Humanistic Nursing

by Josephine G. Paterson; Loretta T. Zderad

HUMANISTIC NURSING

Josephine G. Paterson, DNSc, RN Loretta T. Zderad, PhD, 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 Africa.[1]

But until someone hears the cry and responds, the child will continue to suffer the oppression of the current South African regime; and the world will continue to be less than it could be. To cry aloud when there seems no chance of being heard, belies a hope—perhaps an inherently human trait—that someone, somewhere, somehow will hear that cry and respond to it.

This same hope, that someone would hear and respond, allowed existential psychologist Viktor Frankl to survive the systematic torture and degradation in Nazi death camps. As Frankl and others sought their way, they found meaning and salvation "through love and in love;" and by choosing to believe that "life still waited for him, that a human being waited for his return."[2]

There is power in the call of one person and the potential response of another; and incredible power when the potential response becomes real. There is the power for each person to change as she becomes more than she was before the dialogue. 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 existence. When the call and response between two people is as honest as it can be, there is the revolutionary power which the poet Muriel Rukeyser speaks of:

What would happen if one woman told the truth about her life?
The world would split open.[3]

{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 nurse, to change the situation, to change the world. It is the same authenticity we search for in relationships with our friends and lovers. The person who really listens to what we are saying, who really tries to understand our lived experiences of the world and who asks the same from us. When found, it brings the same exhilarating feeling of self-affirmation and the comforting feeling of well-being.

For, if as holistic beings we are the implicate order explicating itself, as suggested by Bohm[4] and Newman[5] among others, then the responsibilities of those who would help (e.g., nurses) 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 order. When we are successful in helping patients and their loved ones make sense of their lives by bringing meaning to them, we make sense of and bring meaning to our own.

And when we help create meaning, 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 marketplace. These are the moments when by a look or a word or a touch, the patient lets us know that he understands what is happening to him, what his choices are, and what he is going to do; that he knows we know; and that each knows that the other knows. When we get past our science and theories, our technical prowess, our titles and positions of influence, 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 projects.

Nurse educators who seek such authentic exchanges with their students enjoy similar moments. The same can be said of deans of schools of nursing, administrators of delivery systems, executives and staff of nursing and professional organizations, and colleagues on a research project. It is the authentic dialogue between people that makes any activity worthwhile regardless of whether or not it is called successful by others.

When Josephine G. Paterson and Loretta T. Zderad first published their book Humanistic Nursing in 1976, society was in the midst of the new women's movement and nurses were going through the phase of assertiveness training, dressing for success, and learning to play the games that mother never taught us. Since then, nurses have moved into many sectors of society and have held power as we have never held it before. We have proved ourselves as politicians, administrators, researchers, and writers. We have refined our abilities to assess, diagnose, treat, and evaluate. We've raised money and balanced budgets. We've networked, organized, and formed coalitions.

Yet, individually we are uneasy and collectively we are unable to articulate a vision clear enough so that others will join us. This re-issue of Paterson and {v} Zderad's classic work will help to remind us of another way of developing our power. Perhaps we can, once again, look for and call for authentic dialogue with our patients, our students, and our colleagues. Paterson and Zderad are clear in their method: discuss, question, convey, clarify, argue, and reflect. They remind us of our uniqueness and our commonality. They tell us that it is necessary to do with and be with each other in order for any one of us to grow. They help us celebrate the power of our choices.

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 1970s? Then, humanitarianism was in vogue. Now, it is under attack as a secular religion.

Today, the technocratic imperative infiltrates an ever-increasing number of our lived experiences; and it becomes more difficult to ignore or dismiss Habermas's analysis that all interests have become technical rather than human.[6] As health care becomes increasingly commercial the profound experiences of living and dying are discussed in terms of profit and loss. Life itself is the focus of public debates about whether surrogacy involves a whole baby being bought and sold or only half of a baby, since one half already "belongs" to the natural father and so he cannot buy what he already owns.

We have many choices before us: to adopt the values of commerce and redesign health care systems accordingly; to accept competition as the modus operandi or insist on other measures for people in need; to decide who will be cared for, who won't, who will pay, and how much?

Perhaps it is time for us to turn away from the exchange between buyers and sellers, providers and consumers; and turn back to an exchange between two people trying to understand the space they share. Perhaps it is time for a shared dialogue with patients for whom the questions are most vital? Perhaps we need to hear their call and respond authentically. Perhaps they need to hear ours? For only then, as Paterson and Zderad have made quite clear, will our lived experiences in health care have any real meaning.

Patricia Moccia PHD, RN
Associate Professor and Chair
Department of Nursing Education
Teachers College Columbia University