Professional Documents
Culture Documents
Zderad
Theory Descrlptlon
The central questions for Paterson and Zderad were: How do nurses and
patients inleract? and How can nurses develop the knowledge base for the
act of nursing? The humanistie practice nursing theory proposes that the
nurse and the patient are significant eomponents in the nurse/patient
situation. The aet of caring inereases the humanness of both, They both
approach the situation with experiences that influence the encounter. Nurses,
therefore, should consider such encounters as existential experienees and
should describe them from a phenomenological perspective. The sum total
of aU these experiences will enhance the development o the science o
nursing. In seleeting existentialism and phenomenology as context and
method for the development o nursing knowledge, they operate from several
premises. The progress o nursing as a human scienee is hampered by the
mechanistic, deterministie, cause and effeet methods that ha ve dominated it;
in other words, they rejeeted the reeeived view, the logieal positivism view
o theory development (Paterson, 1971, p. 143). They were a decade ahead o
. aU the literature in nursing that is now advoeating sueh a move. They have
also developed their ideas on the premise that the experiences of nurses in
practice supply the impetus for any useful theory for nurses. The preeoneeived
nolions of persons color what is significant and determinately influence the
development of knowledge; they should evolve from nursing practice.
247
Assumptlcns-c-Paterson& Zderad
Assumptlons
Nursing involves two human beings who are willing [O enter nto an existencial relationship with
eacn other.
Nurses and patlents as persons are unique and total biopsychosocial beings with the potential
for becoming through choice and intersubjettivity.
The present experiencesare more than tne !sum total of tne pasto present. and the future. and
are influenced by the pastopresent, and ruture. In their totality they are tess than tne future.
Every encounter with another human being ls an open and profound one, with a great deal of
Intimacy tnar deeply and humanistically influences members in the encounter,
Human beingsare free and are expected to be involved in their own care and in decisionsinvolving
them.
AI/ nursing acts inuence the quality of a person's living and dying.
Nurses and patlenrs coexst: they are independent and interdependent.
A nurse has to "accept and betleve in the cnaos of existence as lived and experienced by eacn
man despte tne shadows he casts. interpreted as poise. control, creer, and joy" (Paterson &
Zderad, 1976, p. 62).
Human beings nave an innate force that moves them to know their angular views and other's
angular views of the world (Paterson & Zderad, 1976; Zderad, 1969).
From Paterson. J.G. and Zderad. L.T.1I9761 Humerstk: mmtnq. New York: Jonn Wlley & Sons: and rrorn Zd.rad. l.T. 119691Empatheric
nursng: Realizaron or a human capaoty. NUfsing Clinics of Nortt "'m~rica. 4. 655-662.
an intersubjective
transand are tota11y present in
intimacy and mutuality
_ .._
-..
---..
__.._--------_
_ ..-._ .. _----~--_..
.. ~.
On Interactions 249
Proposltlons-Paterson
& Zderad
.Nursing's existentia! involvement in patient care is manifested in the active presence of the whole
'nurse in time and space as viewed by lile patient.
Nursing's goal of more weu-be.nq is enhanced by both nurse ano patient as they experience the
process of making responsible ehoiees.
Because nursing is involved with humans, its phenomena are man needing help ano man helping
In nts own slruanon.
Intimaey ario mutuaty in relationships enhance more well-being.
EORY ANALYSIS
rabie 11-11.
Concepts-Paterson
Between
Nurturing
Comfort
Being ano doing
Lived dialogue
Nurturing
Intersubjective transaction
Meeting
Relating
Presence
Intimacy
Mutuality
Call and response
Other human beings
Things
Time
Synchronicity
Spaee
& Zderad
Becoming
I-Thou
I-It
We
AII at once
Wel/-being
Morebeing
ChOices
Authentieity
with ones self
Intellectual awareness
Community'
Concepts for research
Authenticity
with sen
Nursology
--: ...............
1
Deflnltlon
Nursing
Goals of Nursing
Health
Environment
Human Being
Nursing Client
Nursing Problem
Nursing Process
Nurse/Patient Relations
Nursing Therapeutics
Focus
A human discipline involving one human being helping another in an interhuman and intersubjective transaction "containing all the human potennats and limitations of eacn unique partldpant" (1976. p. 21.Incorporates
aIJhuman responsesof a person needing another. "The ability to struggle
with otner man through peak experiences related ro health and suffering
in whictl tne participants in the nursing situation are and become in
accordance with their human potential" (1976. p. 7).
1) Humanistic nursing itself is a goal.
2) Help patients and self to develop their human potenttat and to come
toward. through choice and intersubjectiviry. wellbeing or more welbeing. To help patienrs and self to increasepossibility or making responsible
chotees (1976. pp. 15-17).
More than absence of disease: equared with more wellbeing. as much as
humanly possible (1976. p. 12).
Objecrive world as manifested in "otner human beings" and trnnqs. The
suojectlvemeaningof the people and things. Refersto nurses'and patient's
environment (1976. pp. 34-36. 411.
A unique and "incarnate being always becoming in relation with men and
things in a world of rime and space" (1976. p. 191. Has the capacity to
reect, value, experience to become more. One who asks for help and
one who gives help.
Botn nurse and patient are the nursing cnents (incarnate men). who are
unique. when they "meet in a goaldirected (nurturing wellbeing and
more weli-belnq] intersubjecrive transaction (being with and doing with]
occurring in time and space (as measured and as lived by patent and
nurse)" (1976. p. 231
Seeming discomfort that prornpts a caIJfor help. A person with perceived
needs related to the health/illness quality of living (1976. p. 19).
"Deliberare. responsible.conscious. aware. nonjudgmental extstence of the
nurse in the nursing situation. foIJowed by disciplined. authentic renecuon
and descnption" (1976. pp. 7-8). Basedon awareness on the pan of the
nurse.continuous assessment(p. 17). and developing the human potential
of the patient for responsible choosing between alternatives.
The human dialogue is the essenceor nursing. interaction snursing. Nurse/
patient experience ts an intersubjective transaction with empathy.
A human dialogue involves being and doing. nurturing. well-belnq or more
weIJbeing.and comforting. Existential involvemenr rh,1tis an active preso
ence besides the doing. to provide nurturing and comfort and involves
experiencing. reecttnq. and conceptualizing (1976. pp. 13-251. Nurses
offer alrernauvesand support responsiblechoosing. shareself. knowledge.
and experience.
On the person's unique being and becoming (1976. p. 20).
Orlglns
j;
On Interactions
251
... ,
nursing) through the parts (the various concepts) and the parts through the
whole. The unlqueness of this theory lies in the lack of boundaries between
the experence of the authors as nurses, theoreticians, methodologists. and
writers. Conceptslin the theory describe a11that, and a11experiences descripe
concepts.
,
THEORY CRITIOUE
The theorists, in proposing their htiinanistic theory of nursing, have also
proposed a mthodology congruent with the assumptions of the theory to
develop nursing knowledge (Paterson, 1971)_ They use the logic of phenomenological methodology and call it phenomenological nursology. The method
is aimed at the reality as experienced by the nurse and the patient subjectively
and objectively. They propose the method for research and nursing practice.
Existentialism is the context ofnursing, and concepts are utilized to develop
theory. Phenomenology is the process for clinical nursing and for research
in nursing. Phenomenological nursology evolved out of nursing practice and
is usable for nursing research.
The theorists proposed five phases of phenomenological nursology
(Paterson, 1971):
1. "Preparation of the nurse knower for coming to know";
this could be accomplished by total immersion in selected
and related literary work. Immersion includes reflecting,
contemplating. and discussing.
2. "Nurse knowing of the other intuitively" by seeing the
world through the eyes of the subject or the patient.
Become an insider rather than an outsider.
3. "Nurse knowing the other scientifically" by replaying the
subjective experiences, reflecting on them, and transcribing
the amalgamated view. The nurse considers relationships
and analyzes, synthesizes, and then conceptualizes.
4. "Nurse complernentarity synthesizing known others" by
comparing and contrasting the differences of like nursing
situations to arrive at an expanded view.
5. "Succession within the nurse from the many to the
paradoxcal one," evolving from the multiple realities to an
inclusive conception of the whole that incorpora tes the
,,:[.
multiplicities and contradictions.
.XII
,~l~
..
',;':'j
I
,J
',I'?~".
.:
\
:\. ,
~
On Interactions
the.
-veen
and
cribe
1
also
['y lo
iornthod
ively
:lice.
'elop
-arch
and
llogy
(Stern, 1980; Wilson, 1977). Paterson and Zderad have used the approach to
articula te concepts of empathy (Zderad, 1968, 1969, 1970), and comforl
; (Paterson & Zderad, 1976), but these reports appear to be clinical insights as
a prelude to systematic research findings.
Research lo explore the theory propositions has potential after the
concepts have been operalionalized. For example, the concepts of authenticity,
the "between",
more we11-being, and all-al-once are abstract and lack
definition to render them researchable. The potential of the theory to generate
research is exemplified in this example: the use of the self (the nurse) and
different patterns of "presence" in the patient's "time-space spheres" may be
explored.
The theory depicls a way oflife, an attilude toward humanity, a goal 01
actualization worth striving for on a11 levels of personal and professionaJ
lves. However, it is limited in Ihe form of guidelines for nursing practice.
The only indication of the use of this theory in practice has been offered by
Paterson and Zderad as occurring in the Veterans Administralion Hospital in
Northport, New York.
The theory is a philosophy and a methodology that purports to improve
not only the quality 'of ca re but also the quality of life for the nurse, the
teacher, and the administrator. Objective criteria to measure outcomes are
. antithetical to the theory and the methodology proposed. Therefore, the
subjectivejobjective
assessment of each individual nurse is expected and
accepted; there are no valid or reliable criteria lo measure 'concepts nor are
they warranted within the philoscphical view that guides the theory.
This is a tautological theory; the process o humanistic
nursing is
described by the goal of humanistic nursing, and the complexity of thc
phenomenon it addresses stems from abstractness and lack of boundaries
between its concepts. It appears lo focus on the nurse rather than the patient
as becoming and actualzing in the course of nursing care. Stevens (1979, p.
227) asked if what we need is really a holislic nurse, in which case the
proper subject mal ter of existential nursing theory would appropriately be
the nurse rather than the palient. If that is one of the focuses of nursing, and
Donaldson would agree (1983), then Paterson and Zderad have offered a
theory that appropriately describes one of the nursing phenomena.
External Components
sing
sing
that
and
hese
.ach
of Theory
The theory may be incongruent with prevailing values of practice but more
congruent with emerging values surrounding research and knowledge devel
opment in nursing. Humanistic theory proposes understanding
of human
beings and their experiences as they exist rather than considering what they
ought to be or rather than changing them. That goal of humanistic nursinp
ma:y then be in conflict with professonal values and goals, Stevens (1979)
makes two points to illustrate such incongruences.
The first deals with a
patienl in pain and in need of help.
It is a common existential position that suffering serves to bring about
'a state o self-awareness, thereby creating 'an "openness" to authentic experence that the patient might not otherwise evnce. Suffering crea tes a state
in which the person is brought face to face with his own being. Most nurses,
however, seek to remove (alleviate) suffering. It might be very difficult to
justify nursing acts that remove a patient from the authentic being o
suffering. ~p. 229)
,
Neither Travelbee nor Paterson and Zderad would advocate the removal
of suffering. Nursing to them is to help patients articula te their perceptions
of the situation and the meaning of the suffering.
Stevens' second argument evolves out of the theoretical proposition that
nurse/patient encounters involve an open human dialogue that involves a
degree of intimacy to enhance understanding of the subjective world of the
patient. How many such "meetings" can a nurse be involved in in the course
of her working day and is there potential for emotional drainage leading to
burnout? Do all patients seek and approve of such genuine encounters? i
Paterson and Zderad would argue that the higher levels of "being" gleaned '
from each encounter indica te rejuvenation rather than burnout.
The theory is congruent with that segment of society that espouses
subjectivity and being, but patients may want to evolve their being
in genuine encounters within their own circle rather than with the nursing staff.
When, in 1960, Paterson and Zderad were developing the seeds of their
theory, they may or may not have anticipated the supportive literature of
the 19805 that advocated phenomenology as the methodology most compatible
with nursing. The 19805 witnessed an ernergng world view in nursing
denouncng the empirical positivist view (see Chapter 2) and supporting a
phenomenological view (Menke, 1978; Munhall, 1982; Oiler, 1982). More
importantly, Paterson and Zderad advocated respecting nursing experiences
as sources o knowledge and, indeed, o wsdorn, providing nursing with
nonmechanistic and nonpositvstc strategies for theory development and
research (Paterson, 1978; Zderad, 1978). Nursing would do well to adopt
their views,
.Joyce Travelbee
Theory
Descrlption