The Humanistic Nursing Theory
About Dr. Paterson & Dr. Zderad
Josephine Paterson and Loretta Zderad are from the United States. They both earned their first diplomas in nursing, then Bachelor’s degrees in Nursing education before continuing to graduate programs. Their career as nursing academics got started in the 1950s when they were both employed at Catholic University where they met. They continued to work together and remained friends for the next 40 years. They later continued on to their doctorate degrees in the 1960s.
Through this process, they began to define and reflect on their nursing practice experience, and synthesize a new theory: Humanistic Nursing Theory. By 1971, they had begun to define their theory and what it was that made it unique as an approach to nursing. They then began to research other nurses’ experiences and used their theory as a perspective and method for nurses to examine their experiences. Through this, their goal was to develop it into theoretical propositions, which could serve as guides for nursing practitioners.
Now with established theory, Paterson and Zderad spread knowledge of their theory through courses that they held around the United States. As they taught these courses, they spoke with other nurses about their experiences. From it, they came to describe eleven essences: “awareness, openness, empathy, caring, touching, understanding, responsibility, trust, acceptance, self-recognition, and dialogue” They believe that these eleven essences are common beliefs and values of nurses, based on their dialogues with nurses from across the country. As such, they also describe the 11 essences as underlying elements and are capable of withstanding variations due to culture, geography, the scope of practice, and other variable factors that exist in nursing.
The Humanistic Theory Major Concepts
Nursing Dialogue is when a nurse and patient come together. The nurse presents themselves as a helper ready to assist the patient. The nurse is open to understanding how the patient feels with the intention of improvement. Openness is an essential quality for humanistic nursing dialogue. Paterson and Zderad developed the five phases of the nursing process:
- Preparation of the Nurse Knower For Coming to Know: In this stage, the nurse acts as an investigator who willingly takes risks and has an open mind. The nurse must be a risk-taker and be willing to experience anything. “Accepting the decision to approach the unknown openly”.
- Nurse Knowing of the Other Intuitively: In this stage, the nurse tries to understand the other, as in the “I-thou” relationship, where the nurse as the “I” does not superimpose themselves on the “thou” of the patient.
- Nurse Knowing the Other Scientifically: The nurse as the observer must observe and analyze from the outside. At this stage, the nurse goes from intuition to analysis. The analysis is the sorting, comparing, contrasting, relating, interpreting, and categorizing.
- Nurse Complementarily Synthesizing Known Others: The ability of the nurse to develop or see themselves as a source of knowledge, to continually develop the nursing community through education, and increased understanding of their owned learned experiences.
- Succession Within the Nurse From the Many to the Paradoxical One: In this stage, the nurse takes the information gleaned and applies it in the practical clinical setting. Here the nurse takes brings the dilemma towards resolution.
Nursing Paradigm
Person: According to the humanistic theory of Paterson and Zderad Humans are viewed as open energy fields with special life experiences. As energy fields, they are greater than and different from the sum of their parts and cannot be predicted from knowledge of their parts. Human beings are viewed as being holistic in nature, are special, dynamic, aware, and multidimensional, capable of abstract thought, creativity, capable of taking responsibility. Language, empathy, caring, and other abstract patterns of communication are aspects of an individually high level of complexity and diversity and enable one to increase knowledge of self and environment. Persons are to be valued, to be respected, nurtured, and understood with the right to make informed choices regarding their health, may include families and communities.
Health: (well-being and more-being) According to humanistic Nursing theory there is a call from a person, a family, a community, or from humanity for help with some health-related issue. The nursing act is always related to the health-illness quality of the human condition, or fundamentally, to a man’s personal survival. This is not to say that all instances of nursing are matters of life and death, but rather that every nursing act has to do with the quality of a person’s living and dying. That nursing is related to health and illness is self-evident. How it is related is not so apparent.
“Health” is valued as necessary for survival and is often proposed as the goal of nursing. There are, in actuality, many instances of nursing that could be described as “health-restoring,” “health-sustaining,” or “health-promoting.” Nurses engage in “health teaching” and “health supervision.”
On the other hand, there are instances in which health, taken in its narrowest meaning as freedom from disease, is not seen as an attainable goal, as evidenced, for example, in labels given to patients such as “terminal,” “hopeless,” and “chronic.” Yet in actual practice, these humans’ conditions call forth some of the most complete, expert, total, beautiful nursing care. Nursing, then, as a human response, implies the valuing of some human potential beyond the narrow concept of health taken as the absence of disease. Nursing’s concern is not merely with a person’s well-being but with his more-being, with helping him become more humanly possible in his particular life situation.
Environment: According to Patterson and Zderad, the environment represents the place where the service is delivered, the community, or the world. The environment can be understood as the time and space in which the nursing experience takes place. From the existential perspective, it is the time and space as lived by the nurse and/or patient during the experience.
“For example, waiting, silence, chronicity, emergency, positioning a patient in bed, moving through space in a wheelchair, crutch-walking, pacing, could be considered from the standpoint of the patient’s experienced space and time, or from the nurse’s, or as a shared event. Explorations of this kind could provide valuable insights into important nursing phenomena, such as presence, empathy, comfort, timing. ”
To understand the nursing dialogue, one must put the experience in the context of time: the time lived as the patient and the nurse. The nurse and the patient may be interacting within the same actual time span, but the time may feel very different to the nurse and client. Their experiences of time are unique to their understanding of the situation.
Space is the lived perception of the world around the nurse and patient. Space could be the hospital room, the bed, the waiting room, the visiting area, or any other space in which the interaction takes place. The physical environment can enhance or impede the nursing dialogue based on how comfortable the participants feel and how well the space encourages communication.
Place is another component of space, but it is more personalized; it belongs to the patient or nurse and is highly subjective. It relates to “where I feel I belong or am”. A person may feel out of place or may feel at home or welcomed in the place. The nurse may feel comfortable in the place while the patient does not.
Space and time coincide within the nursing experience. For example, after a longer stay in a hospital, for example, a patient may begin to feel at home, when initially it was foreign. The nursing dialogue is reinforced when the nurse understands how the patient relates to their space.
Nursing: Paterson and Zderad define nursing as a “lived experience between human beings”. It is an evolving, affecting, and helping relationship in which the patient and nurse engage in a dialogue. They emphasize the importance of the nurse being aware of herself and of the client as unique human beings, and of understanding the individual perspective, identity, experiences, condition, and needs of each patient. The nurse must therefore modify her/his response in offering a genuine presence.
Paterson and Zderad refer to this as a “reciprocal call and response” that is achieved through an awareness of the nurse’s own worldview, values, understanding, and responses, and responding to the others’ responses and knowledge. Through understanding the self and the other, the nurse can engage in an authentic, therapeutic exchange of experience, understanding, and of being.
Nursing is unique from other shared, authentic exchanges in that the nurse’s role is to help another who needs help. Nursing possesses a humaneness that is inseparable from the nursing role. Nursing is a “human transaction”, and thus involves all of the human limitations, emotions, and potentials of each patient, as an exchange that affects the nurse, who in turn responds through her/his perspective and authentic being, which in turn affects the patient. Thus, while each participant might experience a situation uniquely, they will also have experience of the shared interaction, the “between” and its message and meaning. For example, the nurse might experience providing care, the patient of being cared for. They will both, however, have an experience of caregiving and care-receiving through their transaction with the other. As well, everything the nurse does physically is shaped by her “character of being in the situation”. Thus, while a nurse might believe she has provided an insulin injection to a patient, she has done so through her own unique character and way of being in that moment. In doing so, the nurse is hereby communicating herself and responding to the client as a human being in much the same way as she is providing insulin in response to the client’s blood sugar levels.
Nursing is an inter-human, transactional, interconnected dialogue of helping in a way that recognizes and expresses one’s own genuine human-ness, and responds to the unique human-ness of the patient.
Additional Information & References
- More notes about Josephine Paterson and Loretta Zderad
- Online slides/notes about the Humanistic Nursing Theory
- Practical Applications; palliative care, spirituality in nursing, midwifery, patient participation, communication
