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HUMANISTIC NURSING THEORY Dr. Josephine Paterson Dr. Loretta Zderad
BIOGRAPHY
DR. JOSEPHINE PATERSON
BIOGRAPHY Josephine
Paterson was born on the 1st of September 1924 in Freeport, New York.
She
had graduated in August 1945 with a diploma from Lenox Hill School of Nursing
Nine
years later (1954, August) she received her master’s degree from John Hopkin’s School of Hygiene and Public Health, Baltimore, Maryland
Her
Doctor for Nursing is from Boston University School of Nursing, Boston, Massachusetts, where she specialized in psychiatric nursing
Dr. Paterson conceptualized and taught humanistic nursing to graduate students, faculty, and staff in a variety of settings
She also served on the faculty of the State University of New York at Stonybrook
She retired in 1985 as a clinical nurse specialist at Northport Veterans istration Medical Center at Northport, New York
DR. LORETTA ZDERAD
Zderad
is a graduate of St. Bernard’s Hospital School of Nursing and Loyola University
She
received her Master of Science degree from Catholic University, Washington, DC, and a doctor of Philosophy (1968) from Georgetown University, Washington, DC
She
has taught in several universities and has led groups on humanistic nursing
Dr.
Zderad also served on the faculty of the State University of New York at Stonybrook
She
retired in 1985 as the Associate Chief for Nursing Education at the Northport Veterans istration Medical Center, Northport, New York
Paterson
and Zderad met in the 1950’s while working at Catholic University, where their task was to create a new program that would include psychiatric and community health.
Friendship
years.
that has lasted over 35
HUMANISTIC NURSING
“Embraces more than a benevolent technically competent subjectobject one-way relationship guided by a nurse in behalf of another. Rather it dictates that nursing is a responsible searching, transactional relationship whose meaningfulness demands conceptualization founded on a nurse's existential awareness of self and of other“ (Paterson & Zderad)
A
highly abstract theory with a major focus on the process of interaction or dialogue between the nurse and patient.
Paterson
and Zderad believed that a simple, scientific approach to nursing education would not be sufficient to create truly effective and content nurses.
IMPLICIT 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 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 ASSERTIONS 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 from “EXISTENTIALISM”. It is a philosophical approach to understanding life. Individuals are faced with possibilities when making choices. These choices determine the direction and meaning in one’s life.
The
purpose of the nurse-patient relationship, or intersubjective relating, is, “nurturing the well-being and morebeing 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 THE BASIS OF NURSING
DIALOGUE
– Nursing is a lived dialogue. It is a nurse-nursed relating creatively. Meeting Response
Presence Relating
– Meeting –is characterized by the expectation that there will be a nurse and a nursed
– Relating –is a process of nurse-nursed doing with each other Subject – Subject Relating "I-Thou" is a coming to know the other and the self in relation, intuitively.
Subject – Object Relating "I-It" is an authentic analyzing, synthesizing, and interpreting of the "I-Thou" relation through reflection.
– Presence –is the quality of being open, receptive, ready, and available to another person
– Call and Response –nurses and clients call and respond to each other both verbally 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.
COMMUNITY
– Meaning comes from the realization that it is through each other that we more fully participate in and expand our lives – Two or more persons struggling together toward a center (Paterson & 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
NURSOLOGY
– Methodology for understanding and describing nursing situations – Assumes a perceived health need by the individual who is involved in an interaction with a health care provider – Concerned with the nature of the facts and what they mean to individuals
5 PHASES OF HUMANISTIC NURSING INQUIRY
Preparation of the nurse knower for coming to know – Preparing to get to know the patient’s pointof-view. This means the nurse uses her education and life experiences to prepare to relate with patients. Your experience communicating with different types of people with different personalities helps you prepare to communicate with patients.
Nurse knowing the other intuitively – Moving the other back and forth between the impressions the nurse becomes aware of herself and recollected real experience of the other (Paterson & Zderad, 1976)
– It is conceptualized as dialectic between the impression and the real. This shifting back and forth allows for sudden insights on the nurse’s part, a new overall grasp, which manifests itself in a clearer, or perhaps a new, “understanding.” These understandings generate further development of the process
– The nurse gains knowledge of the patient through intuitive impressions and learning about the patient’s experiences – At this time, the nurse’s general impressions are in a dialogue with her unbracketed view
Nurse knowing the other scientifically – Separateness from what is known – The nurse gains scientific knowledge of the patient by (phenomenological process) pondering, analyzing, sorting, comparing, contrasting, relating, interpreting, naming, and categorizing data (therapeutic techniques: clarification and verification)
– Collect information about the patient, for example age, pulse and blood pressure
Nurse complementarily synthesizing known others – The nurse combines the subjective and objective information to gain perspective on the situation – Nurse as “noetic loci” or “knowing places”. The nurse examines the communication with the patient and the information collected in light of her education (theoretical foundation) and personal experience. The nurse uses all the information from the patient and from her experiences to form a conclusion. For example, maybe the nurse had a patient before who had the same complaint.
Succession within the nurse from the many to the paradoxical one – The nurse arrives at a new truth, a concept that includes all the information gained, refined into a descriptive construct (Kleiman, 2006) – The nurse makes a conclusion about what is the best way to improve the patient’s well-being. Paradoxical one: descriptive theoretical construct of nursing
NURSING METAPARADIGM
NURSING – Is a nurturing response of one person to another in a time of need that aims toward the development of well-being and more being
– Helping to increase responsible choices – Nursing is concerned with the individual’s unique being and striving towards becoming, focusing on the whole – Is a lived dialogue that incorporates the intersubjective in which a nurse and a patient meet, relate, and are totally present in an existential way that includes intimacy and mutuality
HEALTH
– Matter of personal survival. It is a process of experiencing one’s potential for well-being and more-being, a quality of living and dying. well-being: steady state (maintenance of quality) or more than absence of disease more well-being: process of becoming all that is humanly possible – Finding meaning in life
MAN
–Human beings are characterized as being capable, open to options, person with values, and the unique manifestation of their past, present, and future
ENVIRONMENT – Community: The phenomenon of society or environment – Two or more persons struggling together toward a center – It is only through our community that we are able to reach our full potential
CONCEPTUAL MODEL
CONCEPTUAL FRAMEWORK
EVIDENCE – BASED PRACTICE
Humanistic Nursing Theory: application to hospice and palliative care. Wu HL, Volker DL. Nursing Department, Meiho University Neipu, Pingtung, Taiwan. 2011 Jul 20 ABSTRACT AIM: This article presents a discussion of the relevance of Humanistic Nursing Theory to hospice and palliative care nursing.
BACKGROUND: The World Health Organization has characterized the need for expert, palliative and end-of-life care as a top priority for global health care. The specialty of hospice and palliative care nursing embraces a humanistic caring and holistic approach to patient care. As this resonates with Paterson and Zderad's Humanistic Nursing Theory, an understanding of hospice nurses' experiences can be investigated by application of relevant constructs in the theory.
DATA SOURCES: This article is based on Paterson and Zderad's publications and other theoretical and research articles and books focused on Humanistic Nursing Theory (1976-2009), and data from a phenomenological study of the lived experience of Taiwanese hospice nurses conducted in 2007.
DISCUSSION: Theoretical concepts relevant to hospice and palliative nursing included call-and-response, inter-subjective transaction, and uniquenessotherness.
IMPLICATIONS FOR NURSING: The philosophical perspectives of Humanistic Nursing Theory are relevant to the practice of hospice and palliative care nursing. By 'being with and doing with', hospice and palliative nurses can work with patients to achieve their final goals in the last phase of life.
CONCLUSION: Use of core concepts from Humanistic Nursing Theory can provide a unifying language for planning care and describing interventions. Future research efforts in hospice and palliative nursing should define and evaluate these concepts for efficacy in practice settings.
Training nurses in a humanistic approach to caring for patients with dementia Author: Leonard L. Sarff January 2013
Abstract: This study applied a humanistic perspective to nursing care for people with dementia. A formal training program was designed to help ed Nurses, Licensed Practical Nurses, and Certified Nursing Assistants understand the etiology and progression of dementia, followed by hands-on training addressing the behavioral challenges in these residents. This training taught the nurses to explore not only the medical aspects of dementia but more importantly to see the person suffering from dementia as a whole person who had a life of experiences, dreams, loves, and aspirations for their lives, and what has made the resident a unique individual. The principal question this exploratory case study examined was:
Does training nurses to use a humanistic approach lead to a higher quality of care and improve the personal experiences of the caregiver? A semi-structured interview with one ed Nurse, one Licensed Practical Nurse, and one Certified Nursing Assistant, a subset of those who attended the training, supplemented a survey of 16 participants as well as observations of staff-patient interactions by the investigator. A survey completed by the participants
asked them to compare their own work orientations before training with changes following the training. Training the staff to use a humanistic approach led to 15 out of 16 participants reporting that their participation in the program contributed to one or more aspects of improved personalized care for their patients, benefiting not only the residents but themselves as well. Participants reported feeling more satisfaction with the work they were doing and an increased ability to have a greater impact on the lives of the residents they were treating.
THANK YOU!
BIOGRAPHY
DR. JOSEPHINE PATERSON
BIOGRAPHY Josephine
Paterson was born on the 1st of September 1924 in Freeport, New York.
She
had graduated in August 1945 with a diploma from Lenox Hill School of Nursing
Nine
years later (1954, August) she received her master’s degree from John Hopkin’s School of Hygiene and Public Health, Baltimore, Maryland
Her
Doctor for Nursing is from Boston University School of Nursing, Boston, Massachusetts, where she specialized in psychiatric nursing
Dr. Paterson conceptualized and taught humanistic nursing to graduate students, faculty, and staff in a variety of settings
She also served on the faculty of the State University of New York at Stonybrook
She retired in 1985 as a clinical nurse specialist at Northport Veterans istration Medical Center at Northport, New York
DR. LORETTA ZDERAD
Zderad
is a graduate of St. Bernard’s Hospital School of Nursing and Loyola University
She
received her Master of Science degree from Catholic University, Washington, DC, and a doctor of Philosophy (1968) from Georgetown University, Washington, DC
She
has taught in several universities and has led groups on humanistic nursing
Dr.
Zderad also served on the faculty of the State University of New York at Stonybrook
She
retired in 1985 as the Associate Chief for Nursing Education at the Northport Veterans istration Medical Center, Northport, New York
Paterson
and Zderad met in the 1950’s while working at Catholic University, where their task was to create a new program that would include psychiatric and community health.
Friendship
years.
that has lasted over 35
HUMANISTIC NURSING
“Embraces more than a benevolent technically competent subjectobject one-way relationship guided by a nurse in behalf of another. Rather it dictates that nursing is a responsible searching, transactional relationship whose meaningfulness demands conceptualization founded on a nurse's existential awareness of self and of other“ (Paterson & Zderad)
A
highly abstract theory with a major focus on the process of interaction or dialogue between the nurse and patient.
Paterson
and Zderad believed that a simple, scientific approach to nursing education would not be sufficient to create truly effective and content nurses.
IMPLICIT 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 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 ASSERTIONS 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 from “EXISTENTIALISM”. It is a philosophical approach to understanding life. Individuals are faced with possibilities when making choices. These choices determine the direction and meaning in one’s life.
The
purpose of the nurse-patient relationship, or intersubjective relating, is, “nurturing the well-being and morebeing 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 THE BASIS OF NURSING
DIALOGUE
– Nursing is a lived dialogue. It is a nurse-nursed relating creatively. Meeting Response
Presence Relating
– Meeting –is characterized by the expectation that there will be a nurse and a nursed
– Relating –is a process of nurse-nursed doing with each other Subject – Subject Relating "I-Thou" is a coming to know the other and the self in relation, intuitively.
Subject – Object Relating "I-It" is an authentic analyzing, synthesizing, and interpreting of the "I-Thou" relation through reflection.
– Presence –is the quality of being open, receptive, ready, and available to another person
– Call and Response –nurses and clients call and respond to each other both verbally 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.
COMMUNITY
– Meaning comes from the realization that it is through each other that we more fully participate in and expand our lives – Two or more persons struggling together toward a center (Paterson & 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
NURSOLOGY
– Methodology for understanding and describing nursing situations – Assumes a perceived health need by the individual who is involved in an interaction with a health care provider – Concerned with the nature of the facts and what they mean to individuals
5 PHASES OF HUMANISTIC NURSING INQUIRY
Preparation of the nurse knower for coming to know – Preparing to get to know the patient’s pointof-view. This means the nurse uses her education and life experiences to prepare to relate with patients. Your experience communicating with different types of people with different personalities helps you prepare to communicate with patients.
Nurse knowing the other intuitively – Moving the other back and forth between the impressions the nurse becomes aware of herself and recollected real experience of the other (Paterson & Zderad, 1976)
– It is conceptualized as dialectic between the impression and the real. This shifting back and forth allows for sudden insights on the nurse’s part, a new overall grasp, which manifests itself in a clearer, or perhaps a new, “understanding.” These understandings generate further development of the process
– The nurse gains knowledge of the patient through intuitive impressions and learning about the patient’s experiences – At this time, the nurse’s general impressions are in a dialogue with her unbracketed view
Nurse knowing the other scientifically – Separateness from what is known – The nurse gains scientific knowledge of the patient by (phenomenological process) pondering, analyzing, sorting, comparing, contrasting, relating, interpreting, naming, and categorizing data (therapeutic techniques: clarification and verification)
– Collect information about the patient, for example age, pulse and blood pressure
Nurse complementarily synthesizing known others – The nurse combines the subjective and objective information to gain perspective on the situation – Nurse as “noetic loci” or “knowing places”. The nurse examines the communication with the patient and the information collected in light of her education (theoretical foundation) and personal experience. The nurse uses all the information from the patient and from her experiences to form a conclusion. For example, maybe the nurse had a patient before who had the same complaint.
Succession within the nurse from the many to the paradoxical one – The nurse arrives at a new truth, a concept that includes all the information gained, refined into a descriptive construct (Kleiman, 2006) – The nurse makes a conclusion about what is the best way to improve the patient’s well-being. Paradoxical one: descriptive theoretical construct of nursing
NURSING METAPARADIGM
NURSING – Is a nurturing response of one person to another in a time of need that aims toward the development of well-being and more being
– Helping to increase responsible choices – Nursing is concerned with the individual’s unique being and striving towards becoming, focusing on the whole – Is a lived dialogue that incorporates the intersubjective in which a nurse and a patient meet, relate, and are totally present in an existential way that includes intimacy and mutuality
HEALTH
– Matter of personal survival. It is a process of experiencing one’s potential for well-being and more-being, a quality of living and dying. well-being: steady state (maintenance of quality) or more than absence of disease more well-being: process of becoming all that is humanly possible – Finding meaning in life
MAN
–Human beings are characterized as being capable, open to options, person with values, and the unique manifestation of their past, present, and future
ENVIRONMENT – Community: The phenomenon of society or environment – Two or more persons struggling together toward a center – It is only through our community that we are able to reach our full potential
CONCEPTUAL MODEL
CONCEPTUAL FRAMEWORK
EVIDENCE – BASED PRACTICE
Humanistic Nursing Theory: application to hospice and palliative care. Wu HL, Volker DL. Nursing Department, Meiho University Neipu, Pingtung, Taiwan. 2011 Jul 20 ABSTRACT AIM: This article presents a discussion of the relevance of Humanistic Nursing Theory to hospice and palliative care nursing.
BACKGROUND: The World Health Organization has characterized the need for expert, palliative and end-of-life care as a top priority for global health care. The specialty of hospice and palliative care nursing embraces a humanistic caring and holistic approach to patient care. As this resonates with Paterson and Zderad's Humanistic Nursing Theory, an understanding of hospice nurses' experiences can be investigated by application of relevant constructs in the theory.
DATA SOURCES: This article is based on Paterson and Zderad's publications and other theoretical and research articles and books focused on Humanistic Nursing Theory (1976-2009), and data from a phenomenological study of the lived experience of Taiwanese hospice nurses conducted in 2007.
DISCUSSION: Theoretical concepts relevant to hospice and palliative nursing included call-and-response, inter-subjective transaction, and uniquenessotherness.
IMPLICATIONS FOR NURSING: The philosophical perspectives of Humanistic Nursing Theory are relevant to the practice of hospice and palliative care nursing. By 'being with and doing with', hospice and palliative nurses can work with patients to achieve their final goals in the last phase of life.
CONCLUSION: Use of core concepts from Humanistic Nursing Theory can provide a unifying language for planning care and describing interventions. Future research efforts in hospice and palliative nursing should define and evaluate these concepts for efficacy in practice settings.
Training nurses in a humanistic approach to caring for patients with dementia Author: Leonard L. Sarff January 2013
Abstract: This study applied a humanistic perspective to nursing care for people with dementia. A formal training program was designed to help ed Nurses, Licensed Practical Nurses, and Certified Nursing Assistants understand the etiology and progression of dementia, followed by hands-on training addressing the behavioral challenges in these residents. This training taught the nurses to explore not only the medical aspects of dementia but more importantly to see the person suffering from dementia as a whole person who had a life of experiences, dreams, loves, and aspirations for their lives, and what has made the resident a unique individual. The principal question this exploratory case study examined was:
Does training nurses to use a humanistic approach lead to a higher quality of care and improve the personal experiences of the caregiver? A semi-structured interview with one ed Nurse, one Licensed Practical Nurse, and one Certified Nursing Assistant, a subset of those who attended the training, supplemented a survey of 16 participants as well as observations of staff-patient interactions by the investigator. A survey completed by the participants
asked them to compare their own work orientations before training with changes following the training. Training the staff to use a humanistic approach led to 15 out of 16 participants reporting that their participation in the program contributed to one or more aspects of improved personalized care for their patients, benefiting not only the residents but themselves as well. Participants reported feeling more satisfaction with the work they were doing and an increased ability to have a greater impact on the lives of the residents they were treating.
THANK YOU!
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