,copyright 7,c7 #bjjg by ,josephine ,paterson and ,loretta ,zderad4 ,humanistic ,nursing 7,meta-theoretical ,essays on ,practice7 by ,josephine ,paterson and ,loretta ,zderad ,copyright 7,c7 #bjjg by ,josephine ,paterson and s,loretta ,zderad all rights reserved except as follows4 ,this e-text may be freely copied for academic and scholarly work with the copyright notice clearly affixed to all copies4 ,no commercial use may be made of any part of the text without the express permission of the copyright holders4 ,this e-text version of the classic text ,humanistic ,nursing is made available with the kind permission of the authors and copyright holders1 ,josephine ,paterson and ,loretta ,zderad4 ,the book was originally written to define the ,humanistic ,nursing ,theory which presented a way for each nurse to become-more as a person and to extend that becoming-more to the community of nurses in which he or she practices4 ,the offering of this book in the free e-text format reiterates the continuing contribution of these two nurses long after their retirement from practice4 ,it is their hope that nurses everywhere will take their vision for nursing and expand on it and integrate it into their nursing practice4 ,at the request of the authors this e-text version is complete with the original #aigf ,front ,matter4 ,susan ,kleiman ,for more information or questions about the subject of ,humanistic nursing or this e-text you may contact ,professor ,susan ,kleiman1 ,ph,d1 ,,rn1 ,,cs1 ,,npp at3 susankhumanistic-nursing4com4 ,alternatively you may visit the web site3 www4humanistic-nursing4com4 ,the ,humanistic ,nursing ,inquiry web site provides context for the major initiatives of humanistic nursing1 which celebrate the enduring and immutable ideals of ,humanism that give us insight into the fundamental truths of being in the world of nurses1 patients1 families1 colleagues1 and students4 ,,foreword to the #aigf ,edition ,these essays will evoke different reactions from different readers4 ,well1 ,i know that1 for example1 may be the reaction of a beginner in nursing2 ,i wouldn't have said it that way but ,i knew that is really nursing4 ,since they've given us a methodology1 perhaps from one more experienced in nursing2 ,i'll give it a try4 ,others with still more or different kinds of experience may respond1 ,it's about time nurses put that into words2 it's about time4 ,timely as these essays are ,i would prefer not to use up the foreword with a listing of the crises1 the eco-spasms1 and scientific triumphs that would document their timeliness4 ,it is my pleasure1 rather1 to use this opportunity to relate the six elements of my own reaction3 ,nursing has a solitariness until we find it has many companions in philosophy1 science1 and art4 ,it has a steadiness about its pace yet holds a potential for flights to higher elevations4 ,it is constantly changing yet has an enduring component of permanence4 ,good is the word we use every day2 our vision1 however1 is of excellence4 ,its tasks often have the appearance of homeliness until we glimpse that kind of beauty that is humanness4 ,nursing even sings very softly because our ears are attuned to a different drummer4 ,lilyan ,weymouth1 ,r4,n41 ,m4,s4 ,northampton1 ,massachusetts ,october #aige ,,preface to the #aigf ,edition ,out of necessity nursing1 as a profession1 reflects the qualities of the culture in which it exists4 ,in our culture for the past quarter of a century nursing has been assailed with rapid economic1 technological1 shortage- abundance1 changing scenes' vicissitudes4 ,in the individual nurse these arouse turmoil and uncertainty4 ,these cultural stirrings inflame that part of the nurse's spirit capable of chaotic conflict and doubt4 ,often she questions her professional identity4 '',just what is a nurse8 ,her nurse colleagues1 other professionals1 and nonprofessionals freely1 directly and indirectly-on television1 in the theater1 through the news media and the literature-pummel her with their multitudinous varied views4 ,as searching1 wondering1 reflecting1 relating microcosms within this perplexing health nursing world for longer than a quarter of a century1 we present this book4 ,descriptively we view the chapters as hard-wrung1 philosophical foundations1 synthesized extracts from our lived experiences4 ,these metatheoretical essays on practice present an existential alternative approach for a professional nurse's knowing and becoming4 ,these conceptualized existents are available because ,miss ,marguerite ,l4 ,burt1 formerly ,chief of ,nursing ,service1 ,northport1 ,n4,y4 ,veterans ,administration ,hospital called them forth from us4 ,these chapters are our response to her call4 ,in #aigb ,miss ,burt requested us to develop a course for the professional nursing staff at ,northport ,v4,a4,h4 ,this book has evolved from the original presentations offered to the ten participants in the first course4 ,while we taught and worked with five subsequent groups1 we learned and continually revised and clarified our conceptualizations4 ,the course is entitled ,humanistic ,nursing4 ,fifty-three nurses have been involved in this course4 ,interest1 appreciation1 wonderment1 effort1 and investment characteristically depict their response4 ,they convey that the humanistic nursing practice theory reflects what nursing means to them4 ,their hungry approach to the suggested readings has both surprised and pleased us4 ,our amazement persists over the participants' ability to concentratedly discuss abstract theory and concrete nursing practice for weekly day-long sessions over six-to nine-month periods4 ,presently requests to participate in the next humanistic nursing course are mounting from nurses both within and outside the ,northport complex4 ,the course1 the theory1 and this book are the fruits of our individual and collaborative efforts4 ,while sharing seminar responsibility for graduate students in #aifj1 we began to dialogically and -dialectically struggle with professional and _/clinical nursing issues4 ,discussing and searchingly questioning ourselves and our students became a value4 ,through conveying1 struggling for clarification1 openness to honest argument1 we grew in our awareness that each was moved beyond her beginning thoughts4 ,through reflection we have come to view1 describe1 and distinguish our dialogues as struggles with1 and not against1 others' ideas4 ,differences in response are valued for what they can tell us of our chosen area-nursing4 ,so dialectical dialogue has gradually become our predominant teaching method4 ,we convey our ideas1 are open to others' questions1 struggle to clarify and really communicate1 and question ourselves1 and others4 ,in the process of the humanistic nursing course1 using this methodology1 which is deliberate and1 yet1 natural and authentic for us1 we and our professional nursing staff students have learned and become more human1 more questioning1 more clinical1 and just1 more4 ,we value our moreness4 ,appreciating and valuing the effects of our actualizing selves as human beings1 we must attest to our existential modes of nurse being2 our inner mandate is3 share4 ,hence1 ,humanistic ,nursing has come into being4 ,to find the meaning of nursing we have returned to the thing itself1 to the phenomenon of nursing as it occurs in the everyday world4 ,our reflections on nursing as a lived experience flowed into the realm of metanursing4 ,obviously1 these thoughts are only a beginning4 ,they are offered in the hope of stimulating response and further development4 ,dialogue may be difficult at first because humanistic nursing represents one of our discipline's less articulated streams4 ,yet1 it is a stream traceable to nursing's foundation and1 as such1 is related to nursing's artistic1 scientific1 and technological currents4 ,it is not being1 cannot be1 developed in opposition to them4 ,science and art are forms of human responses to the human situation4 ,they are valued in genuine humanism4 ,thus1 the humanistic nursing approach does not reject advances in nursing technology1 but rather it tries to increase their value by viewing their use within the perspective of the development of human potential4 ,the same holds true for scientific1 artistic1 and clinical developments in nursing practice4 ,they are the necessary means through which and in which humanistic nursing 7a being and doing7 is experienced and developed4 ,at this time when serious concern is being expressed about the survival of nursing as a profession1 humanistic nursing offers a note of optimism4 ,by examining the values underlying practice1 it focuses on the meaning and means of nursing's particular' mode of interhuman caring4 ,it increases respect for that caring as a means of human development4 ,nurses have the privilege of being with persons who are experiencing all the varied meanings of incarnate being with men and things in time and space in the entire range from birth to death4 ,they not only have the opportunity to co-experience and co-search with patients the meaning of life1 suffering1 and death1 but in the process they may become and help others become more-more human4 ,beyond this1 the humanistic nursing approach respects nursing experience as a source of wisdom4 ,by describing and conceptualizing the phenomena experienced in nursing situations1 nurses could contribute to the development of nursing as a discipline4 ,even more1 they could add to the knowledge of man4 ,humanistic nursing1 then1 is neither a break with nor a repetition of nursing's past4 ,it is neither a rejection of nor a satisfaction with nursing's present4 ,rather it is an awakening to the possibilities of shaping our nursing world here and now and for the future4 ,thanks to ,miss ,marguerite ,l4 ,burt are in order for she provoked our conceptualizations of our lived nursing worlds4 ,dr4 ,frederick ,h4 ,wescoe1 while ,chief of ,nursing ,service1 ,northport1 ,n4,y41 ,,vah administratively facilitated the time and the means for our compiling these materials into a manuscript4 ,past nursing students challenged and grappled with our ideas and theirs insisting always on our forwarding our thinking4 ,our consultants1 ,miss ,lilyan ,weymouth and ,miss ,rose ,godbout1 were marvelous resources and counselors4 ,immediately we are most grateful to the participants in the six humanistic nursing courses taught here at the ,northport ,,vah4 ,as nurses1 they received and accepted our expressed ideas to the extent of testing them in the fires of their real lived nursing practice settings4 ,while struggling with our ideas and us1 they gave to us4 ,they were supportive1 loving1 and truly present with us in the community of nurses at ,northport1 ,,vah4 ,miss ,sue ,mc,cann1 clinical nurse specialist1 one of our first course participants1 has read and reviewed our materials4 ,more than this ,miss ,mc,cann has been a counselor1 resource person1 and a dependable friend in our humanistic nursing effort of the last three years4 ,we hope our chapters give back to others1 at least just a part of what we have received from them in our travels in the nursing world4 ,j4,g4,p ,l4,t4,z4 ,transcriber's ,note3 to the #aihh ,edition ,italic text has been marked as text4 ,bold text has been marked as text4 ,obvious punctuation errors in the original have been corrected4 ,other corrections are noted at the end of the text4 ,the original page numbers have been retained1 e4g4 #a marks the start of page #a in the original text4 ,,humanistic ,,nursing ,josephine ,g4 ,paterson1 ,d,n,sc1 ,,rn ,loretta ,t4 ,zderad1 ,ph,d1 ,,rn ,,preface ,somewhere there's a child a crying ,somewhere there's a child a crying ,somewhere there's a child a crying ,crying for freedom in ,south ,africa4#a ,but until someone hears the cry and responds1 the child will continue to suffer the oppression of the current ,south ,african regime2 and the world will continue to be less than it could be4 ,to cry aloud when there seems no chance of being heard1 belies a hope--perhaps an inherently human trait--that someone1 somewhere1 somehow will hear that cry and respond to it4 ,this same hope1 that someone would hear and respond1 allowed existential psychologist ,viktor ,frankl to survive the systematic torture and degradation in ,nazi death camps4 ,as ,frankl and others sought their way1 they found meaning and salvation through love and in love2 and by choosing to believe that life still waited for him1 that a human being waited for his return4#b ,there is power in the call of one person and the potential response of another2 and incredible power when the potential response becomes real4 ,there is the power for each person to change as she becomes more than she was before the dialogue4 ,there is the power to transcend the situation as two people engage the events that are whirling around them and together try to make sense of their worlds and find a meaning to their existence4 ,when the call and response between two people is as honest as it can be1 there is the revolutionary power which the poet ,muriel ,rukeyser speaks of3 ,what would happen if one woman told the truth about her life8 ,the world would split open4#c iv ,the call and response of an authentic dialogue between a nurse and patient has great power--the power to change the lived experiences of both patient and nurse1 to change the situation1 to change the world4 ,it is the same authenticity we search for in relationships with our friends and lovers4 ,the person who really listens to what we are saying1 who really tries to understand our lived experiences of the world and who asks the same from us4 ,when found1 it brings the same exhilarating feeling of self-affirmation and the comforting feeling of well-being4 ,for1 if as holistic beings we are the implicate order explicating itself1 as suggested by ,bohm#d and ,newman#e among others1 then the responsibilities of those who would help 7e4g41 nurses7 include making sense out of the chaos that can occur as illness disrupts past order and as the ever-present threat of non-being disrupts all order4 ,when we are successful in helping patients and their loved ones make sense of their lives by bringing meaning to them1 we make sense of and bring meaning to our own4 ,and when we help create meaning1 it is easier to remember why we chose nursing and why we continue to choose it despite what an underpaid and undervalued job it has become in today's marketplace4 ,these are the moments when by a look or a word or a touch1 the patient lets us know that he understands what is happening to him1 what his choices are1 and what he is going to do2 that he knows we know2 and that each knows that the other knows4 ,when we get past our science and theories1 our technical prowess1 our titles and positions of influence1 it is this shared moment of authenticity--between patient and nurse--that makes us smile and allows us to move forward in our own life projects4 ,nurse educators who seek such authentic exchanges with their students enjoy similar moments4 ,the same can be said of deans of schools of nursing1 administrators of delivery systems1 executives and staff of nursing and professional organizations1 and colleagues on a research project4 ,it is the authentic dialogue between people that makes any activity worthwhile regardless of whether or not it is called successful by others4 ,when ,josephine ,g4 ,paterson and ,loretta ,t4 ,zderad first published their book ,humanistic ,nursing in #aigf1 society was in the midst of the new women's movement and nurses were going through the phase of assertiveness training1 dressing for success1 and learning to play the games that mother never taught us4 ,since then1 nurses have moved into many sectors of society and have held power as we have never held it before4 ,we have proved ourselves as politicians1 administrators1 researchers1 and writers4 ,we have refined our abilities to assess1 diagnose1 treat1 and evaluate4 ,we've raised money and balanced budgets4 ,we've networked1 organized1 and formed coalitions4 ,yet1 individually we are uneasy and collectively we are unable to articulate a vision clear enough so that others will join us4 ,this re-issue of ,paterson and v ,zderad's classic work will help to remind us of another way of developing our power4 ,perhaps we can1 once again1 look for and call for authentic dialogue with our patients1 our students1 and our colleagues4 ,paterson and ,zderad are clear in their method3 discuss1 question1 convey1 clarify1 argue1 and reflect4 ,they remind us of our uniqueness and our commonality4 ,they tell us that it is necessary to do with and be with each other in order for any one of us to grow4 ,they help us celebrate the power of our choices4 ,is it ironic and fortunate that ,humanistic ,nursing should be re-issued now when it is needed even more than it was during the late #aigjs8 ,then1 humanitarianism was in vogue4 ,now1 it is under attack as a secular religion4 ,today1 the technocratic imperative infiltrates an ever-increasing number of our lived experiences2 and it becomes more difficult to ignore or dismiss ,habermas's analysis that all interests have become technical rather than human4#f ,as health care becomes increasingly commercial the profound experiences of living and dying are discussed in terms of profit and loss4 ,life itself is the focus of public debates about whether surrogacy involves a whole baby being bought and sold or only half of a baby1 since one half already belongs to the natural father and so he cannot buy what he already owns4 ,we have many choices before us3 to adopt the values of commerce and redesign health care systems accordingly2 to accept competition as the modus operandi or insist on other measures for people in need2 to decide who will be cared for1 who won't1 who will pay1 and how much8 ,perhaps it is time for us to turn away from the exchange between buyers and sellers1 providers and consumers2 and turn back to an exchange between two people trying to understand the space they share4 ,perhaps it is time for a shared dialogue with patients for whom the questions are most vital8 ,perhaps we need to hear their call and respond authentically4 ,perhaps they need to hear ours8 ,for only then1 as ,paterson and ,zderad have made quite clear1 will our lived experiences in health care have any real meaning4 ,patricia ,moccia ,,phd1 ,,rn ,associate ,professor and ,chair ,department of ,nursing ,education ,teachers ,college ,columbia ,university ,,footnotes3 #a ,azanian ,freedom ,song4 ,lyrics by ,otis ,williams1 music by ,bernice ,johnson ,reagon4 ,washington1 ,,dc3 ,songtalk ,publishing ,co41 #aihb4 #b ,frankl1 ,viktor4 ,man's ,search ,for ,meaning4 ,boston3 ,beacon ,press1 #aiei4 #c ,rukeyser1 ,muriel4 ,kathe ,kollwitz1 in ,by a ,woman ,writ1 ed4 ,joan ,goulianos4 ,new ,york3 ,bobbs ,merrill1 #aigc1 p4 #cgd4 #d ,bohm1 ,david4 ,wholeness and the ,implicate ,order4 ,london3 ,ark1 #aihj4 #e ,newman1 ,margaret4 ,health ,as ,expanding ,consciousness4 ,st4 ,louis3 ,c4 ,v4 ,mosby ,company1 #aihf4 #f ,habermas1 ,jurgen4 ,knowledge and ,human ,interest1 7trans4 ,j4 ,shapiro47 ,boston3 ,beacon ,press1 #aiga4 ,,contents ,,part ,,one ,,theoretical ,,roots #a #a ,humanistic ,nursing ,practice ,theory #c #b ,foundations of ,humanistic ,nursing #aa #c ,humanistic ,nursing3 ,a ,lived ,dialogue #ba #d ,phenomenon of ,community #cg ,,part ,,two ,,methodology--,a ,,process ,,of ,,being #di #e ,toward a ,responsible ,free ,research ,nurse in the ,health ,arena #ea #f ,the ,logic of a ,phenomenological ,methodology #fe #g ,a ,phenomenological ,approach to ,humanistic ,nursing ,theory #gg #h ,humanistic ,nursing and ,art #he #i ,a ,heuristic ,culmination #ie ,appendix #aac ,glossary #aba ,bibliography #abc ,index #abg #a ,part #a ,,theoretical ,,roots #b #c #a ,,humanistic ,,nursing ,,practice ,,theory ,substantively this chapter introduces two aspects of the humanistic nursing practice theory3 first1 what this theory proposes and1 second1 how the proposals of the theory evolved4 ,concisely1 humanistic nursing practice theory proposes that nurses consciously and deliberately approach nursing as an existential experience4 ,then1 they reflect on the experience and phenomenologically describe the calls they receive1 their responses1 and what they come to know from their presence in the nursing situation4 ,it is believed that compilation and complementary syntheses of these phenomenological descriptions over time will build and make explicit a science of nursing4 ,,humanistic ,,nursing3 ,,its ,,meaning ,nursing is an experience lived between human beings4 ,each nursing situation reciprocally evokes and affects the expression and manifestations of these human beings' capacity for and condition of existence4 ,in a nurse this implies a responsibility for the condition of herself or being4 ,the term humanistic nursing was selected thoughtfully to designate this theoretical pursuit to reaffirm and floodlight this responsible characteristic as fundamentally inherent to all artful-scientific nursing4 ,humanistic nursing embraces more than a benevolent technically competent subject-object one-way relationship guided by a nurse in behalf of another4 ,rather it dictates that nursing is a responsible searching1 transactional relationship whose meaningfulness demands conceptualization founded on a nurse's existential awareness of self and of the other4 #d ,,existential ,,experience ,uniqueness--,otherness ,existential experience infers human awareness of the self and of otherness4 ,it calls for a recognition of each man as existing singularly in-his-situation and struggling and striving with his fellows for survival and becoming1 for confirmation of his existence and understanding of its meaning4 ,martin ,buber1 philosophical anthropologist and rabbi1 expressed artfully this uniqueness1 struggle1 and potential of each man4 ,he said3 ,sent forth from the natural domain of species into the hazard of the solitary category1 man surrounded by the air of a chaos which came into being with him1 secretly and bashfully he watches for a ,yes which allows him to be and which can come to him only from one human person to another4#a ,with such uniqueness of each human being as a given1 an assumed fact1 only each person can describe or choose the evolvement of the project which is himself-in-his situation4 ,this awesome and lonely human capacity for choice and novel evolvement presents both hope and fear as regards the unfolding of human moreness4 ,uniqueness is a universal capacity of the human species4 ,so1 all-at-once1 while each man is unique2 paradoxically1 he is also like his fellows4 ,his very uniqueness is a characteristic of his commonality with all other men4 ,authenticity--,experiencing ,in humanistic nursing existential awareness calls for an authenticity with one's self4 ,as a visionary aim1 such authenticity1 self-in-touchness1 is more than what usually is termed intellectual awareness4 ,auditory1 olfactory1 oral1 visual1 tactile1 kinesthetic1 and visceral responses are involved and each can convey unique meaning to man's consciousness4 ,in-touchness with these sensations and our responses informs us about our quality of being1 our thereness1 our degree of presence with others4 ,the kind of between we live with others depends on both our degree of awareness and the meaning we attribute to this awareness4 ,this awareness1 reflected on1 sometimes shared with a responsible other for reality testing1 offers us opportunity for broadening our meaning base1 for becoming more--more in accord with our potential for humanness4 ,perhaps a statement made by ,dr4 ,gene ,phillips1 professor of education at ,boston ,university1 will clarify the importance ,i attach to each nurse becoming as much as she can be4 ,he said1 ,the more mature we are the less it is necessary for us to exclude4 ,presently ,i would paraphrase this statement #e and say1 the more of ourselves we do not have to exclude1 the more of the other we can be open to4 ,our self-awareness1 in-touchness1 self-acceptance1 actualization of our potential allows us to share with others so they can become in relationship with us4 ,in this kind of existential relating1 presence with another1 a nurse is confronted with man as singular in his own peculiar angular1 biased1 or shaded reality4 ,it becomes apparent that each has his very own lived world4 ,so one might describe human existence as man-world as some refer to man as mind-body1 using a hyphen rather than and4 ,man's universal species commonality and peculiar perplexing noncommonality1 has this manness1 affect and constantly interplay with one another4 ,this arena of interplay is complicated further by man's capacity for nondeterminedness1 his ability for envisioning and considering a variety of alternatives and choosing selectively4 ,often these alternatives are experienced as contradictory and inconsistent4 ,humanistic nursing calls forth in the nurse the struggle of recognizing the complexity of men's relating in the nursing world as just how man is and his nature1 his human condition1 as searching1 experiencing1 and an unfolding becoming4 ,moreness--,choice ,how can a nurse let herself know her human responses and the breadth and depth of the possibilities called forth by the other8 ,how can she be1 search1 experience1 become in an accord with the calls and responses of her lived nursing world8 ,it is a chosen1 deliberate life-long process4 ,the process itself is generative4 ,one experience opens the door for the next4 ,in humanistic nursing practice theory we call this kind of experiencing authentic1 genuine1 or letting be what is4 ,it is man conscious of himself1 not necessarily acting out1 but aware of his human responses to his world and their meanings to him4 ,this quality of personal authenticity allows one's responsible chosen actions to be based in human knowledge rather than human defensiveness4 ,man is a knowing place4 ,from education and living experience one assumes an initial innate force in human beingness that moves man to come to know his own and others' angular views of the world4 ,humanistic nursing is concerned with these angular views1 these differences being viewed by nurses responsibly and as realities that are beyond the negative-positive1 good-evil standard of judgement4 ,or1 for example1 nursing is concerned with how this particular man1 with his particular history1 experiences being labeled with this general diagnosis and being admitted1 discharged1 and living out his life with his condition as he views it in-his-world4 ,man has the inherent capacity to respond to other man as other man4 ,only each unique nurse faced with the chaos of her alternatives in a situation can then choose either to relate or not to relate and how to relate in-her-nursing-world to others4 ,choosing to and how to relate or respond cannot be superimposed on man from the outside by another4 ,a person1 to a degree1 can be coerced to behave outwardly in a certain way4 ,for example1 physically1 in a spatial #f sense1 a nurse can be ordered into parallel existence with another4 ,being existentially and genuinely present with another is different4 ,this human mode of being is chosen and controlled by the self4 ,it takes responsible self-ordering that can arise only in the spirit of one's own disciplined being4 ,value--,nonvalue ,to offer genuine presence to others1 a belief must exist within a person that such presence is of value and makes a difference in a situation4 ,if it is a value for a nurse1 it will be offered in her nursing situation4 ,libraries1 concrete buildings bursting with words of great thinkers1 support the value of genuine presence and authentic dialogue between persons4 ,consider the literary works that have conveyed or reflected this message throughout the existence of intellectual man4 ,plato1 ,rousseau1 ,goethe1 ,proust1 ,nietzsche1 ,whitehead1 ,jung1 ,may1 ,frankl1 ,hesse1 de ,chardin1 ,bergson1 ,marcel and ,buber effortlessly come to mind4 ,many nurses are genuine presences in the nursing situation4 ,some have tried to share their experiences2 some have not4 ,and1 there are those who are not genuine presences in the nursing situation4 ,one wonders if this has influenced the distinctions nurses have made over the years with certainty when considering their nurse contemporaries4 ,often one hears1 she is a good nurse1 a natural4 ,these positive critics are often up against it when asked1 why1 how1 what8 ,descriptive literary conceptualizations of nursing that reflect this quality of nurse-being 7presence1 intersubjectiveness7 call for nurses willing to search out and bring to awareness1 the mysteries of their commonplace1 their familiar1 and to appreciate the unique ideas1 values1 and meanings fundamental to their practice4 ,conceptualization of these qualities by practicing nurses is basic and necessary to the development of a science and an actualized profession of nursing4 ,,phenomenological ,,description ,phenomenology directs us to the study of the thing itself4 ,the existential literature1 descriptions of what man has come to know and understand in his experience1 has evolved from the use of the phenomenological approach4 ,in the humanistic nursing practice theory the thing itself is the existentially experienced nursing situation4 ,both phenomenology and existentialism value experience1 man's capacities for surprise and knowing1 and honor the evolving of the new4 ,what ,does ,humanistic ,nursing ,practice ,theory ,ask the ,nurse to ,describe8 ,nurses experience with other human beings peak life events3 creation1 birth1 winning1 nothingness1 losing1 separation1 death4 ,their ,i-,thou empathetic #g relations with persons during these actual lived experiences and their own experiential-educational histories make the between of the nursing situation unique4 ,through in-touchness with self1 authentic awareness and reflection on such experiences the human nurse comes to know4 ,humanistic nursing practice theory asks that the nurse describe what she comes to know3 7#a7 the nurse's unique perspective and responses1 7#b7 the other's knowable responses1 and 7#c7 the reciprocal call and response1 the between1 as they occur in the nursing situation4 ,why ,does ,humanistic ,nursing ,practice ,theory ,ask ,that ,existential ,nursing ,experience ,be ,described ,phenomenologically8 ,there are many reasons4 ,philosophically and fundamentally the reason relates to how humanistic nursing perceives the purpose and aim of nursing4 ,it views nursing as the ability to struggle with other man through peak experiences related to health and suffering in which the participants in the nursing situation are and become in accordance with their human potential4 ,so1 like ,elie ,wiesel1 the novelist1 who states in ,one ,generation ,after that he writes to attest to events of human existence and to come to understand1 humanistic nursing proposes that human forms of existence in nursing situations need attestation and that through describing1 nurses will understand better and relate to man as man is4 ,thus the profession of nursing's service contribution to the community of man will ever become more4 ,the reasons for phenomenologically describing nursing are complex1 interinfluential1 and their ramifications are far reaching4 ,sequentially1 the study and description of human phenomena presented in nursing situations will affect 7#a7 the quality of the nursing situation1 7#b7 man's general knowledge of the variation in human capacity for beingness1 and 7#c7 the development and form of the evolvement of nursing theory and science4 ,how ,can ,nurses ,begin to ,describe ,humanistic ,nursing ,phenomenologically8 ,the process of how to describe nursing events entails deliberate responsible1 conscious1 aware1 nonjudgmental existence of the nurse in the nursing situation followed by disciplined authentic reflection and description4 ,there are obvious common lived human experiences which if considered and wondered about1 can advance a nurse's ability for phenomenological description4 ,these experiences are easily cited1 yet not easily plumbed4 ,often experiences such as anger1 frustration1 waiting1 apathy1 confusion1 perplexity1 questioning1 surprise1 conflict1 headache1 crying1 laughing1 joy are quickly theoretically and analytically interpreted1 labeled1 and dismissed4 ,examining1 reexamining1 mulling over1 brooding on1 and fussing with the situational context of these experiences as nonlabeled1 raw human lived data can yield #h knowledge4 ,knowledge of the nurse's and her other's unique human existence in their on-going struggle becomes explicit4 ,superficial treatment of such human clues results in nonfulfillment of the realistic human possibilities of artful-scientific professional knowing and nursing4 ,words are the major tools of phenomenological description4 ,they are limited by our human ability to express1 and yet they are the best tools we have for expressing the human condition4 ,the novelist ,james ,agee1 in ,let ,us ,now ,praise ,famous ,men1 says that though man or human relatedness never could be described perfectly it would be the greater crime not to try4 ,this1 too1 is a basic premise of the humanistic nursing practice theory4 ,the words we use to describe and discuss this theory are easy words1 everyday ,english words4 ,we all know them4 ,we1 at times1 narrow a word's meaning or make it more specific4 ,some problem is presented by words we are accustomed to using and hearing4 ,habit and our human fallibility can promote only superficial comprehension4 ,thoughtful awareness of the meaning of these same sequentially expressed words can convey the complexity of the never completely fathomable all-at-onceness of lived existence4 ,this theory is expressed in terms like existence confirming1 striving1 becoming1 relation1 and reflection4 ,we intend such words to express the grasp with acceptance and recognition of human limitations while awesomely pondering the open-ended scope of each man's potential4 ,in time1 with disciplined authentic reflective description1 themes common and significant to nursing situations become apparent4 ,they are then available for compilation1 complementary synthesis1 and on-going refinement4 ,a nursing resource bank accrues3 ,not a bank that offers a map of how and what to do but rather one that further stimulates nurses' exploration and understanding4 ,,the ,,evolvement ,,of ,,humanistic ,,nursing ,,practice ,,theory ,since #aifj ,loretta ,t4 ,zderad and myself in dialogue1 together1 and with groups of nurses in graduate schools and in nursing service situations have reflected on1 explored1 and questioned our own and others' nursing situational experiences4 ,over this period we have come to value and appreciate the meaningfulness of these situations to man's existence4 ,this constantly augmented our feelings of responsibility for contributing to these situations beneficially4 ,therefore1 we looked at them for their tractability to research methodology4 ,their loadedness with variations1 changes1 uncontrollables1 and our negative feelings about the implications of viewing human beings as predictable left the strict scientism of positivistic method wanting at this stage of man's knowing4 ,we saw objectivity in nursing situations or our questions1 nursing questions1 in the realm of needing to now how man experienced his existence4 ,this objectivity1 or man's real lived reality paradoxically is subjectively ridden1 man-world4 ,the existential literature dealt with substantive themes encountered in nursing experiences4 ,as ,i previously stated this literature evolves from a phenomenological #i approach to studying being and existence4 ,this approach to studying1 describing1 and developing an artistic science of nursing became ,dr4 ,zderad's and my long-sought haven4 ,all along existentialism and phenomenology had been ours 'and many nurses' what and how4 ,now we had labels that were acceptable and reputable to many--most of all to ourselves4 ,,footnotes3 #a ,martin ,buber1 ,distance and ,relation1 trans4 ,ronald ,gregor ,smith1 in ,the ,knowledge of ,man1 ed4 ,maurice ,friedman 7,new ,york3 ,harper ,row1 ,publishers1 #aife71 p4 #ga4 #aj #aa #b ,,foundations ,,of ,,humanistic ,,nursing ,nursing is a response to the human situation4 ,it comes into being under certain conditions--one human being needs a kind of help and another gives it4 ,the meaning of nursing as a living human act is in the act itself4 ,to understand it1 therefore1 it is necessary to consider nursing as an existent1 a phenomenon occurring in the real world4 ,,the ,,phenomenon ,,of ,,nursing ,the phenomenon of nursing appears in many forms in the real lived world4 ,it varies with the age of the patient1 the pathology or disability1 the kind and degree of help needed1 the duration of the need for help1 the patient's location and his potential for obtaining and using help1 and the nurse's perception of the need and her capacities for responding to it4 ,nursing varies also in relation to the sociocultural context in which it occurs4 ,being one element in an evolving complex system of health care1 nursing is continuously appearing in new specialized forms4 ,as professionals1 we are accustomed to viewing nursing as we practice it within these specialty contexts--for example1 pediatric1 medical1 rehabilitation1 intensive care1 long-term care1 community4 ,there seems to be no end to the proliferation of diversifications4 ,even the attempts of practitioners to combine specialties give rise to new specialties1 such as1 community mental health nursing and child psychiatric nursing4 ,so it is difficult to focus on the phenomenon of nursing as an entity without having one's view colored by a particular clinical1 functional1 or societal context4 ,yet1 if we can bracket 7hold in abeyance7 these adjectival labels and the preconceived viewpoints they signify1 we can consider the thing itself1 the act of nursing in its most simple and general appearance4 #ab ,well-,being and ,more-,being ,in this most basic sense1 then1 disregarding the particular specialized forms in which it appears1 the nursing act always is related to the health-illness quality of the human condition1 or fundamentally1 to a man's personal survival4 ,this is not to say that all instances of nursing are matters of life and death1 but rather that every nursing act has to do with the quality of a person's living and dying4 ,that nursing is related to health and illness is self-evident4 ,how it is related is not so apparent4 ,health is valued as necessary for survival and is often proposed as the goal of nursing4 ,there are1 in actuality1 many instances of nursing that could be described as health restoring1 health sustaining1 or health promoting4 ,nurses engage in health teaching and health supervision4 ,on the other hand1 there are instances in which health1 taken in its narrowest meaning as freedom from disease1 is not seen as an attainable goal1 as evidenced1 for example1 in labels given to patients such as terminal1 hopeless1 and chronic4 ,yet in actual practice these humans' conditions call forth some of the most complete1 expert1 total1 beautiful nursing care4 ,nursing1 then1 as a human response1 implies the valuing of some human potential beyond the narrow concept of health taken as absence of disease4 ,nursing's concern is not merely with a person's well-being but with his more-being1 with helping him become more as humanly possible in his particular life situation4 ,human ,potential ,since nursing involves one human being helping another1 the notion of humaneness has been associated traditionally with nursing4 ,nursing practice is criticized justifiably when it is not humane and is taken for granted or praised when it is4 ,the expectation of humaneness is so ingrained in the concept of nursing that some nurses are surprised when it is acknowledged by patients4 ,if a patient thanks them for their kindness1 patience1 or concern1 these nurses reply1 in their embarrassment1 ,oh1 that's part of my job4 ,however1 to equate nursing's humanistic character solely with an overflowing of the milk of human kindness is a serious error of oversimplification4 ,such a limited view1 in fact1 is a dehumanizing denial of man's potentials4 ,as a human transaction1 the phenomenon of nursing contains all the human potentials and limitations of each unique participant4 ,for instance1 frustration1 discouragement1 anger1 rejection1 withdrawal1 loneliness1 aggression1 impatience1 envy1 grief1 despair1 pain1 and suffering are constituents of nursing1 as well as tenderness1 caring1 courage1 trust1 joy1 hope4 ,in other words1 since nursing is lived by humans1 the stuff of nursing includes all possible responses of man--man needing and man helping--in his situation4 ,intersubjective ,transaction ,looking again at the phenomenon of nursing as it occurs in the real lived world1 obviously it is always an interhuman event4 ,whenever nursing takes #ac place two 7or more7 human beings are related in a shared situation4 ,each participates according to his own mode of being in the situation1 that is1 as a person nursing or as a person begin nursed4 ,since one is nursing and the other is being nursed1 it follows that the essential character of the situation is nurturance4 ,in other words1 the phenomenon of nursing involves nurturing1 being nurtured1 and a relation--the between in which or through which the nurturance occurs4 ,on reflection1 it is obvious that nursing is an intersubjective transaction4 ,both persons1 nurse and patient 7client1 family1 group71 necessarily participate in the proceedings4 ,in this sense1 they are interdependent4 ,yet1 they are both subjects1 that is1 each is the originator of human acts and of human responses to the other4 ,in this sense1 they are independent4 ,the intersubjective transactional character of nursing cannot be escaped when one is experiencing the phenomenon1 either as nurse or as patient4 ,consider for example1 some of the most common nursing activities1 such as1 feeding and being fed1 comforting and being comforted1 giving and taking medications4 ,although this intersubjectivity is unmistakably known in experience1 it is extremely difficult to conceptualize and convey it to others4 ,it rarely is found in descriptions of nursing1 and to the unfortunate extent that it is missing1 the descriptions are not true to life4 ,in real life1 nursing phenomena may be experienced from the reference points of nurturing1 of being nurtured1 or of the nurturing process in the between4 ,for instance1 the nurse may describe comfort as an experience of comforting another person2 the patient1 as an experience of being comforted4 ,however1 while each has experienced something within himself1 he also has experienced something of the between1 namely1 the message or meaning of the comforting-being comforted process4 ,this essential interhuman dimension of nursing is beyond and yet within the technical1 procedural1 or interactional elements of the event4 ,it is a quality of being that is expressed in the doing4 ,being and ,doing ,as an intersubjective1 transactional experience1 nursing necessarily involves both a mode of being and a doing of something4 ,the being and doing are interrelated so inextricably that it is difficult1 even distorting1 to speak of one without the other4 ,descriptions of nursing1 however1 often focus primarily 7sometimes exclusively7 on the doing aspect of the process1 on the nursing techniques or procedures4 ,the observable acts are more easily discerned and discussed4 ,they can be measured1 counted1 and charted4 ,yet1 in the actual interhuman experience of nursing the weight of being is felt4 ,presence and the effect of one's presence can be known much more vividly than they can be described4 ,still1 not to attempt to describe them is to present only a half1 or perhaps less than half1 of the nursing picture4 ,when a nurse refers to a nurse-patient interaction during which a change in the patient's condition or behavior was noted1 one hoping to get a description of nursing may ask1 ,what did you do8 ,often the answer is a description of a #ad manual action or a verbal interchange4 ,sometimes the nurse responds1 ,nothing1 ,i was just there4 ,perhaps it is the question that is wrong4 ,the respondent usually interprets doing in a limited sense4 ,in reality1 everything the nurse does is colored by the character of her being in the situation4 ,the nursing act itself is a behavioral expression of the nurse's state of being1 for example1 concerned1 fatigued1 hurried1 confident1 hopeless4 ,furthermore1 there is a kind of being1 a being with or a being there1 that is really a kind of doing for it involves the nurse's active presence4 ,to be with in this fuller sense requires turning one's attention toward the patient1 being aware of and open to the here and now shared situation1 and communicating one's availability4 ,whether the nursing act is verbal1 or manual1 or both1 a silent glance1 or physical presence1 some degree of intersubjectivity is involved and warrants recognition4 ,to become more aware of and explore more fully this essential constituent of nursing we need to focus on the participants' modes of being in the situation4 ,rather than ask the nurse1 ,what did you do in the nurse-patient situation8 we ought to ask1 ,what happened between you8 ,,humanistic ,,nursing ,when the meaning of nursing is sought by scrutinizing the phenomenon1 that is1 by examining the nursing event itself as it occurs in real life1 one finds nursing embedded within the human context4 ,as a nurturing response of one person to another in need1 it aims at the development of human potential1 at well-being and more-being4 ,as something that happens between people1 it reflects all the human potential and limitations of the persons involved4 ,as an intersubjective transaction1 it holds the possibility for both persons to effect and be affected1 the possibility for both to become more4 ,at its very base1 then1 nursing is humanistic4 ,it is1 at once1 man's expression of and his striving for survival and further development in community4 ,in a way1 to specify nursing as humanistic seems redundant4 ,in view of its source and goals how could it be otherwise8 ,however1 the term humanistic nursing was coined thoughtfully and used purposely here to designate a particular nursing approach4 ,not only does the term signify full recognition of nursing's human foundation and meaning but it also points the direction for nursing's necessary development4 ,what is proposed here is the enrichment of nursing by exploring and expanding its relations to its human context4 ,authentic ,commitment ,when it is genuinely humanistic1 nursing is an expression1 a living out1 of the nurse's authentic commitment4 ,it is an existential engagement directed toward nurturing human potential4 ,the humanistic nurse values nursing as a situation in which the necessary conditions for such human actualization exist and is open to the possibilities in the intimately shared nurse-patient here and now4 #ae ,humanistic nursing calls for an existential involvement1 that is1 an active presence with the whole of the nurse's being4 ,this involved presence is personal and professional4 ,it is personal--a live act stemming from this unique1 individual nurse4 ,it is a chosen human response freely given2 it cannot be assigned or programmed4 ,the involvement is professional--goal directed4 ,it is based on an art-science2 it is held accountable4 ,anyone familiar with typical hectic nursing situations could justifiably question the actual attainability of such an existential involvement4 ,it goes without saying that it would be humanly impossible for a nurse to be wholly present to numerous patients for eight hours a day4 ,but any nurse who has experienced moments of genuine presence in the nurse-patient situation will attest to their reality and to the fact that it is these beautiful moments that give meaning to nursing4 ,in terms of actual practice1 then1 it is more realistic to think of humanistic nursing as occurring in various degrees4 ,it may be more useful1 in fact1 to consider humanistic nursing a goal worth striving for2 or an attitude that strengthens one's perseverance toward attaining the difficult goal2 or fundamentally1 a major value shaping one's nursing practice4 ,process--,choice and ,intersubjectivity ,for the process of nursing to be truly humanistic it must bear out1 that is1 be a lived expression of1 the nurse's recognition and valuing of nursing as an opportunity for the development of the human person4 ,to this end1 humanistic nursing process echoes existential themes related to a person's becoming through choice and intersubjectivity4 ,existentially speaking1 man is his choices4 ,this does not mean that a man can be anything he chooses4 ,naturally1 each individual is unique1 having his own particular potentials and limitations4 ,nor is this view a denial of the forces of unconscious motivation and habit4 ,it does not imply that all of a person's actions result from totally conscious deliberations4 ,by saying1 ,i am my choices1 ,i mean ,i am this here and now person because in my past life ,i took particular paths in preference to others2 of the possibilities open to me1 ,i actualized certain ones4 ,in this sense1 ,i am my history1 ,i am what ,i am1 what ,i have become4 ,but ,i am also what ,i am not1 what ,i have not become4 ,i am a nurse1 this unique here and now nurse with particular experience1 knowledge1 skills1 and values2 without other experience1 knowledge1 skills1 and values4 ,through self-reflection ,i know that ,i have changed1 ,i have experienced growth from within4 ,i know myself as a being capable of becoming more1 capable of actualizing my possibilities1 my self4 ,so ,i am my choices not only in terms of my past but also in regard to my future1 my possibilities4 ,man is an individual being necessarily related to other men in time and space4 ,as every man is beholden to other men for his birth and development1 interdependence is inherent in the human situation4 ,in this sense1 human existence is coexistence4 ,the deeper significance of this truth has been recognized and elucidated by many thinkers1 especially those in the existential stream4 ,over #af and over1 their writings reveal the paradoxical tension of being human3 each man is1 at once1 independent1 a unique individual and interdependent1 a necessarily related being4 ,as ,wilfrid ,desan says1 referring to man as subsistent relation1 ,he is towards-the-other but he is not-the-other4#a ,furthermore1 as ,martin ,buber and ,gabriel ,marcel maintain1 it is actually through his relations with other men that a man becomes1 that his unique individuality is actualized4 ,to know myself as individual is to experience myself as this particular unique here-and-now person and other than that there-and-now person4 ,or in other words1 to know myself as me is to see myself in relation to and distant from other selves4 ,as ,buber so beautifully states1 ,it is from one man to another that the heavenly bread of self-being is passed4#b ,logically1 it follows that the possibility for self-confirmation exists in any intersubjective situation4 ,however1 in everyday life this self-confirmation is experienced to different degrees or on different levels in interhuman relating4 ,since both persons are independent subjects acting with their human capacity for disclosing or enclosing themselves1 there is no guarantee that the availability and presence necessary for a genuine confirming encounter will come forth4 ,presence1 the gift of one's self1 cannot be seized or called forth by demand1 it can only be given freely and be invoked or evoked4 ,since man becomes more through his choices and the aim of nursing is to help man toward well-being or more-being1 the humanistic nursing effort is directed toward increasing the possibilities of making responsible choices4 ,such choice involves1 in the first place1 an openness to and an awareness of one's own situation4 ,a choice is a response to possibility4 ,therefore1 one must first recognize that possibilities or alternatives exist4 ,this openness to options is experienced as a freedom to choose as well as a freedom from the bonds of habit and stereotyped response1 from routine1 from the veils of the obvious4 ,it means getting in touch with one's experience1 one's subjective-objective world4 ,as one becomes more acutely aware of his personal freedom of choice1 there arises concurrently an awareness of the quality of choice1 of the responsibility that is always implied in the freedom4 ,then follows reflective consideration of one's unique situation with its possible alternatives and an examination of the values inherent in them4 ,finally1 the act of choosing is expressed in a response to the situation with a willingness to accept the responsibility for its foreseeable consequences4 ,through this experience the person becomes aware of himself as an individual4 ,as a subject choosing freely and responsibly1 he knows himself as distinct from and yet related to others4 ,nursing1 being an intersubjective transaction1 presents an occasion for both persons1 patient and nurse1 to experience the process of making responsible choices4 ,through living this process in nursing situations1 the nurse develops her own potential for responsible choosing4 ,the satisfaction1 often in the form #ag of a sense of vitality and strength1 that is felt in making responsible competent professional judgments reinforces the habit4 ,in personally coming to experientially appreciate the growth promoting character of responsible choosing1 the nurse may more readily recognize the value of such experiences for any person1 including the one currently labeled patient4 ,the humanistic nurse1 therefore1 is alert to opportunities for the patient to exercise his freedom of choice within the limits of safe and sound practice4 ,she is constantly assessing his capabilities and needs and encourages his maximum participation in his own health care program4 ,through coexperiencing and supporting the process in the patient's experience from his point of view1 the nurse nurtures his human potential for responsible choosing4 ,both patient and nurse become more through making responsible choices in the intersubjective1 transactional nursing situation4 ,theory and ,practice ,the term humanistic nursing refers to a kind of nursing practice and its theoretical foundations4 ,the two are so interrelated that it is difficult1 in fact even somewhat distorting1 to speak exclusively of either the practice or the theory of humanistic nursing4 ,when1 for the sake of clarity or emphasis1 discussion is focused on either the practical or the theoretical realm1 thoughts of the other realm cast their shadows on the fringes4 ,for in our view1 for the process of nursing to be truly humanistic means that the nurse is involved as an experiencing1 valuing1 reflecting1 conceptualizing human person4 ,from the other side1 the theory of humanistic nursing is derived from actual practice1 that is1 from being with and doing with the patient4 ,theory1 says ,r4 ,d4 ,laing1 is the articulated vision of experience4#c ,humanistic nursing is not a matter solely of doing but also of being4 ,the humanistic nurse is open to the reality of the situation in the existential sense4 ,she is available with her total being in the nurse-patient situation4 ,this involves a living out of the nurturing1 intersubjective transaction with all of one's human capacities which include a response to the experienced reality4 ,man is able to set his world at a distance as an independent opposite and enter into relation with it4 ,in fact1 according to ,buber1 this is what distinguishes existence as human4 ,it is man's special way of being4#d ,for nursing to be humanistic in this full sense of the term requires being and doing in the situation and subsequently setting the experienced reality at a distance 7that is1 objectifying it7 and entering into relation with it4 ,the nurse's reflective response to her lived world may take the shape of any form of human dialogue with reality1 such as1 science1 art1 or philosophy4 ,viewed existentially1 every nursing event is unique1 a live intersubjective transaction colored and formed by the individual participants4 ,although the event is ephemeral1 the resultant experiential knowledge is lasting and cumulative4 ,so #ah from the nurse's daily commonplace grows a body of clinical wisdom4 ,the need for describing nursing phenomena1 for expressing and conceptualizing lived nursing worlds1 is basic to the theoretical and actual development of humanistic nursing4 ,in summary1 we contend that humanistic nursing practice necessarily involves the conceptualization of that practice and an examination of its inherent values and that humanistic nursing theory must be derived from nurses' lived experience4 ,the interwoven theory and practice are reciprocally enlightening4 ,framework--,the ,human ,situation ,it is easy to recognize the intrinsic interrelatedness of humanistic nursing theory and practice and the consequent necessity for their concurrent development4 ,it is even quite easy to take the next steps of valuing such development and committing oneself to the task4 ,but then the question arises3 ,where to begin8 ,humanistic nursing is concerned with what is basically nursing1 that is1 with the phenomenon of nursing wherever it occurs regardless of its specialized clinical1 functional1 or sociocultural form4 ,so its domain includes any or all nursing situations4 ,and within this domain1 since humanistic nursing is an intersubjective transaction aimed at nurturing well-being and more-being1 its stuff includes all possible human and interhuman responses4 ,to conceive of so limitless a universe for study is at once exhilarating and overwhelming4 ,how can one get a handle on the nursing universe8 ,is it possible to envision an inclusive frame that would allow an orderly1 systematic1 and hopefully productive approach to the development of humanistic nursing8 ,the key is to return again to the source1 to look at the phenomenon of nursing as it occurs in real life4 ,from this perspective1 the human situation sets the stage where nursing is lived4 ,the major dimensions of humanistic nursing1 then1 may be derived from this situation4 ,existentially1 man is an incarnate being always becoming in relation with men and things in a world of time and space4 ,the nursing situation is a particular kind of human situation in which the interhuman relating is purposely directed toward nurturing the well-being or more-being of a person with perceived needs related to the health-illness quality of living4 ,the elements of the frame1 based on this view of humanistic nursing1 would include incarnate men 7patient and nurse7 meeting 7being and becoming7 in a goal directed 7nurturing well-being and more-being7 intersubjective transaction 7being with and doing with7 occurring in time and space 7measured and as lived by patient and nurse7 in a world of men and things4 ,in other words1 the inexhaustible richness of lived nursing worlds could be explored freely1 imaginatively1 and creatively in any direction suggested by the dimensions of this open framework4 ,it allows for a variety of angular views4 ,for example1 in terms of man as incarnate1 it is certainly not new for nurses to focus on man's bodily existence4 ,naturally1 one of nursing's basic concerns always has been care of people's physical needs4 ,to view nursing from the perspective of the human situation1 however1 is to see beyond physical care1 #ai beyond the categorization of man as a biopsychosocial organism4 ,the focus is on the person's unique being and becoming in his situation4 ,every man is inserted into the common world of men and things through his own unique body4 ,through it he affects the world and the world affects him4 ,through it he develops his own unique personal private world4 ,when a person's bodily functions change during illness the world and his world change for him4 ,the nurse needs to consider how the patient experiences his lived world4 ,ordinary things which nurses simply take for granted1 such as1 hospital noises or odors1 touching1 bathing1 feeding1 sleep or meal schedules1 may have very different meaning for individual patients4 ,they may or may not be experienced as nurturing in a particular person's lived world4 ,in the humanistic perspective the nurse also is viewed as a human person1 as a being in a body rather than merely as a function or a doer of activities4 ,conscious recognition of this fact opens many areas for exploration4 ,obviously1 the nurse's actions 7her being with and doing with71 that affect the patient's world1 are expressed through her body4 ,how is nurturance communicated and actually effected through nursing activities8 ,from the other side1 consider the nurse as being affected by the world through her body4 ,what depths of nursing content could we fathom if we accepted the existential dictum that the body knows8 ,would we dismiss so lightly those gems of clinical wisdom nurses attribute disparagingly to gut reaction1 unscientific intuition1 or years of experience8 ,would we value serious exploration and extraction of these natural resources in the nursing world8 ,the framework suggests1 further1 the possibilities of exploring the development of human potential1 both patient's and nurse's1 as it occurs in the unique domain of nursing's intersubjective transactions4 ,what human resources are called forth in the shared situations during which nurses coexperience and cosearch with patients the varied meanings of being and becoming over the entire range of life from birth to death8 ,how does it occur8 ,what is the process8 ,what promotes well-being or becoming more when facing life1 suffering1 death8 ,for the patient8 ,for the nurse8 ,what knowledge gained through the study of nursing1 a particular form of the human situation1 could be contributed to the general body of human sciences8 ,finally1 within this framework1 all the phenomena experienced in the nursing situation could be explored in relation to their attributes of time and space4 ,more specifically1 from an existential perspective1 the focus would be directed toward the significance of lived time and space1 that is1 time and space as experienced by the patient and_/or the nurse1 and as shared intersubjectively4 ,for example1 waiting1 silence1 chronicity1 emergency1 positioning a patient in bed1 moving through space in a wheelchair1 crutchwalking1 pacing1 could be considered from the standpoint of the patient's experienced space and time1 or from the nurse's1 or as a shared event4 ,explorations of this kind could provide valuable insights into important nursing phenomena1 such as1 presence1 empathy1 comfort1 timing4 #bj ,the human situation1 then1 is the ground within which nursing takes form4 ,as such1 it provides a framework for approaching the study and development of humanistic nursing4 ,as an angular view1 it holds the focus on the basic question underlying nursing practice3 ,is this particular intersubjective1 transactional nursing event humanizing or dehumanizing8 ,,conclusion ,this chapter explored the foundations of humanistic nursing4 ,the discussion flowed naturally1 perhaps unavoidably1 into the realm of meta-nursing4 ,naturally1 for the humanistic nursing approach is itself an outgrowth of the critical examination of nursing as an experienced phenomenon4 ,from this existential perspective of nursing as a living human act1 the meaning of nursing is found in the act itself1 in nursing's relation to its human context4 ,reflection on nursing as it is lived in the real world revealed its existential1 nurturing1 intersubjective1 transactional character4 ,the process of humanistic nursing stemming from the nurse's authentic commitment is a kind of being with and doing with4 ,it aims at the development of human potential through inter subjectivity and responsible choosing4 ,the actualization of humanistic nursing is dependent on the concurrent development of its practice and theoretical foundations by practicing nurses4 ,an open framework derived from the human situation was offered to suggest possible dimensions of humanistic nursing practice that could be described and articulated into a body of theory4 ,nurses who have considered this humanistic nursing approach in terms of their daily practice have felt at home in the ideas4 ,the conceptualizations fit their personal nursing experience4 ,if there is any strangeness in the approach1 it is perhaps that it does not follow the contours of the clinical specialties to which we have grown so accustomed that they may be more ruts than roads4 ,this is not to say that humanistic nursing is opposed to clinical specialization in nursing4 ,in fact1 clinical nursing1 as it exists in any form1 is its very heart and base4 ,humanistic nursing is not compartmentalized into clinical 7or functional1 or sociocultural7 specialties because it applies in all clinical areas4 ,it is1 in the most basic sense1 cross-clinical4 ,this may be the great advantage of humanistic nursing4 ,by orienting its explorations ontologically1 it may foster genuine cross-clinical studies of nursing phenomena4 ,if nurses with highly developed abilities in particular forms of nursing would struggle together in collaborative cross-clinical studies of nursing phenomena1 specialization would serve to advance rather than fragment all nursing4 ,,footnotes3 #a ,wilfred ,desan1 ,the ,planetary ,man1 ,vol4 ,i1 ,a ,noetic ,prelude to a ,united ,world 7,new ,york3 ,the ,macmillan ,company1 #aigb74 p4 #cg4 #b ,martin ,buber1 ,distance and ,relation1 trans4 ,ronald ,gregor ,smith1 in ,the ,knowledge of ,man1 ed4 ,maurice ,friedman 7,new ,york3 ,harper ,row1 ,publishers1 #aife71 p4 #ga4 #c ,r4 ,d4 ,laing1 ,the ,politics of ,experience 7,new ,york3 ,ballantine ,books1 #aifg71 p4 #bc4 #d ,buber1 ,the ,knowledge of ,man1 p4 #fj4 #ba #c ,,humanistic ,,nursing3 ,a ,,lived ,,dialogue ,the meaning of humanistic nursing is found in the human act itself1 that is1 in the phenomenon of nursing as it is experienced in the everyday world4 ,therefore1 the interrelated practical and theoretical development of humanistic nursing is dependent on nurses experiencing1 conceptualizing1 and sharing their unique angular views of their unique lived nursing worlds4 ,an open framework suggesting dimensions for such exploration was derived from a consideration of the phenomenon of nursing within its basic context1 namely1 the human situation4 ,the elements of this humanistic nursing framework include incarnate men 7patient and nurse7 meeting 7being and becoming7 in a goal-directed 7nurturing well-being and more-being71 intersubjective transaction 7being with and doing with7 occurring in time and space 7as measured and as lived by patient and nurse7 in a world of men and things4 ,the framework offers a little security by providing some reference points for the exploration4 ,however1 what is gained in clarity by conceptual abstraction is lost from the flavor of the actual experience4 ,like a weather map that statically represents major factors and currents in their interrelatedness1 the framework discloses a nexus of elements4 ,but it is as far from the real phenomenon of nursing with its pains and suffering and comforting and joys and hopes as the weather map is from real weather with its wind and rain and heat and cold4 ,this chapter is concerned with the same basic framework of humanistic nursing but seen in an enlivened form4 ,to inspirit its constructs the search must return again to the existential source1 to the nursing situation as it is lived4 ,when ,i reflect on an act of mine 7no matter how simple or complex7 that ,i can unhesitatingly label nursing1 ,i become aware of it as goal-directed 7nurturing7 being with and doing with another4 ,the intersubjective or interhuman element1 the between1 runs through nursing interactions like an underground stream conveying the nutrients of healing and growth4 ,in everyday practice1 we are usually so involved with the immediate demands of our being with and #bb doing with the patient that we do not focus on the overshadowed plane of the between4 ,however1 occasionally1 in beautiful moments1 the interhuman currents are so strong that they flood our conscious awareness4 ,such rare and rewarding moments of mutual presence remind us of the elusive ever-present between4 ,from these epiphanic episodes in our personal nursing experience1 we have certain and immediate knowledge of intersubjectivity4 ,through our experience1 too1 we know that both humanizing and dehumanizing effects can result from human interactions4 ,therefore1 it is essential for the development of humanistic nursing to explore and describe its intersubjective character4 ,although many nurses have agreed in principle about the importance of this work1 they also have expressed the feelings of frustration and discouragement attending it4 ,there are real difficulties involved in attempting to describe something so real yet so nebulous as the between4 ,the descriptions must be derived from our own real nursing experiences4 ,this means that we must develop habits of conscious awareness of experience1 of recall1 and of reflection4 ,then we must struggle with our language finding the words in our physically and technologically oriented vocabularies1 perhaps even creating terms1 to convey the substance and flavor of the experience of intersubjectivity4 ,furthermore1 description of the intersubjective quality of nursing is difficult because of its peculiar pervasiveness4 ,whether it is consciously recognized or not1 it is part of every nursing transaction4 ,however1 to consider and explore intersubjectivity solely as a component or constituent of nursing1 even a necessarily inherent or an essential one1 would be to see it out of true perspective4 ,the between is more than a factor or facet of nursing2 it is the basic relation in which and through which nursing can occur4 ,so the question remains4 ,how can our experiences1 our angular views1 our glimpses of this foundation1 this necessary means of nursing1 be conceptualized and shared8 ,once while reflecting on the nature of nursing against a background of notions about intersubjectivity drawn from experience and literature and testing them against my own real life experiences of nursing1 ,i suddenly saw that nursing itself is a particular form of human dialogue4 ,this insight occurred to me with clarity1 conviction1 and all the force of a brand new idea4 ,it was so obvious1 so distinct1 so simple1 so clearly a central intuition that could illuminate the phenomenon of nursing from within4 ,i experienced the idea as fresh and excitingly full of promise4 ,yet1 when ,i said it out loud1 ,nursing is dialogue1 the words seemed too meager to convey the true meaning of the idea and its real significance4 ,there was1 furthermore1 an annoying shadow of familiarity lurking about it4 ,it was almost as if ,i had expressed something similar previously4 ,at first1 ,i hesitated to share this insight with others for fear they would extinguish it by saying1 of course1 everyone knows that1 or ,i've heard you say something like that before4 ,still1 ,i experienced it as an idea ,i had to express4 ,moved by the pressure of feelings of responsibility and desire to share1 in #aigc ,i wrote a paper1 ,the ,dialogue ,called ,nursing4 #bc ,in retrospect1 that paper has the marks of a hesitant beginning1 restrained by cautious statements and supposedly protective references to existential literature4 ,dissatisfaction with it prompted further rethinking and revision4 ,searching through my files during this process1 ,i found1 to my great surprise1 some notes on the dialogic nature of nursing written by myself three and six years previously4 ,in fact1 a three-year-old note contained the very title1 ,dialogue ,called ,nursing6 ,now1 how is it possible to grasp a truth and then forget that one knows it and later meet and grasp the old truth again as new8 ,the difference in these experiences of knowing1 for me at least in this case1 is that now ,i know as if from the inside out that nursing is dialogical4 ,the idea seems to have sprouted out of the lived phenomenon1 to have broken forth from the ground of experience1 as opposed to having been concluded in my earlier intellectual1 theoretical1 or philosophical ponderings4 ,but how did the earlier idea1 the conclusion that nursing is dialogical1 become a live option for me8 ,why did it appeal to me8 ,how did it come to make sense in the first place if not because of my experience8 ,the concept and the actual experience revitalize each other4 ,perhaps this is the value of an existentially grounded insight2 it has a kind of durability resulting from its continuous rejuvenation by the interplay of experiencing and conceptualizing4 ,some old ideas are always new4 ,in this spirit1 this chapter looks again at humanistic nursing as lived dialogue4 ,,lived ,,dialogue ,the central insight 7intuition or idea7 from which this exploration grows is this3 nursing itself is a form of human dialogue4 ,i mean that the phenomenon of nursing1 that is1 the nurturing1 intersubjective transaction1 the event lived or experienced by the participants in the everyday world1 is a dialogue4 ,much has been written about dialogue and1 as the word is now in vogue1 it is being used in different ways4 ,here1 the term dialogue is used to denote a broader concept than the typical dictionary definition of dialogue as a conversation between two or more persons or between characters in a drama or novel4 ,it is used in the existential sense4 ,it implies an ontological sphere1 in ,buber's terms1 or the realm of being to which ,marcel refers4 ,here it refers to a lived dialogue1 that is1 to a particular form of intersubjective relating4 ,this may be understood in terms of seeing the other person as a distinct unique individual and entering into relation with him4 ,in other words1 nursing is a dialogical mode of being in an intersubjective situation4 ,as in common usage1 here also1 the term dialogue implies communication1 but in a much more general sense4 ,it is not restricted to the notion of sending and receiving messages verbally and nonverbally4 ,rather1 dialogue is viewed as communication in terms of call and response4 #bd ,nursing implies a special kind of meeting of human persons4 ,it occurs in response to a perceived need related to the health-illness quality of the human condition4 ,within that domain1 which is shared by other health professions1 nursing is directed toward the goal of nurturing well-being and more-being 7human potential74 ,nursing1 therefore1 does not involve a merely fortuitous encounter but rather one in which there is purposeful call and response4 ,in this vein1 humanistic nursing may be considered as a special kind of lived dialogue4 ,,nursing ,,viewed ,,as ,,dialogue ,these considerations of the dialogical character of nursing will be more fruitful if they are related to some concrete nursing experience4 ,reflect for a moment on your daily nursing practice4 ,recall an encounter1 a specific interaction with a patient 7client74 ,try to remember the details4 ,where were you8 ,what time of day was it8 ,who was present8 ,what was your state of being--what were you feeling1 thinking1 doing8 ,how did the interaction begin8 ,what happened between you8 ,what was felt1 said1 done8 ,what was left unsaid1 undone8 ,how did the interaction end or close8 ,how long did the flavor last8 ,now keep this concrete instance of your lived nursing reality in mind and let it raise its questions in the following exploration4 ,meeting ,the act of nursing involves a meeting of human persons4 ,as was noted above1 it is a special or particular kind of meeting because it is purposeful4 ,both patient and nurse have a goal or expectation in mind4 ,the inter subjective transaction1 therefore1 has meaning for them2 the event is experienced in light of their goal7s74 ,or in other words1 the living human act of nursing is formed by its purpose4 ,its goal-directedness colors the attributes and process of the nursing dialogue4 ,when a nurse and patient come together in a nursing situation1 their meeting may be expected or planned by one or both or it may be unexpected by one or both4 ,in any case1 the goal or purpose of nursing holds4 ,even in a spontaneous interaction where they have met only by chance1 in a health care facility or any place where one is identified as patient and the other as nurse1 there is an implicit expectation that the nurse will extend herself in a helpful way if the patient needs assistance4 ,if the meeting is planned or expected1 this factor influences the dialogue4 ,each comes with feelings aroused by anticipation of the event1 for example anxiety1 fear1 dread1 hope1 pleasure1 waiting1 impatience1 dependence1 hostility1 responsibility4 ,another factor experienced in their meeting is the amount of choice or control either nurse or patient had over their coming together4 ,in today's complex health care systems1 a nurse may be assigned to care for a particular patient1 or for persons in an area or unit1 or may be called into service through a registry1 #be or may be approached directly by a patient4 ,from the other side1 the patient also experiences varying degrees of control over his meetings with nurses depending on the system in which the health care is offered1 his location1 his financial means1 and so forth4 ,so when a patient and nurse do meet in a given instance1 each comes to the situation bearing remnants of feeling of having caused or not having caused this encounter with this particular individual4 7,of course1 even in the most de-individualized systems the nurse and_/or patient can still control their meetings to some extent1 for example1 avoidance by the nurse being too busy or avoidance by the patient feigning sleep47 ,the patient and the nurse are two unique individuals meeting for a purpose4 ,in the existential sense1 each of these persons is his choice1 each is his history4 ,each comes to meet the other with all that he is and all that he is not at this moment in this place4 ,each comes as a particular incarnate being4 ,each is a specific being in a specific body through which he affects the other and the world and through which he is affected by them4 ,this nurse who uses her eyes1 ears1 nose1 hands1 her body1 this way here and now meets this patient whose body in this condition serves him this way here and now4 ,furthermore1 both the patient and the nurse have the human capacity for disclosing or enclosing themselves4 ,so they have some control over the quality of their meeting by choosing how and how much to be open with and to be open to the other4 ,their openness is influenced by their views of the purpose of the meeting4 ,in general1 the patient expects to receive help and the nurse expects to give it4 ,however1 their views may differ on the precise need and the kind of help to be given4 ,also1 although the nurse and the patient have the same goal1 that is1 well-being and more-being1 they have different modes of being in the shared situation4 ,one's purpose is to nurture2 the other's is to be nurtured4 ,this difference in the perspectives from which they approach the meeting is reflected in the kind and degree of their openness to each other4 ,in describing their experiences nurses often have revealed that they are open to patients in a certain way4 ,this is evident when nurse and patient meet4 ,the nurse may have prior knowledge of the patient1 perhaps even an image of him drawn from case history1 charts1 tour of duty reports1 and so forth2 or she may meet him as a total stranger4 ,but when they come together1 the nurse sees the patient as a whole4 ,this global apprehension is not experienced as an additive summation but rather as a gestalt4 ,it may result in a very clear picture of the patient's condition with nursing action initiated almost before the picture registers in full conscious awareness4 ,or the perception may be imprecise yet strong that something is wrong4 ,from these experiences one may infer that a nurse's openness involves being open to what is and to what is not in the patient's state of being as weighed against some notion 7or standard7 of what ought to be1 with the intention of doing something about the difference4 ,thus1 the nurse is open-as-a-helper to the patient4 ,this kind of openness is a quality that characterizes the humanistic nursing dialogue4 ,of course1 every nurse-patient meeting differs1 for each participant comes to the situation as the #bf unique individual he is1 with his own expectations and capacities for giving and taking help4 ,when these factors are considered in terms of an actual personal nursing experience 7for instance1 the example recalled above by the reader71 they highlight a tension in the lived nursing world4 ,the meeting through which the nursing dialogue is initiated and consequently is possible is1 to a certain extent1 out of the nurse's control4 ,she is assigned to approach or she approaches the patient in terms of her function4 ,in this sense1 the nurse is synonymous with the function nursing4 ,yet she experiences each meeting as herself--a unique individual person1 this here-and-now being in this body responding in this situation4 ,she is at once a replaceable cog in a wheel of an incomprehensibly complex system and a unique human being sharing most intimately in another's search for the meanings of suffering1 living1 dying4 ,can these two world views be reconciled8 ,how can they be lived in the nursing dialogue8 ,relating ,as a human response to a person in need1 the nursing act is necessarily an intersubjective transaction4 ,or to put it in other words1 regardless of the complexity of need and_/or response1 when nurse and patient meet in the event of nursing both have to do with each other4 ,since both are human1 their doing with means being with4 7,reflect for a moment on the personally experienced patient encounter you recalled at the beginning of this exploration4 ,relive it and see clearly again that the nursing dialogue involves being with and doing with the patient47 ,men can do with and be with each other because they are able to see others and things as distinct from themselves and enter into relation with them4 ,what distinguishes the human situation is that men can enter into a dialogue with reality4 ,they have a capacity for for internal relationships1 for knowing themselves and their worlds within themselves1 they can relate as subject to object 7for example1 as knower to thing known7 and as subject to subject1 that is1 as person to person4 ,both types of relationships are essential for genuine human existence4 ,it is natural1 in fact unavoidable1 for man to relate to his world as subject to object4 ,how could a person survive even one day without knowing and using objects8 ,therefore1 man's abilities to abstract1 objectify1 conceptualize1 categorize1 and so forth1 are necessary for everyday living4 ,even beyond this1 the human capacity for relating to the other as object is basic to the advancement of mankind for it underlies science1 art1 and philosophy4 ,it is simply one way of being human4 ,another mode of relating is open to men4 ,whenever two persons are present to each other as human beings1 the possibility of intersubjective dialogue exists4 ,since both are subjects with the capabilities for internal relationships1 they can be open1 available1 and knowable to each other4 ,they can know each other within themselves4 ,furthermore1 they can be truly with each other in the #bg intersubjective realm because while maintaining their own unique identities1 they can participate in an interior union4 ,intersubjective relating is also necessary for human existence4 ,for it is through his relationships with other men that a person develops his human potential and becomes a unique individual4 ,nursing1 being an interhuman event1 has within it possibilities for various types and degrees of relationships4 ,both nurse and patient can view themselves and the other as objects and as subjects or in any variation or combination of these ways4 ,a person can view and relate to another person as an object1 for instance as a mere function 7patient1 nurse1 supervisor1 medicine nurse1 admitting nurse1 administration7 or as a case or type 7schizophrenic1 cardiac1 outpatient1 readmission1 bed patient1 wheelchair patient1 total care patient1 terminal patient74 ,such subject-object or ,i-,it relationships differ essentially from subject-subject or ,i-,thou relationships4 ,as the derivation of the term indicates1 an object is something placed before or opposite2 it is anything that can be apprehended intellectually4 ,through objectification the object is de-individualized and therefore made replaceable for the purpose of study by any other object with the same properties4 ,it is indifferent to the act by which it is thought and1 therefore1 the subject studying the object may also be replaced by a similar subject4 ,although it is possible to view a person as an object1 persons and things are necessarily different kinds of objects4 ,a thing1 as object1 is open to a subject's scrutiny1 while a person1 as object1 can make himself knowable or set up barriers to objectification4 ,he can keep his thoughts to himself1 remain silent1 or deliberately conceal some of his qualities4 ,through the scientific objective approach1 that is1 subject-object relating1 it is possible to gain certain knowledge about a person2 through intersubjective1 that is1 subject-subject relating1 it is possible to know a person in his unique individuality4 ,thus1 both subject-subject and subject-object relationships are essential to the clinical nursing process4 ,both are integral elements of humanistic nursing4 ,presence ,in the nursing world1 as in the world at large1 human encounters may range from the trivial to the extremely significant4 ,within a day's work1 the nurse may experience many levels of intersubjectivity from the lowest level of being called on as a function or being used as an object1 to the other end of the scale of being recognized as a presence or a thou in genuine dialogue4 ,nursing activities bring a nurse and patient into close physical proximity1 but this in itself does not guarantee genuine intersubjectivity in which a man relates to another person as a presence rather than an object4 ,a presence cannot be grasped or seized like an object4 ,it cannot be demanded or #bh commanded2 it only can be welcomed or rejected4 ,in a sense1 it lies beyond comprehension and can only be invoked or evoked4 ,there is a quality of unpredictableness or spontaneity about genuine dialogue4 ,a nurse may be going through her daily activities1 functioning effectively1 relating humanely1 when suddenly she is stopped by something in the patient1 perhaps a look of fear1 a tug at her sleeve1 a moan1 a reaching for her hand1 a question1 emptiness4 ,in a suspenseful pause two persons hover between their private worlds and the realm of intersubjectivity4 ,two humans stand on the brink of the between for a precious moment filled with promise and fear4 ,with my hand on the doorknob to open myself from within1 ,i hesitate--should ,i1 will ,i let me out1 let him in8 ,time is suspended1 then moves again as ,i move with resolve to recognize1 to give testimony to the other presence4 ,thus1 for genuine dialogue to occur there must be a certain openness1 a receptivity1 readiness1 or availability4 ,the open or available person reveals himself as present4 ,this is not the same as being attentive2 a listener may be attentive and still refuse to give himself4 ,visible actions do not necessarily signify presence so it cannot be proven4 ,but it can be revealed directly and unmistakably in a glance1 a touch1 a tone of voice4 7,i can only ask you to substantiate this statement with your own experience47 ,availability implies1 therefore1 not only being at the other's disposal but also being with him with the whole of oneself4 ,furthermore1 it involves a reciprocity4 ,the other is also seen as a presence1 as a person rather than an object1 such as a function or a case4 ,as was discussed earlier1 the nursing dialogue occurs within the domain of health and illness and has a purpose in the minds of the participants4 ,nursing is a lived dialogue 7a being with and doing with7 aimed at nurturing well-being and more-being4 ,this fact of goal-directedness modifies or characterizes dialogical presence4 ,as a nurse ,i try to be open to the other as a person1 a presence1 and to be available to the other4 ,yet1 when ,i reflect upon my presence1 ,i realize that my openness is an openness to a person-with-needs and my availability is an availability-in-a-helping-way4 ,by comparison1 my experiences of openness and availability in social1 family1 or friend relationships and in nurse-patient relationships differ4 ,in the later1 ,i find myself responding with a kind of professional reserve4 ,while it is true that what ,i conceive of as professional and the degree of reserve has varied over the years and from patient to patient1 nevertheless1 it is always a factor influencing the tone of my lived dialogue of nursing4 ,it is the qualitative differences in the various experiences of presence that deserve1 yet almost defy1 description4 ,for instance1 the presence seems to have a different quality of intimacy4 ,it is not experienced as less intense or less deep in the nurse-patient relationship1 but as somehow colored by a sense of responsibility or regard for what is seen as the patient's vulnerability4 ,at times ,i am aware of a shadow of holding back in terms of what ,i consider nurturing #bi or therapeutically appropriate at a given moment4 ,as a nurse1 ,i find my presence flows through a filter of therapeutic tact4 ,or again1 the mutuality of presence may be experienced in the nurse-patient situation4 ,at times ,i become consciously and acutely aware of the reciprocal flow of openness in the dialogue4 ,it is as strong1 definite1 immediate1 and total as in other dialogical relationships and yet it is somehow different4 ,it is felt as a flow between two persons with different modes of being in the shared situation4 ,my reason for being there1 to nurture1 and his1 to be nurtured1 bob into my consciousness like buoys marking the channel of openness4 ,often in nursing it is necessary to focus my attention on some aspect of the patient's body or behavior4 ,the patient may or may not have the same focus of attention4 ,at least momentarily then1 or even for a prolonged period1 ,i place some aspect of the patient before or opposite myself 7that is1 objectify it74 ,and to the extent that this detail absorbs my attention1 ,i lose my sight of and my relatedness to the whole person who happens to be the patient4 ,while ,i know this focusing on details to be a necessary step in the nursing process1 sometimes ,i find myself abruptly refocusing my attention on the whole person with almost a twinge of guilt for having abandoned him4 7,patients have described this uncomfortable intersubjective experience as feeling looked at or watched by staff47 ,at other times1 on reflection1 ,i find my attention was oscillating between the detail and the person1 or focusing on both relating one to the other4 ,from these experiences it is evident that dialogical presence is complicated in the nursing situation4 ,it is inhibited when the focus of attention 7of one or both participants7 is on the patient's body itself or on his behavior4 ,yet the body is an integral part of the person and his behavior is an expression of his mode of existence or his way of being in the world4 ,man is an embodied being1 and the nurse1 in nurturing the patient's well-being and more-being1 must relate to him and his body in their mysterious interrelatedness4 ,call and ,response ,the dialogical character of nursing may be explored further by considering it in the general sense of a call and response4 ,nursing is a purposeful call and response1 that is1 it is related to some particular kind of help in the domain of health and illness4 ,a patient calls for a nurse with the expectation of being cared for1 of having his need met4 ,he is asking for something4 ,a nurse responds to a patient for the purpose of meeting his need1 of caring for him4 ,the nurse expects to be needed4 ,in reflecting on nursing experiences1 it becomes obvious that the call and response in the nursing dialogue goes both ways for nursing is transactional4 ,both patient and nurse call and respond4 ,the pattern of the dialogue is complex4 ,it continues over time1 from moments to years1 in an ongoing sequence that either patient or nurse may begin1 interrupt1 resume1 or end4 ,for instance1 #cj the patient turns on his call light to ask for something4 ,this is not only a call but also a response to the nurse's previously stated suggestion that he use the signal if he needs her help4 ,or again1 a nurse may stop and talk with a patient during a chance meeting recalling that he previously had expressed feelings of loneliness1 boredom1 pain1 or joy4 ,also1 other persons or events may interrupt or end a nursing dialogue4 ,for instance1 the nurse is called away to help in another situation1 the patient is discharged on the nurse's day off1 the patient expires4 ,furthermore1 the call and response are not only sequential but also simultaneous4 ,in this live dialogue both patient and nurse are calling and responding all at once4 ,the patient's request1 for instance1 is a call for help and at the same time a response to the nurse's availability or offer to be of help4 ,from the other side1 the way a nurse responds to a patient's call is1 itself1 a call to him for a particular kind of response1 a call for his participation in the dialogue4 ,reflect for a moment on your own example4 ,was your response to the patient influenced by the value you placed on such factors as his independence1 motivation1 rehabilitation1 growth1 strengths1 pathology2 on time1 on place2 on agency policy8 ,here again goal-directedness affects nursing dialogue4 ,our interpretation of the patient's calls as well as our responses are colored by the aim of our practice4 ,our values are like calls within the calls4 ,or to state it differently1 the values underlying our practice give meaning to the calls4 ,viewing dialogical nursing as a particular form of call and response highlights its complexity4 ,it reveals the intricacy not only of its patterns of flow but also of its means of expression4 ,nursing is a lived call and response reflective of every mode of human communication4 ,much has been studied and written about verbal dialogue between patient and nurse4 ,examining verbal exchanges from the perspective of call and response could uncover even more about this aspect of the nursing dialogue4 ,it is more difficult to find written descriptions of nonverbal nurse-patient communication1 although this aspect is generally recognized to be of equal significance4 ,here again the call and response framework could be a useful aid4 ,for instance1 what does a nurse's mere physical presence mean to a patient either as a call or response8 ,or from the nurse's standpoint1 under what circumstances is a patient's presence experienced as a call and1 even more1 as a call for a particular nursing response8 ,what prompts us to respond in terms of his posture1 his color1 his facial expression1 his behavior1 the appearance of his clothes8 ,are we almost unconsciously checking some kind of vital signs in the inter subjective realm8 ,nursing dialogue is characterized by the unique feature of occurring through nursing acts4 ,the dialogue is experienced in what the nurse does with the patient4 ,a call and response of caring is lived through in nurse-patient transactions 7nursing care activities7 from the simplest1 most basic acts of bathing and feeding to the most dramatic resuscitation4 #ca ,the nursing act itself contains a meaning for each person in the dialogue and the meanings may differ 7for example1 touching and being touched1 feeding and being fed1 bathing and being bathed74 ,in addition1 as a behavioral expression1 the nursing act conveys a message1 a reflection of the nurse's state of being 7for example1 anxious1 hurried1 troubled1 absent1 present1 fully present74 ,furthermore1 a nursing act may serve as an occasion1 or even a catalyst1 for opening or moving the dialogue in some direction on a verbal level 7for example1 bathing a patient may prompt his discussion of his body image or of his fear of disfigurement74 ,the complexity of possibilities in this unique feature of nursing dialogue 7occurring through nursing acts7 is staggering1 especially so when one considers the additional factors associated with the effects of technological advances in nursing4 ,think1 for instance1 of the influence on your nursing dialogue of any technical nursing procedure4 ,what happens between you and the patient when you place a thermometer into his mouth8 ,take his blood pressure8 ,give him an injection8 ,aspirate him8 ,do any form of monitoring1 from the simplest to the most complex8 ,are the technical procedures and instruments bridges or barriers in the between8 ,,dialogical ,,nursing ,,in ,,the ,,real ,,world ,it is necessary now to look again at dialogical nursing in a broader perspective1 for by limiting the exploration to the nurse1 the patient1 and their between1 the previous discussion grossly oversimplified the way the dialogue actually evolves in real life4 ,in the above1 it was as if nursing were a drama acted out by two characters on a specially designed stage where precisely placed props lay ready to serve the actors and the passage of time is controlled by the chiming of a clock or the dimming of lights4 ,as it is actually lived1 the nursing dialogue is subjected to all the chaotic forces of real life4 ,nursing takes place in a real world of men and things in time and space4 ,in many cases1 it is a special world1 a health system world1 within the everyday world4 ,other ,human ,beings ,the dialogue lived between nurse and patient is affected by their numerous other interhuman relationships4 ,for a nurse to be genuinely with a patient involves her coexperiencing his world with him4 ,his family1 friends1 and significant others are a very real part of this world whether they are physically present or distant4 ,so to be open to the patient is to be open to him as a person necessarily related to other men4 ,furthermore1 in caring for a patient the nurse relates to him not only as an individual patient but also as one in a group of patients4 ,the group may be physically present 7for example1 in a ward1 in an intensive care unit1 in a #cb waiting room1 in a dining room1 in a therapeutic group7 or they may be present in the nurse's mind 7for example1 while caring for one she may think ,i have three more patients to visit1 so and so needs his medication in five minutes1 ,i promised so and so ,i'd get back to him1 three other patients are waiting to be fed74 ,even when the nurse is responsible for only one patient1 she often views him in relation to other patients she has nursed4 ,the nurse herself also functions within complex networks of interhuman relationships that affect the nursing dialogue4 ,as health care becomes more specialized1 more groups of health care workers arise and the various groups become more diversified4 ,so the nurse's intersubjective transactions with her patients occur within an intra- and interdisciplinary milieu of constantly changing personnel1 functions1 and roles4 ,while her own role is expanding1 extending1 deepening1 broadening1 becoming more specialized1 she must relate with others undergoing similar change4 ,and here again1 as with the patients so with her colleagues1 the nurse is constantly faced with the possibility and necessity of relating to others in terms of their functions and as persons4 ,finally1 it should be recognized that while it is easy and common to think of the nurse as synonymous with the function nursing1 in real life the nurse is a human being necessarily related to others4 ,she learns to focus on those present in her here and now work situation4 ,but she too is her history and brings to her work world all that she is and all that she is not including her past experienced and future anticipated interhuman relationships4 ,so each nurse affects her peopled nursing world and is affected by it in her own unique way4 ,from the other side1 the patient also enters into the nursing dialogue with his various networks of interhuman relationships4 ,how he experiences his relationships with his family and significant others1 with the patient groups of which he becomes a part in different degrees1 with members of various disciplines and health services groups1 with the nurse and his nurse1 all influence the lived nursing dialogue4 ,it is always colored by the patient's current mode of interpersonal relating4 ,of course1 the current mode reflects his past1 for example1 learned habits of response1 and his future1 for example1 concerns about anticipated changes in interpersonal relationships due to the effects of his illness4 ,in some cases1 the intersubjective behavior itself becomes the focus of the nursing dialogue as the area of the patient's greatest needs in attaining well-being and more-being4 ,things ,the nursing dialogue takes place in a real world of things1 ordinary things of everyday living and all forms of health care equipment4 ,both types of objects affect the nurse-patient transactions and their influence varies for they may be experienced differently by nurse and patient4 ,ordinary objects used everyday--eating utensils1 clothes1 furniture1 books1 television sets--are so familiar that one usually takes their use for granted4 #cc ,however due to illness a person may be unable to manipulate a knife and fork1 for example4 ,they become frustrating objects4 ,his tools are no longer extensions of himself but impediments and barriers4 ,he feels handicapped4 ,his world of things changes4 ,on entering a health care facility1 the patient finds himself in a foreign world of strange objects4 ,in place of his familiar possessions he is surrounded by equipment1 machines1 instruments1 solutions1 and so forth4 ,he may experience these as bewildering1 frightening1 painful1 supportive1 soothing1 life-sustaining4 ,the nurse1 on the other hand1 may experience these same objects quite differently4 ,to her they may be familiar tools1 useful aids1 complex machines1 annoyingly defective equipment4 ,even in a situation that does not have special equipment1 for instance in a home1 the patient's world of things changes as the nurse converts ordinary objects into tools4 ,thus1 while nurse and patient share a situation1 the things in their shared world have different meanings for each4 ,the things themselves as well as the persons' relations to them can serve to enhance or inhibit the intersubjective transaction of nursing4 ,time ,to view dialogical nursing as it is actually experienced in the real world1 one must conceive of it as occurring in time1 not simply measured time but also time as lived by patient and nurse4 ,certainly both participants are caught up in measured time and this influences their shared world1 for example1 eight-hour tours of duty1 a day off1 surgery scheduled at #h3jj a4m41 discharge in two days1 visit three times a week1 clinic appointment in #cj days4 ,thus1 to an extent1 both patient and nurse must live by the clock and calendar4 ,however1 equally important1 or perhaps even more important1 in the lived dialogue of nursing is the participants' experience of time4 ,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 years4 ,how the involved persons experience this continuity is an individual matter4 ,the nurse may conceive of herself as one of many persons contributing to a continuous stream of caring for the patient4 ,so she will give and hear and write and read reports1 note observations1 keep records4 ,she will carry an image of the patient in her mind continually adding to it or changing it with each interaction or report4 ,sometimes1 after not seeing the patient for a time1 on meeting him again she will pick up where she left off1 treating him as if he were the same person1 as if days1 months1 years of living had not intervened4 ,oh1 it's him again4 ,or she may be startled by the visible changes and resume the dialogue from that point4 ,or even if change is not visible1 she may be aware that it may have occurred and try to fill in the gap4 ,these possibilities may be mirrored from the patient's standpoint1 for he likewise experiences continuity or lack of it in his care4 ,and yet1 the experience must be different for him4 ,for instance1 nurses may think of continuity of care in terms of coverage for a planned program of care4 ,so it has often been #cd claimed that the nurse is with the patient #bd hours a day4 ,from the patient's point of view this is not true4 ,a nurse may be with him but each nurse is different4 ,the function of nursing may be continuous1 but individual nurses come and go2 the day nurse1 the evening nurse1 the night nurse are each unique individuals4 ,and the nursing dialogue as lived1 intersubjective transaction occurs between a particular nurse and a particular patient4 ,when we speak of a nurse and a hospitalized patient spending a day together1 we usually are referring to eight hours out of a #bd-;hour day4 ,they may both experience the spacing of this time by functions or activities such as meal time1 medicine time1 visiting time4 ,yet the measured minutes and hours are experienced differently by each in their different modes of being in the situation4 ,nurses often express feelings of not having enough time to give the care they want to give2 of having too many demands on their time2 of trying to make time for patients who ask do you have a minute8 ,patients live their time in relation to boredom1 pain1 loneliness1 separation1 waiting4 ,the nursing dialogue runs its course in clock time but both nurse and patient live it in their private times4 ,when the nursing dialogue is genuinely intersubjective1 it has a kind of synchronicity that is evident in the nurse's being with and doing with the patient4 ,this kind of timing is related to the transactional character of nursing and to its goal of nurturing the development of human potential4 ,it is experienced in openness1 availability1 and presence1 as well as in nursing care activities4 ,the nurse feels in harmony with the rhythm of the dialogue and1 sensing the timing of its flow1 she paces her call and response to patient's ability to call and respond in that moment4 ,so1 as a nurse1 you may find yourself almost unconsciously or intuitively waiting1 holding back1 anticipating1 urging the patient4 ,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 experience4 ,good or right timing somehow involves the between4 ,it implies that nurse and patient share not only clock time but private1 lived time4 ,space ,by exploring the dialogue of nursing as it is lived in the real world the factor of space becomes apparent4 ,here again the dialogue is influenced by space as it is measured and space as it is experienced by nurse and patient4 ,when thinking of health care facilities1 space may be synonymous with such things as beds1 waiting rooms1 interview rooms1 treatment areas1 size of patient's room1 visiting areas1 a quiet place1 a private place4 ,naturally1 the physical setting1 whether in a hospital1 home1 anywhere in the community1 can serve to enhance or impede the nursing dialogue4 ,however1 the person's experience of the space may be even more important4 ,space is lived in terms of large and small1 far and near1 long and short1 high and deep1 above and below1 before and behind1 left and right1 across1 all #ce around1 empty1 crowded4 ,these perceptions and experiences of space may be influenced by the effects of illness1 for example1 changes in vision or locomotor ability4 ,thus1 a patient's spatial world may change1 expand or diminish1 become unmanageable or manageable day by day4 ,furthermore1 a patient's attitude toward and experience of a particular place may be affected by his mental association to it 7for example1 oncology ward1 psychiatric unit71 his previous experience in it 7for example1 emergency room1 operating room71 or a desire to be somewhere else 7for example1 ,this is a nice hospital but ,i'd rather be home74 ,place is a kind of lived space4 ,it is personalized space4 ,one says1 for example1 ,come to my place meaning to my home4 ,or even more personally1 it relates to where ,i feel ,i belong or am1 for instance1 he put me in my place2 ,i felt put down4 ,the patient may feel out of place in the health care setting1 while it may be commonplace to the nurse4 ,there may be areas in the setting that the patient experiences as his territory1 for example1 his bed1 his room1 his ward2 while other areas are theirs or restricted to authorized personnel4 ,so a nurse and a patient may be in a place together1 yet one feels at home and the other does not4 ,for the nurse to be really with the patient involves her knowing him in his lived space1 in his here and now4 ,lived space is interrelated with lived time4 ,patients hospitalized for a long time often express a proprietary attitude toward the hospital4 ,the same holds true for personnel4 ,with time and familiarity a feeling of reciprocal belongingness grows4 ,the person belongs in the place and the place belongs to the person4 ,on the other hand1 when a person finds himself in a new place he may feel the discomfort of not belonging4 ,this is as true for the nurse in an unfamiliar setting as for the patient4 ,again in this regard1 the lived nursing dialogue is enhanced by the nurse's awareness of not only her own experience of space but the patient's as well4 ,,conclusion ,this chapter explored the basic view of humanistic nursing as a phenomenon in which human persons meet in a nurturing1 intersubjective transaction4 ,beginning with the central intuition that nursing is lived dialogue1 the examination turned to its existential source1 the nursing situation as it is lived4 ,reflection on actual experience clarified the phenomena of meeting1 relating1 presence1 and call and response as they occur in humanistic nursing4 ,dialogical nursing was then reconsidered in broader perspective as it actually evolves in the real world of men and things in time and space4 ,as scientific advances multiply in the health field1 nursing is swept along in the tide4 ,continuous technological changes1 ever increasing specialization1 emphasis in nursing education and research on scientific methodology all have marked influence on the development of nursing4 ,science 7with a capital ,s7 colors the nursing world4 ,at every turn it permeates the nurse's being with and #cf doing with the patient4 ,it offers a certain security by providing a consistent and effective approach to some problems and questions1 and1 in some cases1 results in general laws to guide practice4 ,at the same time1 in the lived nursing world the nurse experiences a reality that is not open to the scientific approach1 a reality not always verifiable through sense perception1 a reality of individuality4 ,the uniqueness of individuality 7her own as well as the patient's7 pervades the nursing dialogue4 ,the ever-present individual differences may be regarded as intractable elements to be conquered for the sake of the efficiency of the system 7for example1 fit the patient to the treatment program74 ,or they may be valued as indicators of the inexhaustible richness of human potential to be developed4 ,in their daily practice1 nurses are drawn toward the two realities--the reality of the objective scientific world and the reality of the subjective-objective lived world4 ,this tension is lived out in the nursing act4 ,doing with and being with the patient calls for a complementary synthesis by the nurse of these two forms of human dialogue1 ,i-,it and ,i-,thou4 ,both are inherent in humanistic nursing for it is a dialogue lived in the objective and intersubjective realms of the real world4 ,in the highly complex health care system nurses experience many demands from many directions4 ,their clinical judgments in daily practice must be made within a continuous stream of decisions about priorities of investment of their time and efforts4 ,sometimes1 survival in the system reduces the nurse to following the line of least resistance1 that is1 responding to the immediate or to the loudest demands4 ,however1 even with their total commitment this course of response does not guarantee that nurses are making their greatest possible contribution to health care4 ,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 need4 ,humanistic nursing1 viewed as a lived dialogue1 offers a frame of orientation that places the center of our universe at the nurse-patient inter subjective transaction4 ,insightful recognition of the lived nursing act as the point around which all our functions revolve1 could require a ,copernican revolution of orientation of some nurses4 ,it does provide1 for all nurses1 a true sense of direction that can be actualized by each unique nurse through creative human dialogue4 #cg #d ,,phenomenon ,,of ,,community ,humanistic nursing creates1 happens within1 and is affected by community4 ,this chapter will discuss the abstract term community4 ,to stimulate thought on a nurse's influence on community1 consideration will be given to three points3 7#a7 my angular view of community and its evolvement1 7#b7 how man has considered community over time1 7#c7 how a human being comes to be through community4 ,,my ,,angular ,,view ,one can view members of a family1 a student class1 a hospital unit1 a hospital staff1 several related hospital staffs1 health services organizations within a geographic area1 a profession1 a town to a world or universe as community4 ,man's mind1 my mind1 determines where ,i superimpose the limits or lift the limits or relate components4 ,in ,the ,republic ,plato depicted a community as a macrocosm4#a ,its nature was conditioned by the kinds of men1 the microcosms1 that composed it4 ,the macrocosm was a reflection of its microcosms4 ,so each human person1 each nurse1 as a microcosm1 could make a difference4 ,reflecting on the lived worlds of nurses1 their communities1 if we use ,plato's philosophical analogy of macrocosm-microcosm1 despite the varieties of situation1 we can make meaningful a basic concept of community4 ,such a concept utilized by a nurse to view her particular ongoing changing world can help her to understand more realistically1 survive within1 and strugglingly participate as a quality force4 ,to be a quality force within community a nurse must open her being to the endless innovative possibilities and unattempted choices available to her4 #ch ,the ability to thus open one's self requires our exposing our biases1 the shades through which we regard the world1 to the sunlight4 ,in nursing our shades often are closed categories1 labels1 diagnoses1 trite superficial hackneyed expressions learned by us1 taught to us as fact1 taken in unexamined1 and left unreexamined despite other changes in ourselves and our situations4 ,socrates said1 and it still holds1 that the unexamined life is not worth living4 ,our shades can be cherished concepts1 beliefs that guide us automatically rather than thoughtfully4 ,whether they are entirely myth or partial truths1 they can cause us agonizing dilemma because they obscure the obviously relevant and the possibilities beyond4 ,a concept of community1 if grasped and if a nurse is truly consciously aware1 can help her to understand how her nursing world has evolved1 is presently1 and how she can be1 to shape its future in accordance with her values4 ,as nurses one of our shades is often the confining labels we give to ourselves as doers in service giving profession4 ,i would like to go on record as most respectful of this aspect of my world4 ,i regret1 nonetheless1 that we have not always similarly crystallized and floodlighted the discovery and creative possibilities in our communities4 ,in our very personal1 intimate1 involved professional nursing relations with other man we are privileged to be included in human happenings open to no other group4 ,as nurses1 we have had and are having emphasized to us the importance of facts handed to us4 ,can we actuate the importance of the knowledge of man that becomes part of us through our nursing worlds8 ,it is hard to honor the significance of the everyday1 the commonplace1 the intimately known8 ,it has been said that one could know of the whole universe if one could make every possible relationship starting from a piece of bread4 ,think of a simple or routine nursing situation4 ,think of its true complexity and how it can trigger puzzlement1 wonderment1 and thinking4 ,as learning situations1 nurses' situations are existentially priceless4 ,returning now to ,plato's conception of community understood through the terms macrocosm and microcosm1 what can the nursing world situation reveal to us of community8 ,what are the qualities of the participants1 the microcosms1 and how are these qualities reflected in our nursing communities8 ,,history3 ,,the ,,shades ,,of ,,my ,,world1 ,,bracketed ,in years past as a public health mental health psychiatric nurse ,i have structured facts about man1 family1 and community precisely for presentation4 ,approaching the data sociopsychologically ,i framed it in the public health model of promotion of health1 prevention of illness1 treatment1 rehabilitation1 and maintenance4 ,i thought of family sociologically as nuclear1 procreative1 and extended4 ,in accordance with the psychoanalytic model1 family members were oral1 anal1 oedipal1 latent1 homosexual1 adolescent1 heterosexual1 and_/or mature4 ,community1 like person and family1 was considered according to a #ci closed paradigm1 ranging from ideal to abysmal1 from the smallest to the largest unit in which persons congregated for common purposes4 ,i selected from experience nursing examples to make these sociopsychological public health constructs meaningful4 ,i did not start from nursing experiences to come up with nursing concepts of man1 family1 and community4 ,i denied my particular self as a source of knowledge of these areas4 ,had education programmed me to value only others' ideas gleaned in the classroom or from books8 ,i projected this devaluation of my own ideas onto my colleagues and until ,i really knew them gave them what ,i thought they wanted1 others' ideas4 ,presently ,i prize my uncertainty about the nature of man in family and community and my striving toward an ever explorative process of being and becoming1 available for surprise4 ,paradoxically1 ,i believe it was these very same capacities1 uncertainty and striving1 that compelled my superimposing on my colleagues with certainty other persons' and other professions' views4 ,actually1 my certainty about the conundrums3 man1 family1 community come only in particulars and only in fits and starts1 and my certainty is at once a truth and a nontruth4 ,i see my aim as ever striving toward certainty while constantly wrestling with the discomfort of uncertainty4 ,,each ,,nurse3 ,a ,,noetic ,,locus#b ,each nurse is a knowing place4 ,it feels as if my greatest talents1 as a human nurse person1 awaited my acceptance that came through as ,i related to the existentialist thinking of persons like ,martin ,buber1 ,teilhard de ,chardin1 ,frederick ,nietzsche1 ,karl ,popper1 ,hermann ,hesse1 ,wilfrid ,desan1 and ,norman ,cousins4 ,now when ,i think of the phenomena--man1 family1 community--,theresa ,g4 ,muller1 nurse educator and clinician1 who quoted ,hersey from his novel1 ,a ,single ,pebble1 comes to mind4#c ,he said1 ,i approached the river as a dry scientific problem2 ,i found it instead an avenue along which human beings moved whom ,i had not the insight1 even though ,i had the vocabulary1 to understand4 ,i consider my greatest gifts as a human being nurse my ability to relate to other man1 to wonder1 search1 and imagine about my experience1 and to create out of what ,i come to know4 ,my ever developing internalized community of world thinkers dynamically interrelated with my conscious awareness of my experienced nursing realm allows my appreciation of my human gifts and the ever enrichment of myself as a knowing place4 ,,nurse3 ,,experience ,,internalized ,nursing experience taught me that each man1 each family1 each community was at once alike and different4 ,hesse1 an existential novelist1 in ,steppenwolf1 #dj describes each man who has become in family and community as like an onion with hundreds of integuments or a texture with many threads4#d ,then man's differences would be in the quality of his integuments and their development or in his threads in their preponderance4 ,contemplating the struggles in community regarding mutual understanding1 ,i expanded ,hesse's conception of man and found my vision of community to be a salad tossing or a patchwork quilt tumble drying4 ,valuing the complexity of this conception of man and therefore of community ,i find myself smiling at the naivety of the earlier more static frames of order ,i superimposed on these phenomena4 ,these oversimplifications maintained the shade through which ,i viewed my world4 ,the shade was3 others are knowing places1 they are responsible2 therefore if ,i quote authority from outside of myself1 ,i can speak with certainty about what ,i know and believe and no one can attack me4 ,and yet1 my unique knowledge was not given and so my defense1 my clutching at security foiled my human need for conceptualization of and expression of my own nurse vision of reality4 ,this defeated the development by me of nursing theory4 ,now ,i realize how ,i underestimated the potentialities of my nursing effect1 of the difference ,i made1 and could make4 ,just consider the given human uniqueness of each participant in the nursing situation whose familial potential goes back to an origin of thinking being or consciousness1 and forward to his anticipation of the future1 his eternity4 ,in the nursing literature1 it is rather infrequent that we philosophically share our innermost thoughts1 dreams1 ideals1 and strivings without a strong overlay of indoctrination or conversion4 ,nietzsche presents philosophy as autobiographical1 such sharing does not offer maps4 ,it could offer relevant resources and stimulate other nurses to influence the shape and becoming of the profession4 ,this chapter attempts to discuss ideas of community1 the macrocosm1 by considering man1 the microcosm1 as he develops in family and community4 ,the ideas represent my here and now as it reflects my past and anticipated nursing world1 including my hopes and expectations4 ,man's ,experience ,each human being carries a view of persons1 families1 and communities shaded by the views of his nuclear family4 ,the past usually is corrected2 it is never erased4 ,so in his family of origin man internalizes ideas of right-wrong1 appropriate-inappropriate1 expected-unexpected4 ,each family's shaded world echoes its procreators' familial1 psychosocialeconomic1 religious and experiential breadth1 closely resembled or distorted4 ,two persons1 perhaps more1 usually husband and wife1 bring shaded views together in some combination or balance that becomes the stuff1 the authority1 of #da their children's worlds4 ,thus1 children see their early worlds through the complementariness and conflict of this initial home view1 acting at times with it2 at times against it4 ,adults1 in response to and through one another1 procreate new sensitive beings whom they want and_/or do not want and whom they may and_/or may not experience as their responsibility in varying degrees4 ,marcel1 a ,french existentialist philosopher1 views procreation and responsible parenthood as quite different4 ,my past nursing experience substantiates this4 ,marcel expresses my bias about responsible parenthood1 and this statement is also worthy of consideration by nurses in positions of authority to others4 ,he says1 ,we have to lay down the principle that our children 7or those for whom we care7 are destined1 as we are ourselves1 to render a special service1 to share in a work1 we have humbly to acknowledge that we cannot conceive of this work in its entirety and that a fortiori we are incapable of knowing or imagining how it is destined to shape itself for the young will1 it is our province to awaken to a consciousness of itself4#e ,think of this statement of responsible authority4 ,how has it been evidenced in families and nursing situations of your nursing world8 ,what are your expectations of your patients or nurses with whom you work8 ,teilhard de ,chardin1 paleontologist1 biologist1 and philosopher1 like ,nietzsche1 depicts man as lacking a fixed nature with his own mode of being as his fundamental project4#f ,initially1 each person takes on a mode of being in his world dependent upon his degree of freedom and the how and what of the world as presented by his family and perceived by him4 ,the world as presented is reflective of the family's culture1 their provincial world view1 their unique experienced here and now1 and the times4 ,metaphorically1 the family's lived world1 how they experience at this particular cross-section of their lives1 can be symbolically described as a kaleidoscopic telescoping of its past and anticipated future4 ,now1 this would be what was presented at any particular time4 ,what would a child's perception do to this metaphorical symbol8 ,the child's current human development and his narrow experience would be like a circus house mirror that would interpret the metaphorical symbol distortedly4 ,witness a three-year-old speaking questioningly and complainingly about her tension headache to her mute1 nonperceptive doll1 and asking her to please1 please stop making such a mess and racket4 ,the earliest childhood views of family and community are influenced over time1 gradually and abruptly1 and grow in complexity4 ,the child's puzzlement is aroused by others' comings and goings1 happenings within the family1 immediate neighborhood1 and adjacent community1 and the world presented through books and technologically1 on radio1 television1 and tape recorder4 ,each child attends these presentations with varying measures of complacency1 questioning1 bafflement1 and involvement4 #db ,for instance1 for myself1 as a child there was the excitement of the construction of a new house in the woods next door and meeting new neighbors4 ,initially my parents expressed their differences from ourselves4 ,the differences they perceived were followed by negative projections on these unknown folk4 ,were these others really humanly different8 ,i investigated2 my family investigated4 ,the folk became persons4 ,they expressed themselves differently in volume and sometimes in language4 ,they looked different4 ,yet they were not fearsome4 ,they felt1 cared1 responded1 and worried much as we did4 ,mutual knowledge allowed increasing closeness and liking4 ,forbidden6 ,this was the neighborhood across the tracks4 ,i cried when an uncle teasingly proclaimed one day that my missing mother was over there4 ,later ,i attended school with both white and black children who lived over there4 ,and again1 each was different1 yet not different2 each was knowable1 likeable1 and loveable4 ,adult family members whispered about a neighbor woman from across the street4 ,she was apparently hospitalized permanently4 ,when ,i inquired as to why1 eyebrows were raised and strange looks were exchanged4 ,i was told in a not believable way1 ,she broke her leg falling off the back porch4 ,a neighbor husband and wife frequently could be heard fighting both verbally and physically4 ,family talk at our house depicted the husband as evil1 the wife as a poor soul4 ,i did not enjoy being in these peoples' house4 ,perhaps the violence frightened me2 perhaps ,i was uncertain when it might erupt8 ,perhaps ,i was concerned that ,i might one day somehow become part of such a situation8 ,now1 looking back over the years1 ,i would guess that both this husband and wife were poor souls struggling with their humanness as best they could4 ,an adolescent girl lived down the block4 ,she was labeled as strange1 peculiar1 odd1 crazy4 ,often one saw her talking to herself1 skipping and rotating as she moved along in her always solitary and mysterious way4 ,all expressed great sorrow for her always solitary and mysterious way4 ,all expressed great sorrow for her elderly mother and father on her admission to the ,state ,hospital4 ,years later ,i wondered1 and still wonder what happened to that girl1 herself8 ,what kind of an existence has she experienced8 ,during these early years there was also separation from and loss of close loved family members4 ,when ,i was three and a half a great aunt who always appreciated my side of things moved out of our home due to a family argument4 ,perhaps most confusing of all during these preschool years1 at four and a half1 my father died suddenly4 ,they said that he went to heaven1 that ,god called him4 ,why did he go8 ,why would he leave us8 ,most important how could he leave me8 ,what had ,i done wrong8 ,was it that ,i had not loved him enough8 ,been good enough to him8 ,was he angry8 ,what kind of ,god is ,god1 anyway8 ,is he benevolent1 malevolent1 indifferent8 ,is he real3 is he believable8 ,what can one expect and how should one act toward authority and power8 ,the world didn't feel like a very safe place nor did persons appear to be dependable4 ,then there was school4 ,with additional authorities and peers there arose new wonderment and expectation4 ,the way one was to be in school was #dc different from at home4 ,and what was happening at home while ,i was at school8 ,could ,i depend on things being safe8 ,in kindergarten ,i made an ash tray of clay for my already dead father4 ,in my child world there were books1 radio1 and the movies4 ,today children experience these1 as well as television and record players4 ,for me1 books1 radio1 and the movies brought into my world new aspects of fear1 excitement1 joy1 love1 horror1 violence1 imagination1 and suspense4 ,they depicted at times the ideal and at times the abysmal4 ,sometimes1 despite everything1 good triumphed4 ,at other times regardless of the effort invested all was lost4 ,where was the harmony of logical reason8 ,is our world absurd8 ,are we absurd to respond to it with an expectation of reason8 ,for each child there are very special1 long-remembered events3 being taught to swim by one's father1 family picnics1 trips into the world beyond city or country1 going to the circus1 a world's fair1 a zoo or a fantasy land4 ,there1 also are the events of being loved and loving deeply1 linked somehow with times of feeling unloved and unloving4 ,more than earlier1 today there are multiple community groups for children where activities are guided and supervised4 ,within these situations and in the free play of neighborhood children1 there is always the confusing1 enlightening1 and frequently distorted information gained through discovering your relationship with both boys and girls4 ,exploration by children into their sexual similarities and differences1 a healthy pursuit1 in the past more than today often aroused parental furor4 ,furor and different reactions from different involved parents lead to further child confusion and focus4 ,within childhood peer relations there are games1 play1 and schoolwork that allow the child to come to know personally the meanings and feelings of competing1 collaborating1 fighting1 winning1 losing1 destroying1 building1 aggression1 passivity1 constriction1 freedom1 and choice4 ,then there is adolescence with all its moodiness1 questions1 fears1 and experimenting related to adult modes of being4 ,the moods are a mystery and the questions often unanswerable or the answers contradictory4 ,norman ,kiell in ,the ,universal ,experience of ,adolescence says that as adults we forget the intensity1 turmoil1 and concretes of this period and that perhaps we have to4#g ,yet1 it is not possible that the instability and discomfort of spirit lived in adolescence does not leave its ingrained tracing as part of our eternal presents4 ,when the focus of our responsibility shifts from play to work1 during these early years of becoming1 depends on our particular circumstances and abilities4 ,for most persons there is a tipping of the balance between these4 ,hopefully neither extreme is the master4 ,fortunately1 in many instances1 as the child's work as been to play2 the adult's work world1 his world of responsibility is lived1 experienced by him1 to an extent as play--it gives satisfaction and pleasure4 #dd ,some adults select another and are chosen by this other for a sharing of their worlds4 ,some go it alone4 ,some procreate new beings2 some create in other ways2 some give-take and exist2 some just lean4 ,these last appear to be1 and yet to not be1 all-at-once4 ,,man ,,becomes ,,ever ,,more ,buber perceives man becoming more through his human capacity to relate to other being in all forms from the materialistic to the spiritual in ,i-,thou1 ,i-,it1 and ,we ways4#h ,gestation1 with the closeness of mother and child1 has left man with an ingrained knowing of the experience of closeness4 ,thus1 throughout man's life his condition of existence is affected by and desires relationship with and closeness to other being4 ,the closeness of the conditions of gestation is never again possible1 hence existential loneliness4 ,yet because of this prenatal experience ,buber conceives of man as born with a ,thou--another--before he is conscious of himself1 his ,i4 ,with growing consciousness he sorts out his ,i from his ,thou4 ,you can see the late infant doing1 acting through1 this separation4 ,during this growing phase1 often to the care-taking adult's frustration1 he repeatedly1 intensely1 and excitedly throws his toys or bottle out of the crib1 carriage1 or playpen4 ,often he runs away from his ,thou1 his parental security source1 to a safe distance with intense awareness of what he is doing4 ,while internalizing these and subsequent ,thous as part of his ,i1 his knowing place1 paradoxically1 he sorts out who he is1 and who and what is other than himself4 ,so with ever more relationship1 ever more experience1 he becomes ever more the person he has the human capacity to be4 ,he becomes more through his relations with others1 never the same as these others1 though he does internalize these others as part of himself4 ,buber describes ,i-,thou relating1 man merging with otherness1 as always necessitating an ,i1 a man1 capable of recognizing self as at a distance1 apart from otherness4 ,therefore1 his ,i-,thou relating1 a merging of beings1 is not like the psychological defense1 unconscious identification4 ,buber's ,i-,thou relating emphasizes awareness of each being's uniqueness without a superimposing1 or a deciding about the other without a knowing4 ,such relating is a turning to the other1 offering the other authentic presence1 allowing the authentic presence of the other with the self1 and maintaining one's capacity to question4 ,it is not then identification or an idealization of the other4 ,within this mysterious happening of ,i-,thou relating1 when both participants are human1 each becomes more4 ,buber refers to the event of this merging of otherness1 of man with other being1 as the between4 ,humanistic nursing is concerned with the between of nurses and their others4 ,their others1 the #de microcosms of their communities1 would be patients1 patients' families1 professional colleagues1 and other health service personnel4 ,buber describes man's ability to come to know and relate in ,i-,it as man looking back1 reflecting on his past ,i-,thou relations4 ,looking back these ,i-,thou relations are viewed as an object to be known1 as ,it4 ,i-,it relating allows man to interpret1 categorize1 and accrue scientific knowledge4 ,finally man relates with others as ,we4 ,this permits the phenomenon of community and of adult unique contribution4 ,so man becomes through relating with family1 others1 and community1 like ,hesse's onion or a being who actively moves toward ever more integuments1 qualities1 threads1 and complexity4#i ,many unique contradictory type beings1 then1 have influenced the becoming of each individual human person4 ,in a sense each unique person might be viewed as a community of the beings with whom he has meaningfully related in struggle and_/or complementariness4 ,in fact ,buber talks of thinking man as a dialogue of internalized ,thous4 ,,community3 ,,nursing ,if each man can be likened to a community of his internalized ,thous1 logically think of the outcome of many men struggling together supposedly for a common purpose4 ,since time began1 man in community has been experienced by man as chaotic4 ,thus ,plato wrote ,the ,republic4#aj ,this presentation depicted an impossible scheme for developing an ideal community4 ,as a classic1 ,the ,republic continues to be a thought provoking thesis4 ,its antiquity makes one realize that this desire to control1 our continued concern with genetic planning1 is a part of the very nature of man4 ,and yet1 considering man's ever existing recognition of the chaos of community how naive we often behave1 for example1 enraged at experiencing another communication break4 ,plato envisioned regulating and controlling almost every dimension of the individual's existence in accordance with his particular potential for development to fulfill the needs of his ideally conceptualized community4 ,today ,heinlein1 a science fiction novelist1 still writes of breeding for longevity in man1 as we breed animal stock for the greatest amount of meat and profit4#aa ,giving ,plato his due1 he recognized at the end of his book concern and doubt as to whether men so carefully mated and reared would fulfill their designated responsibilities4 ,he wondered if things could1 would1 or would not go in accordance with his plan4 ,he then logically indicated the process and kinds of community deteriorations which could ensue4 ,plato had a concept of an ideal community1 of ideal types of necessary men1 and of ideal male-female breeding relationships4 ,he viewed our present-style family as one that saps the #df strength of community and does not support this concept4 ,he conceived of communal living more like the communal living of our present-day communes4 ,however1 ,plato's communes would have been regulated by the plan as he conceived it4 ,existence in these communes was to be predetermined and very determined4 ,nursing1 though not generally the ruling force of this type of planning1 certainly is involved in control measures analogous to ,plato's4 ,nurses do influence who gets the hospital bed and who does not1 who gets the specialized treatment and equipment1 who is discharged and when1 and what goes into the education and planning for post-hospital health care4 ,also1 how do our biases influence our teaching regarding family8 ,innuendoes are frequent in the areas of birth control1 abortion1 and family size4 ,so nurses can make a difference regarding community thought1 purpose1 and action4 ,nietzsche put forth a concept of community of a more indefinite nature than ,plato's4#ab ,two major themes dominated the nature of community in his conception3 7#a7 the legitimate purpose of community was the total support of its elite men and 7#b7 the criterion for determining the elite was to be based on those who selected their own values with a will to say1 yes to life4 ,he referred to his elite as supermen4 ,he questioned the realization of such a community because of the preponderance of conforming nonquestioning mediocre men4 ,this complacent majority fearful of the different or strange would subdue the possibility of his supermen4 ,nietzsche did not seem to trust man2 he spoke of him as human1 all too human4 ,unlike ,plato1 ,nietzsche viewed good and evil as arising from a common source4 ,man in his humanness1 ,nietzsche felt1 denied his animal heritage and animal qualities4 ,recognition of these1 of one's ,dionysian nature1 as a source of both good and evil was necessary for becoming superman4 ,to me it is wondrous to ponder my own conscious purposefulness and unconscious purposelessness1 my quality of force as a member of the nursing and health communities1 viewed through the deep extensive conceptualized thought ,nietzsche bequeathed4 ,i offhand consider our communities as egalitarian1 part of a larger egalitarian society4 ,are they really8 ,does the citizen affect the quality of organizational structure in accordance with his existential needs while in our commonplace--the health-nursing world8 ,whose values set and direct on this stage of life8 ,do ,i1 nurse1 search out the values on which ,i want to base my nursing practice8 ,do ,i look for direction and values from others8 ,did ,i take on values during my initial nursing experience--values never to be reexamined8 ,within the nursing community are there nurses eagerly noncomplacent and desirous of looking at1 of sharing their explorations1 and of determining and choosing the values that they want to underlie their nursing practice8 #dg ,would supernurses be allowed to be the mediocre many8 ,who would determine the elite of the nursing community8 ,could supernurses survive without approval of their being different8 ,would they be strengthened by the fruits of suffering in their struggle within the profession8 ,would these fruits of suffering contribute constructively to the strengthening of the nursing community8 ,buber1 like ,nietzsche1 sees man-in-community with possibilities for evolving1 being1 and becoming more4 ,buber trusts each man as a unique potential involved in an ongoing struggle with his fellows directed toward a center4#ac ,his nonstatic1 nonselected community where men become in and through ongoing struggle with each other expresses the reality of my nursing world4 ,who would expect a community without struggle if they accepted each man as his history inclusive of antecedents that go back to beginnings of man's consciousness and of anticipations that go forth into this man's notions of eternity8 ,considering the complexity of each man's being and becoming1 it is surprising that we come to understand each other in community at all1 rather than the reverse4 ,how can we hope for a sustained thereness1 presences of nurses with other man 7patients1 patients' families1 professional colleagues1 and other health service personnel7 as ,we in an ongoing struggle of community considering their multitudinous differences8 ,norman ,cousins1 in ,who ,speaks for ,man1 comments on man's inability to respond affirmatively to those he experiences as different from himself4#ad ,for the human community to progress he suggests federation4 ,a unity in which differences would be valued as promoting thought1 human evolvement1 and community advancement4 ,cousins gives examples of man's inhumanity to man based on differences viewed as nonvalues4 ,the prevalence of this latter view of differences is very evident in our commonplace health-nursing world4 ,can nurses and other health care maintainers look at the ways they respond to differences consciously1 and can they deliberately choose to be open to responding to them as valuable8 ,can we conceive of there being value in that which we see as not right1 untrue1 wrong8 ,the ability to be there1 to stay involved in community with my fellows1 is a problem worthy of concern to me as a nurse4 ,how do ,i stay in an existential way with my contemporaries1 patients1 patients' families when their values in reality are so different from my own8 ,how do ,i go beyond a negative judgmental to a prizing attitude that would open the possibility of seeing strengths in others' views perhaps lost1 discarded1 or never previously existent in my own8 ,nonsuperimposing of my own value system through recognizing and bracketing it is a difficult professional goal4 ,and yet1 a goal that if coupled with the courage for personal existence1 could sustain me in the health-nursing community4 #dh ,so for a health-nursing community to truly be actualized each nurse would prepare to be all it was possible for her to be as a nurse4 ,then1 through exploration there would be a recognition of the reality of the existent community4 ,over time a merger of the values of the nurse and of the existing community would be reflected as moreness in each4 ,the nurse would be more through her relation with the community2 the community would be more through its relation with the nurse4 ,each would make an important difference in the other4 ,the macrocosm1 the community1 would reflect the nurse's quality of presence4 ,the microcosm1 the nurse1 would reflect the presence of the community with her4 ,each unique man becomes in community through communication with other uniquely different men4 ,,footnotes3 #a ,plato1 ,the ,republic1 trans4 ,francis ,mac,donald ,cornford 7,new ,york3 ,oxford ,university ,press1 #aide74 #b ,wilfrid ,desan1 ,planetary ,man 7,new ,york3 ,the ,macmillan ,company1 #aigb74 #c ,john ,hersey1 ,a ,single ,pebble 7,new ,york3 ,alfred ,a4 ,knopf1 #aief71 p4 #ah4 #d ,hermann ,hesse1 ,steppenwolf 7,new ,york3 ,holt1 ,rinehart and ,winston1 #aiff71 p4 #fj4 #e ,gabriel ,marcel1 ,homo ,viator 7,new ,york3 ,harper ,row1 ,publishers1 ,harper ,torchbooks1 #aifb71 p4 #aba4 #f ,teilhard de ,chardin1 ,the ,phenomenon of ,man 7,new ,york3 ,harper ,row1 ,publishers1 #aifa74 #g ,norman ,kiell1 ,the ,universal ,experience of ,adolescence 7,new ,york3 ,international ,universities ,press1 #aifd71 pp4 #bb-dd4 #h ,martin ,buber1 ,i and ,thou1 #bnd ed41 trans4 ,ronald ,gregor ,smith 7,new ,york3 ,charles ,schribner's ,sons1 #aieh74 #i ,hesse1 ,steppenwolf1 p4 #fj4 #aj ,plato1 ,the ,republic4 #aa ,robert ,a4 ,heinlein1 ,time ,enough for ,love 7,new ,york3 ,g4 ,p4 ,putnam's ,sons4 #aigc74 #ab ,frederich ,nietzsche1 ,beyond ,good and ,evil1 trans4 ,helen ,zimmern1 in ,the ,philosophy of ,nietzsche 7,new ,york3 ,random ,house1 #aibg7 and ,thus ,spoke ,zarathustra4 trans4 ,thomas ,common1 in the ,philosophy of ,nietzsche 7,new ,york3 ,random ,house1 #aibg74 #ac ,martin ,buber1 ,between ,man and ,man1 trans4 ,ronald ,gregor ,smith 7,boston3 ,beacon ,press1 #aiee74 #ad ,norman ,cousins1 ,who ,speaks for ,man8 7,new ,york3 ,the ,macmillan ,company1 #aiec74 #di ,part #b ,,methodology--,a ,,process ,,of ,,being #ej #ea #e ,,toward ,a ,,responsible ,,free ,,research ,,nurse ,,in ,,the ,,health ,,arena ,,angular ,,view ,research is an inherent component of humanistic nursing4 ,what condition of humanness is necessary in the nurse for the actualization of nursing's research potential8 ,this chapter will attempt to share some brooding and mulling on this problem4 ,nurses practice within ever-moving1 changing settings where formulated plans frequently and suddenly go awry4 ,unexpected patient needs arise4 ,powerful others make both reasonable and unreasonable demands4 ,depended on others fail us due to human frailty or lack of dependability4 ,the nurse's setting1 her researchable area1 is the extreme opposite of her colleague's1 the laboratory investigator's4 ,her area is beyond research control measures4 ,too1 it lacks the quiet isolated atmosphere conducive to contemplation and creative thinking associated with research4 ,conversely1 it is oversaturated with the stuff of meaningful existence4 ,it can stimulate questions to the frenzy of immobilization4 ,the human nurse's system can become overloaded4 ,such overloading reflects the humanness of the nurse2 like all man she can envision possibilities beyond any human being's ability of fulfillment4 ,nurses know there are events in their commonplace worlds that scream for human interpretation1 understanding1 and attestation4 ,the question becomes how4 ,this how depends on more than concretes and events in the nurse's setting4 ,this how depends on relevant ifs4 ,the meaningfulness of the nursing world will be actualized conceptually if this is supported by institutional economic and administrative planners1 other nurses1 and intradisciplinary colleagues4 ,for knowledge available and visible to nurses in the health setting to be preserved1 conceptualized for durability1 it needs to be valued by the institutional health community4 ,still1 most necessary to its duration is the appreciating of this knowledge by the nurse1 herself4 #eb ,,human ,,condition ,,of ,,being3 ,,nurse ,,researcher ,initiation of a ,nurse ,researcher ,the nurse student1 recently arrived in her experiential world1 is awed with the need to be cognizant of multitudinous factors4 ,at this initial introductory phase one could say her being as a nurse is programmed or imprinted with3 ,it is your responsibility to report and attend all the things that influence the response and comfort of those for whom you care4 ,this programming supports and is supported by any already existing tendencies within the nurse student toward unrealistic1 perfectionistic expectations of self4 ,then in research courses1 usually positivistically geared1 her programming jams4 ,her system is fed3 ,select out1 isolate1 focus down on a single question1 limit your variables1 establish a protocol of operation1 control for reliability and validity1 tunnel your vision1 and safeguard objectivity4 ,the jamming is the result of the human nurse's capacity to see relationships between the part and the whole4 ,human intelligence1 as a condition of humanness1 demands this relating of one thing to another4 ,often such relating is intuitive1 human1 based on much thinking for purposes of understanding and solution4 ,yet1 often it cannot be substantiated fully and conceptualized logically at specific times1 therefore it is subjective4 ,to highlight the obvious in the above ,i attempted facetiousness4 ,many nurses acutely aware of the complexities1 contradictions1 and inconsistencies of their nursing worlds have struggled and used the positivistic method in research studies4 ,hence1 they have isolated a researchable question1 stated their basic assumptions1 hypothesized outcomes1 selected samples1 established experimental and control groups1 formulated methodologies1 searched out and utilized appropriate findings1 and have made recommendations4 ,usually these research efforts have advanced scientific knowing and knowledge of existents within the health-nursing situation4 ,and yet1 often these efforts have discouraged the research wonderment of the nurse interested in the nature and meaning of the nursing act and how the event of nursing is lived1 experienced1 and responded to by the participants4 ,these positivistic research methods have made available answers4 ,still1 they have not answered the questions most relevant to nursing practice and to nurses4 ,these nurses were certain that man generally could not be prescribed for interpersonally2 he was not predictable1 not yet an automaton4 ,faced with alternatives men often surprised4 ,consequently these positivistic approaches to studying human events1 unless one forced one's data crowbar style1 always terminated with a kind of miscellaneous category4 ,man's undeterminedness makes him all-at-once frustrating to study1 impossible to distinctly categorize1 and excitingly mysterious and the most worthy focus of nursing research4 #ec ,a ,nurse ,researcher's ,presence in the ,nursing-,health ,setting ,the existent1 a nurse labeled researcher1 in the health world brings a disquiet that has to be understood and endured4 ,necessities for scientific study in the nurse's world of the nursing event or situation are wonderment1 concern1 and responsibility4 ,open adherence to such qualities frequently startles others into speculating about the researcher4 ,she1 herself1 becomes an oddity4 ,persons ponder the possibility of her study's having a hidden agenda that involves them4 ,over time these persons generally accept or reject the searcher's efforts4 ,if rejected the searcher is often labeled a worthless nosey troublemaker4 ,subtly it is conveyed among those involved that she is to be interfered with often by mechanisms of ignoring or forgetting or righteously setting patient's needs above conforming to the study plan4 ,for instance1 how often have research nurses met with responses from staff at the time of their planned arrival on a unit to work with a patient1 ,oh1 he seemed to need activity1 he was restless1 ,i forgot you were coming1 ,i sent him to the gym1 or ,oh1 7surprise7 did you want to give the patient his morning care8 ,that was done a while ago2 we give care early4 ,if accepted the searcher is often labeled an interested1 interesting person whose efforts are to be fostered because her findings will enhance situation nursing4 ,the distinction frequently is based in staffs' responses to the searcher's personality more than in the value of the issues of the investigation4 ,significant to negative staff responses toward a nurse searcher is the necessity for her to withhold information4 ,this withholding may be necessary to protect the study results4 ,for example1 it is necessary when a special type of patient care is being tested against usual patient care or when confidentiality is an issue4 ,confidentiality requires a nurse1 searcher or not1 to censor communications when personal knowledge of individuals make them identifiable4 ,the need for confidentiality can be determined by the nurse's considering the knowledge gained in view of whether it will or will not influence the over-all treatment plan4 ,if it will affect the plan1 there is reason to reveal it2 then it must be related in a manner that insures the patient's continued protection and1 if possible1 with his permission4 ,if over-all treatment is not influenced1 one must censor the knowledge gained to check one's own free communications4 ,would the patient want it revealed2 is it knowledge of a quality that brings ridicule1 is looked at negatively or nonacceptably in our particular culture generally8 ,is it of a sensitive nature and therefore knowledge we do not just reveal to anyone8 ,other patient care givers may sense this withholding by the nurse searcher4 ,they may reasonably accept it or unreasonably not accept it4 ,the researcher may or may not be aware of or concern herself with her colleagues' sensitivity4 ,this would depend on the searcher's usual modus operandi and on the importance she associates with her colleagues' sway in her investigation4 ,the latter can be much greater than is obvious4 #ed ,confidentiality--,description3 ,humanistic ,nursing ,humanistic nursing practice theory proposes phenomenology1 a descriptive approach to participants in the nursing situation as a method for studying1 interpreting1 and attesting the nature and meaning of the lived events4 ,humane nursing is not humanistic nursing within this theory unless that which becomes visible to the nurse in the nursing situation is shared in a durable form with colleagues4 ,confidentiality1 then1 becomes an important issue in humanistic nursing4 ,no scientific methodology of research is affixed with ought or should virtues regarding knowledge gained4 ,in nursing1 a professional helping realm1 a practitioner or researcher is wed to ought and should virtues4 ,the knowledge gained ought to be dispersed to colleagues for their increased understanding4 ,it should enhance the constructive force of the profession4 ,to so enhance it must be communicated in a manner that allows understanding while protecting distinct individuals and groups4 ,words and conceptualized ideas are the tools of phenomenology4 ,protection of distinct persons and meaningful communication can be augmented through the utilization of abstractions1 metaphors1 analogies1 and parables4 ,so humanistic nurses1 as practitioners and researchers1 are inherently responsible for their manner of being1 responding1 and consciously sculpturing knowledge into words4 ,responsibility ,when ,sharing3 ,understanding of ,man ,how does a nurse searcher1 who wonders1 notices1 relates1 and comes to know1 become humanly responsible8 ,nietzsche's philosophical works would direct a nurse searcher to look at her values4 ,the values known through looking at what determines her actual behavior considering how these values correlate with her privilege of calling herself1 nurse4 ,empathy1 knowing how another experiences1 when coupled with the title1 nurse1 dictates a performance that encompasses no harm to others and hopefully benefits them4 ,despite the human excitement of discovery1 disciplined effort and rigorous evaluation enter into preparing knowledge of man for dispersal4 ,revelation should not merely shock2 rather1 professionally we use shock to awaken surprise1 a fundamental1 for human constructive movement toward moreness4 ,the former1 mere shock1 needs to be guarded against4 ,the latter1 shock to awaken surprise needs to be exactingly1 uncompromisingly attended for the communicability of knowledge and the actualization of the phenomenon1 nursing4 ,in considering confidentiality and the quality of knowledge of man available to me1 as nurse1 my consciousness is confronted with my former mentor1 and internalized ,thou1 ,paul ,v4 ,lemkau1 ,m4,d41 psychiatrist4 ,he #ee emphasized repeatedly that the professional person1 as he increasingly understands man1 should take on increasing responsibility to man1 one's self and one's others4 ,buber says1 ,as we become free 444 our responsibility must become personal and solitary4#a ,one can extend this and say that to help others struggle for freedom one must realize that others must responsibly decide and that although they do this through and in the authentic presence of a nurse1 these others are alone in deciding4 ,and nurses in deciding what and how to convey of their knowing must decide freely1 responsibly1 personally1 and alone4 ,the nurse in deciding what and how to convey1 considering the professional necessities of both confidentiality and dispersion of knowledge1 can be guided by a conception of the nature of man-in-his-world4 ,man in humanistic nursing practice theory is viewed as a conflictual1 contradictory1 inconsistent dilemma4 ,one horn of the dilemma is ideal spirituality that wrestles against the other horn1 protective materialistic animalism4 ,this all-at-once struggling1 stretched1 mixed nature of man needs recognition4 ,recognition of man's nature1 as such1 supports greater self-acceptance4 ,self-acceptance and this view of man-in-his-world1 like a magnifying glass1 unmasks for a nurse her possible responses1 motivations1 and alternatives4 ,cognizant of these1 she can responsibly select what knowledge to disperse to protect individuals and to continually shape and conceptually actualize the nursing profession4 ,utilizing this magnifying glass on self in humanistic nursing practice theory to let one's existing mixed1 varied1 struggling responses1 motives1 and alternatives into self-awareness is an axiom referred to as authenticity with self4 ,acceptance of the others' human nature or human condition of being is usually easier than acceptance of our own4 ,usually each man is his own severest judge4 ,lilyan ,weymouth1 ,r4,n41 clinical specialist1 my past teacher and present friend1 in sympathetic moments1 speaking of suffering others1 often says1 the poor devils4 ,once1 feeling anxious and annoyed1 ,i responded1 we are all poor devils4 ,she retorted1 ,i am glad you recognize that4 ,stopped short1 ,i found myself continuing to ponder the phrase1 poor devils4 ,man's dilemma is that he is neither saint nor devil4 ,he is a poor saint and a poor devil1 and by his nature he is pushed and pulled in both directions1 all-at-once4 ,our human existence in the world calls for an enduring with our virtues and vices1 our energy and our laziness1 our altruism and our selfishness1 in a word with our humanness4 ,what meaning does this conception of man have for humanistic nursing practice theory8 ,this theory necessitates a nurse who accepts and believes in the chaos of existence as lived and experienced by each man despite the shadows he casts interpreted as poise1 control1 order1 and joy4 ,labeled mental patients in therapeutic situation1 in the sun beyond the shadows1 express how they set themselves apart from the rest of the community #ef of man4 ,they express how they experience themselves4 ,they view themselves as the worst1 the noblest1 the unhappiest1 the most maligned1 and the most afraid4 ,it comes out as if these superlative distinctions are their only claims to fame4 ,in my humanness ,i appreciate the awesome dreads they live4 ,they need to know that they exist in their unique distinctness4 ,and yet1 the separation and loneliness with which they adorn themselves and which professionally we have fostered with fear engendering diagnostic labels seem a heavier than necessary burden4 ,in the light of existential loneliness1 a part of each human existence1 often ,i invite them to see themselves as not so unlike other men and as suffering the turmoil of existence as part of the human community1 such as it is4 ,one usually can note their surprise and disbelief of my view4 ,then1 momentarily at least1 tension seems to visibly fall from their faces and forms4 ,when this idea of them is heard by them1 its effect corresponds to how ,i experienced the technique in sensitivity group of literally being allowed to dance into what felt like the circle of man1 our group4 ,to hear opportunities for humanistic nursing acceptance and support nurses1 too1 need to question their self-nurse-image within the nursing and health community4 ,do they know that they make and have real potential for making a difference1 an important difference8 ,do they accept themselves as nurse8 ,to me1 a nurse is a being1 becoming through intersubjectively calling and responding in her suffering1 joyous1 struggling1 chaotic humanness1 always trying beyond the possible while never completely free from ignoble personal human wants4 ,and1 through her presence it is possible for other persons to be all they can be in crisis situations of their worlds4 ,for the nurse to be humanistic it is necessary for her to live her human condition-in-her-nursing-world proudly with all its vulnerability and all its wonders4 ,as man1 the nurse can recall and reflect on her ,i1 on her past ,i-,other experiences1 and she can come to know and accept more and more of herself1 as she becomes more4 ,in humanistically recalling and reflecting a nurse will understand and respond empathetically and sympathetically to both her own humanness and the other's4 ,she will recognize both self and other as poor devil and poor saint1 all-at-once4 ,on the other hand1 if a nurse denies her own struggling humanness1 she self-righteously will be apt to accuse either self or her other4 ,this way of being denies1 suppresses1 and represses one's own and the other's ability to be1 to be as much as potentially possible4 ,understanding man through this conception of him is important to the possibility of augmenting the implementation of humanistic nursing practice theory4 ,authenticity ,with ,the ,self3 ,for ,actualization of ,nursing's ,potential ,husserl1 the father of phenomenology1 suggested the study of our lived worlds1 our experience1 a return to the study of the thing itself4 ,looking at the lived worlds of nurses one is confronted with conflicts and multiple #eg values4 ,in their nursing worlds nurses often risk themselves in their commitment to good for their patients4 ,they come to know aspects of their own and others' unique natures4 ,these are often different from and frequently in conflict with generally accepted cultural values and_/or institutional policies and rules4 ,if confidentiality is an issue1 does this dictate a suppression of nurses' complete knowing8 ,or does this call for a recognition of as complete a knowing as possible followed by responsible selection and revelation of that knowing which will advance knowledge and understanding of man8 ,understanding of man can change a person's way of being with other man and his way of existing in and responding to his world4 ,i suggest the latter1 as complete knowing as possible followed by responsible selection and revelation1 with occasional risk taking to deepen the level of accepted cultural knowledge of man4 ,always1 the nurse would protect an individual other man4 ,this dispersion of knowledge1 then1 requires not only responsible being in the nursing situation but also mulling1 pondering1 assessing1 and judging prior to disclosure4 ,as complete a knowing as possible1 in humanistic nursing refers to its axiom1 authenticity with the self4 ,when ,i1 nurse1 respond in the arena of my lived nursing world1 ,i respond to a particular person in this here and now with all my background and all my anticipation of the future4 ,by respond1 ,i do not mean to indicate that ,i overtly deliberately communicate or verbalize my total response4 ,rather ,i mean that ,i strive for awareness of my total response within myself to a particular person in a particular here and now viewed through my particular past and anticipated future4 ,it is a struggle to grasp how ,i perceive and respond within all my capacity of human beingness4 ,to attain the highest possible level of authenticity with the self requires later recollection of ongoing perceptions of the other and reciprocal responses1 selected communications1 and actions by the self4 ,these recollections now become raw data available for analyzing1 questioning1 relating1 synthesizing1 hypothetically considering1 and ongoing correcting4 ,sometimes sharing such recollections with a trustworthy confidant 7clinical specialist1 consultant7 for purposes of reality testing is helpful4 ,often this can broaden the professional meaning base ,i attribute to both my perceptions and my responses4 ,on return to the arena of my nursing world ,i then verify my perceptions4 ,i can let the other know how ,i perceived his actions and be open to his further expression of how this world is for him4 ,in professional nursing this kind of experiencing1 searching1 validating1 utilizing of one's human potential capacity must be based in the ideals on which nursing rests4 ,primarily for me1 ,i see myself1 nurse1 as comforter or being nurse in such a way that my other is helped to be all that he can humanly be in this particular here and now considering his unique potential4 ,so1 being authentic with the self1 is not an acting out of a nonthought through response or merely a doing of what one feels like doing4 ,rather it is the very opposite of this4 ,it is a thought through responsible choosing of overt response based in knowledge and on nursing values4 ,it must correspond positively with one's belief that searching and sharing in one's nursing world will promote both the nursed and the nurse to be more4 ,if it is merely a #eh peeking in on1 an exploitation of the other1 for selfish learning purposes1 it desecrates the very concept of nursing4 ,one has the broad human potential of feeling like doing many things1 all-at-once1 that extend into all kinds of living4 ,and this is true in1 as well as outside1 a nurse world4 ,in recollecting and reflecting on perceptions and responses in all these extremes one becomes freer to select from within one's self the values to be chosen1 actualized1 and potentiated in one's nursing practice4 ,authenticity with the self calls forth confrontation of the self with one's motivations and alternatives4 ,this permits a purposeful selection and an aware actualized overt response based on one's nursing value criteria artfully tailored to a particular situation4 ,i consider each nurse a scientific-artist3 classical1 modern1 primitive1 cubic1 or interpretive4 ,my inference here is that we express artfully in accordance with our uniqueness4 ,many nurses given the same data would accomplish with the same or a similar degree of adequacy through use of their particular distinct selves4 ,therefore1 though the function called for might be the same1 each nurse would approach the function and the patient differently4 ,how one actualizes the result of thinking1 and being authentic with one's self recalls what ,jung said about art4 ,art is a kind of innate drive that seizes a human being and makes him its instrument4 ,the artist is not a person endowed with free will that seeks his own ends1 but one who allows art to realize its purpose through him4 ,as a human being he may have moods and a will and personal aims1 but as an artist he is man in a higher sense--he is collective man--one who carries and shapes the unconscious1 psychic life of mankind4#b ,through the years1 over and over1 ,i have met nurses so driven1 motivated1 and expressive in their nursing worlds4 ,i called this section authenticity with the self3 for actualization of nursing's potential4 ,in it ,i have been trying to say1 the more of ourselves we are able to awarely include1 the more of the other we can be open to and with4 ,a capacity for presence with others allows us to share ourselves4 ,through this sharing others become more4 ,they are able to internalize us as ,thou4 ,this happening occurs in the reverse1 too1 and we become more4 ,in a nursing situation the quality of being authentic with the self is to be striven for4 ,it is a taking advantage of and appreciating of our human ability and spirit4 ,it fosters our pursuit of inquiry1 improves our caring for others1 the contributing of our unique knowing1 and it allows us to shape ever further a scientific-artistic profession of nursing4 ,authenticity ,with the ,self3 ,potentiated in ,lived ,experience ,this example is offered to support the claims for authenticity with the self made in the last paragraph of the prior section4 #ei ,as clinical supervisor and thesis advisor to a young graduate nursing student in her twenties the benefits of authenticity with the self were again brought home to me4 ,she was taping her therapy sessions with two patients4 ,these taped materials were to become her thesis data4 ,one of her patients was not much younger than herself4 ,the other was a divorced woman in her forties1 around my age4 ,this young graduate nursing student was receiving clinical nursing supervision as a necessity in her particular situation not by personal choice or awareness of need4 ,from the onset of her clinical supervision with me ,i was aware that it aroused her feelings about dependence4 ,at her age this had meaning since she was still struggling for independence and interdependence4 ,this is a difficult time4 ,her response to me was respectful1 sweetly and unawarely hostile1 and she made it apparent that ,i was another nurse authority to be appeased1 manipulated1 and outsmarted4 ,this behavior had been successful for her with past authorities4 ,she was bright and had been able to complete intellectual requests and assignments at the last minute with little effort4 ,during the initial phase of our relationship awareness of her struggle1 her difficulties and her assets1 allowed me to maintain a supportive kind of being with her4 ,in listening to her therapy tapes ,i realized that another clinical supervisory approach was called for4 ,she was defending against relating to her older patient by behaving toward her as she probably felt toward her own mother1 and often toward me4 ,also1 she was defeating her therapeutic purpose with her younger patient by viewing her as if the patient were herself4 ,the older suicidal1 depressed patient was begging her for an understanding therapeutic relationship4 ,she needed terribly to share her suffering4 ,this woman did not need a rejecting daughter working hard to outwit her4 ,the younger patient needed to share her angry feelings and sense of worthlessness4 ,through the tapes and through weekly sessions with the graduate student1 ,i came to know and understand her existing nursing situations4 ,at this time neither the student's need to understand nor the patients' therapeutic needs were being met4 ,the student1 too1 was aware of this in a sort of suppressed way4 ,indirectly1 in responding to her patients1 knowing ,i would be listening to the tape she would take a sweet swipe at me which placed the responsibility of all our efforts on my shoulders4 ,so if there were no beneficial outcomes1 obviously the blame could be placed4 ,during the initial phase of my relationship with the graduate student and during the initial phases of her relationship with her patients ,i came to understand4 ,i listened1 got into the rhythm of these other spirits1 reflected on what ,i had come to know1 and out of this experience assessed and planned4 ,later1 taking what ,i had come to know1 as just how it was for all of us1 ,i shared my knowing with the graduate student and budding first-rate therapist4 ,together we explored the implications of the above4 ,she became invested1 involved1 and excited about herself becoming more4 ,we1 myself and each of her patients1 become for her more whom we essentially were4 ,most important to her and to me1 this graduate student grew in her recognition and acceptance #fj of herself and her ability as an adult nurse therapist4 ,the thanks and meaningful praise she received from both her patients on termination of therapy made this apparent4 ,it brought tears to both her eyes and mine4 ,i felt joy in being with a now-respected colleague1 as opposed to the earlier being with a person who felt like an unasked for awe struck defensive daughter4 ,authenticity with myself1 and this graduate student's ability for authenticity with herself allowed these patients' progress to occur4 ,it allowed a realistic articulation in this student's phenomenological master's thesis of her lived nurse experience4 ,from such articulation will a theory and scientific-artistic profession of nursing ever mold1 flow1 and form4 ,,words ,,distinctly ,,human3 ,,limiting1 ,,yet ,,humanizing ,through words we humanly share the meaning to us of our behavior1 experience1 and profession4 ,words attest to and endure4 ,thus1 a professional history is possible1 accrues1 and has lasting duration4 ,the study of the nursing event itself and its conceptualization as proposed in humanistic nursing practice theory is an application of phenomenology4 ,articulation of our perspective1 experience1 and ideas is the human way of phenomenology4 ,words are symbols to which man gives meaning as an outgrowth of his civilization within his culture4 ,through words man attempts to communicatively describe his experienced states of being-in-his-world4 ,in describing1 of necessity1 he relegates his uniquely known experiences to already known word symbols or categories4 ,thus1 the conceptualized experience is limited1 or less real than the lived unique experience4 ,so1 while words prevent the loss of the wisdom of lived experience1 they are both a wonder of humanness and a limitation of humanness4 ,in describing human experiences there are efforts that can cut back this limitation4 ,if we truly wish to convey meaning to others1 really want to share what we have experienced in living1 we will put forth the effort4 ,to put forth such effort requires going beyond ,i must publish to publish4 ,it takes writing1 structuring1 rewriting1 and restructuring often to a point where for a period one comes to hate materials he once held dear4 ,through the years many of us come to use words as a means of passing a course1 or we view words as a mode for self-explosion1 expression1 and self-understanding4 ,in these ways they hold much purpose4 ,the requirement that words convey unique experiences of being to others demands much more4 ,this necessitates one selecting words that depict one's perspective1 his unique human angular view2 or depict for another1 this particular man as he perceives and responds to his unique experience4 ,such a depiction has to be unknown to the other2 each one's vantage point1 given his history as an existent in this time and place1 is singular4 ,then it requires finding words and putting them #fa together in a way that best conveys the meaning the nursing event had to the nurse4 ,an adequate dictionary and thesaurus can be useful4 ,the actual presentation of experience for an audience demands an ordering of data in a sequence that will be sensibly logical for them4 ,we live experience in an order that flows from our being and history within a multiplicity of calls and responses4 ,presently human expression is limited to sequentiality4 ,so again we see that the conceptualized experience is different from and lacks the reality of the uniquely lived event4 ,structuring a logical sequential presentation of data1 deciding on those aspects that influenced meaning1 and having it conform as closely as possible to the real is difficult4 ,often1 when it seems that one has done his very best1 it is wise to have a trusted other react to conceptualizations4 ,another's questions can bring to the conceptualizer's awareness thought connections that moved him along and that he has failed to convey4 ,also1 such a reader can indicate aspects of thought trips the writer took that add nothing to the issue at stake and weaken his message4 ,too1 another's response can make apparent to a writer the need to clarify meaning4 ,this clarification may merely entail a better choice of words or phrases1 or it may suggest the use of a meaningful metaphor1 analogy1 or parable4 ,these last imaginative forms of expression we frequently use meaningfully1 sometimes like a shorthand1 with our intimates4 ,a phrase1 metaphor1 or analogy conveys with an immediacy the quality or spirit of an event4 ,for example1 a nurse working in a psychiatric hospital unit speaking of a patient said1 ,he came down the hall looking like an accident about to happen4 ,a page of technical description could not have given me as much feeling for what she and the patient were experiencing at that moment4 ,in nurses' efforts to express objectively1 scientifically1 and eruditely such modes of expression are often deleted from our written professional works4 ,it is as if we enforce the rules of medical record charting of precision1 conciseness1 and use of weasel words onto all our written works to the detriment of a theoretical and professional enduring body of nursing knowledge being actualized4 ,it takes considerable pain and endeavor to find egress from such human programming4 ,with it we have purified1 equalized1 wearied1 and dehumanized supreme experiences of human existence4 ,and1 we have negated the meaning and importance of ourselves and nursing4 ,how often have you heard1 ,i am just a nurse8 ,phenomenology requires rigorous investment into respectfully1 appreciatively1 and acceptingly making evident our lived worlds and their ramifications for the now1 the past1 and the anticipated future4 ,nursing literature of this caliber would call and inspire those who attended it to further nursing practice and responsibly share the meaning they attribute to their area of specialized dedication4 ,the raw data of our lived nursing worlds do not easily reveal their meanings or messages4 ,many see their worlds only superficially1 and themselves as mere functions4 ,how often a nurse is surprised1 confounded1 on hearing a relative or friend speak of a nursing event in their lives that may have occurred #fb from #aj to #dj years previously4 ,frequently persons express appreciation for the meaning these events have had for them through the years4 ,they remember the pleasure1 anger1 pain1 fear1 and_/or joy they experienced4 ,it is not loose performance that allows raw data to convey its message to a nurse4 ,new data are sucked easily and immediately into old1 worn out1 known theoretical frames and networks of words4 ,severe self-discipline enters into describing nursing experience with the vigor of how it was lived4 ,too easily the description is let fall to mediocre common forms4 ,proper grammar and plain ,english should suffice4 ,this would carry the nursing message1 as jargon borrowed from other disciplines in which the nurse always speaks as an alien1 never will4 ,humanistic nursing practice theory in asking for description does not ask one to forget or deny known terms and knowledge4 ,rather it asks for a bracketing or holding of this knowledge to the side4 ,the nursing experience should be given an opportunity to be seen in its pure form1 rather than forcing it to conform to foreign prestigious terms borrowed from other areas of specialization1 which beg the meaning of the nursing event4 ,prior to dispersion1 of course1 one should weigh one's expression in ,english against one's expression in one's known foreign jargon4 ,then one will be open to choose how one wants to express and share the meaning of her nursing world4 ,phenomenology accepts categorization as a necessity of communicating4 ,it holds1 nevertheless1 that this is secondary to initial aware experiencing4 ,this study method acknowledges the unfathomable complexity of existing and knowing4 ,it strives for as adequate conceptualization of the existential experience as possible4 ,it honors the knowing person's continued capacity for surprise and wonderment4 ,phenomenology asks us to go beyond the common labels to the surprise of our own and other's unique existences-in-the-world4 ,a nurse who had been struggling over many months with a family in their home1 on the day she first experienced an ,i-,thou relationship with them said1 ,it was as if ,i had gone beyond the uncooperativeness and dirtiness of the situation4 ,immediacy in labeling offers us the complacency and security of a wrapped up problem4 ,how could a nurse be held responsible for what happened to a dirty1 uncooperative family4 ,the many commonly heard labels humans attribute inhumanely to others rarely relate to answers in situations or to the dreadful human suffering problems generate4 ,phenomenology seeks attestation of the meaning of a situation to a participant4 ,positivism seeks general objective categories within the universal4 ,phenomenology prizes differences1 variations1 and struggles for their representation as parts of the whole4 ,rather than emphasize the majority as holding sway1 it recognizes that the unique contribution can possibly be the weightiest in meaning4 #fc ,,the ,,process3 ,,becoming ,a ,,free ,,responsible ,,research ,,nurse ,for a nurse to become a free responsible research nurse in the health arena she accepts her lived nursing world as beyond the controls valued in positivistic science4 ,she appreciates her lived nursing world as saturated with knowledge to be extracted or wrung4 ,then she must examine1 recognize1 appreciate1 and unfold her history1 her angular view1 and her human nurse potential4 ,in prizing her view1 as nurse1 she will ask relevant nursing questions4 ,to attain her potential as nurse she will discipline herself rigorously for authenticity with the self4 ,with the self-acceptance that comes with self-authenticity she will know the importance of the difference she and the nursing profession make and can make in the community of man4 ,then out of her own human social need and for the survival of nursing she will describe to propel knowledge1 nursing theory1 and practice forward4 ,in this process and in its effects she will become more human as she contributes to man's humanization4 ,,footnotes3 #a ,martin ,buber1 ,between ,man and ,man1 trans4 ,ronald ,gregor ,smith 7,boston3 ,beacon ,press1 #aiee71 p4 #ic4 #b ,carl ,g4 ,jung1 ,modern ,man in ,search of a ,soul1 trans4 ,w4 ,s4 ,dell and ,cary ,f4 ,baynes 7,new ,york3 ,harcourt1 ,brace and ,world1 #aicc71 p4 #afi4 #fd #fe #f ,,the ,,logic ,,of ,a ,,phenomenological ,,methodology ,,perspective3 ,,angular ,,view ,in humanistic nursing practice theory we1 ,dr4 ,zderad and myself1 propose that nursing practice when studied1 like any other area studied1 will only become available for human conceptualization if the study methods are appropriate to its nature4 ,therefore1 the methodology presented in this chapter is relevant to humanistic nursing practice theory4 ,embraced within this chapter is a methodology for studying nursing that evolved out of the process of my nursing practice4 ,the logic of this method and of my process of nursing are one4 ,it is not a method of another discipline superimposed on nursing4 ,so this method did not force nursing or change nursing to have it mold or conform4 ,as this method unfolded it arose from and in accord with nursing process4 ,this methodology came into being only after years in which various attempts were made to get positivistic methodology to answer relevant nursing questions and to develop a professional scientific theory of nursing4 ,the method presented here was used initially to creatively conceptualize nursing constructs in #aifg-fh4 ,the data for the development of the constructs comfort and clinical were gathered from my clinical nursing practice and while ,i was deeply engrossed in existential readings4 ,the process or method used was not conceptualized until it was called for while writing my doctoral dissertation in #aifh4 ,it had then been used to study the clinical literary works of two psychiatric mental health nurses1 ,theresa ,g4 ,muller and ,ruth ,gilbert4#a ,its conceptualization at that time was rudimentary4 ,gradually it has been further conceptualized4 ,from a ,philosophy of ,nursing to a ,method of #ff ,nursology1 an article published in ,nursing ,research in #aigb1 was my next attempt4#b ,graduate nursing students studied this article and repeated the process of the methodology in their studies of their clinical nursing data4 ,reflecting on this article and realizing how others had to study and struggle with it4 ,i became aware that still only the bare bones of my thinking were presented4 ,further elaboration of this methodology was called forth to share it with the humanistic nursing practice theory course participants4 ,since #aigj ,i have delved into phenomenologists' writings and at this time can say that this process of studying nursing is a phenomenological method of nursology4 ,interesting to me is that the initiation of this method came when ,i first began to read the existentialist literature4 ,existentialism can be viewed as the fruits of phenomenological study4 ,the process of this method has become clearer and clearer to me over time4 ,phenomenologically the process or method has grown out of the reality of the thing itself to be studied1 in this case1 clinical nursing practice4 ,this chapter then is the result of reflecting on these past efforts and is a conceptualization of this method as ,i understand it now4 ,the following quote is offered to support and validate the efforts put into conceptualizing this method4 ,the philosopher of science ,abraham ,kaplan says of methodology3 ,the aim of methodology 444 is to invite speculation from science and practicality from philosophy 444 to help us understand in the broadest possible terms1 not the products of scientific inquiry1 but the process itself4#c ,the above quotation expresses the spirit in which this presentation is offered4 ,positivistic science aims at objectivity and its results are viewed as scientific facts4 ,nursing practice has been understood by many as an implementation of such theoretical facts4 ,considering my and other nurses' implementation of such facts it is apparent that in these endeavors nurses come to know much about human existence4 ,philosophy is often viewed as man's contemplations1 autobiographical revelations1 and the values and belief systems that underlie man's actions1 ,can an explicit philosophy of nursing allow for more meaningful quality practice1 be a resource for nurses1 improve service1 be available for reexamination1 correction1 and the forwarding of knowledge8 ,if nursing practice is viewed as the implementation of scientific facts and what they call forth in the nursing situation related to man's condition of existence1 is a heuristic science of nursing developed from this situation1 by nurses1 an appropriate practical professional aim8 #fg ,this presentation is my answer1 a committed ,yes4 ,the method offered here1 a phenomenological method of nursology1 aims at the reality of man1 how he experiences his world1 or it aims at a subjective-objective state4 ,it aims at description of the professional clinical nursing situation which in reality is subjective-objective world that occurs between subjective-objective beings4 ,the description focuses on this between and preserves the complex mobile flow of the river of nursing to make apparent that superficial precise portrayals are only an overlay of its river bed1 course1 and eventual destinations4 ,the relevance of phenomenological nursology ranges from the formulation of nursing constructs to the creation of theoretical propositions4 ,it is applicable to one's own clinical data and to others' clinical data1 here and now1 or in historical study of the literature4 ,,methodological ,,starting ,,point ,this method addresses itself to the question3 ,how can a nurse1 a subjective-objective human being know self and the other and compare and complementarily synthesize these known betweens8 ,basic to this method is a belief system1 a philosophy about the nature of man explicitly commented on by thinkers throughout human history4 ,plato said3 ,i cannot be sure whether or not ,i see it as it really is2 but we can be sure there is some such reality which it concerns us to see4#d ,nurses are with other men in times of peak life experiences under the most intimate circumstances4 ,we1 too1 can not be certain about what we come to know in our betweens4 ,we can be sure that these realities of human experience are worthy of exploration4 ,our opportunities are unique1 only we can describe man in the nursing situation4 ,in ,let ,us ,now ,praise ,famous ,men1 ,james ,agee voices a similar concern about the need to describe man-in-his-world and the adequacy of human description4#e ,aware of the wonders and complexities of man he considers not trying to describe worse than the inadequacy of description4 ,thinkers have also acknowledged that we can come to know from others4 ,a poem by ,goethe expresses an attitude about this3 ,somebody says3 ',of no school ,i am part1 ,never to living master lost my heart2 ,nor anymore can ,i be said ,to have learned anything from the dead4' #fh ,that statement--subject to appeal-- ,means3 ',i'm a self-made imbecile4'#f ,in nursing what better master than the nursing situation in which we become through our relations with others4 ,each human person has something unique to teach us if we can but hear4 ,about our inadequacies of expression1 many things are1 are true1 all-at-once4 ,the law of contradiction does not apply in-the-lived-experienced-world4 ,we each view the world through our unique histories4 ,wisdom is many sided truth4 ,wisdom cannot be expressed all-at-once4 ,truths can be stated only in sequence or metaphorically4 ,if ,i were supercritical of my human limitations to express all-at-once wisdom1 ,i would say nothing4 ,jung points up the dangers of this1 he says3 ,i must prevent my critical powers from destroying my creativeness4 ,i know well enough that every word ,i utter carries with it something of myself--of my special and unique self with its particular history and its particular world4#g ,each nurse's uniqueness dictates then a responsibility to share her particular knowing with fellow struggling human beings4 ,only through each describing can there be correction and complementary synthesis to movement beyond4 ,the nurse's world is an experiential place for becoming influenced by each participant's here and now inclusive or origin1 history1 and hopes1 fears1 and alternatives of the confronting future4 ,positivistic science focuses on selected particulars4 ,henri ,bergson says3 444 for us conscious beings1 it is the units that matter1 for we do not count extremities of intervals1 we feel and live the intervals themselves4#h ,each human participant in the nursing situation has a unique flow of consciousness which is intersubjectively influential4 ,so as human nurses we are limited in our ability to express the reality of our-lived worlds4 ,yet1 also1 this world depends on and demands that we1 as human nurses1 give it meaning1 understand it in accordance with our #fi humanness4 ,will and ,ariel ,durant1 historians1 professionals who are forced to selectively present the world for other humans1 say3 ,the historian will not mourn because he can see no meaning in human existence except that which man puts into it3 let it be our pride that we ourselves may put meaning into our lives1 and sometimes a significance that transcends death4#i ,humans are the only beings conscious of themselves4 ,nurses are human beings4 ,as such we are capable of looking at our existence1 choosing our values1 giving our world meaning and of constantly transcending ourselves1 or becoming more4 ,if we value and prize our human nursing world and our human potential for consciousness and expression1 we will actuate our potential and conceptualize our human nurse-world4 ,this suggests questions to me4 ,what do ,i want nursing to be8 ,how can ,i influence the meaning of the term1 nursing8 ,how committed am ,i8 ,what investment am ,i willing to make8 ,will ,i risk exploring and saying what ,i see in my nursing world8 ,am ,i open to knowing8 ,how can ,i actuate my uniqueness to allow the realistic potential of my nursing profession to become1 become ever more8 ,am ,i contributing my nursing here and now to nursing's history through a lasting form of expression8 ,of what importance is what ,i think or say2 do ,i make any difference8 ,hermann ,hesse says of each man's uniqueness3 444 every man is more than just himself2 he also represents the unique1 the very special and always significant and remarkable point at which the world's phenomena intersect1 only once in this way and never again4#aj ,or1 a nurse might say3 444 every nurse is more than just herself1 she also represents the unique1 the very special and always significant and remarkable point at which the nursing world's phenomena intersect1 only once in this way and never again4 ,to me1 human freedom means recognizing our unique potential1 responsibility1 and limitations4 ,our singularity as a nurse among nurses1 then1 confronts us with a responsibility that belongs to one else4 ,martin ,buber1 philosophical anthropologist says3 ,as we become free 444 our responsibility must become personal and solitary4#aa ,our unlikeness to other nurses is a lonely1 very person conditioned state4 ,only each nurse can be responsible for herself4 ,the wonders of freedom are #gj paradoxically1 all-at-once1 both a delight and a burden4 ,in nursing it is important for us to understand freedom not as opposing or agreeing3 freedom is choosing--choosing and saying yes to one's self4 ,human endeavor between man and men in their-worlds1 in this instance professional clinical nursing1 if explored and described is viewed as contributing to man's human evolvement and to knowledge of the human condition and how man becomes4 ,integrally all the above statements are the bases and biases of this human phenomenological method of nursology4 ,in a phrase1 ,i suppose what all these starting point statements say is3 ,nursing situations make available human existence events significantly worthy of description4 ,only human nurses can describe them4 ,humans' ability to describe reality adequately has its limits4 ,we should describe since pridefully we humans are the only existing beings capable of giving meaning to1 looking at1 and expressing our consciousness4 ,in the long run this effort could yield a nursing science4 ,,phases ,,of ,,phenomenologic ,,nursology ,phase ,i3 ,preparation of the ,nurse ,knower ,for ,coming to ,know ,this method engages the investigator as a risk taker and as a knowing place4 ,risk taking necessitates decision4 ,decision imposes confronting ambivalence in one's self4 ,the ambivalence of wanting to be all-at-once responsible and dependent4 ,superimposing an already accepted and acceptable structure on data is safe feeling4 ,approaching the situation or data openly1 letting the structure emerge from it1 not deciding what to look for1 being willing to be surprised1 give feelings of excitement1 fear1 and uncertainty4 ,there exists the possibility that our humanness may include the dilemma of our not being able to perceive the messages of our data1 that we will not be able to merge with it and become more4 ,the question arises1 ,are we knowing places that can relate to otherness and intuitively synthesize knowledge8 ,this process of accepting the decision to approach the unknown openly is experienced as an internal struggle and we become consciously aware of our rigidity and satisfaction with the status quo4 ,conforming to the usual1 in this case positivism1 gives a security that is not easily relinquished despite the advantages of actualizing our unique responsible freedom4 ,russell's metaphorical phrase1 windows always open to the world1 depicts the sought state of mind4 ,his elaboration on this phrase gives the flavor of the process of preparing the mind4 ,he says1 ,through one's windows one sees not only the joy and beauty of the world1 but also its pain and cruelty and ugliness1 and the one is as well worth seeing as the other1 and one must look into hell before one has any right to speak of heaven4#ab ,pain1 cruelty1 ugliness1 hell seem appropriate words to convey seeing our #galong-cherished ideas and values1 our security blankets1 as only false gods4 ,nietzsche in speaking of confrontation of one's values said1 ,and now only cometh to him the great terror1 the great outlook1 the great sickness1 the great nausea1 the great seasickness4#ac ,so this human methodology seeks a condition of being in the investigator4 ,the investigator must be aware of her own angular view and democratically open to giving the angular views apparent in the data1 the called for representation4 ,the first phase of this method of research correlates well with the struggle experienced by me in clarifying my approach to patients in public health1 medical-surgical1 and psychiatric mental health situations4 ,in these situations1 one truly has to struggle with democratically keeping one's windows open to the world4 ,and this is a continual process4 ,having experienced this struggle in clinical nursing made this approach to research valid and meaningful to me4 ,preparing the mind for knowing in clinical or research endeavors may be accomplished by several means4 ,one means is by immersing one's self in dramatic and literary works and contemplating1 reflecting on1 and discussing them as they relate to the knower's already known1 in this case1 nursing practice4 ,in clinical or research nursing the selection of literary works to stimulate the opening of one's human view is based on their presentation1 depictions1 and descriptions of man's nature4 ,in literature authors share their thoughts as men and present possible ways men may view and relate to their worlds4 ,phase ,,ii3 ,nurse ,knowing of the ,other ,intuitively ,bergson conceives of man knowing through a dilatation of his imagination getting inside of1 into le dure1 into the rhythm and mobility of the other4 ,living the rhythm of the other he believes results in an absolute1 intuitive1 inexpressible1 unique knowledge of the other4 ,he says3 444 an absolute can only be given in an intuition1 while all the rest has to go with analysis4 444 from intuition one can pass on to analysis1 but not from analysis to intuition4 444 fixed concepts can be extracted by our thought from the mobile reality2 but there is not means whatever of reconstituting with the fixity of concepts the mobility of the real4#ad ,the known1 clinical nursing practice1 gave meaning to the above for me4 ,over the years in nursing conferences ,i had been told my grasp of nursing situations was intuitive4 ,most times this was offered rather disparagingly although the nursing outcomes were most times successful4 ,along with having #gb the attribute of intuition assigned to me persons often asked1 ,why are you so fascinated with other persons' situations8 ,together these relate to ,dewey's view of intuition4 ,he views intuition as a mulling over of conditions and a mental synthesis that results in true judgments since the controlling standards are intelligent selection1 estimation1 and problem solution4#ae ,in nursing practice research knowing the other and how he experiences and views his world is viewed as the problem4 ,knowing intuitively1 as described by ,bergson1 is comparable to ,buber's considerations of man's necessary mode of becoming through ,i-,thou relation4 ,the criteria ,buber describes as characteristic for ,i-,thou relation are subscribed to in my approach to nursing practice and in this human or phenomenological nursology approach4#af ,buber held as prerequisite for intuitive type knowing of the other1 or imagining the real of his potential for being1 a knower1 and ,i1 capable of distance from the other1 able to see the other as a unique other1 one who turns to the other1 makes his being present to the other1 and allows the other presence4 ,the knowing1 ,i1 in this case the nurse1 responds to the other's uniqueness1 does not superimpose1 maintains a capacity for surprise and question1 and is with the other1 as opposed to seeming to be4 ,this kind of relating cannot be superimposed on a nurse clinician or researcher4 ,it must be personally responsibly chosen and invested in4 ,the approach then of the second phase of this method and of the transactional phase of nursing when nurses are in the arena with others is the same4 ,this method proposes that to study nursing from outside the arena for purposes of objectivity bursts asunder the very nature of nursing practice4 ,the studier is a part of that which is being studied4 ,observations interpreted from outside the situation could be classified only as projections4 ,phase ,,iii3 ,nurse ,knowing the ,other ,scientifically ,bergson believes man knows incompletely through standing outside the thing to be known1 metaphorically walking around it1 and observing it4 ,this analytical process1 this viewing of a thing's many aspects1 he conceives as the habitual function of positive science4 ,this is the third phase of this phenomenological nursology method4 ,bergson says3 444 analysis multiplies endlessly the points of view 444 to complete the ever incomplete representation4 ,all analysis is thus a translation1 a development into symbols1 a representation taken from successive points of view4 ,analysis 444 is the operation which reduces the object to elements already known1 that is1 common to that object and to others4#ag #gc ,so phenomenological nursology proposes that after the studier has experienced the other intuitively and absolutely1 the experience be conceptualized and expressed in accordance with the nurse's human potential4 ,humanly we can express only sequentially while our actual experienced lived worlds flow in an all-at-once fashion4 ,our words are known symbols and categories used to convey the experience and thus deny the uniqueness of each realized experience4 ,buber's description of man's ,i-,it way of relating to the world is in agreement with ,bergson4 ,he conveys the necessity of this kind of relating by man to his world2 and despite its lacks proposes that man prize his analytical ability4 ,like ,bergson1 ,buber views knowing as a movement from intuition to analysis1 and not the other way around4 ,buber sees knowledge expressed or science created through the knowing ,i transcending itself1 recollecting1 reflecting on1 and experiencing its past ,i-,thou relation as an ,it4 ,this is man being conscious of1 looking at1 himself and that which he has taken in1 merged with1 made part of himself4 ,this is the time when he mulls over1 analyzes1 sorts out1 compares1 contrasts1 relates1 interprets1 gives a name to1 and categorizes4 ,the third phase of this methodology is the same as that phase of clinical nursing practice in which the nurse1 removed from the nursing arena1 replays and reflects on this area and transcribes her angular view of it4 ,in this reflective state the nurse analyzes1 considers relationships between components1 synthesizes themes or patterns1 and then conceptualizes or symbolically interprets a sequential view of this past lived reality4 ,the challenge of communicating a lived nursing reality demands authenticity with the self and rigorous effort in the selection of words1 phrases1 and precise grammar4 ,phase ,,iv3 ,nurse ,complementarily ,synthesizing ,known ,others ,in this phase of the methodology the nurse researcher1 the knower1 compares and synthesizes multiple known realities4 ,buber says of comparison3 ,the act of contrasting1 carried out properly and adequately1 leads to the grasp of the principle4#ah ,in this comparison and synthesis the ,i of the researcher assumes the position of the knowing place4 ,the knower1 like an interpreter1 allows dialogue between the multiple known realities4 ,these realities are unknowable to each other directly4 ,the knower interprets1 sorts1 and classifies4 ,in the human knowing place discovered differences in similar realities do not compete1 one does not negate the other4 ,each can be true1 present1 all-at-once4 ,differences can make visible the greater realities of each4 ,desan1 the philosopher1 says of this kind of synthesis3 #gd 444 a synthetic view where two or more positions are seen to illuminate and to transfigure one another through their mutual presence4#ai ,the knower alert to an aspect present in a single reality can question the other reality on this aspect4 ,this aspect may be present in both1 more blatant in one than in another4 ,its forms may be different or modified in each4 ,it may be totally absent in one4 ,differences found may arouse or bring to consciousness other questions to ask of the data4 ,this oscillating1 dialectical process continues throughout reflection on the multiple realities4 ,this indirect dialogue is recorded by the investigator as the complementary synthesis4 ,this synthesis is more than additive because it allows mutual representation and the illumination of one reality by another4 ,the fourth phase of this research methodology is like that phase of clinical nursing in which a nurse compares and synthesizes the similarities and differences of like nursing situations and arrives at an expanded view4 ,phase ,v3 ,succession ,within the ,nurse ,from the ,many to the ,paradoxical ,one ,this phase of phenomenological nursology is highly probable if not absolutely necessary4 ,desan says3 ,truth emerges in and through the relational operation4 ,for the way of paradox is the way of truth4#bj ,the investigator may struggle with the multiplicity of views now consciously part of and within herself4 ,again ,desan3 444 this unrest is the mind of man1 reaching its center4444 ,from this center the splendor of multiplicity is visible4#ba ,the researcher1 mulling over and considering the relationships between the multiple views1 insightfully corrects and expands her own angular view4 ,this is not a right-wrong type of correction4 ,such correction would amount only to an ongoing eternal recurrence of a frustrating nature4 ,rather this correction takes the form of ever more inclusiveness4 ,struggling with the communion of the different ideas the knower takes an intuitive leap1 through and yet beyond these ideas1 into a greater understanding4 ,she then may come up with a conception or abstraction that is inclusive of and beyond the multiplicities and contradictions4 ,this inclusive conception or abstraction is an expression of the investigator in her here and now1 with the old truths and the novel truths1 none obliterated4 #ge ,the fifth phase of this phenomenological nursology method can be equated to that phase of clinical professional nursing in which the nurse propels nursing knowledge forward4 ,in this phase a nurse struggling with the mutual communion of multiple nursing situations arrives at a conception that is meaningful to the many or to all4 ,from the specific concrete ideas of the many situations she moves through dilemma to resolution which is nursing expressed abstractly in units or as a whole1 as one4 ,experiential knowledge of nursing1 years in which ,i came to know self and the other while implementing scientific facts1 allowed me as a knower to recognize the relevance of this philosophical nursology method4 ,this method does not aim at conventionality4 ,rather it strives to meaningfully augment and share conceptualized nurse-world realities4 ,,footnotes3 #a ,josephine ,g4 ,paterson1 ,echo into ,tomorrow3 ,a ,mental ,health ,psychiatric ,philosophical ,conceptualization of ,nursing ,d4,n4,sc4 dissertation1 ,boston ,university1 #aifi4 #b ,josephine ,g4 ,paterson ,from a ,philosophy of ,clinical ,nursing to a ,method of ,nursology1 ,nursing ,research1 ,vol4 ,,xx 7,march-,april1 #aiga71 pp4 #adc-adf4 #c ,abraham ,kaplan1 ,conduct of ,inquiry 7,san ,francisco3 ,chandler ,publishing ,co41 #aifd71 p4 #bc4 #d ,plato1 ,the ,republic1 trans4 ,francis ,mac,donald ,cornford 7,new ,york3 ,oxford ,university ,press1 #aide71 p4 #de4 #e ,james ,agee1 ,let ,us ,now ,praise ,famous ,men 7,new ,york3 ,ballantine ,books1 #aici71 pp4 #ia-ajb4 #f ,johann ,wolfgang von ,goethe1 ,on ,originality4 ,in ,great ,writings of ,goethe1 ed4 ,stephen ,spender 7,new ,york3 ,mentor ,press1 #aieh71 p4 #de4 #g ,c4 ,g4 ,jung1 ,modern ,man in ,search of a ,soul1 trans4 ,w4 ,s4 ,dell and ,cary ,f4 ,baynes 7,new ,york3 ,harcourt1 ,brace and ,world1 #aicc71 p4 #aah4 #h ,henri ,bergson1 ,time in the ,history of ,western ,philosophy1 in ,philosophy in the ,twentieth ,century1 ed4 ,william ,barrett and ,henry ,d4 ,aiken 7,new ,york3 ,random ,house1 #aifb71 p4 #beb4 #i ,will ,durant and ,ariel ,durant1 ,lessons of ,history 7,new ,york3 ,simon and ,schuster1 #aifh71 p4 #ajb4 #aj ,hermann ,hesse1 ,demian1 trans4 ,michael ,roloff and ,michael ,lebeck 7,new ,york3 ,harper ,row1 #aife71 p4 #d4 #aa ,martin ,buber1 ,between ,man and ,man1 trans4 ,ronald ,gregor ,smith 7,boston3 ,beacon ,press1 #aiee71 p4 #ic4 #ab ,bertrand ,russell1 ,the ,autobiography of ,bertrand ,russell1 #aiad-aidd 7,boston3 ,little1 ,brown and ,co41 #aifh71 p4 #ig4 #ac ,frederick ,nietzsche ,thus ,spake ,zarathustra1 trans4 ,thomas ,common1 in ,the ,philosophy of ,nietzsche 7,new ,york3 ,random ,house1 #aibg71 p4 #bci4 #ad ,henri ,bergson1 ,an ,introduction to ,metaphysics1 in ,philosophy in the ,twentieth ,century1 ed4 ,william ,barrett and ,henry ,d4 ,aiken 7,new ,york3 ,random ,house1 #aifb71 pp4 #cjc-cca4 #ae ,john ,dewey1 ,how ,we ,think 7,boston3 ,d4 ,c4 ,heath ,co41 ,publishers1 #aiaj71 p4 #aje4 #af ,martin ,buber1 ,distance and ,relation1 trans4 ,ronald ,gregor ,smith1 in ,the ,knowledge of ,man1 ed4 ,maurice ,friedman4 7,new ,york3 ,harper ,row1 ,publishers1 #aife71 pp4 #fj-hb4 #ag ,bergson1 ,an ,introduction to ,metaphysics1 pp4 #cjc-cca4 #ah ,martin ,buber1 ,i and ,thou1 #bnd ed41 trans4 ,ronald ,gregor ,smith1 7,new ,york3 ,charles ,scribner's ,sons1 #aieh74 pp4 #c-cd4 #ai ,w4 ,d4 ,desan1 ,planetary ,man 7,new ,york3 ,the ,macmillan ,company1 #aigb71 p4 #gg4 #bj ,ibid4 #ba ,ibid41 p4 #hj4 #gf #gg #g ,a ,,phenomenological ,,approach ,,to ,,humanistic ,,nursing ,,theory ,humanistic nursing is dialogical in the theoretical as well as the practical realm4 ,just as the meaning of humanistic nursing is found in the existential intersubjective act1 that is1 in the dialogue as it is lived out by nurse and patient in the real world1 so the theory of humanistic nursing is formed1 in the dialogical interplay of articulated experiences shared by searching1 abstracting1 conceptualizing nurses4 ,the theory of humanistic nursing originates from and is continually revitalized and refined by actual nursing experience4 ,but each nurse1 as a unique human being1 necessarily experiences the nursing dialogue and her nursing world in a unique way4 ,so the development of humanistic nursing theory rests on the sharing of individual unique angular views4 ,and the theory as a totality will become richer1 more consonant with reality1 as it represents more and more nurses' views4 ,so often nurses1 even nurses who know that their clinical expertise grew out of their practice1 hesitate to share their nursing experiences4 ,they are apt to say deprecatingly1 ,oh1 that's only my personal experience4 ,yet that is precisely where the value lies1 in the uniqueness of human experience4 ,since each nurse's description of her nursing experience is a glimpse of a real nursing world1 the views cannot justifiably be judged as right or wrong2 they simply are4 ,once the various views are expressed1 they can be compared and contrasted1 not for the purpose of accepting some and rejecting others but rather in the interest of clarifying each in relation to the other4 ,such a dialogue of experientially based conceptualizations can result in a complementary synthesis4 ,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 nurses4 ,this view1 that the development of humanistic nursing practice theory is a dialogical process1 has led to our valuing 7in fact1 insisting on7 the description #gh of nursing phenomena4 ,we see phenomenological description as a basic and essential step in theory building4 ,indeed1 considering the state-of-the-art of nursing theory development1 it is the most crucial and immediate need4 ,looking back at the historical evolvement of our humanistic nursing approach1 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 label1 ,phenomenological ,psychiatric ,mental ,health ,nursing1 in a course offered to a group of nurses at ,northport ,veterans ,administration ,hospital in ,april #aigb4 ,although we were aware much earlier that our interests and work were flowing in the general stream of phenomenology1 we usually refrained from using the label because it did little to clarify our position4#a ,the term has grown less precise with the extension of its use in different disciplines and with variations in methodology4 ,when we began applying the term phenomenological to our work1 we learned that to many persons it sounds strange1 unpronounceable1 foreign2 to some forbidding2 to others enticing4 ,we later coined the title humanistic nursing as being more suitable for it encompasses our general existential bent4 ,however1 this change in title does not imply any abandonment of our phenomenological approach4 ,the description of nursing phenomena is as highly prized now as ever4 ,in humanistic nursing1 phenomenological and existential currents interrelate4 ,having an existential view of nursing as a living dialogue influences which phenomena one becomes aware of1 experiences1 values1 studies1 and describes4 ,reciprocally1 as one discovers and struggles to describe and develop meaningful ways of describing nursing phenomena1 the lived nursing dialogue itself will be continually perfected4 ,it is more precise to speak of phenomenological methods 7in the plural7 rather than phenomenological method 7in the singular71 for1 since ,edmund ,husserl's original work1 the approach has been used by different disciplines4 ,with its spread there has developed a corresponding variation in methodology4 ,this1 in a sense1 is the beauty of phenomenology3 it thrives on variety of perspective2 it allows1 perhaps requires1 individual creativeness2 it is always open4 ,in this spirit1 ideas are offered here with the hope of stimulating imaginative1 critical response1 and further development of methodology4 ,this chapter considers some of the more concrete details of phenomenological methodology as they relate to humanistic nursing4 ,the general approach and procedures discussed below have been used1 individually #gi and collaboratively1 by ,dr4 ,josephine ,paterson and myself with individual and groups of nurses to explore and describe their nursing experiences4 ,they have helped nurses in various levels and types of nursing service to take a fresh look at their practice and make desirable changes4 ,we have lived through the process with graduate students in nursing1 and it has led both the students and us to new conceptualizations and reconceptualizations of nursing phenomena4 ,we have found this to be a fruitful research method when applied to clinical nursing phenomena personally experienced and_/or reported in the literature4 ,and we are currently exploring its potentials with interested nurses at ,northport ,veterans ,administration ,hospital4 ,a ,,phenomenological ,,approach ,the method may be characterized generally as descriptive but it is not a simple cataloguing of qualities or counting of elements4 ,basically1 it involves an openness to nursing phenomena1 a spirit of receptivity1 readiness for surprise1 the courage to experience the unknown4 ,equally important is awareness of one's own perspective and of personal biases4 ,the methodological process is subjective-objective and intuitive-analytic4 ,besides subjective knowing or personal experiencing of the phenomenon1 rigorous analysis also is required4 ,this being-with 7subjective1 intuitive knowing and experiencing7 and looking at 7objective analyzing7 the phenomenon all at once sparks a creative synthesis1 a conceptualization from which emanates insightful description4 ,more specifically1 the method entails an intuitive grasp of the phenomenon1 analytic examination of its occurrences1 synthesis1 and description4 ,in actuality1 as the method is carried out1 one does not necessarily recognize or focus on these processes as distinct phases or steps4 ,in the flow of the experience1 at times1 some seem to occur simultaneously or in oscillation4 ,bearing this in mind1 the processes will be considered in more detail4 ,intuitive ,grasp of the ,phenomenon ,phenomenology is grounded in experience4 ,it values the raw data of immediate experience4 7,to the things themselves1 was the slogan that inspired and guided ,husserl and his followers47 ,so this approach requires1 in the first place1 attitudes of openness and awareness4 ,it involves learning to become conscious of spontaneous perceptions1 or in other words1 getting in touch with one's sensations and feelings4 ,it means capturing prereflective experience1 that is1 becoming aware of one's immediate impression or response to reality before labeling1 categorizing1 or judging it4 ,in this kind of a state of readiness to receive what appears1 a phenomenon may be grasped intuitively4 ,it is as if a particular bit of reality1 a happening1 flashes impressively into one's awareness4 ,the intensity of the experience and the absorption of one's attention in the phenomenon vary over a wide range4 ,there may be only a fleeting recognition of a phenomenon accompanied by #hj a half-formulated thought or judgment1 such as1 hmm1 that's interesting1 with immediate dismissal from or replacement of it by something else in one's consciousness4 ,the impression may1 of course1 be stored in memory and pop out again at a later time4 ,or the phenomenon may strike on one's consciousness more forcefully causing further pondering and wonder4 ,or the impression of the phenomenon may be so startling that it fills one's consciousness to the point of pushing all else out2 a person is momentarily stopped in his tracks4 ,in the intuitive grasp1 regardless of its intensity or duration1 the phenomenon appears clear and distinct4 ,the intuitive grasp is an insight into reality that bears the certainty of immediate experience4 ,no discursive process intervenes2 one simply knows the phenomenon as it is experienced4 ,furthermore1 the intuitive grasp provides a kind of definite and whole understanding1 a gestalt1 that allows recognition of the phenomenon in other situations4 ,so when the person is faced with another event he can say1 ,yes1 that is the phenomenon under consideration1 or ,no1 that is not it4 ,in order to be open to the data of experience in using a phenomenological approach1 one strives to eliminate the a priori 7that which exists in his mind prior to and independent of the experience74 ,this is done by attempting to bracket 7hold in abeyance7 theoretical presuppositions1 interpretations1 labels1 categories1 judgments1 and so forth4 ,granted1 a person cannot be completely perspectiveless4 ,man is an individual2 he is a unique here and now person4 ,so naturally1 necessarily1 he has an angular view for he experiences reality from the angle of his own particular here and his own particular now4 ,or1 stated differently1 as a knowing1 experiencing subject1 each man must have some perspective of the phenomenon being experienced4 ,however1 by recognizing and considering the particular perspective from which he is experiencing it1 a person may become more open to the thing itself4 ,furthermore1 this kind of openness to one's own perspective can be developed through deliberate practice4 ,several approaches may be used4 ,to begin with1 a person can develop the habit of recognizing and exposing his own biases4 ,this could involve something as basic as stating the actual physical situation or circumstance in which the phenomenon was experienced4 ,for example3 the phenomenon could be something seen from above or below1 at a distance or nearby2 something heard in a quiet room or above the din of background noise2 a patient's behavior in a large group or in a small group1 with his family1 with on particular nurse1 with his doctor2 a patient's response while being fed1 bathed1 monitored4 ,beyond this unavoidable bias of the angle of perception1 the nurse's experience of her lived world may be dulled by habituation4 ,it is necessary to break through the tunnel vision of routine4 ,for instance1 a nurse new to a situation may notice a patient's response to her and remark about it to another nurse4 ,the second nurse1 to whom the patient's behavior is familiar1 may respond1 ,oh1 he's done that for years4 ,often this is the end of the dialogue2 it should be the beginning1 for the duration of a phenomenon is not #ha equal to its description or meaning1 but rather1 is an indication of its significance4 ,the mystery of the commonplace is hidden by veils of the obvious4 ,to recognize one's biases means to put one's beliefs1 one's cherished notions1 out on the table4 ,a helpful aid in reflecting on and articulating an experience is the question1 ,what am ,i taking for granted8 ,commonly used terms1 such as1 psychiatric patient1 orthopedic patient1 oncology unit1 uncooperative1 emotional1 chronic1 terminal1 hopeless1 outpatient1 ambulatory1 visitors1 family1 doctor1 nurse1 administration1 front office have an aura of connotations that may correspond to or differ greatly from the actual immediate experience4 ,it may be a case where believing is seeing4 ,the habit of premature labeling may close a person to the full savoring of experience4 ,another means of increasing openness to one's own perspective is to consciously note whether the phenomenon is being experienced actively or passively4 ,for example1 the phenomenon may be the motion of changing a patient's position in bed4 ,both experience the motion1 but it is a different experience for the nurse who actively moves the patient and for the patient who is moved passively4 ,or again1 many studies of the phenomenon of empathy have been reported in the literature4 ,almost exclusively1 these are descriptions of empathizing with someone2 only rarely are they concerned with the experience of being empathized with4 ,yet obviously1 the active and passive experiences of the phenomenon of empathy are different4 ,the same holds true for touching and being touched1 bathing and being bathed1 feeding and being fed1 supporting and being supported1 reassuring and being reassured1 and many other phenomena in nursing4 ,similarly1 awareness of one's perspective may be increased by consciously realizing whether the phenomenon is being viewed objectively or subjectively4 ,consider for example1 phenomena such as pain1 anxiety1 sleep1 restlessness1 boredom4 ,seeing evidence of pain in another person is not the same as feeling pain within myself4 ,recognizing objective signs of anxiety in another person differs from the subjective experience of feeling anxious myself4 ,sleeping and observing someone sleeping are two different experiences4 ,the same hold true for restlessness1 boredom1 and so forth4 ,in view of nursing's dialogical character it may be assumed that many phenomena of major concern would be intersubjective or transactional4 ,it is important then for nurses1 attempting to develop openness to their own perspectives1 to consider whether the phenomenon involves two subjects and their between4 ,does the action go both ways8 ,are both persons calling and responding to each other simultaneously8 ,take the phenomenon of timing for example4 ,the nurse's verbal response to a patient depends not only on her perception of her own here-and-now and his perception of his here-and-now but rather it also involves their perceptions of their shared here-and-now situation4 ,the nursing world is filled with intersubjective phenomena such as1 eye #hb contact1 touch1 silence4 ,to describe these fully the nurse must be open to her perspective1 the patient's perspective1 and their between4 ,analysis1 ,synthesis1 and ,description ,after a nursing phenomenon is grasped intuitively1 it is desirable to find as many instances of it as possible for the sake of description4 ,keeping the phenomenon in mind and reflecting on it from time to time1 the nurse becomes more alert to its occurrence in her lived world4 ,the phenomenon may be experienced directly4 ,in which case1 it is described and reflected on and descriptions1 reflections1 and questions are recorded4 ,when she observes the phenomenon in others1 the nurse may ask them to describe it and verify her own observations4 ,some nurses have involved other staff members in discovering and describing instances of the phenomenon being studied4 ,similarly1 one becomes more open to descriptions of it in the literature--any literature--or in any form of human expression1 for example1 poetry1 drama1 art1 science4 ,as many descriptions of the phenomenon are gathered from as many angles as possible1 these are the data to be analytically examined1 synthesized1 and described4 ,the three processes of analysis1 synthesis1 and description are so interrelated and so intertwined in reality that it is simpler to discuss techniques in relation to all three4 ,some techniques are equally useful in the analytic examination and the description of phenomena4 ,in a sense1 a person does both at once4 ,and often1 it is during this process of shifting back and forth1 analyzing and describing an experience that synthesis occurs4 ,a person gets a sudden insight1 everything falls into place1 it clicks4 ,one gets a gestalt1 a whole1 not necessarily a whole in the sense of complete and entire1 but a whole frame1 form1 or structure that allows for further developing and filling in of details4 ,there are many ways of going about the analysis and description4 ,the following are some that have been found useful in the explication of nursing phenomena4 ,comparing and contrasting instances of the phenomenon lead to the discovery of similarities and differences4 ,for instance1 in studying patients' crying it was found that their crying was with or without tears2 loud or silent2 expressing pain1 anger1 fear1 sorrow4 ,or again1 silence may be defined simply as absence of sound4 ,but silence as experienced in the real nursing world has other characteristics4 ,it may convey anger1 fear1 peacefulness1 and so forth4 ,it is these nuances or qualities of silence that are significant cues for the nursing dialogue4 ,they could be brought to light by comparing and contrasting descriptions of silence4 ,various instances of the phenomenon being studied may be examined to discover common elements4 ,characteristics or elements seen in one instance are sought in the others4 ,for example1 when descriptions of interpersonal empathy were scrutinized1 it became evident that in all cases there were physiological1 psychological1 and social components4 ,examining experiences #hc of reassurance revealed they had elements such as empathy1 sympathy1 reality orientation1 feelings of hope and comfort4 ,one may determine which elements are essential to the phenomenon by imaginative variation1 that is1 by trying to imagine the phenomenon without a particular element4 ,for instance1 reassurance without empathy or sympathy would be false reassurance or1 in other words1 would not reassure4 ,the elements of the phenomenon can be studied to determine how they are interrelated4 ,one may ask1 is there a priority in time8 ,does one element develop from another8 ,consider the phenomenon of reassurance2 does empathy precede sympathy8 ,or1 to take another example1 in the empathic experience1 an openness to the other and an imaginative projection into his place lead to the vicarious experiencing of his situation4 ,for further clarification of its distinctive qualities the phenomenon may be related to and distinguished from other similar phenomena4 ,for example1 empathy is similar to and also different from identification1 projection1 compassion1 sympathy1 love1 and encounter4 ,by considering what it has in common with other phenomena1 the phenomenon being described may be classified as being subsumed in a broader category4 ,thus1 empathy is a human response1 a coalescent movement1 a form of relating4 ,the phenomenon may be described by selecting its central or decisive characteristics and abstracting its accidentals4 ,for instance1 interpersonal empathy always involves movement into another's perspective and as a form of movement it has directions1 dimensions1 and degrees4 ,it can occur between persons of difference age1 education1 experience1 sex2 these latter characteristics are accidental4 ,some descriptions make use of negation4 ,a phenomenon cannot be described completely by negation but it may be clarified to some extent by saying what it is not4 ,for instance1 empathy is not sympathy2 it is not projection2 it is not identification4 ,analogy may be used to promote analytic examination and description4 ,this involves a comparison based on partial similarity between like features of two things4 ,for example1 the movement of empathy is like the currents in the sea2 the heart is like a pump4 ,the advantage of using analogy is that the comparison raises questions about the nature of the phenomenon under consideration4 ,however1 since the similarity between the analogues is always partial1 one must guard against overextending the comparison to unwarranted conclusions4 ,the description must always be consonant with the phenomenon as it occurs in reality4 ,the use of a metaphor also may enhance description and analysis4 ,a metaphor suggests comparison of the phenomenon with another by the nonliteral application of a word4 ,for example1 the between is a secret place4 ,the use of metaphor may be criticized in regard to its lack of precision4 ,on the other hand1 there are some 7for example1 ,marcel1 ,buber7 who hold that the intersubjective realm can be described only metaphorically because it is #hd beyond the level of objectivity4 ,and to attempt to describe intersubjective phenomena in precise terms related to the physical world would tend to distort rather than clarify4 ,many of the nursing phenomena requiring description occur within the intersubjective realm4 ,metaphors could cast some light on these4 ,,conclusion ,as a theory of practice1 humanistic nursing is derived from individual nurses' actual experiences in their uniquely perceived but commonly shared nursing world4 ,its development1 therefore1 depends on the articulation of their angular views and also on the truly collaborative effort of a genuine community of nurses struggling together to describe humanistic nursing practice4 ,since the description of nursing phenomena is recognized as a basic and essential step in theory development1 this chapter presented an approach and detailed some techniques used by nurses to describe phenomena4 ,it is hoped that these would be viewed critically and creatively2 that they would be used1 varied1 combined adapted1 and lead to new methods suited to the description of nursing phenomena4 ,and if they are developed1 it is hoped that they will be shared for the growth of humanistic nursing depends not only on using and sharing what we learn but also on describing how we come to know4 ,then humanistic nursing theory will grow in dialogue4 ,,footnotes3 #a ,loretta ,t4 ,zderad1 ,a ,concept of ,empathy 7,ph4,d4 dissertation1 ,georgetown ,university1 #aifh74 ,josephine ,g4 ,paterson1 ,echo into ,tomorrow3 ,a ,mental ,health ,psychiatric ,philosophical ,conceptualization of ,nursing 7,d4,n4,sc4 dissertation1 ,boston ,university1 #aifi74 ,loretta ,t4 ,zderad1 ,empathy--,from ,cliche to ,construct1 ,proceedings of the ,third ,nursing ,theory ,conference 7,university of ,kansas ,medical ,center ,department of ,nursing ,education1 #aigj71 pp4 #df-ge4 ,josephine ,g4 ,paterson1 ,from a ,philosophy of ,clinical ,nursing to a ,method of ,nursology1 ,nursing ,research1 ,vol4 ,,xx 7,march-,april1 #aigb71 pp4 #adc-adf4 ,josephine ,g4 ,paterson and ,loretta ,t4 ,zderad1 ,all ,together ,through ,complementary ,synthesis1 ,image1 ,vol4 ,,iv1 ,no4 #c 7#aigj-ga71 pp4 #ac-af4 #he #h ,,humanistic ,,nursing ,,and ,,art ,the term humanistic nursing often is interpreted as implying humaneness4 ,logically1 humane caring must be one aspect 7a major aspect7 or a natural expression of humanistic nursing practice theory4 ,but the term means more4 ,according to the position being taken here1 nursing may be described appropriately as humanistic since at its very base it is an inter-human event4 ,as an intersubjective transaction1 its meaning is found in the human situation in which it occurs4 ,as an existential act1 it involves all the participants' capacities and aims at the development of human potential1 that is1 at well-being and more-being4 ,our approach qualifies1 then1 as a form of humanism1 according to the dictionary definition1 being a system or mode of thought or action in which human interests1 values1 and dignity are taken to be of primary importance4 ,in another sense of the word1 our theoretical stance is humanistic by virtue of its regard for the humanities and arts4 ,philosophy1 literature1 poetry1 drama1 and other forms of art are valued as resources for enriching our knowledge of man and the human situation4 ,they also are seen as suitable means for expressing or describing the lived realities of the nurse's world4 ,contemporary nursing1 being a true child of its time1 reflects ,american society's high regard for ,science4 ,values of science are easily discernible in nursing and affect the character of its research1 education1 and practice4 ,consider1 for instance1 how the nursing dialogue is influenced by the prizing of objectivity1 precision of language1 operational definitions1 scientific jargon1 development of constructs and theories1 methodology of scientific inquiry1 emphasis on quantification and measurement4 ,there is much more written in our current literature about nursing as a science than about nursing as an art4 ,although slighted1 the humanities have not been rejected4 ,in fact1 some nurses and educators are urging that the role #hf of the humanities and arts be recognized in nursing and that they be used more effectively in undergraduate and graduate nursing education4#a ,turning to my own personal experience1 ,i recall that one of the first definitions ,i had to learn in my basic nursing program began with the statement1 ,nursing is an art and science4444 7,it is interesting that now1 years later1 this is all ,i can recall of the definition67 ,at that time1 ,i accepted the statement at face value4 ,i did not question it4 ,perhaps ,i had not thought enough about art and science and certainly ,i did not know enough about nursing to question the description4 ,yet over the years many experiences and insights have turned into questions that challenge this adopted cherished notion4 ,in the beginning ,i merely accepted the view that nursing is an art in the sense of being a skillful or aesthetic application of scientific principles4 ,after all1 we had a course in nursing arts 7later called fundamentals of nursing74 ,this had to do with bathing1 feeding1 making beds1 and hundreds of other nursing procedures that were presented as nursing arts1 the doing of nursing4 ,at the time ,i also had courses in the humanities and liberal arts4 ,these courses were not related directly to nursing by either the teachers or myself1 as ,i recall4 ,i did not ask3 ,in what way is nursing an art8 ,what kind of art is nursing8 ,or1 how does the art of nursing differ from other arts8 ,the notion 7perhaps conviction would be more accurate7 that nursing is an art in some sense other than an artful application of scientific principles has been with me for a long time4 ,i do not know its origin nor even the form in which the view first appealed to me4 ,i do recall having difficulty on several occasions in trying to express let alone explain1 my idea4 ,at these times1 what ,i experienced subjectively as an intuitive flash of insight would end up objectified in an amorphous blob of words4 ,yet the theme returns over and over in a variety of questions and issues that demand response if not resolution4 ,this chapter offers some further reflections on the relatedness of humanistic nursing and art4 ,,use ,,of ,,arts ,one of the most obvious ways in which nursing and art are related is in nursing's use of the arts4 ,this may be seen in nursing education as well as in nursing practice4 #hg ,liberalization ,usually1 when arts and humanities are included in nursing education programs1 it is for their humanizing effects4 ,traditionally they have been recognized as having a civilizing influence4 ,so in nursing they are seen as supporting the elements of humaneness and humanitarianism4 ,furthermore1 they are a necessary antidote for the depersonalization that accompanies scientific technology and mechanization4 ,the arts are valued also for their liberalizing effect4 ,they stimulate imaginative creativity4 ,they broaden a person's perspective of the human situation1 of man in his world4 ,for instance1 depictions of suffering man or of other aspects of the human condition that are found in poetry1 drama1 or literature are far more descriptive and much closer to reality than those given in typical textbooks4 ,current nursing practice reflects the educational preparation of nurses that is weighted heavily with scientific courses and the methodology of positivistic science4 ,arts and humanities are a necessary complement4 ,science aims at universals and the discovery of general laws2 art reveals the uniqueness of the individual4 ,while science strives for quantification1 art is more concerned with quality4 ,strict conformance to methodology and replicability are prized in scientific studies1 whereas freedom and uniqueness of style reign in art4 ,science1 forever updating itself1 opens the nurse's eyes to constant change and innovation2 the classics promote a sense of the unchanging and lasting in man's world4 ,science may provide the nurse with knowledge on which to base her decision1 but it remains for the arts and humanities to direct the nurse toward examination of values underlying her practice4 ,thus1 humanistic nursing has both scientific and artistic dimensions4 ,expression ,humanistic nursing and art are interrelated in another way4 ,some nurses who are also artists use their respective arts to express their nursing experience4 ,poetry is a good example4 ,in an article1 ,nurses as ,poets1 ,trautman notes that since the #aidjs progressively greater numbers of poems about nursing have been published and since the #aifjs the quality of these poems has improved considerably4#b ,she believes that nurses' ability to express their feelings about nursing in poetry cannot be attributed entirely to a change in times4 ,rather1 it is a reflection of change in nursing practice4 ,for one thing1 contemporary nursing requires a great deal of abstract thinking4 ,it calls for an understanding involving mental and emotional investment1 and imaginative feeling with the patient4 ,the #hh nurse-poet puts aside technical terms1 looks at her patient in a fresh and creative way and shares her view in a poem4 ,a second reason offered by ,trautman is the increased emphasis in nursing education on communication and verbal skills4 ,a nurse with a talent for writing may be moved by a particular experience to share it4 ,thus1 the sensitive nurse-writer may use poetic expression to work through a problem1 to muse about a detail1 or to record a profound experience4#c ,finally1 she states that some nurses write poetry about aspects of their work that defy scientific analysis and cannot be easily contained in technical papers4 ,in this1 then1 nurses' poetry goes beyond the personal satisfaction accompanying expression2 it preserves a unique angular view of nursing's lived world and adds to our store of clinical wisdom4 ,as ,trautman concludes3 ,poetry has trailed the profession for many years1 probably because nurses were not encouraged in creative writing of any kind4 ,today1 however1 ,i think that poetry leads the profession because most of it never loses sight of human needs--both nurses' and patients'4 ,our poets lend a clear and vital voice to our profession4 ,they cite their experiences1 emotions1 beliefs1 and awareness in lieu of a science-oriented bibliography4 ,they appeal to our common sense but1 more importantly to our hearts4 ,they tell us to observe honestly and to feel4 ,above all1 our poets tell us to believe in our observations and to trust in our feelings--for patients1 for ourselves4#d ,some elements or aspects of nursing lend themselves to scientific exploration and discovery while others1 equally important and likewise deserving expression1 reveal themselves only through the artist's vision4 ,so what has been said of poetry1 therefore1 may hold true in other arts4 ,each art has its own form of dialogue with reality4 ,the painter1 for example1 feels with his eyes2 he feels lines1 points1 planes1 texture1 and color4#e ,what could the nurse-painter share8 ,or as ,garner1 a nurse-musician1 suggests1 nursing could be conceptualized along the schema of tones1 texture1 rhythm1 meter1 intensity1 temperament4#f ,what nursing content would accrue if the various nurse-artists used their forms of knowledge1 skill1 and vision to explore nursing as the various nurse-scientists do8 ,what can our poets1 painters1 musicians and dancers see1 hear1 feel in the nursing dialogue8 ,therapeutics ,there is a third way in which humanistic nursing and art are related4 ,for many years1 the arts have been used in nursing for their therapeutic effects1 especially with psychiatric1 geriatric1 and pediatric patients4 ,the nurse and a patient or a group of patients participate in an artistic experience together4 ,these may be passive activities1 such as1 attending a concert or play or visiting #hi an art exhibit2 or they may be active ones in which nurse and patients are involved in artistic expression or creation4 ,music1 poetry1 painting1 drama1 and dance have been used effectively in various nursing situations4 ,for instance1 ,christoffers1 a nurse and dancer1 emphasizes the importance of body language as communication and supports her view with clinical evidence4 ,she urges nurses to become physically literate--to develop an understanding and appreciation of the part played by body language in human relationships4#g ,or again1 according to ,garner1 ,music1 when carefully planned1 can be used as a source of culture1 nurturance1 communication1 socialization1 and therapeusis4#h ,a major therapeutic value of art lies in the fact that it confronts one with reality4 ,art is a lie which makes us realize the truth4#i ,in his novel1 ,the ,conspiracy1 ,hersey has ,lucan1 a poet1 write to ,seneca3 ,to me the ideal of a work of art is that each man should be able1 in contemplating it1 to see himself as he really is4 ,thus art and reality meet4 ,this is the great healing strength of art1 this is the power of art1 444 ,art's power which nothing can challenge1 is the blinding light of recognition4#aj ,by using various art forms the nurse helps the patient experience1 become aware of1 and express his feelings4 ,when the activity occurs in a group1 the members have the additional advantage of sharing in others' expressions and of developing fellow-feeling4 ,increased socialization is another important therapeutic effect nurse-artists_/art appreciators seek in the use of art4 ,a corollary benefit is improved communication between the patient and the nurse or between the patient and others4 ,obviously1 self-knowledge and fellow-feeling are consistent with the aim of humanistic nursing to nurture well-being and more-being4 ,a person develops his human potential and becomes the unique individual he is through his relationships with other men4 ,,nursing ,,as ,,art ,thus far1 this chapter has been concerned with the relatedness of nursing and art4 ,it was seen that nurses may study arts and humanities for a broader understanding of the human situation1 may express their nursing worlds through various art forms1 and may use the arts therapeutically4 ,now the question is raised whether nursing is an art1 and if so1 what kind of art4 #ij ,artful ,application ,even the most scientific nurses do not deny that nursing is1 in some way1 an art4 ,but precisely how the art and science of nursing are interrelated is not clear4 ,for example1 ,abdellah writes3 ,the art of nursing must not be confused with the science of nursing4 ,the former concerns itself with intuitive and technical skills 7often ritualistic71 and also the more supportive aspects of nursing2 the latter concerns itself with scientific truths4 ,both are important4 ,they are interwoven and complement each other4#aa ,however1 ,abdellah gives no further elaboration of this point4 ,usually1 when nurses are asked about the relatedness of the art and the science of nursing1 the view expressed is that science has to do with general principles and laws that govern nursing and art has to do with the particular application of principles in individual cases4 ,furthermore1 when a nurse describes some event as beautiful nursing and is pressed to elaborate1 she usually describes nursing actions that were performed artfully1 skillfully1 harmoniously4 ,thus1 in some way1 the art of nursing has to do with the nurse's response to human needs through actions that are purposeful and aesthetic4 ,useful ,art ,in current usage1 the term art is most commonly associated with the beautiful1 that is1 with aesthetics or the fine arts4 ,frequently1 it is restricted even more to signify one group of the fine arts1 namely1 painting and sculpture4 ,for instance1 one refers simply to an art exhibit or an art museum but specifies further a center for the performing arts4 ,however1 historically the word art was related to utility and knowledge1 and its traditional meanings still exist today4 ,for example1 we speak of industrial arts and arts and crafts through which useful things are produced4 ,on the other hand1 liberal arts 7work befitting a free man7 are those related to skills of the mind4 ,we also refer to the art of medicine1 of teaching1 of nursing1 of politics1 of navigation1 of military strategy1 and so forth4 ,the word art can refer to both the effect of human work 7works of art7 and the cause of things produced by human work 7the knowledge and skill of the artist74 ,it is obvious that not only knowledge but also some form of work and skill are involved in all art1 useful or fine4 ,art is the root of artisan as well as of artist4#ab ,some arts1 such as nursing1 medicine1 and teaching1 may be considered useful1 yet they differ from other useful arts1 such as industrial arts1 for they #ia do not result in tangible products4 ,nursing for instance1 aims purposively for well-being1 more-being1 health1 comfort1 growth4 ,these are the results of the art of nursing4 ,as an artist1 therefore1 the nurse must know how to obtain desired effects and must work skillfully to get them4 ,the nurse cannot make well-being or comfort or health as one can make a shoe or a painting or a speech4 ,the art of nursing involves a skillful doing rather than a making4 ,furthermore1 nursing is concerned with changes in human persons not merely with the transformation of physical objects4 ,it is intersubjective and transactional1 so the art of nursing must involve a doing with and a being with4 ,performing ,art ,along this vein1 nursing may be viewed as a kind of performing art4 ,fahy1 nurse-educator-actress1 draws an interesting comparison between the process of nursing and acting in a drama4 ,in a play the actors know certain things1 there are a certain number of given circumstances3 plot1 events1 epoch1 time1 and plan of action1 conditions of life1 director's interpretation4 ,the technical things are also there3 setting1 props1 lights1 sound effects1 and so forth4 ,but it remains at the time of curtain for the actors to go on alone and produce4 ,in the act of nursing there are some known facts that the nursing student or the nurse can pick up3 name1 age1 religion1 ethnic background1 medical diagnosis1 and plan of care 7sometimes71 her own background knowledge and experience1 and her own unique personality4 ,however1 when she encounters other patients--watch it6 ,the same thing happens in the teaching-learning process4 ,edward ,a4 ,wright in ,understanding ,today's ,theater says about the actor and acting something which ,i believe about the nurse and nursing4 '444 the actor 444 is his own instrument4 ,his tools are himself1 his talent1 and his ability4 ,unlike other creative artists1 he must work through and with his own body1 voice1 emotions1 appearance1 and his own elusive personal quality4444 ,he uses his intelligence1 his memory of emotions1 his experiences1 and his knowledge of himself and his fellow men--but always he is his own instrument4'#ac ,here is another example of viewing nursing as a performing art4 ,once a nurse was trying to describe the nursing care she received from another nurse when she had been ill4 ,she struggled with some details of finer points and then summed it up by saying1 ,i felt her nursing care was just like a symphony4 ,that's the only way ,i can describe it4 ,these comparisons bring many aesthetic qualities to mind1 for instance1 harmony1 rhythm1 tone1 feeling4 ,nursing is like music and drama in other ways4 ,the nursing procedure1 like a musical score or a play script1 allows for individual interpretations1 adaptations1 and embellishments4 ,although nurses follow the same general principles1 each can develop her own unique style4 #ib ,if nursing really is viewed as a performing art1 there are opportunities for creative exploration and development of the art of nursing4 ,and furthermore1 these individualized styles of nursing are worthy of description and sharing4 ,another similarity is the ephemeral character of nursing1 music1 and drama4 ,a particular nursing transaction1 like a concert or play1 is transitory1 short-lived4 ,yet the effects may be long-lasting and remembered4 ,there is this difference in nursing1 ,i believe4 ,each nursing transaction may flow into a stream of nursing care extending continuously over #bd hours a day for weeks1 months1 years4 ,and many individual nurses get into the act4 ,how does this affect the art of nursing8 ,how is nursing like and unlike the other performing arts8 ,the answers to these and similar questions must come from the nurse-artists4 ,,humanistic ,,nursing ,,as ,,clinical ,,art ,the relatedness of nursing and art1 viewed existentially1 is more basic1 more fundamental than mere similarity of qualities and characteristics as discussed above4 ,both art and nursing are kinds of lived dialogue4 ,in both1 man responds to his world of men and things through distance and relation4 ,they affect him and he affects them with the creative force of his relation4 ,in fact1 one may say further that humanistic nursing is itself an art--a clinical art--creative and existential4 ,this is evident when one returns again to the thing itself1 to the nursing dialogue as it is lived in the everyday world4 ,in genuine meeting the nurse recognizes the patient as distinct from herself and turns to him as a presence4 ,she is fully present to him1 authentically with her whole being and is open to him1 not as an object1 but as a presence1 a human being with potentials4 ,in such a genuine lived dialogue1 the nurse sees within the patient a form 7that is1 a possibility7 of well-being or more-being 7or comfort or health or growth1 and so forth74 ,like a beautiful landscape inspiring a painter or poet1 the form in the patient addresses itself to the nurse1 a call for help demanding recognition and response4 ,the form is clearer than experienced objects2 it is not an image of her fancy2 it exists in the present although it is not objective4 ,the relation in which the nurse 7artist7 stands to the form is real for it affects her and she affects it4 ,if she enters into genuine relation with the patient 7,i-,thou7 her effective power 7caring1 nursing skills1 hope7 brings forth the form 7well-being1 more-being1 comfort1 growth71 just as the painter's or poet's power and skill create a painting or a poem4 ,of course1 there is this difference4 ,the art of nursing1 being goal-directed and intersubjective1 is more complex than the arts of painting and poetry1 for example4 ,as a clinical art1 it involves being with and doing with4 ,for the patient must participate as an active subject to actualize the possibility 7form7 within himself4 ,perhaps the art of nursing could be described as transactional4 ,not only does the nurse see the possibilities in the patient but the patient also sees a form in the nurse 7for example1 possibility of help1 of comfort1 of support71 and he responds in relation to bring it forth4 #ic ,then the question logically may be raised3 ,is the patient's responses in relation 7,i-,thou7 a necessary condition for the art of nursing8 ,or to state it differently3 can there be any art of nursing the infant1 the unresponsive1 the comatose1 the dying8 ,i would answer that the art of nursing can exist even if the relation is not mutual4 ,for as ,buber writes1 ,even if the man to whom ,i say ,thou is not aware of it in the midst of his experience1 yet relation may exist4 ,for ,thou is more than ,it realises4 ,no deception penetrates here2 here is the cradle of ,real ,life4#ad ,,dialogical ,,nursing3 ,,art-,,science ,art and science1 like nursing1 represent angular views4 ,each is a view with a particular purpose4 ,they are human responses to the everyday world in which man lives4 ,existentially speaking1 each is a form of living dialogue between man and his human situation4 ,it is possible that there is in nursing a kind of human response to reality that is a combination1 a true synthesis of art and science8 ,the more one focuses on nursing as it is lived1 on the intersubjective transaction as it is experienced in the everyday world1 the more questions arise about it as art and science4 ,elements of both art and science are evident in nursing4 ,the practicing nurse must integrate them in her mode of being in the situation4 ,while ,dr4 ,josephine ,paterson was developing a methodology of inquiry from a clinical nursing process and describing her construct of the all-at-once1 she was so intent on communicating the interrelated reality of the art and science elements in nursing1 that she welded them together with a hyphen into one word1 art-science4 ,and even then there is some dissatisfaction when the weld is interpreted merely as a seam4 ,for the combination is more than additive2 it is a new synthetic whole4 ,i experienced a similar difficulty in trying to describe the synthesis of art and science that takes place in the nursing process4 ,the nursing dialogue reflects the orientations of art and science for it involves both the patient's and the nurse's subjective and objective worlds4 ,i believe the synthesis of art and science is lived by the nurse in the nursing act4 ,this is a phenomenon more readily experienced than described4 ,yet if we truly experience nursing as a kind of art-science1 as a particular kind of flowing1 synthesizing1 subjective-objective intersubjective dialogue1 then nursing offers a unique path to human knowledge and it is our responsibility to try to describe and share it4 ,,footnotes3 #a ,new ,england ,council on ,higher ,education for ,nursing1 ,humanities and the ,arts as ,bases for ,nursing3 ,implications for ,newer ,dimensions in ,generic ,nursing ,education1 ,proceedings of the ,fifth ,inter-,university ,work ,conference 7,lennox1 ,mass3 ,new ,england ,council on ,higher ,education for ,nursing1 ,june1 #aifh74 ,humanities1 ,humaneness1 ,humanitarianism1 ,editorial in ,nursing ,outlook1 ,vol4 #ah1 ,no4 #i 7,september1 #aigj71 p4 #ba4 ,charles ,e4 ,berry and ,e4 ,j4 ,drummond1 ,the ,place of the ,humanities in ,nursing ,education1 ,nursing ,outlook1 ,vol4 #ah1 ,no4 #i 7,september1 #aigj71 pp4 #cj-ca4 ,marion ,e4 ,kalkman1 ,the ,role of the ,humanities in ,graduate ,programs in ,nursing1 in ,doctoral ,preparation for ,nurses1 ed4 ,esther ,a4 ,garrison 7,san ,francisco3 ,university of ,california1 #aigc71 pp4 #ach-aee4 #b ,mary ,jane ,trautman1 ,nurses as ,poets1 ,american ,journal of ,nursing1 ,vol4 #ga1 ,no4 #d 7,april1 #aiga71 p4 #gbg4 #c ,ibid41 p4 #gbh4 #d ,ibid4 #e ,chaim ,potok1 ,my ,name ,is ,asher ,lev 7,greenwich1 ,conn43 ,fawcett ,publications1 #aigb71 p4 #aje4 #f ,grayce ,c4 ,scott ,garner1 ,qualitative and ,quantitative ,analyses of ,schizophrenic ,verbal and ,non-,verbal ,acts ,related to ,selected ,kinds of ,music1 ,humanities and the ,arts1 p4 #di4 #g ,carol ,ann ,christoffers1 ,movigenic ,nursing3 ,an ,expanded ,dimension1 ,humanities and the ,arts1 p4 #ie4 #h ,garner1 p4 #dj4 #i ,picasso as quoted in ,my ,name ,is ,asher ,lev4 #aj ,john ,hersey1 ,the ,conspiracy 7,new ,york3 ,alfred ,a4 ,knopf1 #aigb71 p4 #hb4 #aa ,faye ,g4 ,abdellah1 ,the ,nature of ,nursing ,science1 ,nursing ,research1 ,vol4 ,,xviii 7,september-,october1 #aifi71 p4 #cic4 #ab ,art1 ,the ,great ,ideas3 ,a ,syntopicon of ,great ,books of the ,western ,world ,i1 ,vol4 #b1 #aieb1 pp4 #fd-fe4 #ac ,ellen ,t4 ,fahy1 ,nursing ,process as a ,performing ,art1 ,humanities and the ,arts1 p4 #abd4 #ad ,martin ,buber1 ,i and ,thou1 #bnd ed41 trans4 ,ronald ,gregor ,smith 7,new ,york3 ,charles ,scribner's ,sons1 #aieh71 p4 #i4 #id #ie #i ,a ,,heuristic ,,culmination ,this chapter presents an application of the humanistic nursing practice theory over time and an outcome4 ,the outcome represents my present conscious conceptualization of my personal theory of nursing4 ,it has grown out of my nursing practice experience1 my reflecting1 relating1 describing1 and synthesizing4 ,this is heuristic culmination of much mulling over my lived world of nursing4 ,,angular ,,view3 ,,present ,,perspective ,in #aiga after a presentation on concept development ,i heard myself in a chatty response to the audience declare my unique theory of nursing4 ,it was based in constructs that ,i had developed and conceptualized4 ,previously ,i had viewed these constructs only as distinct entities4 ,my synthesis of them surprised me4 ,this was the first time ,i conveyed them as my why1 how1 and what of nursing4 ,this synthesis may have emerged as a sequence to my reexamination and reflection on each of these constructs in preparation for this #aiga presentation4#a ,now it became evident that their sequential evolvement had a logic that had come from my being without my awareness4 ,since #aiga ,i have planned to reflect on these synthetic constructs to better understand how they relate to one another complementarily4 ,why8 ,to further the development of these constructs and to state them as propositions4 ,statements of propositions are movement toward nursing theory4 ,theory is considered here as a conceptualized vision teased out of my knowing from my nursing experience4 #if ,like ,elie ,wiesel1 the novelist and literary artist1 ,i write to better understand and to attest to happenings4 ,this chapter is the fruit of this endeavor4 ,the first term1 comfort1 was developed as a construct in #aifg4 ,after recording and exploring my clinical experiential data1 a conceptualized response emerged to my question3 ,why1 as a nurse1 am ,i in the clinical health-nursing situation8 ,the second term1 clinical1 was developed as a construct in #aifh4 ,it was a conceptualized response to a dialectical process within myself4 ,i asked1 ,what is clinical8 ,i answered1 ,i am a clinician4 ,i asked1 ,as a nurse clinician what do ,i do2 what is the condition of my being in the nursing situation8 ,i answered1 ,this described would equate to clinical4 ,consequently ,i compared and contrasted two nursing experiences similarly labeled to properly grasp the principle of clinical for conceptualization4 ,the third term or phrase1 all-at-once1 arose intuitively within me as a construct in #aifi and was partially conceptualized4 ,it arose after mulling over other nurses' published clinical data and asking1 ,what can you tell me of the clinical nursing situation8 ,what do you perceive as the nature of nursing8 ,therese ,g4 ,muller's1 ,ruth ,gilbert's and my thought on the nursing situation merged into a view of these as multifariously loaded with all levels of incomparable data1 the all-at-once4 ,incommensurables relate to the nature of nursing and its concerns4 ,how can one study unrelated appearances8 ,muller often used an historical approach while ,gilbert emphasized individualization4 ,in humanistic nursing practice theory a descriptive1 intersubjective1 phenomenological approach is proposed for greater understanding and attestation of the events and process of the nursing situation4 ,the construction of comfort1 clinical1 and all-at-once ,i would now label as conceptualized phenomenologically4 ,i view them as relevant phenomena to any nurse and this nurse-in-her-nursing-world4 ,theory3 ,unrest1 ,beginning ,involvement ,this desire to develop nursing theory goes back to my years 7#aiei-fd7 as a faculty member in a graduate nursing program4 ,i fussed with the idea1 did not know exactly what ,i was fussing about1 and expressed my desire1 interest1 and concern poorly4 ,much1 ,i am sure now1 to others' dismay4 ,teaching in nursing was an offering of multitudinous theories developed in and for other disciplines using nursing examples4 ,there were both similarities and differences in the many nursing examples in which attempts were made to describe the qualities of the participants' beings4 ,emphasis was placed on the observations by the nurse of the others' responses in the nursing situation4 ,nursing education was rife with lengthy repetitive examples utilized to focus on particular variations4 ,i desired a unifying base applicable to all nursing situations4 ,this was not a seeking for conformity nor an attempt to negate individuality4 ,certainly ,i did not want such a base to exclude individual nurses' talents4 ,rather this base1 foundation of nursing indicative of the nature of nursing1 would heuristically promote endless variations to flow1 blossom1 cross-pollinate1 and evolve4 #ig ,in these observations and thinkings ,i was attempting to understand1 sort out1 and clarify the questions that underlay my puzzlement4 ,this puzzlement arose out of my #ah years in nursing practice and education4 ,in a theory course and a philosophy of science course1 while in doctoral study1 ,i recognized and learned to label my unrest and puzzlement as a recognition of the need for nursing theory4 ,in #aiff in discussing my purposes for doctoral study1 ,i expressed this unrest and puzzlement4 ,i viewed my varied past experiences in nursing as excellent4 ,i sought time to reflect on the past #bd years of living nursing to see what it could tell me1 and to come to better understand its meaning to the profession of nursing4 ,the philosophical nature of these questions and what they express of myself is evident4 ,such personal revelation at this time is no risk1 and withholding would only deprive myself and others of the answers that might be brought forth4 ,as in most school situations initially responding to class assignments and involvement in new clinical situations consumed my time and thwarted my personal1 professional interests4 ,when ,i commented on this my interests were interpreted to me as a desire to live in the past4 ,living in the present was recommended and terms like up-to-date and progressive were employed4 ,i felt stopped cold4 ,i had never viewed myself as old fashioned or non-progressive4 ,many of my past nursing experiences were still avant-garde as compared with general current practices4 ,there was something different though in recalling and reflecting on the past as opposed to current experiences4 ,one's past would be visible in view of how one approached and experienced the present4 ,self-confrontation moved me beyond confining myself either to the past or to the present4 ,in my writings one could detect a comparison of what had been known with what was coming to be known4 ,it was as if a light of a different hue lit up the whole--past and present--as a different scene4 ,similarly ,i viewed and experienced my clinical experience differently4 ,i gained awareness of a quality of my being that always had been there1 but which ,i hid4 ,now ,i valued this part1 struggled with it1 and expressed it directly with courage1 integrity1 and pride4 ,the power with which this self-actualization imbued me has been sculpturing my ,i into a form of my choosing ever more acceptable to me1 and accepting of others4 ,concept ,development ,in a nursing theory course the final assignment was3 develop a concept relevant to nursing4 ,again ,i found myself struggling4 ,the didactically stated importance of investing precious time and energy into constructing a synthetic conceptualization of a term eluded me4 ,time and energy spent to better understand man as he was known to me in the nursing situation seemed so limited4 ,in these situations persons were expressing so many things at one time1 how could the conceptualization of one term be relevant4 ,finally ,i understood3 no one was saying that any one term could equate any particular or group of #ih nursing situations4 ,they were saying that to communicate the nature or experience of nursing with words1 to develop nursing theory1 relevant terms needed clarification as to the meaning they conveyed and delineation as to their inclusiveness and exclusiveness4 ,as this struggle subsided ,i could hear1 a term could be developed as a concept or synthetic construct if one conceptualized its why1 what1 how1 when1 and where and how these interrelated4 ,in approaching concept development the last but not least hurdle was1 what term did ,i consider relevant enough in nursing to expend this precious time and energy on considering the many possibilities4 ,the first term ,i began to intellectually play with was ambivalence4 ,now1 ,i would attribute my selection of ambivalence to my then existing ambivalence about conceptualizing a synthetic construct4 ,then1 ,i based its selection only on its existence in my clinical nursing world4 ,i was working therapeutically on a regular1 individual basis with an ambivalent adolescent male labeled diagnostically as a paranoid schizophrenic4 ,i began to consider my clinically recorded data of my sessions with ,bob through ambivalence4 ,what were the relationships between why1 how1 what1 when1 and where ,bob expressed ambivalence8 ,struggling with the term ambivalence involved and interested me in concept development4 ,during this phase ,i overcame my fear of exposing my thoughts1 ,i took the risk1 and my courage had the upper hand4 ,nevertheless1 another choice had to be made since now ,i was not willing to invest this much time on conceptualizing ambivalence as so relevant to nursing4 ,perhaps this signified that my own ambivalence had dissipated4 ,and again1 ,i faced the question1 what term would ,i want to develop as a synthetic construct8 ,the next question that occurred to me was1 what term would indicate why1 as a nurse1 ,i am in the clinical health-nursing situation8 ,did ,i view my value mainly as growth1 health1 freedom1 or openness promotion8 ,i worked for a while with each of these terms and eventually discarded them4 ,some long-hospitalized persons with whom ,i was working on a demonstration psychiatric unit to prepare them for a more independent and appropriate form of community living would never be stably balanced in health1 growing1 freedom or openness4 ,for many1 these could be only flitting memorable beautiful moments4 ,still ,i believed ,i was very much there in the nursing situation for these persons1 as well as for those who moved into the community and found work and social satisfactions4 ,something occurred between all of these #ae patients and myself--and that was nursing4 ,,comfort3 ,,why ,while considering what construct to conceptualize1 ,i was in the process of recording my three-hour1 twice a week interactions in the demonstration unit4 ,i reflected on these interactions and waited for the data to reveal to me the major value underlying my nursing practice4 ,then the term comfort came #ii to mind4 ,perhaps at this point ,i became comfortable in this unit1 or perhaps the unit1 itself1 became a more comfortable setting4 ,when ,i had first begun my experience with this demonstration unit1 it was still being planned and the hospital was new to me4 ,however1 the term comfort has long been associated with nursing4 ,one can find it as a historical constant throughout the professional nursing literature4 ,the term had been used recently in an ,,ana publication4#b ,when ,i considered the idea of comforting in nursing practice ,i felt such experiences had fulfilled and satisfied me1 made me feel adequate4 ,i could recall specific experiences that went back to my initial nursing practice settings4 ,i could conceive of comfort as an umbrella under which all the other terms--growth1 health1 freedom1 and openness--could be sheltered4 ,some of my contemporaries scoffed and viewed this term as much too trivial4 ,now1 again reviewing my months of gathered clinical data1 ,i sorted out #ab nurse behaviors that ,i viewed as aiming toward patient comfort4 ,they were3 #a4 ,i focused on recognizing patients by name1 being certain ,i was correct about their names1 and using their names often and appropriately4 ,i also introduced myself4 ,names were viewed as supportive to the internalization of personal identification1 dignity1 and worth4 #b4 ,i interpreted1 taught1 and gave as much honest information as ,i could about patients' situations when it was sought or when puzzlement was apparent4 ,this was based in the belief that it was their life1 and choice was their prerogative as they were their own projects4 #c4 ,i verbalized my acceptance of patients' expressions of feeling with explanations of why ,i experienced these feelings of acceptance when ,i could do this authentically and appropriately4 #d4 ,when verbalizations of acceptance were not appropriate1 ,i acted out this acceptance by staying with or doing for when appropriate4 #e4 ,i expressed purposely1 to burst asunder negative self-concepts1 my authentic human tender feelings for patients when appropriate and acceptable4 #f4 ,i supported patients' rights to agape-type love relationships with others3 families1 other staff1 and other patients4 #g4 ,i showed respect for patients as persons with the right to make as many choices for themselves as their current capabilities allowed4 #h4 ,i attempted to help patients consider their currently expressed feelings and behaviors in light of past life experiences and patterns1 like and unlike their current ones4 #ajj #i4 ,i encouraged patients' expression to better understand their behavioral messages and to enable me to respond overtly as therapeutically as possible4 #aj4 ,i verified my intuitive grasp of how patients were experiencing events by questions and comments and being alert to their responses4 #aa4 ,i attempted to encourage hope realistically through discussing individual therapeutic gains that could be derived from patients' investment in therapeutic opportunities available to them4 #ab4 ,i supported appropriate patient self-images with as many concrete hard to denies as possible4 ,each of these nurse behaviors was repeatedly evident in the months of recording patient-nurse interactions4 ,for the conceptualization of the term comfort1 a representative clinical example was given to enhance the meaning of the behavior cited 7see ,appendix74 ,when compiling materials for the conceptualization of this term1 ,i found #ab assumptions about psychiatric nursing that ,i had written for the theory course in one of the first class sessions4 ,although these assumptions were expressed in different words1 their congruence with my #ab selected behaviors made me believe that these behaviors were somehow verified both in my conceptualized philosophy of psychiatric nursing and in my behavior while being a psychiatric nurse4 ,next ,i struggled with an idealistic conception of comfort as opposed to a continuum of behavior which would indicate a person's degree or state of discomfort-comfort4 ,again1 reflecting on and teasing out aspects of my data1 ,i set up four behaviorally recognizable criteria for estimating a person's discomfort-comfort state3 #a4 ,relationships with other persons which confirm one as an existent important person4 #b4 ,affective adaptation to the environment in accord with knowledge1 potential1 and values4 #c4 ,awareness of and response to the reality of the now with understanding of the influence of and separation from the past4 #d4 ,appreciation and recognition of both powers and limitations which enlighten the alternatives of the future4 ,these behavioral criteria1 too1 could each be spread on a continuum to evaluate the effects of this aim of nursing on a patient's actual comfort status at any particular point in time4 ,considering the concept of comfort as a proper aim of psychiatric nursing brought forth the necessity of considering its opposite1 discomfort1 as a concept4 ,evidence for the existence of discomfort could be inferred in the absence of the above behavioral criteria4 #aja ,the basic foundation to justify the concept of comfort as a proper aim of psychiatric nursing would be both organic and environmental4 ,in our culture1 among the species man1 we are moving toward being able to effect some organic conditions by genetic controls and surgical and chemical means4 ,the professions have struggled long years to influence environmental deterrents to comfort4 ,if an individual as a fetus1 or as an infant1 or young child never internalizes comfort of any kind from his environs1 the probability of initiating a continuum within himself as an adult that is propelled toward comfort seems unlikely4 ,such individuals1 lacking any potential capacity for comfort1 ,i suspect are rare4 ,there is evidence for the existence of this dormant seed of comfort in persons with schizophrenia in the hospital setting4 ,consider how repetitively and ambivalently they reach out to authority figures4 ,this dormant comfort seed requires nourishment of a high quality for testing whether it can develop and bear the fruits of health1 growth1 freedom1 and openness4 ,when the development of this synthetic construct of comfort was discussed in the theory course a question was raised3 ,is a person who denies all feeling1 presents himself as emotionally dead1 comfortable8 ,if feelings are not relegated to the mind alone1 as the effects of a peptic ulcer cannot be relegated to the stomach1 if feelings are an essential of the nature of humanness1 a human who denies this essential of his nature would not fit into this concept as comfortable4 ,this synthetic construct of comfort1 like its synonym contentment1 described by ,plutarch ,a4,d4 #df-abj1 does not imply passivity1 resignation1 retirement1 or a simple avoiding of trouble4 ,plutarch said1 ,contentment comes very dear if its price is inactivity4#c ,i would perceive of comfort or contentment as implying that a human being was all he could be in accordance with his potential at any particular time in any particular situation4 ,continuing the aforementioned twelve nurse behaviors1 observing behavior through the four established criteria and conceptualizing the construct of comfort1 ,i began to wonder4 ,was ,i seeing what ,i had decided was the state of psychiatric patients' conditions of being8 ,was ,i projecting discomfort onto patients8 ,i did not expect straight answers4 ,nonetheless1 ,i decided to ask patients about their discomfort-comfort states to verify my perception of the condition of their beings4 ,all fourteen patients ,i asked assured me by their responses that ,i was not projecting or seeing discomfort where it did not exist4 ,some described physical discomfort and sought the cause within and outside themselves 7either another caused it1 or another could cure it1 pills would cure it71 negatively viewed self-images1 guilt based in their behaviors or thoughts4 ,one patient defined comfort by analogy and stated directly to my surprise that he seldom felt comfortable and that his excessive ritualistic behavior was his way of coping with his discomfort4 ,one repetitively stated a happy illusion that he seemed to hang on to for dear life4 ,when ,i asked what he would do if this illusion was not truth1 he said that he had never considered #ajb this possibility4 ,i knew he had been confronted with the truth of his situation many times in many ways4 ,one patient merely looked directly at me and walked away4 ,then ,i again reviewed my clinical recorded data to see what kinds of knowledge nursing with an aim to comfort would infer as necessary4 ,fifty-two items of knowledge were extrapolated from the clinical examples selected as representative of the twelve nurse behaviors4 ,these items were categorized under broad cognitive and affective domains4 ,this was an arbitrary point of separation4 ,they were teased apart simply as an aid to conceptualization and understanding4 ,if these knowledge domains had related to one another in a simple direct manner1 ,i would have conveyed them in a table in which each would have been across from its mate4 ,their relationships to one another were far too complex to be handled in any such a way4 ,the affective domain knowledge areas were a dynamic internalized synthesis of several knowledge areas from the cognitive domain4 ,thus1 the expression of these affective knowledge areas was evidence of the practice of nursing as an artful form of expressing cognitive knowing4 ,in looking directly at the discomfort of long-term hospitalized psychiatric patients1 ,i found myself faced with behaviors that resulted possibly from a muddle of many contributories4 ,what in the behavior resulted from lifetime environmental influences and compounded responses that deepened scars8 ,what resulted from long-term hospitalization8 ,how many varieties of ills superimposed like layers on the above were expressed in what ,i saw as discomfort in these psychiatric patients8 ,diagnostic classifications are necessary for statistical economic planning reasons4 ,still1 how naively and superficially they convey the human therapeutic care needs of each person4 ,at this point of construct development ,i saw a positive relationship in my thinking about comfort as a proper aim of psychiatric nursing and ,viktor ,frankl's description of his aim in logotherapy toward meaning4 ,i had struggled with the idea of aiming at comfort while with patients who possessed ability and a favorable prognosis1 often purposefully and deliberately asking them to consider ideas that caused them immediate greater discomfort4 ,frankl's quotes from ,nietzsche and ,goethe supported my altruistic intention4 ,nietzsche said3 ,he who has a why to live can bear almost any how4#d ,goethe said3 ,when we take man as he is1 we make him worse2 but when we take man as if he were already what he should be1 we promote him to what he can be4#e ,in conclusion to this stage of development of a synthetic construct of comfort as an aim of psychiatric nursing ,i can say3 ,comfort is an aim toward #ajc which persons' conditions of being move through relationship with others by internalizing freedom from painful controlling effects of the past4 ,these effects have inhibited their self-control1 realistic planning1 and prevented them from being all that they could be in accordance with their potential at any particular time in any particular situation4 ,i would project this as an aim for nursing in all situations although the data for constructing this conceptualization were gathered in a clinical psychiatric setting4 ,,clinical3 ,,how ,as a component of my doctoral examinations ,i was faced with having to rewrite a clinical paper4 ,this led to my deliberately and personally choosing to conceptualize a synthetic construct of clinical4 ,this was my decision4 ,it speaks well for the value of having had the experience of conceptualizing comfort4 ,often it is said that man repeats that which he finds as meaningful and good4 ,this choice also signifies a real overcoming of my resistance and ambivalence toward synthetic construct development in a year's time4 ,clinical was developed as a synthetic construct in #aifh4 ,it was a conceptualized response to a dialectical process within myself4 ,if ,i am a clinician1 then how ,i am in the health-nursing situation would equate to clinical4 ,in conceptualizing this construct ,i teased out of my lived-nursing-world the how of my working toward my own and others' comfort4 ,confusion1 over what was meant when persons casually and currently popularly attributed the term clinical to situations and persons1 called forth this conceptualization4 ,it grew out of comparing and contrasting two nursing consultation experiences in the psychiatric-mental health area4 ,beginning this conceptualization ,i would have referred to both these experiences as clinical4 ,at the termination of the conceptualization they were both clinical4 ,they were very different experiences for me1 and yet of equal value in my advancement toward my more of being4 ,prior to this conceptualization because my attending emotions were so disturbing and unacceptable to me in relation to one of these experiences1 automatically ,i repressed part of them and found reasons to suppress the rest of them4 ,unfortunately1 all else that was of value to me in having lived this experience was integrally enmeshed with these emotions4 ,this1 too1 became unavailable to my conscious awareness4 ,conceptualization made recall and reflection a necessity4 ,clinical includes inherently a process of experiencing awarely and then recalling1 looking at1 reflecting on1 and sorting out to come to knowing4 ,before knowing how to approach the rewriting of my clinical paper as a partial requirement for receiving my doctoral degree ,i experienced a depression4 ,i felt frightened1 angry1 and inadequate4 ,the original clinical paper had been judged as more intellectual and scholarly than clinical4 ,i could conceive of only two alternatives4 ,both seemed self-defeating4 ,one1 ,i could revise my former clinical paper into a more intellectual and scholarly paper that still #ajd would not be clinical and would still leave my ,i out4 ,or1 two1 ,i could revise my former clinical paper1 dump all my feelings in the situational experience1 blame everyone else for these feelings1 and culminate at least with my clinical passions visible4 ,conflict resulted from my considering pursuing either of these routes4 ,i was immobilized for a time4 ,a time limitation and time passing pushed me to begin somewhere4 ,i began4 ,choosing the second alternative in the belief that at least through writing ,i would better understand what ,i had lived in the experience4 ,i could support the value of dredging up these old feelings and looking at them4 ,authentically letting myself be aware of what ,i had experienced1 not necessarily communicating this or acting out in accordance with these redredged feelings2 just really looking at them might allow me choice in how ,i wanted to live with them4 ,one support for the value of looking at these old feelings was my own past three and one-half years in psychoanalysis in which ,i profited through such a process4 ,the other support was my readings of the past two years4 ,these included works of ,russell1#f ,nietzsche1#g ,plato1#h ,popper1#i ,dewey1#aj ,buber1#aa ,bergson1#ab ,cousins1#ac and de ,chardin4#ad ,as this experience became in shape and meaning through my writing1 ,i began to view this product as like an existential play filled with blatant atrocities and absurdities that had to be nonrealities4 ,this production1 also1 made visible beautiful raw data4 ,as meaning in this clinical nursing consultation experience as a graduate student became evident1 comparison of it with the meaning of clinical work experiences in nursing consultation situations flowed naturally4 ,then joy1 it was like sunshine burst forth and warmed my spirit4 ,before entering school1 ,i was1 for two years1 a mental health psychiatric clinical nurse consultant to a staff of forty-five visiting nurses4 ,i had become intrigued #aje with what ,i had come to understand about consultation related to clinical situations4 ,i wrote a paper for publication on the subject4 ,busy in the process of returning to school1 and awaiting the publication of two other papers--both of these proceedings feeling unreal and out of my control1 not to mention self-exposing--,i merely filed in my desk the typed submittable rendition of this consultation paper4 ,now1 ,i dug it out4 ,this meant that ,i had two conceptualized presentations of similar type personal experiences in nursing consultation to compare and contrast4 ,from these1 my conceptualization of clinical1 and the values on which my clinical practice rests1 could be extrapolated4 ,a ,student ,consultation ,experience ,becomes ,clinical ,in the graduate student nurse consultation experience ,i felt helpless1 confused1 unwanted1 guilty1 anxious1 and unimportant4 ,it was a passion-filled experience for me4 ,as a nurse-student consultant among interdisciplinary nonstudent-consultants ,i experienced dependency for my being and doing on persons ,i viewed as anxious1 critical1 nonempathetic1 and inadequate4 ,we were attempting to offer consultation to a professional group of nonpsychiatric mental health oriented consultees who were anxious and felt inadequate in this area4 ,i felt forced into an observer rather than participant mode of being1 and my recorded data support this4 ,impotency comes to mind when ,i recall this experience1 as well as a racking rage and suffering that obliterates feelings of love1 good-will1 tenderness1 or hope4 ,about that time ,i was reading ,nietzsche's eternal recurrence phenomenon#ae and viewed it most pessimistically--all was awful1 it would continue to be awful1 life was just a vicious cycle of awfulness4 ,defense or health1 it is questionable4 ,suddenly1 perhaps it was having hit feelings of rock bottom1 ,i began to view ,nietzsche's eternal recurrence phenomenon optimistically4 ,did the polarization of my negative feelings magnetically call forth my opposite feelings8 ,all1 now1 contained the new1 it would continue to contain the new1 life was a series of similar and yet different cycles that always contained the new4 ,now my reflections let in hope1 positiveness1 comradeship1 good feelings1 and progress made by myself and others in our year and a half together as consultants4 ,during this period we met with the consultees for an hour once or twice a week4 ,the group had continued over this period despite its components of psychiatric mental health professionals and nonpsychiatric mental health profession culturally1 professionally1 and historically having been quite alienated from one another4 ,attendance had improved some over time4 ,toward the end of the year and a half1 during the last three months1 the focus of discussion was on patients and their worlds for longer periods of time4 ,there was less defensive acting out in which things1 fees1 time1 and mechanics consumed the hour4 #ajf ,toward the end of these sessions the consultant chief found more acceptable space in which to meet for the consultation4 ,eating lunch became part of the session4 ,food can be looked at in many ways4 ,in this case it seemed to be a cohesive force1 rather than a distracting1 socializing force4 ,was this because of the underlying meanings food had for these people8 ,or was the meaning of food in this situation concrete8 ,now the consultees could have their lunch served to them while receiving consultation4 ,this latter saved their time and meant money to them4 ,this was a giving gesture on the part of the consultants even though the lunch monies did come out of the project funding source4 ,the meaning of food was never discussed in the group4 ,i wonder if this feeding was done with deliberate awareness or was just serendipitous4 ,during the last three months of meeting ,i began to feel related on a deeper level with a few of the participants1 consultants and consultees4 ,individual to individual we began to communicate collaboratively with one another as professional colleagues4 ,we discussed both patients' lived worlds and the meaning of psychiatric mental health terms and ideas4 ,i can conceive1 now1 that this may have occurred between other group members before or after sessions4 ,initially there were often only two to three consultees to five or six consultants4 ,later the total group contained fifteen to sixteen people4 ,now ,i would project that the very existence of this group could influence future groups positively4 ,a ,clinical ,work ,consultation ,experience ,in this work consultation experience my feelings were openness1 reflectiveness1 pain1 helpfulness1 alertness1 searchfulness1 appreciativeness1 receptiveness1 responsiveness1 wantedness1 competence1 joy1 and importance4 ,it was both a passionate and a dispassionate experience4 ,as a working consultant ,i met with consultees either alone or as part of a collaborating team of consultants4 ,often the situations the consultees presented which they struggled with and stayed in struck me with awe4 ,they aroused my humility while making me feel whole and fulfilled in my participation with the consultees4 ,in my explorations of and with the consultees my presence1 thereness1 and authenticity were all important4 ,buber would say that my aim in consultation was to imagine the real of what the consultee and the patients and families she discussed with me could be4#af ,this was my initial disposition4 ,i aimed to be open to and accept the potentials of these others4 ,in initial receptiveness1 grounded in my comfort1 was the key to the door of the consultant-consultee ,i-,thou relation in which ,i could come to know intuitively the experience of this particular other nurse-in-her-lived-nursing-world4 ,the consultees offered their lived-nursing-worlds each in their unique ways4 ,some discussed directly their pains1 joys1 adequacies1 and inadequacies4 ,some discussed indirectly their panic1 success1 action1 and immobilization4 ,some beyond being able to discuss their lived-worlds #ajg spontaneously acted out their lived-worlds4 ,for example1 these often behaved toward me as their patients and families behaved toward them4 ,these kinds of acted out lived-worlds ,i had to sense my way into to understand4 ,when ,i began to wonder what it was that they wanted from consultation to take back to their lived-nursing-worlds1 ,i would pull out of the ,i-,thou form of relating4 ,this wonderment became my conscious clue4 ,it was time to reflect and look at what my explorations had uncovered4 ,at this point transcending this ,i-,thou relation1 ,i would look at ,it4 ,seeing1 now1 what was within me1 what the condition of my being was that ,i had intuitively taken on from the consultee1 ,i would set it apart from myself1 and see it as an empathic response4 ,i knew that these feelings ,i experienced which ,i received existentially1 globally through the compound of the consultee's words1 tone inflection1 volume1 facial expression1 posture1 and positioning to me were what she experienced in her-nursing world4 ,verbalization of this empathized understanding fulfilled several purposes3 7#a7 it conveyed my sympathy or joy with1 and always my caring1 7#b7 it validated that ,i saw it as it was for this nurse1 and 7#c7 it opened the door to our working through the possible meanings of the nurse's experience and to speculating about outcomes of alternative future nurse actions and behaviors4 ,cognitively the range of these consultation discussions was broad4 ,some common themes were social and health histories of families1 pertinent psychological growth and development factors of persons in the families of concern to the consultees1 relationships between persons within the situations1 resources available to the families1 ways the consultees could relate with the parents and patients' families1 friends1 and other professionals in the situation1 and the meaning of all these themes to the particular consultee4 ,this clinical consultation experience necessitated my being certain ways4 ,it necessitated my being authentic with myself with regard to what responses were called forth in me in relating with a particular consultee4 ,i viewed honesty with the consultee as a value necessary to the consultation process4 ,in approaching the consultation ,i needed to be open to the consultee's angular view and predisposed toward an ,i-,thou relationship4 ,the ,i-,thou relating necessitated subsequent scientific understanding extrapolated from it through reflection on it as ,i-,it4 ,my hope in consultation was to offer both a cognitive1 as well as1 an ontic experience in which a mutual feeling apart from and toward the other would exist4 ,this latter seemed most important to me4 ,if the consultee experienced my being authentically present with her1 she then would be apt to offer this type of relationship to the patients and families of concern to her4 ,results of ,comparison ,the two clinical consultation experiences were juxtaposed1 contrasted1 questioned1 related1 and synthesized to envision their unified contribution to the construct of clinical4 ,the synthetic construct of clinical is not viewed as a mere juxtaposing1 a disintegrating1 or reconstructing of the contributions #ajh to my knowing from either of these experiences4 ,this comparison is viewed as a facing of the multiplicities they both present4 ,the synthesis is an illumination of both experiences with each transfigured through their mutual presence in the knowing place of the comparer4#ag ,in this comparison my appreciation grew of how ,i had uniquely implemented and conceptualized clinical consultation in my work experience4 ,i recognized through the comparison that adequate clinical consultation demands both a passionate and dispassionate phase of ,i-,thou and ,i-,it relating4 ,without either of these forms of consultant being-in-the-situation we degrade the term clinical if we employ it4 ,consultation lends itself naturally to a collaborative cooperative relationship4 ,the consultant is dependent on the consultee for presentation of the specifics of particular situations4 ,the consultee is dependent on the consultant for the tailoring of general knowledge to the consultees' particular situations4 ,the relationship if appropriately called consultation is then of necessity interdependent4 ,in being separate from the other while feeling with the other the consultant does not lose the ability to question4 ,passion undealt with or identification with the consultee inhibits the clinical purpose of the consultant and of the consultation4 ,in identification one feels as if he were the other1 rather than turning to the other and feeling with him4 ,the degree of anxiety this provokes in the consultant can prevent looking at the consultation situation and issues in an ,i-,it manner4 ,the consultant loses the ability to question4 ,through this comparison ,i was able to reflect on the graduate student nursing consultation experience in an ,i-,it way4 ,at this time it became a clinical experience for me4 ,the lack of this reflective phase in this experience highlighted the reflective phase already existent in the working clinical consultation experience4 ,the existence of this phase in the working clinical consultation experience highlighted its absence in the graduate student nursing consultation experience4 ,my commonplace nursing world through this comparison became awarely meaningful and availed itself for conceptualization4 ,a situation is not a clinical experience until the would be clinician can reflect1 analyze1 categorize1 and synthesize it4 ,clinical ,is ,a potentially clinical psychiatric mental health situation becomes clinical if the clinician relates to the helpee to awaken his unique potential or ontic wholeness1 and noetically transcending this relating conceptualizes its meaning4 ,clinician signifies a particular mode of being and a particular kind of cognitive knowledge4 ,with all his human capacity the clinician relates with his clinical-world consciously and deliberately in ,i-,thou1 and ,i-,it4 ,relating in ,i-,thou with the other in-his-clinical-world the clinician gives himself and receives back the other and himself in the sphere of the between4 #aji ,he knows the other and the more of himself in this relating4 ,he is confirmed and confirms the other through the other's presence with him4 ,thus1 he calls forth the other's actualizing of self through the clinical relationship4 ,in accepting the other as he is the clinician imagines and responds to the reality of his potential for becoming1 becoming according to his unique capacity for humanness4 ,relating in ,i-,it with his clinical world the clinician noetically transcends himself1 objectifies himself1 and studies his ,i-,thou knowing4 ,he teases it apart4 ,he classifies and studies it4 ,he asks it questions4 ,he compares and contrasts it to other clinical experiences4 ,he discusses its many aspects in dialogue with his inward1 and possibly outward ,thous4 ,he reorders its parts4 ,he shapes1 creates1 plans from and for its clinical existence4 ,thus1 he ever augments a world of heuristic knowing4 ,this how allows the clinical fulfillment of my nursing why4 ,comfort is why ,i1 as a nurse1 am in the health-nursing situation4 ,as conceptualized comfort is being able to freely control and plan for one's self1 being fully in accord at a particular time1 in a particular situation1 with one's unique potential4 ,now1 what is the nature of the nurse's world1 the health-nursing situation8 ,,all-,,at-,,once3 ,,what ,the term all-at-once1 arose within me as a construct that would metaphorically describe the multifarious multiplicities that exist within nursing situations4 ,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 fussing4#ah ,your question is probably1 mulling and fussing over what8 ,while ,i mulled over and fussed ,i believe ,i1 too1 was perplexed4 ,why was ,i unsatisfied8 ,i had compared ,gilbert's and ,muller's writing styles1 their conceptions of man1 approaches to nursing1 nursing education1 supervision1 and consultation4 ,their similarities and differences were noted1 and how each presented herself predominantly4 ,then ,i cited the nursing communities they sought to influence and those in which they were while writing4 ,through reviewing their bibliographies and biographies ,i indicated the sources that had influenced them4 ,still ,i mulled over1 fussed1 and was perplexed4 ,i awakened in the middle of one night in #aifi understanding what had been causing my struggle4 ,the all-at-once was my answer4 ,the description of single constructs and single examples originally had felt unrelated to the reality of the nurse's world4 ,they oversimplified its complexity4 ,the nature of nursing was complex4 ,it seemed to me that we needed1 as a profession1 constructs that simplified and allowed clear communications4 ,we1 also1 needed constructs that conveyed the reality and complexity of the #aaj worlds in which nurses nursed4 ,perhaps a description of what all-at-once expressed for me would convey to others the lived-unobservable-worlds of nurses4 ,nurses relate to other man in situations of all-at-once4 ,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 it4 ,these two ways that man can relate to and come to know his world and himself demand sequential expression for clear communication4 ,however1 the responsible authentic nurse in the nursing arena lives them all-at-once4 ,aware of the multifarious multiplicities of her responses to another and at once to the surrounding field of action1 the nurse selects and overtly expresses her responses that actualize the purpose1 values1 and potential of the artful science of professional nursing4 ,awareness of the multifarious multiplicities affecting the other and the self in the nursing arena is a component of ,i-,thou relating4 ,selectively overtly expressing concordantly with the purpose1 values1 and potential of nursing necessitates a looking at1 which is a component of ,i-,it relating1 while acting and being4 ,therefore both ,i-,thou and ,i-,it modes of being are all-at-once4 ,this necessity for a nurse's duality in her mode of being came to my awareness through comparing ,gilbert' and ,muller's works1 studying ,buber's conceptions of man1 and considering them in relation to my current and past lived-experiences in the nursing-arena4 ,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 purpose4 ,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 being4 ,to make these multifarious multiplicities explicit ,i would like to offer a description of a recent1 personal nursing experience4 ,in a community psychiatric mental health psychosocial clinic1 ,i sat across from and focused on relating with a psychiatric client4 ,after long years of hospitalization he was now living in a community foster home and visiting the clinic three days a week4 ,when there was no special clinic activity in progress and often even when there was1 he sat by himself and played poker4 ,he told me about his game many times1 over weeks and months4 ,he dealt out five poker hands4 ,each hand was dealt to a member of his family1 long dead4 ,he did not accept their deadness4 ,one day while describing the poker games and his relatives1 he intermittently expressed his fantasies which he projected on to a sweet cheerful #fe-year-old community volunteer4 ,she was somewhat deaf4 ,his fantasies were angry4 ,when he gestured toward her1 she in a motherly way came over to him1 put her arm around him1 and her ear down to his mouth4 ,it was a moment of possible client explosion4 ,with my eyes ,i attempted to communicate with her4 ,this1 and the tone of the patient's voice warned her to move away4 ,while this was occurring another patient jealous of my attentions to this patient walked up and down1 and in passing negatively commented on the religious background of the man ,i was sitting with4 ,in the rear of the room a dietician was conducting a group on obesity4 ,and all of this was set to the #aaa melodious1 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 clients4 ,meanwhile two staff nurses were observing my part in all this since ,i was labeled expert4 ,the client did support me that day and responded to my staying with him4 ,much to my surprise he began playing poker with me4 ,he dealt me out a hand4 ,this was1 at this time1 a new behavior on his part4 ,it was movement toward his potential for relating to live persons in his current world4 ,this1 again1 is just one example of the multifarious multiplicities of one very common type of nursing situation4 ,the inference from the above is that professional artistic-scientific nurses relate in ,i-,thou1 ,i-,it1 all-at-once to the specific general1 critical nonconsequential1 and the healthy ill4 ,this presents a paradoxical dilemma4 ,nurses1 as human beings1 have a highly developed capacity for living all-at-once in and with the flow of the multifarious multiplicities of their worlds4 ,nurses1 as human beings1 like all other human beings1 are limited to thinking1 interpreting1 and expressing conceptually only in succession4 ,this metaphoric synthetic construct1 all-at-once1 has allowed me to better convey how ,i experience the health nursing situation4 ,it also has aided my understanding of the multifarious multiplicity of angular views expressed by several professionals in responding to and describing a similar situation4 ,i can accept each description as truth for each responder4 ,each responds with his uniqueness in the situation4 ,comparing1 contrasting1 and complementarily synthesizing these multiple views inclusive of their inconsistencies and contradictions1 none negating the other1 allows a better understanding of man-in-his-world in the health situation than the so frequently presented oversimplifications4 ,these oversimplified presentations usually deal only with what is occurring that is important to the particular interests of the reporter4 ,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 point4 ,in such reporting the existent in the situation labeled unimportant1 unacceptable1 or unrelated is not considered4 ,such existents1 nonetheless1 may control the patients1 the families1 the nurses and health professionals generally4 ,their control may well be more powerful than any erudite oversimplification or its presentation4 ,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 dispersal4 ,unless nurses appreciate and give recognition to the dynamic meaningful breadth1 depth1 and future influence of their worlds the actualization of the potential thrust of the nursing professional will never be or become4 ,a ,,theory ,,of ,,nursing ,a human nurse nurses through a clinical process of ,i-,thou1 ,i-,it1 all-at-once to comfort4 #aab ,i-,thou is a coming to know the other and the self in relation1 intuitively4 ,i-,it is an authentic analyzing1 synthesizing1 and interpreting of the ,i-,thou relation through reflection4 ,the all-at-once symbolizes the multifarious multiplicities of extremes 7incommensurables1 criticals1 nonconsequentials1 contradictions1 and inconsistencies7 as metaphorically representative of what exists in the nurse's world4 ,comfort is a state valued by a nurse as an aim in which a person is free to be and become1 controlling and planning his own destiny1 in accordance with his potential at a particular time in a particular situation4 ,,footnotes3 #a ,josephine ,g4 ,paterson1 ,a ,perspective on ,teaching ,nursing3 ,how ,concepts ,become1 in ,a ,conceptual ,approach to the ,teaching of ,nursing in ,baccalaureate ,programs1 a report of a project directed by ,rose ,m4 ,herrera 7,washington1 ,d4,c43 ,the ,catholic ,university of ,america1 ,school of ,nursing1 #aigc71 pp4 #ag-bg4 #b ,american ,nurses' ,association1 ,division on ,psychiatric-,mental ,health ,nursing1 ,statement on ,psychiatric ,nursing ,practice 7,new ,york3 ,american ,nurses' ,association1 #aifg71 p4 ,,iv4 #c ,plutarch1 ,contentment1 in ,gateway to the ,great ,books1 ,vol4 #aj1 ,philosophical ,essays 7,chicago3 ,encyclopaedia ,britannica1 #aifc71 p4 #bfe4 #d ,viktor ,e4 ,frankl1 ,from ,death-,camp to ,existentialism 7,boston3 ,beacon ,press1 #aifa71 p4 #ajc4 #e ,ibid41 p4 #aaj4 #f ,bertrand ,russell1 ,the ,autobiography of ,bertrand ,russell 7,boston3 ,little1 ,brown and ,company1 #aifh7 and ,an ,outline of ,philosophy 7,cleveland3 ,the ,world ,publishing ,company1 #aifg74 #g ,frederick ,nietzsche1 ,beyond ,good and ,evil1 trans4 ,helen ,zimmern1 in ,the ,philosophy of ,nietzsche 7,new ,york3 ,the ,modern ,library1 #aibg7 and ,thus ,spake ,zarathustra1 trans4 ,thomas ,common1 in ,the ,philosophy of ,nietzsche 7,new ,york3 ,the ,modern ,library1 #aibg74 #h ,plato1 ,the ,republic1 trans4 ,francis ,mac,donald ,cornford 7,new ,york1 ,oxford ,university ,press1 #aide74 #i ,karl ,popper1 ,conjectures and ,refutations 7,new ,york3 ,basic ,books1 ,publishers1 #aifc74 #aj ,john ,dewey1 ,the ,knowing and the ,known 7,boston3 ,the ,beacon ,press1 #aidi7 and ,the ,process of ,thought from ,how ,we ,think1 in ,gateway to the ,great ,books1 ed4 ,robert ,w4 ,hutchins1 et al4 7,chicago3 ,encyclopaedia ,britannica1 #aifc74 #aa ,martin ,buber1 ,between ,man and ,man1 trans4 ,ronald ,gregor ,smith 7,boston3 ,beacon ,press1 #aiee72 ,i and ,thou1 #bnd ed41 trans4 ,ronald ,gregor ,smith 7,new ,york3 ,charles ,scribner's ,sons1 #aieh72 ,the ,knowledge of ,man1 ed4 ,maurice ,friedman 7,new ,york3 ,harper ,row1 ,publishers1 #aife74 #ab ,henri ,bergson1 ,introduction to ,metaphysics1 in ,philosophy in the ,twentieth ,century1 ,vol4 ,,iii1 ed4 ,william ,barrett and ,henry ,d4 ,aiken 7,new ,york3 ,random ,house1 #aifb7 and ,time in the ,history of ,western ,philosophy1 in ,philosophy in the ,twentieth ,century1 ,vol4 ,,iii1 ed4 ,william ,barrett and ,henry ,d4 ,aiken 7,new ,york3 ,random ,house1 #aifb74 #ac ,norman ,cousins1 ,who ,speaks for ,man 7,new ,york3 ,the ,macmillan ,company1 #aiec74 #ad ,pierre ,teilhard de ,chardin1 ,letters from a ,traveler1 7,new ,york3 ,harper ,row1 ,publishers1 #aifb7 and ,the ,phenomenon of ,man 7,new ,york3 ,harper ,torchbooks1 ,harper ,row1 ,publishers1 #aifa74 #ae ,nietzsche1 ,the ,philosophy of ,nietzsche1 p4 #dda4 #af ,buber1 ,the ,knowledge of ,man1 ,appendix1 p4 #afh4 #ag ,wilfrid ,desan1 ,planetary ,man 7,new ,york3 ,the ,macmillan ,company1 #aigb71 p4 #gg4 #ah ,josephine ,g4 ,paterson1 ,echo into ,tomorrow3 ,a ,mental ,health ,psychiatric ,philosophical ,conceptualization of ,nursing 7,d4,n4,sc4 dissertation1 ,boston ,university1 #aifi74 #aac ,,appendix ,,nurse ,,behaviors ,,extracted ,,from ,,clinical ,,data ,in pursuing the idea of conceptualizing comfort as a proper aim of psychiatric nursing ,i extracted #ab nurse behaviors from my clinical data that were used repeatedly to increase patient comfort4 ,i quantified these behaviors for two months4 ,the following are a list of these behaviors with a representative example of all but the first4 ,the first was too general and continuous for example4 #a4 ,i focused on recognizing patients by name1 being certain ,i was correct about their names1 and using their names often and appropriately4 ,i also introduced myself4 ,names were viewed as supportive to the internalization of personal feelings of dignity and worth4 #b4 ,i interpreted1 taught1 and gave as much honest information as ,i could about patients' situations when it was sought or when puzzlement was apparent4 ,this was based on the belief that it was their life1 and choice was their prerogative since they were their own projects4 ,examples 7a7 ,while drinking coffee with a few patients at the dining room table suddenly we could hear ,sidney1 in his customary way1 wailing1 moaning1 and muttering in another room4 ,it is a sad sound4 ,i was about to get up and go to him as ,i often do1 when ,arthur1 who was sitting next to me1 face working1 and tense posture-wise1 aggravatedly said1 ,sidney doesn't have to do that1 he should control himself1 the rest of us control ourselves4 ,i said1 ,when others express how miserable they feel1 it sometimes arouses our own feelings about our misery4 ,this was an attempt to provoke #cb-year-old ,arthur to work on his own #aad feelings of misery and to deter his projection of anger at himself out onto ,sidney4 ,arthur looked at me sharply1 like he had gotten the message1 and agreed by relaxedly nodding his head4 7b7 ,alice1 diagnosed as manic depressive1 has been depressed4 ,this depression dates from her going out to a department store and asking for a job4 ,she was hired for a five-day-a-week job4 ,this was done on her own4 ,later her readiness for a five-day-a-week job and her participation in the unit were questioned4 ,then ,alice became depressed4 ,alice was sitting in the dayroom4 ,i sat down next to her4 ,she looked very sad1 her eyelids as well as her mouth1 drooped4 ,her mouth worked as if she wanted to talk1 but she was quiet4 ,i asked her about her job decision4 ,she said that she had not taken it4 ,i said1 ,you look so sad that ,i feel like holding your hand4 ,her hands were in her coat pockets1 but she looked at me and smiled weakly4 ,i said1 ,sometimes a conflict of wanting to do two things at once in the present and not being able to can bring up the feelings of a past very much more important similar experience4 ,alice just shook her head up and down and looked at me4 ,alice is in her mid-forties4 ,later ,i was walking down the hall to leave saying goodbyes to various people4 ,alice came out of a side room1 put both her hands out to me1 and said1 goodbye and thank you4 ,in a previous contact ,alice had discussed her suicidal thoughts with me4 #c4 ,i verbalized my acceptance of patients' expressions of feelings with explanations of why ,i experienced these feelings of acceptance when ,i could do this authentically and appropriately4 ,example ,i met a new patient at coffee4 ,later she was the only patient in the dayroom when ,i went in4 ,she had not spoken at coffee4 ,now she sat very stiffly in her chair4 ,i sat down next to her and reintroduced myself4 ,she looked scared but told me her name4 ,her shifting eyes reminded me of a cornered animal4 ,she blurted out1 ,i don't believe ,i've met you4 ,it was like she had said1 go away4 ,i smiled at her and said1 ,we were introduced at coffee1 but with so many new people it's hard to remember4 ,conversation continued to be tense4 ,at one point ,marion bolted from her chair toward the door4 ,i thought she was going to leave4 ,i stayed in my chair4 ,she went to the fish bowl in the corner4 ,we continued to talk about the fish4 ,marion came back and sat down a few seats away from me4 ,i said that ,i felt ,i'd been asking her an awful lot of questions but that ,i was only trying to get to know her4 ,marion seemed to relax in her chair and gave a great deal of information about herself in a strange stiff sort of way often inserting a word that did not have meaning for me4 ,i encouraged1 supported and showed my interest4 ,finally she said that she #aae had been admitted to ,mc,lean in her third year of nurses' training just before her psychiatric experience4 ,she had been in therapy there1 one-to-one for a couple of years4 ,i teased her about knowing the ropes1 yet giving me a difficult time4 ,this was an attempt to increase her feelings of adequacy by bringing out the similarities of the old situation which she knew and this new situation4 ,for the first time she really grinned at me1 almost laughed4 ,marion is in her early thirties4 #d4 ,when verbalizations of acceptance were not appropriate1 ,i acted out this acceptance by my behavior of staying with or doing for when appropriate4 ,example ,mary is a middle-aged patient who1 on her first days in the unit1 was liberally gobbling her food with alertness for only more to be had4 ,her only rather loud1 irrelevant1 smiling expression was about her daughter who was a go-go dancer1 had three children1 and whom she had visited twice by bus in ,california4 ,this day she approached me and asked if ,i would file her nails4 ,i said that ,i would but asked if she knew if there was a file in the unit4 ,another patient offered his4 ,we sat down and ,i filed4 ,the patient poured out a life story full of misery4 ,this was a side of this patient that ,i had not perceived4 ,i listened1 nodded1 and filed4 ,the story started in the #aicjs about her husband and mother-in-law's behavior2 their marital separation2 his being killed in ,world ,war ,,ii2 their two children2 their son1 now thirty1 was born with cerebral palsy1 is blind and mute1 and has been institutionalized since eleven months old2 their daughter's husband left her with three children after fourteen years of marriage4 ,i silently wondered what old feeling might have been aroused in her by her daughter's marital separation4 ,her daughter is so busy that she is unable to write regularly4 ,she has told ,mary not to worry if she doesn't hear from her4 ,mary then expressed concern over not receiving her usual letter this week from her mother1 whom she visits4 ,mary had tried to reach her by phone and would again4 ,i inquired if her mother lived alone4 ,yes1 but next to relatives4 ,she then related the drastic physical problems of a relative4 ,i felt the sadness of this woman as she talked and empathized with the tough time she had had4 #e4 ,i expressed purposely1 to burst asunder negative self concepts1 my authentic human tender feelings for patients when appropriate and acceptable4 ,example ,i was sitting in a rather large group of patients in the dayroom4 ,a casual conversation ensued about ,thanksgiving as it had been and ,christmas as it might be4 ,there was talk of having been at home and plans for being at home4 ,i supported and encouraged the discussion because of the meaningfulness of holidays1 past and present4 ,snow was initiated as a #aaf topic4 ,i said1 ,it would be nice to have a white ,christmas1 but not too white4 ,vincent1 a stiff1 exact1 ritualistic person who avoids stepping in an obvious fashion on thresholds1 does little jiggle-like dance steps before sitting down1 and again before settling in his chair1 suddenly spoke4 ,josephine1 ,i beg your pardon1 but ,i must take issue with you4 ,i encouraged his unusual behavioral expression4 ,he went on and on about the importance of a white ,christmas4 ,i let my mind flow with his jumbled discourse trying to decipher what he was getting at rather than each specific rapidly mentioned issue4 ,he went from white to black1 day to night1 goodness to badness1 love to hate1 this side of the world to the other side of the world 7,vietnam74 ,i expressed that he seemed to keep mentioning two sides of things and that for some reason ,i could not help thinking of boys and girls4 ,i said that he was over on that side of the world 7room7 and that ,i was over on this side of the world4 ,i asked why he did not come over to my side1 paused a minute1 felt this was asking too much of this patient1 and said1 ,well ,i'll come over to your side then4 ,when ,i sat down next to ,vincent1 he giggled as he does4 ,arthur1 a younger patient1 made a critical jealous type comment about ,vincent's age 7#ej;ish74 ,arthur has done this before when ,i give attention to ,vincent4 ,has ,arthur a stereotype of father images and perhaps mother images8 ,i said to ,vincent you have beautiful white hair1 and big1 brown1 smiling ,italian eyes4 ,vincent sat back smiling shyly but comfortably and the discussion of the group continued4 #f4 ,i supported patients' rights to loving relationships with others3 families1 other staff1 and other patients4 ,example ,alice ,m4 said that she was sad to be back at the hospital after her weekend at home4 ,alice is a quiet1 bland1 soft-spoken person about fifty4 ,she wears a worried expression even when she smiles and strikes me like she is turned inside herself4 ,i encouraged her to talk about her time at home4 ,she told me about how they had painted the living room with what for her was a show of real excitement4 ,i said that her wish to be at home was very understandable4 ,i did this because this patient almost whispers her wish to be at home and1 generally1 no one responds to it4 ,alice talked on with encouragement about the single sister whom she visits and the pleasure it gives her to be with this sister4 ,i have other examples of this nurse behavior that indicate supporting of relationships between patients and between patients and other personnel4 #g4 ,i showed respect for patients as persons with the rights to make as many choices for themselves as their current capabilities allowed4 ,example ,discussion of group at coffee revolved around ,carolyn's needing a new pair of shoes4 ,the issues were where these might be gotten 7,carolyn has #aag money71 what kind she should get1 and who and when someone would take her for them4 ,it struck me as if ,carolyn might not have been present4 ,i asked ,carolyn what kind of shoes she would like4 ,carolyn responded that she did not know whether she should buy regular shoes1 or sneakers1 or canvas shoes like ,marilyn had gotten4 ,she beamed4 ,since1 she has come up to me several times and discussed the two pairs of different kinds of shoes she bought and why4 ,carolyn is a sweet1 simple1 retarded1 deaf sixty year old whose behavior resembles an eight year old4 #h4 ,i attempted to help patients consider their currently expressed feelings and behaviors in light of past life experiences and patterns1 like and unlike their current ones4 ,example ,on my arrival after ,christmas1 ,irene expressed anger at me in a laughing way for having been away4 ,then she moved from a seat in the corner of the room to a chair behind me at the coffee table4 ,i moved to allow her to move up to the table1 but she did not4 ,after coffee ,irene nonverbally with eyes and body movements told me to follow her4 ,she led me into a small beauty parlor room and we both sat down4 ,she closed her eyes4 ,i said1 ,you seem to have some feelings about us all having been away4 ,first she blurted1 ,i missed you1 then in a quieter voice denied this1 ,it wasn't important that you weren't here4 ,i said1 ,it could be helpful to you to talk about your present missing feelings as you had some very important losses of people when you were younger4 ,her eyes literally popped open and she again blurted1 ,you mean my parents8 ,i said1 ,yes and your therapist could help you with this4 ,i then asked if she ever had the opportunity to talk with anyone about such things4 ,she replied1 ,no1 well ,i had a social worker when ,i was a little girl4 ,i tried at this point to transfer feelings of the past to the present4 ,oh1 for how long8 ,what was she like8 ,i don't remember1 and ,irene closed her eyes4 ,in a few minutes ,irene requested that ,i set her hair4 ,she is capable of doing this herself4 ,i set her hair1 but discussed the question of what she was really asking for4 ,i believe she was asking for concrete attention to test my ability to care for her4 ,i was trying to say1 concretely1 by setting her hair1 that people could care about her4 #i4 ,i encouraged patients' expression to come to understand better their behavioral messages to enable me to respond overtly as appropriately and therapeutically as possible4 ,example ,the previous time ,i was at the hospital ,alice had not come to the unit4 ,i was told that she felt too depressed to come down4 ,i went to see her4 ,she had looked surprised and impressed by my visit4 ,she talked on at some length about her suicidal thoughts4 ,i supported this on the basis that #aah verbal expression might make active expression unnecessary if she experienced empathy regarding how dreadful she felt4 ,then with little encouragement she had come down to the unit with me4 ,today1 ,alice was always near me1 but nonverbal except for concise responses to questions that were offered with effort4 ,i verbalized my reflections on her behavior and said that ,i was wondering about it4 ,she said1 ,i like having you around2 it takes me away from my thoughts4 ,how are your thoughts8 ,the same1 ,i wonder if ,i'll ever get better8 ,you've gotten better before4 ,i wonder if you're not more concerned about whether you can stay well4 ,alice1 eyes watery1 agreed with a nod4 ,irene1 another patient1 interrupted1 ,don't expect too much from me1 ,i've been here twelve years4 ,i responded to them both1 ,but1 ,i do expect a lot of you2 things don't always have to be the same4 #aj4 ,i verified my intuitive grasp of how patients were experiencing events by questions and comments1 and being alert to their responses4 ,example ,vincent's ritualistic behavior is associated in my mind with his exaggerated conscious expression of only the true1 the good1 and the beautiful4 ,on this occasion we had just had a long talk about his weekend at home1 his concerns about his family1 and his food likes and dislikes4 ,as we left a room he took his usual long step over the threshold4 ,i noted this aloud and asked him if he knew why he did this4 ,his expression became wide-eyed and smiling which indicates to me he consciously or unconsciously is selecting what he is going to say4 ,we came to the next threshold4 ,he stopped me by touching my arm and said1 ,josephine1 ,i almost grabbed you to prevent your bumping into that patient4 ,in relation to my last question ,i focused on the grabbed you and said1 ,vincent1 to think about grabbing me is a pretty natural thought1 and no reason to take a wide step over a threshold4 ,he put his foot very deliberately if rather testily1 right in the middle of this threshold4 ,he stopped1 looked at me with his hands together and giggled4 ,then he had to go to the bathroom4 #aa4 ,i attempted to encourage hope realistically through discussing individual therapeutic gains that could be derived from patients' investment in therapeutic opportunities available to them4 ,example ,my impression of ,arthur1 a thirty-two year old1 is that he works at responding to me agreeably as he thinks ,i want him to1 he frequently goes out of his way to make cutting comments to me about middle-aged men patients1 and he responds with anger or teasing to a female patient his age4 ,arthur has a mother1 father1 and two older sisters4 ,he obviously let me win at ,ping-pong several times4 ,i discussed this with him and asked if #aai he had ever talked with anyone about his responses to older women1 people in general1 or if he understood them4 ,he said1 ,no1 ,i have not been able to exactly figure this out yet4 ,i repeated the talking it over4 ,he said1 ,i haven't had much chance for that4 ,then staring at me he asked seriously1 ,do you think talking it over would help8 ,i said1 ,i think that it would take a great deal of effort on your part1 but ,i believe that it could help4 #ab4 ,i supported appropriate patient self-images with as many concrete hard to denies as possible4 ,example ,alice1 a middle-aged woman1 in the midst of a discussion of the difficulties of living outside the hospital1 past relationships with nursing personnel1 and her past practical nurse jobs suddenly said1 ,i worry about being sexually ,,ok4 ,this was kind of blurted out and she observed me closely4 ,i said1 ,i thought that you had some concerns about this in relation to how you responded to my cutting the hairs on your face4 ,i guess everyone worries at times about their adequacy in this area4 ,she said1 ,i've never been able to have intercourse2 ,i can just go as far as heavy petting4 ,people say you can get a lot expressed if you have intercourse4 ,i said1 ,some people can1 but if you have other standards that you've grown up with1 7,i suspect a rather religious1 rigid ,jewish background7 it might cause difficulties to go against those standards4 7,alice first became ill at sixteen1 left school1 and had some treatment in the community47 ,it's pretty responsible not to be willing to bring a fatherless baby into the world1 and ,i'm sure you'd have feelings about how your family might have responded to this sort of thing4 ,alice nodded and said ,it's just that ,i don't know how womanly ,i am4 ,i said with gestures and emphatically1 ,well1 ,alice1 if you have two things up here and no thing down here1 then the fact is that you are a woman4 ,discussion pursued about her further talking about this topic with her therapist and the value of her working through her feelings in this area4 ,this was a lengthy discussion and the first talking ,i had experienced ,alice doing since her depression4 #abj #aba ,,glossary angular view4 ,an individual's unique vision of reality necessarily restricted by the angle of his particular here and now4 authenticity4 ,genuineness2 congruence with the self4 7the7 between4 ,the realm of the intersubjective4 bracket4 ,hold in abeyance4 community4 ,two or more persons struggling together toward a center4 existential4 ,of1 relating to1 or affirming existence2 grounded in existence or the experience of living4 existential dialogue4 ,a unique individual person with the wholeness of his being is present1 open to1 and relates to the other seen in his unique individual wholeness2 an exchange in which two persons transcend themselves and participate in the other's being2 an interior unification2 a mutual common union in being4 existential experience4 ,contact with reality with the whole of one's being2 involves all that a man is as opposed to experiencing through one or several faculties4 existentialism4 ,philosophy based on phenomenological studies of reality2 centers on the analysis of existence particularly of the individual human being1 stresses the freedom and responsibility of the individual1 regards human existence as not completely describable or understandable in idealistic or scientific terms4 here and now4 ,an individual's unique experience of his present spatial and temporal reality including his past experiences and expectations of the future4 humanistic nursing4 ,a theory and practice that rest on an existential philosophy1 value experiencing and the evolving of the new1 and aim at phenomenological description of the art-science of nursing viewed as a lived intersubjective transactional experience2 nursing seen within its human context4 intersubjective4 ,pertaining to two or more human persons and their shared between2 a relationship of two or more human beings in which each is the originator of human acts and responses4 #abb lived dialogue4 ,a form of existential intersubjective relating expressed in being with and doing with the other who is regarded as a presence 7as opposed to an object72 a lived call and response4 lived world4 ,the everyday world as it is experienced in the here and now4 metanursing4 ,a discipline designed to deal critically with nursing1 ontological study of nursing2 study of the phenomenon of nursing2 a critical study of nursing within its human context4 metatheoretical4 ,transcending theory2 ontological inquiry from which theory may be derived4 nursology4 ,study of the phenomenon of nursing aimed toward the development of nursing theory4 phenomenology4 ,the descriptive study of phenomena4 phenomenon4 ,an observable fact1 event1 occurrence or circumstance2 an appearance or immediate object of awareness in experience4 ,a phenomenon may be objective 7that is1 external to the person aware of it7 or subjective 7for example1 a thought or feeling74 prereflective experience4 ,primary awareness or perception of reality not yet thought about2 spontaneous experience2 immediate experience or perception4 presence4 ,a mode of being available or open in a situation with the wholeness of one's unique individual being2 a gift of the self which can only be given freely1 invoked1 or evoked4 transactional4 ,an aware knowing of one's effect in a situation of which one is a part2 an action that goes both ways between persons4 #abc ,,selected ,,bibliography ,in addition to the extensive discussions that have been generated since the initial publication of ,paterson and ,zderad's ,humanistic ,nursing1 the work has been formally cited and or discussed in the nursing literature4 ,this selected bibliography was compiled by ,helen ,streubert1 ,,msn1 ,,rn doctoral candidate and research assistant in the ,department of ,nursing ,education1 ,teachers ,college_/,columbia ,university1 ,new ,york4 ,,books ,chenitz1 ,w4 ,c4 7#aihf74 ,from practice to grounded theory4 ,menlo ,park1 ,california3 ,addison-,wesley4 ,chinn1 ,p4 ,o41 ,jacobs1 ,m4 ,k4 7#aihc74 ,theory and nursing4 ,st4 ,louis3 ,mosby ,company4 ,duldt1 ,b4 ,w4 7#aihe74 ,theoretical perspectives for nursing4 ,boston3 ,little-,brown ,company4 ,ellis1 ,r4 7#aihd74 ,philosophic inquiry4 ,in ,h4 ,h4 ,werley ,j4 ,j4 ,fitzpatrick 7,eds471 ,annual review of nursing research 7pp4 #baa-bbh74 ,new ,york3 ,springer ,publishing ,company4 ,fitzpatrick1 ,j41 ,whall1 ,a4 7#aihc74 ,conceptual models of nursing3 ,analysis application4 ,bowie1 ,maryland3 ,brady ,company4 ,kleiman1 ,s4 7#aihf74 ,humanistic nursing3 ,the phenomenological theory of ,paterson and ,zderad4 ,in ,p4 ,winstead-,fry 7,ed471 ,case studies in nursing theory 7pp4 #afg-aie74 ,new ,york3 ,national ,league for ,nursing4 ,leininger1 ,m4 7#aihe74 ,ethnography and ethnonursing models and modes of qualitative data analysis4 ,in ,m4 ,leininger 7,ed471 ,qualitative research methods in nursing4 ,orlando1 ,florida3 ,grune ,stratton4 ,meleis1 ,a4 ,i4 7#aihe74 ,theoretical nursing3 ,development and progress4 ,philadelphia3 ,lippincott4 #abd ,moccia1 ,p4 7,ed474 7#aihf74 ,new approaches to theory development4 ,new ,york3 ,national ,league for ,nursing4 ,munhall1 ,p4 ,l41 ,oiler1 ,c4 ,j4 7#aihf71 ,nursing research3 ,a qualitative perspective4 ,norwalk1 ,connecticut3 ,appleton-,century-,crofts4 ,paterson1 ,j4 ,g4 7#aigh74 ,the tortuous way toward nursing theory4 ,in ,theory development3 ,what1 why1 how8 7pp4 #di-fe74 ,new ,york3 ,national ,league for ,nursing4 ,phipps1 ,w4 ,j41 ,long1 ,b4 ,c41 ,woods1 ,n4 ,f4 7#aihg74 ,medical-surgical nursing3 ,concepts and clinical practice 7#crd ed474 ,st4 ,louis3 ,mosby ,company4 ,roy1 ,c4 7#aihd74 ,introduction to nursing3 ,an adaptation model 7#bnd ed474 ,englewood ,cliffs1 ,,nj3 ,prentice-,hall1 ,inc4 ,stevens1 ,b4 ,j4 7#aihd74 ,nursing theory3 ,analysis1 application1 evaluation 7#bnd ed474 ,boston3 ,little ,brown ,co4 ,suppe1 ,f41 ,jacox1 ,a4 7#aihe74 ,philosophy of science and the development of nursing theory4 ,in ,h4 ,h4 ,werley ,j4 ,j4 ,fitzpatrick 7,eds471 ,annual review of nursing research 7pp4 #bda-bfg74 ,new ,york3 ,springer ,publishing ,company4 ,zderad1 ,l4 ,t4 7#aigh74 ,from here-and-now to theory3 ,reflections on how4 ,in ,theory development3 ,what1 why1 how 7pp4 #ce-dh74 ,new ,york3 ,national ,league for ,nursing4 ,,articles ,bael1 ,e4 ,d41 ,lowry1 ,b4 ,j4 7#aihg74 ,patient and situational factors that affect nursing students' like or dislike of caring for patient4 ,nursing ,research1 #cf 7#e71 #bih-cjb4 ,beckstrand1 ,j4 7#aihj74 ,a critique of several conceptions of practice theory in nursing4 ,research in ,nursing and ,health1 #c1 #fi-gi4 ,bottorff1 ,j4 ,l41 ,d'cruz1 ,j4 ,v4 7#aihd74 ,towards inclusive notions of patient and nurse4 ,journal of ,advanced ,nursing1 #i 7#f71 #edi-eec4 ,braun ,j4 ,l41 ,baines1 ,s4 ,l41 ,olson1 ,n4 ,g41 ,scruby1 ,l4 ,s4 7#aihd74 ,health ,values1 #h 7#c71 #ab-ae4 ,brown1 ,l4 7#aihf74 ,the experience of care3 ,patient perspectives4 ,topics in ,clinical ,nursing1 #h 7#b71 #ef-fb4 ,chenitz1 ,w4 ,c41 ,swanson1 ,j4 ,m4 7#aihd74 ,surfacing nursing process--,a method for generating nursing theory from practice4 ,journal of ,advanced ,nursing1 #i 7#b71 #bje-bae4 ,drew1 ,n4 7#aihf74 ,exclusion and confirmation3 ,a phenomenology of patients' experiences with caregivers4 ,image1 #ah 7#b71 #ci-dc4 ,flaskerud1 ,j4 ,h4 7#aihf74 ,on toward a theory of nursing action skills and competency in nurse-patient interaction4 ,nursing ,research1 #ce 7#d71 #bej-beb4 #abe ,king1 ,e4 ,c4 7#aihd74 ,humanistic education3 ,theory and teaching strategies4 ,nurse ,education #h 7#d71 #ci-db4 ,nahon1 ,n4 ,e4 7#aihb74 ,the relationship of self-disclosure1 interpersonal dependency1 and life changes to loneliness in young adults4 ,nursing ,research1 #ca 7#f71 #cdc-cdg4 ,oiler1 ,c4 7#aihb74 ,the phenomenological approach in nursing research4 ,nursing ,research1 #ca 7#c7 #agh-aha4 ,rigdon1 ,i4 ,s41 ,clayton1 ,b4 ,c41 ,dimond1 ,m4 7#aihg74 ,toward a theory of helpfulness for the elderly bereaved3 ,an invitation to a new life4 ,advances in ,nursing ,science1 #i 7#b71 #cb-dc4 ,sarter1 ,b4 7#aihg74 ,evolutionary idealism3 ,a philosophical foundation for holistic nursing theory4 ,advances in ,nursing ,science1 #i 7#b71 #a-i4 ,taylor1 ,s4 ,g4 7#aihe74 ,rights and responsibilities3 ,nurse patient relationships4 ,image1 #ag 7#a71 #i-af4 #abf #abg ,,index ,abdellah1 ,faye ,g41 #ij ,agee1 ,james1 #h1 #fg ,all-at-once1 #d1 #h1 #dd1 #eb1 #ee1 #ef1 #fh1 #gj1 #gc1 #ic1 #if1 #aji-aaa ,analogy1 #cg1 #ed1 #fa1 #hc ,analysis1 #gb1 #gi1 #hb-hd ,angular view1 #e1 #bj1 #cg-ch1 #ea1 #fe-fg1 #ga1 #gd1 #hj-hb1 #hd1 #hh1 #ie-ih1 #aaa ,art1 #c1 #g-h1 #ad1 #ag1 #eh1 #fj1 #he-ic1 #aaa ,authenticity1 #d-e1 #ad-ae1 #ee1 #ef-fj1 #fc1 #ajd1 #ajf1 #aaa ,being and doing1 #ac-ad1 #ag1 #ai1 #bf1 #ib ,bergson1 ,henri1 #f1 #fh1 #ga1 #gb1 #gc1 #ajd ,between1 7the71 #d1 #g1 #ac1 #ba-bb1 #ca1 #dd1 #fg1 #hb1 #ajh4 ,see also ,dialogue2 ,intersubjective2 ,presence2 and ,transaction ,bracket1 #ch1 #fb1 #hj ,buber1 ,martin1 #d1 #f1 #af1 #bc1 #ci1 #dd1 #de1 #dg1 #ee1 #fi1 #gb1 #gc1 #ic1 #ajd1 #ajf1 #aaj ,call and ,response1 #c1 #e1 #g1 #bd1 #bi-ca ,choice1 #d-f1 #ae-ag1 #bj1 #bd1 #cg1 #eg1 #fi1 #gb4 ,see also ,confidentiality2 ,responsibility ,christoffers1 ,carol ,ann1 #hi ,clinical1 #fe1 #fg1 #ib-ic1 #if1 #ajc-aji ,comfort1 #fe1 #if1 #ih-ajc1 #ajf1 #aaa-aab ,community1 #g1 #ad1 #cg-dh1 #fc1 #hd ,complementary synthesis1 #c1 #h1 #cf1 #fh1 #gc-gd1 #aaa4 ,see also ,synthesis ,confidentiality1 #ec-ef4 ,see also ,choice2 ,responsibility ,cousins1 ,norman1 #ci1 #dg1 #ajd ,cross-clinical1 #bj de ,chardin1 ,pierre ,teilhard1 #f1 #ci1 #da1 #ajd ,desan1 ,wilfrid1 #af1 #ci1 #gc1 #gd1 #ajh ,description1 see ,phenomenological description ,dewey1 ,john1 #gb1 #ajd ,dialogue1 #ba-cf1 #gc1 #gg1 #ib-ic4 ,see also ,between 7the72 ,intersubjective2 ,presence2 and ,transaction ,durant1 ,ariel1 #fi ,durant1 ,will1 #fi ,existential1 existentialism1 #d-i1 #ad1 #ae1 #bc1 #ch1 #dg1 #fe-ff4 ,see also ,phenomenology2 ,philosophy ,fahy1 ,ellen ,t41 #ia ,family1 #ch-de ,frankl1 ,viktor ,e41 #f1 #ajb ,garner1 ,grayce ,c4 ,scott1 #hh1 #hi ,gilbert1 ,ruth1 #fe1 #if1 #aji1 #aaj ,goethe1 ,johann ,wolfgang von1 #f1 #fg1 #ajb #abh ,heinlein1 ,robert ,a41 #de ,here and now1 #dj1 #da1 #eg1 #fh1 #fi1 #hj1 #ha ,hersey1 ,john1 #ci1 #hi ,hesse1 ,herman1 #f1 #ci1 #dj1 #de1 #fi ,humanistic nursing1 #c1 #e1 #ad-bj1 #ba1 #he1 #ib-ic ,humanistic nursing practice theory1 #c1 #f-g1 #h1 #ag-bj1 #ba1 #ee1 #fj1 #fb1 #fe1 #gj1 #gg-hd1 #ie-aab ,human situation1 #aa1 #ah-bj1 #hg1 #hi ,husserl1 ,edmund1 #ef1 #gh1 #gi ,intersubjective1 #ac1 #ae-ag1 #ba-bb1 #bf-bg1 #ca-cb1 #ce-cf1 #fh1 #ha1 #ij1 #ic4 ,see also ,between1 7the72 ,dialogue2 ,presence2 and ,transaction ,intuition1 intuitive1 #ai1 #bc1 #eb1 #ga-gb1 #gc1 #gi-hb1 #if1 #aji ,i-,it1 #bg1 #cf1 #dd-de1 #gc1 #ajf-aab ,i-,thou1 #f1 #bg1 #cf1 #dd-de1 #fb1 #gb1 #gc1 #ib1 #ajf-aab ,jung1 ,carl ,g41 #f1 #eh1 #fh ,kaplan1 ,abraham1 #ff ,kiell1 ,norman1 #dc ,laing1 ,r4 ,d41 #ag ,lemkau1 ,paul ,v41 #ed-ee ,man1 concept of1 #e1 #ae-af1 #ah-ai1 #bf1 #ch-de1 #ea1 #eb1 #ed-ef1 #fg-ga ,marcel1 ,gabriel1 #f1 #af1 #bc1 #da ,may1 ,rollo1 #f ,meeting1 #ah1 #bd-bf ,metanursing1 #bj ,metaphor1 #ed1 #fa1 #hd ,methodology1 #fe-ge1 #gg-hd1 #ie-aab ,microcosm-macrocosm1 #cg-ch1 #dj1 #dh ,more-being1 moreness1 #d-f1 #ab1 #af-ag1 #ai1 #bi1 #cb1 #cf1 #dd-de1 #dh1 #fc1 #fi1 #hi1 #ib ,muller1 ,theresa ,g41 #ci1 #fe1 #if1 #aji1 #aaj ,nietzsche1 ,frederick1 #f1 #ci1 #dj1 #da1 #df1 #dg1 #ed1 #ga1 #ajb1 #ajd1 #aje ,nursing1 #c1 #e1 #g1 #aa-ag1 #ba1 #de-dh1 #eg-eh1 #fe1 #fi1 #ga1 #gb1 #gc1 #gd1 #ge1 #ij-ib1 #ie-aab4 ,see also ,humanistic nursing ,nursology1 #fe1 #fg1 #gj1 #gb1 #gc1 #gd ,nurture1 #ac1 #ah-ai1 #be ,objective1 see ,subjective-objective ,paradox1 #d1 #ci1 #gj ,phenomenological description1 #c1 #f-h1 #ac-ad1 #ed1 #fj-fb1 #gj1 #gg-hd1 #if1 #aaa ,phenomenology1 #f1 #i1 #fj-fb1 #ff1 #fg1 #gb1 #gh1 #gi ,phillips1 ,gene1 #d ,philosophy1 #ag1 #dj1 #ff1 #fg1 #ge1 #ig4 ,see also ,existentialism2 ,phenomenology ,plato1 #f1 #cg1 #de1 #fg1 #ajd ,plutarch1 #aja ,popper1 ,karl1 #ci1 #ajd ,practice1 see ,humanistic nursing practice theory ,presence1 #c1 #e1 #f1 #ac1 #ae1 #af1 #bg-bi1 #dg1 #ef1 #eh1 #gb1 #ajf4 ,see also ,between1 7the72 ,dialogue2 ,intersubjective2 and ,transaction ,proust1 ,marcel1 #f ,research1 #ea-fc ,responsibility1 #c1 #f1 #af-ag1 #bj1 #bh1 #da1 #ec-ee1 #eg1 #fc1 #fi1 #gj1 #gb1 #aaj4 ,see also ,choice2 ,confidentiality ,rousseau1 ,jean-,jacques1 #f ,russell1 ,bertrand1 #gj1 #ajd ,science1 scientific1 #c1 #f1 #g1 #h1 #ae1 #ag1 #ce1 #de1 #eb1 #ec1 #eh1 #fj1 #ff1 #fh1 #gj1 #gb1 #he-hg1 #hh1 #ij1 #ic1 #aaa #abi ,socrates1 #ch ,space1 #ah-bj1 #cd-ce ,subjective-objective1 #bg1 #ce-cf1 #eb1 #fg1 #gi1 #ha1 #ic ,synthesis1 #gb-gd1 #gi1 #hb-hd1 #ic1 #ie1 #ajb1 #ajc1 #ajh1 #aaa4 ,see also ,complementary synthesis ,theory1 see ,humanistic nursing practice theory ,time1 #ah-bj1 #bi1 #cc-cd ,transactions1 #aa1 #ab-ac1 #af-bj1 #ba1 #ce-cf4 ,see also ,between1 7the72 ,dialogue2 ,intersubjective2 and ,presence ,trautman1 ,mary ,jane1 #hg1 #hh ,uniqueness1 #d1 #g1 #ae1 #bc1 #be1 #bf1 #bg1 #cb1 #cd1 #ce-cf1 #dj1 #de1 #ef1 #fh1 #fi1 #gb1 #gg1 #aaa ,value1 #f1 #af1 #ag1 #ah1 #cj1 #ci1 #df-dh1 #ed1 #ef-eg1 #fi1 #ga1 #gg1 #gi1 #he1 #ig1 #ih1 #ajd1 #aje ,well-being1 #ab1 #af1 #cf1 #hi1 #ib ,whitehead1 ,alfred ,north1 #f ,wiesel1 ,elie1 #g1 #if ,weymouth1 ,lilyan1 #ee ,words1 #h1 #fj-fb1 #gc1 #ha1 #ih ,wright1 ,edward ,a41 #ia ,transcriber's ,note3 ,the following corrections have been made in this version4 ,page iv 'exhilirating' corrected to 'exhilarating'3 same exhilarating feeling 'evalute' corrected to'evaluate'3 and evaluate4 ,page #aa 'sitution' corrected to 'situation'3 the human situation 'appers' corrected to 'appears'3 nursing appears in ,page #ab 'limtations' corrected to 'limitations'3 and limitations of ,page #ad 'siuation' corrected to 'situation'3 now shared situation ,page #ae 'wothout' corrected to 'without'3 goes without saying 'echos' corrected to 'echoes'3 process echoes existential ,page #ah 'wiscom' corrected to 'wisdom'3 of clinical wisdom 'wourlds' corrected to 'worlds'3 lived nursing worlds ,page #bj 'appraoch' corrected to 'approach'3 nursing approach is 'cross-clincal' corrected to 'cross-clinical'3 genuine cross-clinical ,page #ba 'clairty' corrected to 'clarity'3 gained in clarity 'nusing' corrected to 'nursing'3 runs through nursing 'conveyting' corrected to 'conveying'3 stream conveying the ,page #bb 'languge' corrected to 'language'3 with our language 'consitituent' corrected to 'constituent'3 component or constituent 'relfecting' corrected to 'reflecting'3 ,once while reflecting ,page #bc 'dicionary' corrected to 'dictionary'3 the typical dictionary ,page #be 'ot' corrected to 'to'3 expects to give 'reflectd' corrected to 'reflected'3 meeting is reflected ,page #bf 'for for' corrected to 'for'3 have a capacity for 'tor' corrected to 'for'3 necessary for everyday ,page #bg 'objectivication' corrected to 'objectification'3 ,through objectification 'his' corrected to 'this'3 but this in ,page #bh 'availbility' corrected to 'availability'3 and availability in ,page #bi 'begin' corrected to 'being'3 modes of being 'purposefull' corrected to 'purposeful'3 a purposeful call ,page #cj 'communicaion' corrected to 'communication'3 nurse-patient communication ,page #ca 'expecially' corrected to 'especially'3 staggering1 especially so ',futhermore' corrected to ',furthermore'3 ,furthermore1 in caring ,page #cc 'occured' corrected to 'occurred'3 may have occurred 'possiblities' corrected to 'possibilities'3 ,these possibilities may ,page #ce 'exmination' corrected to 'examination'3 the examination turned ,page #dj 'echos' corrected to 'echoes'3 world echoes its ,page #da 'childrens'' corrected to 'children's'3 their children's worlds 'intial' corrected to 'initial'3 this initial home ,page #db 'errupt' corrected to 'erupt'3 it might erupt8 ',ofen' corrected to ',often'3 ,often one saw ,page #dc 'long-rememberd' corrected to 'long-remembered'3 long-remembered events 'of of' corrected to 'of'3 times of feeling 'there' correct to 'there are'3 there are multiple 'give' corrected to 'gives'3 it gives satisfaction ,page #dg 'contemporaires' corrected to 'contemporaries'3 with my contemporaries ,page #ea 'necesssary' corrected to 'necessary'3 is necessary in 'reasonbale' corrected to 'reasonable'3 both reasonable and ,page #eb 'substanitated' corrected to 'substantiated'3 be substantiated fully ,page #ec 'of' corrected to 'or'3 care or when ,page #ee 'viewd' correct to 'viewed'3 is viewed as 'profesion' corrected to 'profession'3 nursing profession4 ,utilizing 'reponses' corrected to 'responses'3 struggling responses ,page #eg 'knowlege' corrected to 'knowledge'3 dispersion of knowledge ,page #ei 'clincial' corrected to 'clinical'3 ,as clinical supervisor 'theapeutic' corrected to 'therapeutic'3 patients' therapeutic needs ,page #fj 'civilzation' corrected to 'civilization'3 his civilization within ,page #fa 'somethimes' corrected to 'sometimes'3 sometimes like a 'us' corrected to 'use'3 and use of weasel ,page #fb 'presitigious' corrected to 'prestigious'3 foreign prestigious terms 'intial' corrected to 'initial'3 to initial aware ,page #ff 'mehtodology' corrected to 'methodology'3 the methodology in 'reexemaination' corrected to 'reexamination'3 available for reexamination1 'phenomenologic' corrected to 'phenomenological'3 a phenomenological method ,page #fh 'citical' corrected to 'critical'3 my critical powers ,page #gj 'excietment' corrected to 'excitement'3 feelings of excitement 'easilty' corrected to 'easily'3 not easily relinquished ,page #ga 'clincal' corrected to 'clinical'3 struggle in clinical 'reconsituting' corrected to 'reconstituting'3 of reconstituting with ,page #gb 'assunder' corrected to 'asunder'3 bursts asunder ,page #gd 'oscilating' corrected to 'oscillating'3 ,this oscillating1 dialectical ,page #gh 'the the' corrected to 'the'3 the approach has been 'desciplines' corrected to 'disciplines'3 by different disciplines 'deatils' corrected to 'details'3 more concrete details ,page #ha 'perpectives' corrected to 'perspectives'3 their own perspectives 'aslo' corrected to 'also'3 rather it also ,page #hb 'a' corrected to 'as'3 angles as possible 'expliction' corrected to 'explication'3 the explication of 'chracteristics' corrected to 'characteristics'3 has other characteristics 'convy' corrected to 'convey'3 may convey anger ,page #hc 'empahty' corrected to 'empathy'3 ,thus1 empathy is ,page #he 'othe' corrected to 'other'3 and other forms ,page #hg 'peparation' corrected to 'preparation'3 educational preparation 'sceintific' corrected to 'scientific'3 with scientific courses 'quanitification' corrected to 'quantification'3 strives for quantification ,page #ij - footnote #aa ',sceince' corrected to ',science'3 ,nursing ,science ,page #ia 'physcial' corrected to 'physical'3 of physical objects ,page #ic 'responsses' corrected to 'responses'3 human responses to 'it' corrected to 'is'3 ,it is possible ,page #ig 'nusring' corrected to 'nursing'3 for nursing theory 'veiwed' corrected to 'viewed'3 never viewed myself ,page #ajj 'opportunties' corrected to 'opportunities'3 therapeutic opportunities available ,page #ajb 'necesary' corrected to 'necessary'3 are necessary for 'contributaries' corrected to 'contributories'3 of many contributories ',geothe' corrected to ',goethe'3 ,nietzsche and ,goethe ,page #ajd 'comparision' corrected to 'comparison'3 comparison of it ,footnote #i ',pbulishers' corrected to ',publishers'3 ,basic ,books1 ,publishers ,page #ajf 'containted' corrected to 'contained'3 total group contained ,page #aaj 'nurse'' corrected to 'nurse's'3 a nurse's duality ,page #aaa 'nusing' corrected to 'nursing'3 ,humanistic nursing practice ,page #aad '',sometimes' corrected to ',sometimes'3 ,i said1 ,sometimes ,page #aae 'know' corrected to 'knew'3 if she knew 'assunder' corrected to 'asunder'3 to burst asunder ,page #aag 'encourged' corrected to 'encouraged'3 ,i encouraged patients' ,page #aah 'therapeautic' corrected to 'therapeutic'3 individual therapeutic gains 'aggreeably' corrected to 'agreeably'3 to me agreeably ,page #aba 'mure' corrected to 'more'3 two or more ,page #abc ',hursing' corrected to ',nursing'3 ,zderad's ,humanistic ,nursing ,page #abd ',refelections' corrected to ',reflections'3 ,reflections on how ',dcruz' corrected to ',d'cruz'3 ,d'cruz1 ,j4 ,v4 ,page #abh ',nietzche' corrected to ',nietzsche'3 ,nietzsche1 ,frederick1