HUMANISTIC HUMANISTIC NURSINGNURSINGTHEORYTHEORY

Dr. Josephine Dr. Josephine PatersonPaterson

Dr. Loretta ZderadDr. Loretta Zderad

BIOGRAPHYBIOGRAPHY

DR. JOSEPHINE PATERSONDR. JOSEPHINE PATERSON

BIOGRAPHYBIOGRAPHY

Josephine Paterson was born on Josephine Paterson was born on the 1st of September 1924 in the 1st of September 1924 in Freeport, New York. Freeport, New York.

She had graduated in August She had graduated in August 1945 with a diploma from Lenox 1945 with a diploma from Lenox Hill School of NursingHill School of Nursing

Nine years later (1954, August) she Nine years later (1954, August) she received her master’s degree from received her master’s degree from John Hopkin’s School of Hygiene John Hopkin’s School of Hygiene and Public Health, Baltimore, and Public Health, Baltimore, MarylandMaryland

Her Doctor for Nursing is from Her Doctor for Nursing is from Boston University School of Nursing, Boston University School of Nursing, Boston, Massachusetts, where she Boston, Massachusetts, where she specialized in psychiatric nursingspecialized in psychiatric nursing

Dr. Paterson conceptualized and taught Dr. Paterson conceptualized and taught humanistic nursing to graduate students, humanistic nursing to graduate students, faculty, and staff in a variety of settingsfaculty, and staff in a variety of settings

She also served on the faculty of the State She also served on the faculty of the State University of New York at StonybrookUniversity of New York at Stonybrook

She retired in 1985 as a clinical nurse She retired in 1985 as a clinical nurse specialist at Northport Veterans Administration specialist at Northport Veterans Administration Medical Center at Northport, New YorkMedical Center at Northport, New York

DR. LORETTA ZDERADDR. LORETTA ZDERAD

Zderad is a graduate of St. Bernard’s Zderad is a graduate of St. Bernard’s Hospital School of Nursing and Loyola Hospital School of Nursing and Loyola UniversityUniversity

She received her Master of Science She received her Master of Science degree from Catholic University, degree from Catholic University, Washington, DC, and a doctor of Washington, DC, and a doctor of Philosophy (1968) from Georgetown Philosophy (1968) from Georgetown University, Washington, DCUniversity, Washington, DC

She has taught in several universities She has taught in several universities and has led groups on humanistic and has led groups on humanistic nursingnursing

Dr. Zderad also served on the Dr. Zderad also served on the faculty of the State University of faculty of the State University of New York at StonybrookNew York at Stonybrook

She retired in 1985 as the She retired in 1985 as the Associate Chief for Nursing Associate Chief for Nursing Education at the Northport Education at the Northport Veterans Administration Medical Veterans Administration Medical Center, Northport, New YorkCenter, Northport, New York

Paterson and Zderad met in the Paterson and Zderad met in the 1950’s while working at Catholic 1950’s while working at Catholic University, where their task was to University, where their task was to create a new program that would create a new program that would include psychiatric and community include psychiatric and community health.health.

Friendship that has lasted over 35 Friendship that has lasted over 35 years.years.

HUMANISTIC NURSINGHUMANISTIC NURSING ““Embraces more than a benevolent Embraces more than a benevolent

technically competent subject-object one-technically competent subject-object one-way relationship guided by a nurse way relationship guided by a nurse in behalf of another. Rather it dictates in behalf of another. Rather it dictates that nursing is a responsible searching, that nursing is a responsible searching, transactional relationship whose transactional relationship whose meaningfulness demands meaningfulness demands conceptualization founded on a nurse's conceptualization founded on a nurse's existential awareness of self and of existential awareness of self and of other“ (Paterson & Zderad)other“ (Paterson & Zderad)

A highly abstract theory with a A highly abstract theory with a major focus on the process of major focus on the process of interaction or dialogue between interaction or dialogue between the nurse and patient. the nurse and patient.

Paterson and Zderad believed Paterson and Zderad believed that a simple, scientific approach that a simple, scientific approach to nursing education would not to nursing education would not be sufficient to create truly be sufficient to create truly effective and content nurses.effective and content nurses.

IMPLICIT ASSUMPTIONSIMPLICIT ASSUMPTIONS

Nursing involves two human beings who are willing to enter into an existential relationship with each other.

Nurses and patients as human beings are unique and total biopsychosocial beings with the potential for becoming through choice and intersubjectivity.

Every encounter with another human being is an open and profound one, with a great deal of intimacy that deeply and humanistically influences members in the encounter.

Human beings are free and are expected to be involved in their own care and in decisions involving them.

All nursing acts influence the quality of a person’s living and dying.

Nurses and patients coexist; they are independent and interdependent.

A nurse has to “accept and believe in the chaos of existence as lived and experienced by each man despite the shadows he casts, interpreted as poise, control, order, and joy” (Paterson and Zderad, 1988,p. 56).

Human beings have an innate force that moves them to know their angular views and other’s angular views of the world (Paterson and Zderad, 1976; Zderad, 1969).

THEORETICAL THEORETICAL ASSERTIONSASSERTIONS

Through the Humanistic Theory, the nurse is able to connect with the patient and their struggle, enabling them to gain a deeper understanding of their situation and face the battle together.

Humanistic nursing practice is developed from the lived experiences of the nurse and the person receiving care.

The practice of nursing is rooted The practice of nursing is rooted from from “EXISTENTIALISM”.“EXISTENTIALISM”. It is a It is a philosophical approach to philosophical approach to understanding life. Individuals are understanding life. Individuals are faced with possibilities when faced with possibilities when making choices. These choices making choices. These choices determine the direction and determine the direction and meaning in one’s life.meaning in one’s life.

The purpose of the nurse-patient relationship, or intersubjective relating, is, “nurturing the well-being and more-being of persons in need”. Humanistic nursing focuses on the intersubjectivity experience, the most important activity for the nurse to engage in may be the use of self, or presence with the patient.

3 CONCEPTS PROVIDING 3 CONCEPTS PROVIDING THE BASIS OF NURSINGTHE BASIS OF NURSING

DIALOGUEDIALOGUE

– Nursing is a lived dialogueNursing is a lived dialogue. . It is a nurse-It is a nurse-nursed relating creatively.nursed relating creatively. MeetingMeeting PresencePresence ResponseResponse RelatingRelating

– MeetingMeeting– is characterized by the expectation is characterized by the expectation

that there will be a nursethat there will be a nurse and a nursedand a nursed

– RelatingRelating–is a process of nurse-nursed doing is a process of nurse-nursed doing with each otherwith each otherSubject – Subject RelatingSubject – Subject Relating

"I-Thou" is a coming to know the other and the self in relation, intuitively.

Subject – Object RelatingSubject – Object Relating "I-It" is an authentic analyzing, synthesizing, and

interpreting of the "I-Thou" relation through reflection.

– PresencePresence– is the quality of being open, is the quality of being open, receptive, ready, and available to receptive, ready, and available to another personanother person

– Call and ResponseCall and Response–nurses and clients call and nurses and clients call and respond to each other both respond to each other both verbally and nonverballyverbally and nonverbally

Call and response relationship is where the client call for assistance and the nurses hear the call and respond with their knowledge, life experience, and skills to help the caller with the health – related need. What happens during this dialogue, the “and” in the “call and response,” the “between,” is nursing.

COMMUNITYCOMMUNITY– Meaning comes from the Meaning comes from the

realization that it is through each realization that it is through each other that we more fully other that we more fully participate in and expand our livesparticipate in and expand our lives

– Two or more persons struggling Two or more persons struggling together toward a center (Paterson together toward a center (Paterson & Zderad, 1976)& Zderad, 1976)

Through openness, sharing, and caring, we each will expand our angular views, each becoming more than before. Subsequently, we take back into our nursing community these expanded selves, which in turn will touch our patients, other colleagues, and the world of health care.

According to Humanistic Nursing Theory, there is an inherent obligation of nurses to one another and to the community of nurses. That which enhances one of us, enhances all of us.

So for a health-nursing community to truly be actualized each nurse would prepare to be all it was possible forher to be as a nurse. Then, through exploration there would be a recognition of the reality of the existentcommunity. Over time a merger of the values of the nurse and of the existing community would be reflectedas moreness in each. The nurse would be more through her

relation with the community; the communitywould be more through its relation with the nurse. Each would make an important difference in the other. Themacrocosm, the community, would reflect the nurse's quality of presence. The microcosm, the nurse, wouldreflect the presence of the community with her. Each unique man becomes in community throughcommunication with other uniquely different men.

PHENOMENOLOGIC NURSOLOGYPHENOMENOLOGIC NURSOLOGY

– Methodology for understanding and Methodology for understanding and describing nursing situationsdescribing nursing situations

– Assumes a perceived health need by the Assumes a perceived health need by the individual who is involved in an interaction individual who is involved in an interaction with a health care providerwith a health care provider

– Concerned with the nature of the facts and Concerned with the nature of the facts and what they mean to individualswhat they mean to individuals

5 PHASES OF HUMANISTIC 5 PHASES OF HUMANISTIC NURSING INQUIRYNURSING INQUIRY

Preparation of the nurse knower Preparation of the nurse knower for coming to knowfor coming to know– Preparing to get to know the patient’s Preparing to get to know the patient’s

point-of-view. This means the nurse point-of-view. This means the nurse uses her education and life experiences uses her education and life experiences to prepare to relate with patients. Your to prepare to relate with patients. Your experience communicating with experience communicating with different types of peopledifferent types of peoplewith different personalities helps you with different personalities helps you prepare to communicate with patients. prepare to communicate with patients.

Nurse knowing the other intuitivelyNurse knowing the other intuitively– Moving the other back and forth between Moving the other back and forth between

the impressions the nurse becomes aware the impressions the nurse becomes aware of herself and recollected real experience of herself and recollected real experience of the other (Paterson & Zderad, 1976)of the other (Paterson & Zderad, 1976)

– It is conceptualized as dialectic between It is conceptualized as dialectic between the impression and the real. This shifting the impression and the real. This shifting back and forth allows for sudden insights back and forth allows for sudden insights on the nurse’s part, a new overall grasp, on the nurse’s part, a new overall grasp, which manifests itself in a clearer, or which manifests itself in a clearer, or perhaps a new, “understanding.” These perhaps a new, “understanding.” These understandings generate further understandings generate further development of the process development of the process

– The nurse gains knowledge of the patient The nurse gains knowledge of the patient through through intuitive impressionsintuitive impressions and learning and learning about the patient’s experiencesabout the patient’s experiences

– At this time, the nurse’s general At this time, the nurse’s general impressions are in a dialogue with her impressions are in a dialogue with her unbracketed view unbracketed view

Nurse knowing the other scientificallyNurse knowing the other scientifically– Separateness from what is knownSeparateness from what is known

– The nurse gains scientific knowledge of The nurse gains scientific knowledge of the patient by (phenomenological the patient by (phenomenological process) pondering, analyzing, sorting, process) pondering, analyzing, sorting, comparing, contrasting, relating, comparing, contrasting, relating, interpreting, naming, and categorizing interpreting, naming, and categorizing data (therapeutic techniques: clarification data (therapeutic techniques: clarification and verification)and verification)

– Collect information about the patient, for Collect information about the patient, for example age, pulse and blood pressureexample age, pulse and blood pressure

Nurse complementarily synthesizing Nurse complementarily synthesizing known others known others – The nurse combines the subjective and The nurse combines the subjective and

objective information to gain perspective objective information to gain perspective on the situationon the situation

– Nurse as “noetic loci” or “knowing Nurse as “noetic loci” or “knowing places”. The nurse examines the places”. The nurse examines the communication with the patient and the communication with the patient and the information collected in light of her information collected in light of her education (theoretical foundation) and education (theoretical foundation) and personal experience. The nurse uses all personal experience. The nurse uses all the information from the patient and from the information from the patient and from her experiences to form a conclusion. For her experiences to form a conclusion. For example, maybe the nurse had a patient example, maybe the nurse had a patient before who had the same complaint.before who had the same complaint.

Succession within the nurse from Succession within the nurse from the many to the paradoxical onethe many to the paradoxical one– The nurse arrives at a new truth, a The nurse arrives at a new truth, a

concept that includes all the concept that includes all the information gained, refined into a information gained, refined into a descriptive construct (Kleiman, descriptive construct (Kleiman, 2006)2006)

– The nurse makes a conclusion about The nurse makes a conclusion about what is the best way to improve the what is the best way to improve the patient’s well-being. patient’s well-being.

Paradoxical one: descriptive theoretical Paradoxical one: descriptive theoretical construct of nursingconstruct of nursing

NURSING NURSING METAPARADIGMMETAPARADIGM

NURSING NURSING – Is a nurturing response of one person to Is a nurturing response of one person to

another in a time of need that aims toward another in a time of need that aims toward the development of well-being and more the development of well-being and more beingbeing

– Helping to increase responsible choicesHelping to increase responsible choices

– Nursing is concerned with the individual’s Nursing is concerned with the individual’s unique being and striving towards unique being and striving towards becoming, focusing on the wholebecoming, focusing on the whole

– Is a lived dialogue that incorporates the Is a lived dialogue that incorporates the intersubjective in which a nurse and a intersubjective in which a nurse and a patient meet, relate, and are totally patient meet, relate, and are totally present in an existential way that includes present in an existential way that includes intimacy and mutuality intimacy and mutuality

HEALTHHEALTH

– Matter of personal survival. It is a process of Matter of personal survival. It is a process of experiencing one’s potential for well-being experiencing one’s potential for well-being and more-being, a quality of living and dying.and more-being, a quality of living and dying.well-being: steady state (maintenance of well-being: steady state (maintenance of quality) or more than absence of diseasequality) or more than absence of disease

more well-being: process of becoming all more well-being: process of becoming all that is humanly possiblethat is humanly possible

– Finding meaning in lifeFinding meaning in life

MANMAN– Human beings are characterized as Human beings are characterized as

being capable, open to options, being capable, open to options, person with values, and the unique person with values, and the unique manifestation of their past, present, manifestation of their past, present, and futureand future

ENVIRONMENTENVIRONMENT– Community: The phenomenon of Community: The phenomenon of

society or environmentsociety or environment

– Two or more persons struggling Two or more persons struggling together toward a centertogether toward a center

– It is only through our community It is only through our community that we are able to reach our full that we are able to reach our full potentialpotential

CONCEPTUAL MODELCONCEPTUAL MODEL

CONCEPTUAL CONCEPTUAL FRAMEWORKFRAMEWORK

EVIDENCE – BASED EVIDENCE – BASED PRACTICEPRACTICE

Humanistic Nursing Theory: Humanistic Nursing Theory: application to hospice and palliative application to hospice and palliative care.care.

Wu HLWu HL, , Volker DLVolker DL..

Nursing Department, Meiho University Nursing Department, Meiho University Neipu,Neipu,

Pingtung, Taiwan.Pingtung, Taiwan.

2011 Jul 202011 Jul 20

ABSTRACTABSTRACT AIM: AIM:

This article presents a discussion of the This article presents a discussion of the relevance of Humanistic Nursing Theory to relevance of Humanistic Nursing Theory to hospice and palliative care nursing.hospice and palliative care nursing.

BACKGROUND: BACKGROUND:

The World Health Organization has The World Health Organization has characterized the need for expert, characterized the need for expert, palliative and end-of-life care as a top palliative and end-of-life care as a top priority for global health care. The priority for global health care. The specialty of hospice and palliative care specialty of hospice and palliative care nursing embraces a humanistic caring and nursing embraces a humanistic caring and holistic approach to patient care. As this holistic approach to patient care. As this resonates with Paterson and Zderad's resonates with Paterson and Zderad's Humanistic Nursing Theory, an Humanistic Nursing Theory, an understanding of hospice nurses' understanding of hospice nurses' experiences can be investigated by experiences can be investigated by application of relevant constructs in the application of relevant constructs in the theory.theory.

DATA SOURCES: DATA SOURCES: This article is based on Paterson and This article is based on Paterson and Zderad's publications and other theoretical Zderad's publications and other theoretical and research articles and books focused on and research articles and books focused on Humanistic Nursing Theory (1976-2009), Humanistic Nursing Theory (1976-2009), and data from a phenomenological study of and data from a phenomenological study of the lived experience of Taiwanese hospice the lived experience of Taiwanese hospice nurses conducted in 2007.nurses conducted in 2007.

DISCUSSION: DISCUSSION: Theoretical concepts relevant to hospice Theoretical concepts relevant to hospice and palliative nursing included call-and-and palliative nursing included call-and-response, inter-subjective transaction, and response, inter-subjective transaction, and uniqueness-otherness.uniqueness-otherness.

IMPLICATIONS FOR NURSING: IMPLICATIONS FOR NURSING: The philosophical perspectives of Humanistic The philosophical perspectives of Humanistic Nursing Theory are relevant to the practice of Nursing Theory are relevant to the practice of hospice and palliative care nursing. By 'being hospice and palliative care nursing. By 'being with and doing with', hospice and palliative with and doing with', hospice and palliative nurses can work with patients to achieve nurses can work with patients to achieve their final goals in the last phase of life.their final goals in the last phase of life.

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

Training nurses in a humanistic approach to Training nurses in a humanistic approach to caring for patients with dementiacaring for patients with dementia

Author: Leonard L. Sarff Author: Leonard L. Sarff January 2013January 2013

Abstract: This study applied a humanistic Abstract: This study applied a humanistic perspective to nursing care for people with perspective to nursing care for people with dementia. A formal training program was designed dementia. A formal training program was designed to help Registered Nurses, Licensed Practical to help Registered Nurses, Licensed Practical Nurses, and Certified Nursing Assistants Nurses, and Certified Nursing Assistants understand the etiology and progression of understand the etiology and progression of dementia, followed by hands-on training dementia, followed by hands-on training addressing the behavioral challenges in these addressing the behavioral challenges in these residents. This training taught the nurses to residents. This training taught the nurses to explore not only the medical aspects of dementia explore not only the medical aspects of dementia but more importantly to see the person suffering but more importantly to see the person suffering from dementia as a whole person who had a life of from dementia as a whole person who had a life of experiences, dreams, loves, and aspirations for experiences, dreams, loves, and aspirations for their lives, and what has made the resident a their lives, and what has made the resident a unique individual. The principal question this unique individual. The principal question this exploratory case study examined was:exploratory case study examined was:

Does training nurses to use a Does training nurses to use a humanistic approach lead to a humanistic approach lead to a higher quality of care and improve higher quality of care and improve the personal experiences of the the personal experiences of the caregiver? A semi-structured caregiver? A semi-structured interview with one Registered interview with one Registered Nurse, one Licensed Practical Nurse, one Licensed Practical Nurse, and one Certified Nursing Nurse, and one Certified Nursing Assistant, a subset of those who Assistant, a subset of those who attended the training, attended the training, supplemented a survey of 16 supplemented a survey of 16 participants as well as observations participants as well as observations of staff-patient interactions by the of staff-patient interactions by the investigator. A survey completed by investigator. A survey completed by the participantsthe participants

asked them to compare their own work asked them to compare their own work orientations before training with orientations before training with changes following the training. Training changes following the training. Training the staff to use a humanistic approach the staff to use a humanistic approach led to 15 out of 16 participants led to 15 out of 16 participants reporting that their participation in the reporting that their participation in the program contributed to one or more program contributed to one or more aspects of improved personalized care aspects of improved personalized care for their patients, benefiting not only for their patients, benefiting not only the residents but themselves as well. the residents but themselves as well. Participants reported feeling more Participants reported feeling more satisfaction with the work they were satisfaction with the work they were doing and an increased ability to have a doing and an increased ability to have a greater impact on the lives of the greater impact on the lives of the residents they were treating. residents they were treating.

THANK THANK YOU!YOU!