Humanistic Nursing Part 10

"... every man is more than just himself; he also represents the unique, the very special and always significant and remarkable point at which the world's phenomena intersect, only once in this way and never again."[10]

Or, a nurse might say:

"... every nurse is more than just herself, she also represents the unique, the very special and always significant and remarkable point at which the nursing world's phenomena intersect, only once in this way and never again."

To me, human freedom means recognizing our unique potential, responsibility, and limitations. Our singularity as a nurse among nurses, then, confronts us with a responsibility that belongs to one else. Martin Buber, philosophical anthropologist says:

"As we become free ... our responsibility must become personal and solitary."[11]

Our unlikeness to other nurses is a lonely, very person conditioned state. Only each nurse can be responsible for herself. The wonders of freedom are {70} paradoxically, "all-at-once," both a delight and a burden. In nursing it is important for us to understand freedom not as opposing or agreeing: freedom is choosing--choosing and saying "yes" to one's self.

Human endeavor between man and men in their-worlds, in this instance professional clinical nursing, if explored and described is viewed as contributing to man's human evolvement and to knowledge of the human condition and how man becomes.

Integrally all the above statements are the bases and biases of this human phenomenological method of nursology. In a phrase, I suppose what all these _starting point_ statements say is: Nursing situations make available human existence events significantly worthy of description.

Only human nurses can describe them. Humans' ability to describe reality adequately has its limits. We should describe since pridefully we humans are the only existing beings capable of giving meaning to, looking at, and expressing our consciousness. In the long run this effort could yield a nursing science.

PHASES OF PHENOMENOLOGIC NURSOLOGY

Phase I: Preparation of the Nurse Knower For Coming to Know

This method engages the investigator as a risk taker and as a "knowing place." Risk taking necessitates decision. Decision imposes confronting ambivalence in one's self. The ambivalence of wanting to be "all-at-once" responsible and dependent. Superimposing an already accepted and acceptable structure on data is safe feeling. Approaching the situation or data openly, letting the structure emerge from it, not deciding what to look for, being willing to be surprised, give feelings of excitement, fear, and uncertainty. There exists the possibility that our humanness may include the dilemma of our not being able to perceive the messages of our data, that we will not be able to merge with it and become more. The question arises, Are we knowing places that can relate to otherness and intuitively synthesize knowledge? This process of accepting the decision to approach the unknown openly is experienced as an internal struggle and we become consciously aware of our rigidity and satisfaction with the status quo. Conforming to the usual, in this case positivism, gives a security that is not easily relinquished despite the advantages of actualizing our unique responsible freedom.

Russell's metaphorical phrase, "windows always open to the world,"

depicts the sought state of mind. His elaboration on this phrase gives the flavor of the process of preparing the mind. He says, "Through one's windows one sees not only the joy and beauty of the world, but also its pain and cruelty and ugliness, and the one is as well worth seeing as the other, and one must look into h.e.l.l before one has any right to speak of heaven."[12] Pain, cruelty, ugliness, h.e.l.l seem appropriate words to convey seeing our {71}long-cherished ideas and values, our security blankets, as only false G.o.ds. Nietzsche in speaking of confrontation of one's values said, "And now only cometh to him the great terror, the great outlook, the great sickness, the great nausea, the great seasickness."[13] So this human methodology seeks a condition of being in the investigator. The investigator must be aware of her own angular view and democratically open to giving the angular views apparent in the data, the called for representation.

The first phase of this method of research correlates well with the struggle experienced by me in clarifying my approach to patients in public health, medical-surgical, and psychiatric mental health situations. In these situations, one truly has to struggle with democratically keeping one's windows open to the world. And this is a continual process. Having experienced this struggle in clinical nursing made this approach to research valid and meaningful to me.

Preparing the mind for knowing in clinical or research endeavors may be accomplished by several means. One means is by immersing one's self in dramatic and literary works and contemplating, reflecting on, and discussing them as they relate to the knower's already known, in this case, nursing practice. In clinical or research nursing the selection of literary works to stimulate the opening of one's human view is based on their presentation, depictions, and descriptions of man's nature. In literature authors share their thoughts as men and present possible ways men may view and relate to their worlds.

Phase II: Nurse Knowing of the Other Intuitively

Bergson conceives of man knowing through a dilatation of his imagination getting inside of, into _le duree_, into the rhythm and mobility of the other. Living the rhythm of the other he believes results in an absolute, intuitive, inexpressible, unique knowledge of the other. He says:

"... an absolute can only be given in an intuition, while all the rest has to go with a.n.a.lysis."

"... from intuition one can pa.s.s on to a.n.a.lysis, but not from a.n.a.lysis to intuition."

"... fixed concepts can be extracted by our thought from the mobile reality; but there is not means whatever of reconst.i.tuting with the fixity of concepts the mobility of the real."[14]

The known, clinical nursing practice, gave meaning to the above for me.

Over the years in nursing conferences I had been told my grasp of nursing situations was intuitive. Most times this was offered rather disparagingly although the nursing outcomes were most times successful.

Along with having {72} the attribute of intuition a.s.signed to me persons often asked, "Why are you so fascinated with other persons'

situations?" Together these relate to Dewey's view of intuition. He views intuition as a mulling over of conditions and a mental synthesis that results in true judgments since the controlling standards are intelligent selection, estimation, and problem solution.[15] In nursing practice research knowing the other and how he experiences and views his world is viewed as the problem.

Knowing intuitively, as described by Bergson, is comparable to Buber's considerations of man's necessary mode of becoming through "I-Thou"

relation. The criteria Buber describes as characteristic for "I-Thou"

relation are subscribed to in my approach to nursing practice and in this human or phenomenological nursology approach.[16] Buber held as prerequisite for intuitive type knowing of the other, or imagining the real of his potential for being, a knower, and "I," capable of distance from the other, able to see the other as a unique other, one who turns to the other, makes his being present to the other, and allows the other presence. The knowing, "I," in this case the nurse, responds to the other's uniqueness, does not superimpose, maintains a capacity for surprise and question, and is with the other, as opposed to "seeming to be." This kind of relating cannot be superimposed on a nurse clinician or researcher. It must be personally responsibly chosen and invested in.

The approach then of the second phase of this method and of the transactional phase of nursing when nurses are in the arena with others is the same. This method proposes that to study nursing from outside the arena for purposes of objectivity bursts asunder the very nature of nursing practice. The studier is a part of that which is being studied.

Observations interpreted from outside the situation could be cla.s.sified only as projections.

Phase III: Nurse Knowing the Other Scientifically

Bergson believes man knows incompletely through standing outside the thing to be known, metaphorically walking around it, and observing it.

This a.n.a.lytical process, this viewing of a thing's many aspects, he conceives as the habitual function of positive science. This is the third phase of this phenomenological nursology method. Bergson says:

"... a.n.a.lysis multiplies endlessly the points of view ... to complete the ever incomplete representation."

"All a.n.a.lysis is thus a translation, a development into symbols, a representation taken from successive points of view."

"a.n.a.lysis ... is the operation which reduces the object to elements already known, that is, common to that object and to others."[17]

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So phenomenological nursology proposes that after the studier has experienced the other intuitively and absolutely, the experience be conceptualized and expressed in accordance with the nurse's human potential. Humanly we can express only sequentially while our actual experienced lived worlds flow in an "all-at-once" fashion. Our words are known symbols and categories used to convey the experience and thus deny the uniqueness of each realized experience.

Buber's description of man's "I-It" way of relating to the world is in agreement with Bergson. He conveys the necessity of this kind of relating by man to his world; and despite its lacks proposes that man prize his a.n.a.lytical ability. Like Bergson, Buber views knowing as a movement from intuition to a.n.a.lysis, and not the other way around. Buber sees knowledge expressed or science created through the knowing "I"

transcending itself, recollecting, reflecting on, and experiencing its past "I-Thou" relation as an "It." This is man being conscious of, looking at, himself and that which he has taken in, merged with, made part of himself. This is the time when he mulls over, a.n.a.lyzes, sorts out, compares, contrasts, relates, interprets, gives a name to, and categorizes.

The third phase of this methodology is the same as that phase of clinical nursing practice in which the nurse, removed from the nursing arena, replays and reflects on this area and transcribes her angular view of it. In this reflective state the nurse a.n.a.lyzes, considers relationships between components, synthesizes themes or patterns, and then conceptualizes or symbolically interprets a sequential view of this past lived reality. The challenge of communicating a lived nursing reality demands authenticity with the self and rigorous effort in the selection of words, phrases, and precise grammar.

Phase IV: Nurse Complementarily Synthesizing Known Others

In this phase of the methodology the nurse researcher, the knower, compares and synthesizes multiple known realities. Buber says of comparison:

"The act of contrasting, carried out properly and adequately, leads to the grasp of the principle."[18]

In this comparison and synthesis the "I" of the researcher a.s.sumes the position of the knowing place. The knower, like an interpreter, allows dialogue between the multiple known realities. These realities are unknowable to each other directly. The knower interprets, sorts, and cla.s.sifies.

In the human knowing place discovered differences in similar realities do not compete, one does not negate the other. Each can be true, present, "all-at-once." Differences can make visible the greater realities of each. Desan, the philosopher, says of this kind of synthesis:

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"... a synthetic view where two or more positions are seen to illuminate and to transfigure one another through their mutual presence."[19]

The knower alert to an aspect present in a single reality can question the other reality on this aspect. This aspect may be present in both, more blatant in one than in another. Its forms may be different or modified in each. It may be totally absent in one. Differences found may arouse or bring to consciousness other questions to ask of the data.

This oscillating, dialectical process continues throughout reflection on the multiple realities. This indirect dialogue is recorded by the investigator as the complementary synthesis.

This synthesis is more than additive because it allows mutual representation and the illumination of one reality by another.

The fourth phase of this research methodology is like that phase of clinical nursing in which a nurse compares and synthesizes the similarities and differences of like nursing situations and arrives at an expanded view.

Phase V: Succession Within the Nurse From the Many to the Paradoxical One