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

FOOTNOTES:

[1] Azanian Freedom Song. Lyrics by Otis Williams, music by Bernice Johnson Reagon. Washington, DC: Songtalk Publishing Co., 1982.

[2] Frankl, Viktor. Man's Search For Meaning. Boston: Beacon Press, 1959.

[3] Rukeyser, Muriel. "Kathe Kollwitz," in By a Woman Writ, ed. Joan Goulianos. New York: Bobbs Merrill, 1973, p. 374.

[4] Bohm, David. Wholeness and the Implicate Order. London: Ark, 1980.

[5] Newman, Margaret. Health As Expanding Consciousness. St. Louis: C. V. Mosby Company, 1986.

[6] Habermas, Jurgen. Knowledge and Human Interest, (trans. J. Shapiro.) Boston: Beacon Press, 1971.

CONTENTS

PART ONE

THEORETICAL ROOTS 1

1 Humanistic Nursing Practice Theory 3 2 Foundations of Humanistic Nursing 11 3 Humanistic Nursing: A Lived Dialogue 21 4 Phenomenon of Community 37

PART TWO

METHODOLOGY—A PROCESS OF BEING 49

5 Toward a Responsible Free Research Nurse in the Health Arena 51 6 The Logic of a Phenomenological Methodology 65 7 A Phenomenological Approach to Humanistic Nursing Theory 77 8 Humanistic Nursing and Art 85 9 A Heuristic Culmination 95

Appendix 113
Glossary 121
Bibliography 123
Index 127

{1}

Part 1

THEORETICAL ROOTS

{2} {3}

1

HUMANISTIC NURSING PRACTICE THEORY

Substantively this chapter introduces two aspects of the humanistic nursing practice theory: first, what this theory proposes and, second, how the proposals of the theory evolved.

Concisely, humanistic nursing practice theory proposes that nurses consciously and deliberately approach nursing as an existential experience. Then, they reflect on the experience and phenomenologically describe the calls they receive, their responses, and what they come to know from their presence in the nursing situation. It is believed that compilation and complementary syntheses of these phenomenological descriptions over time will build and make explicit a science of nursing.

HUMANISTIC NURSING: ITS MEANING

Nursing is an experience lived between human beings. Each nursing situation reciprocally evokes and affects the expression and manifestations of these human beings' capacity for and condition of existence. In a nurse this implies a responsibility for the condition of herself or being. The term "humanistic nursing" was selected thoughtfully to designate this theoretical pursuit to reaffirm and floodlight this responsible characteristic as fundamentally inherent to all artful-scientific nursing. Humanistic nursing embraces more than a benevolent technically competent subject-object 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 the other. {4}

EXISTENTIAL EXPERIENCE