’• . What happens during this dialogue, the

“and” in the “call-and-response”, the between, is

nursing

CONCEPTUAL FRAMEWORK

• Although the call and response is between the nurse and the patient, it is important to understand that all else that makes the individual person to interact.

• The nurse interweaves her professional identity and professional education, with all her other life experiences to create her own tapestry, which she projects through her nursing responses.

METAPARADIGMS

PERSON

NURSINGHUMANISTIC CARING

HEALTH ENVIRONMENT

PERSON

Person is viewed as an “Incarnate being” always becoming in relation with man and things in a world of time and space’’

Person have the capability of self reflection.

NURSINGNursing is conceptualized as a lived human act , a response to a human act ,a response to human situation .

The dialogical quality of nursing is emphasized; nursing is viewed as a transaction between persons.

HUMANISTIC NURSING

• Transactional relationship whose meaningfulness demands conceptualization founded on a nurse’s existential awareness of self and the other.

• Humanistic nursing aims at the development of human potential , at wellbeing and more being

HEALTH

• Nursing’s concern is said to be ‘not merely with a person’s wellbeing but within his morebeing; with helping him become more as humanly possible in his particular life situation.

• Wellbeing and Morebeing, that health

is conceptualized as somewhat more than the freedom from disease.

ENVIRONMENT

View person as actually living in two worlds.o An angular, inner world, also described as a

biased or shaded reality.o The objective world , of persons and things.

Openness to and acceptance of the other’s inner world is essential for true interaction between persons.

PHENOMENOLOGICAL DESCRIPTION

The existential literature, descriptions of what man has come to know and understand in his experience, has evolved from the use of the phenomenological approach.

In phenomenology a statement’s validity is based on whether or not it describes the phenomenon accurately.

Succession within the nurse from the many to the paradoxical one

Nurse complementarily synthesizing known others

Nurse knowing the other scientifically

Nurse knowing the other intuitively

Preparation of the nurse knower for coming to know

PHASES OF PHENOMENOLOGICAL DESCRIPTION

1.Preparation of the nurse knower for coming to know

Understanding own viewpoint/angle helps to make sense and aid in acquiring meaning of experience

”Angular view involves the gestalt of the human.

She struggles with understanding and identifying her own “angular view”

Being open to new and different ideas/understandings is a necessary position in being able to get to know the other intuitively

2.Nurse knowing the other intuitively

3.Nurse knowing the other scientifically

4.Nurse complementarily synthesizing known others

• The ability of the nurse to develop or see themselves as a source of knowledge,

to continually develop the nursing community through education, and increased understanding of their learned experiences.

5.Succession within the nurse from the many to the paradoxical one

•Allows for reflection, correction and expansion of own angular interpretation• Implies universal understanding from the simplest to most complex dialogue and interactions between the nurse and assimilates patient experience.

USE OF THEORY IN RESEARCH

• The Phenomenological method is proposed as a descriptive approach for participants in the nursing situation to study ,interpret ,and attest the nature and meaning of the lived events .

• A group research project that was conducted in the clinical setting of a psychiatric hospital by Paterson and Zderad (1988)

An effort to better understand why some patients stayed in the day hospital and others left, the nursing staff conducted a phenomenological study that investigated the experiences of patients as they enter and become engaged in treatment in a day hospital system.

The initial step in the process, in Dr. Paterson’s and Dr. Zderad’s terms, is to prepare the nurse knower for coming to know.

Literature was handed out on this and meetings were held to discuss the articles and any questions about them. They also shared their feelings about this method, their concerns, and other experiences related to this study.

As they did this, they began to establish an atmosphere of openness and trust.

• . Once the descriptions were obtained , they interpreted with the phenomenological method of reflecting, intuiting, analyzing, and synthesizing.

They interviewed 15 patients over a period of 8 months, on their day of admission and every 4 weeks thereafter until discharge.

They found from interviews that there were many anxiety-producing experiences on the first day in the day hospital, but very few anxiety-reducing experiences that offered the patient comfort and support

• After reviewing the interviews of a patient who had a particularly difficult course of treatment, one of the nurses who was on her treatment team remarked, “We weren’t listening to what she was telling us—we just didn’t hear the pain. ”Another nurse had a similar insight into a patient’s experiences

In future interactions with this patient the nurse was empathic and supportive rather than judgmental and angry.

APPLICATION TO NURSING PRACTICE

• The bounded concern for attention to physical status gives support for application of the theory

• The difficulty of continuous “active presence “ with the whole of the nurse’s being is addressed by the theorists

• Have limited applicability in situations in which the nurse as helper interacts with a child or comatose patient

EVIDENCE BASED PRACTICE

Humanistic nursing theory : application to hospice and palliative care .

Wu HL, Volker DL2011 Jul 20

DISCUSSION Theoretical concepts relevant to hospice and palliative

nursing included call-and-response ,inter-subjective transaction, and uniqueness –otherness.

• IMPLICATIONS FOR NURSING The philosophical perspectives of Humanistic

Nursing Theory are relevant to the practice of hospice and palliative care nursing . By being with and doing with hospice and palliative nurses can work with patients to achieve their final goal in the last phase.

• CONCLUSION . Use of core concepts from Humanistic Nursing Theory can provide a unifying language for planning care and description of investigations. Future research efforts in hospice and palliative nursing should define and evaluate these concepts for efficacy in practice settings.

CONCLUSION

REFERENCE1. Fitzpatrick J, Whall A. Conceptual models of nursing:

analysis and application. Bowie (ML): Robert J Brady co; p. 181-200.

2. Marilyn EP. Nursing theories and nursing practice. Philadelphia (AS): FA Davis Company; p. 152-67

3. Josephine Paterson and Loretta Zderad . The Project Gutenberg eBook: Humanistic Nursing. 2008; p. 3-112

4. Ellis R. Annual review of nursing research: philosophic inquiry. New York: Springer Publishing Company; p. 211-228

Thank you