This phase of phenomenological nursology is highly probable if not absolutely necessary. Desan says:
"Truth emerges in and through the relational operation. For the way of paradox is the way of truth."[20]
The investigator may struggle with the multiplicity of views now consciously part of and within herself. Again Desan:
"... this unrest "is" the mind of man, reaching its center....
From this center the splendor of multiplicity is visible."[21]
The researcher, mulling over and considering the relationships between the multiple views, insightfully corrects and expands her own angular view. This is not a right-wrong type of correction. Such correction would amount only to an ongoing eternal recurrence of a frustrating nature. Rather this correction takes the form of ever more inclusiveness. Struggling with the communion of the different ideas the knower takes an intuitive leap, through and yet beyond these ideas, into a greater understanding. She then may come up with a conception or abstraction that is inclusive of and beyond the multiplicities and contradictions.
This inclusive conception or abstraction is an expression of the investigator in her here and now, with the old truths and the novel truths, none obliterated.
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The fifth phase of this phenomenological nursology method can be equated to that phase of clinical professional nursing in which the nurse propels nursing knowledge forward. In this phase a nurse struggling with the mutual communion of multiple nursing situations arrives at a conception that is meaningful to the many or to all. From the specific concrete ideas of the many situations she moves through dilemma to resolution which is nursing expressed abstractly in units or as a whole, as one.
Experiential knowledge of nursing, years in which I came to know self and the other while implementing scientific facts, allowed me as a knower to recognize the relevance of this philosophical nursology method. This method does not aim at conventionality. Rather it strives to meaningfully augment and share conceptualized nurse-world realities.
FOOTNOTES:
[1] Josephine G. Paterson, "Echo into Tomorrow: A Mental Health Psychiatric Philosophical Conceptualization of Nursing" D.N.Sc.
dissertation, Boston University, 1969.
[2] Josephine G. Paterson "From a Philosophy of Clinical Nursing to a Method of Nursology," _Nursing Research_, Vol. XX (March-April, 1971), pp. 143-146.
[3] Abraham Kaplan, _Conduct of Inquiry_ (San Francisco: Chandler Publishing Co., 1964), p. 23.
[4] Plato, _The Republic_, trans. Francis MacDonald Cornford (New York: Oxford University Press, 1945), p. 45.
[5] James Agee, _Let Us Now Praise Famous Men_ (New York: Ballantine Books, 1939), pp. 91-102.
[6] Johann Wolfgang von Goethe, "On Originality." In _Great Writings of Goethe_, ed. Stephen Spender (New York: Mentor Press, 1958), p. 45.
[7] C. G. Jung, _Modern Man in Search of a Soul_, trans. W. S. Dell and Cary F. Baynes (New York: Harcourt, Brace and World, 1933), p. 118.
[8] Henri Bergson, "Time in the History of Western Philosophy," in _Philosophy in the Twentieth Century_, ed. William Barrett and Henry D.
Aiken (New York: Random House, 1962), p. 252.
[9] Will Durant and Ariel Durant, _Lessons of History_ (New York: Simon and Schuster, 1968), p. 102.
[10] Hermann Hesse, _Demian_, trans. Michael Roloff and Michael Lebeck (New York: Harper & Row, 1965), p. 4.
[11] Martin Buber, _Between Man and Man_, trans. Ronald Gregor Smith (Boston: Beacon Press, 1955), p. 93.
[12] Bertrand Russell, _The Autobiography of Bertrand Russell, 1914-1944_ (Boston: Little, Brown and Co., 1968), p. 97.
[13] Frederick Nietzsche "Thus Spake Zarathustra," trans. Thomas Common, in _The Philosophy of Nietzsche_ (New York: Random House, 1927), p. 239.
[14] Henri Bergson, "An Introduction to Metaphysics," in _Philosophy in the Twentieth Century_, ed. William Barrett and Henry D. Aiken (New York: Random House, 1962), pp. 303-331.
[15] John Dewey, _How We Think_ (Boston: D. C. Heath & Co., Publishers, 1910), p. 105.
[16] Martin Buber, "Distance and Relation," trans. Ronald Gregor Smith, in _The Knowledge of Man_, ed. Maurice Friedman. (New York: Harper & Row, Publishers, 1965), pp. 60-82.
[17] Bergson, "_An Introduction to Metaphysics_," pp. 303-331.
[18] Martin Buber, _I and Thou_, 2nd ed., trans. Ronald Gregor Smith, (New York: Charles Scribner"s Sons, 1958). pp. 3-34.
[19] W. D. Desan, _Planetary Man_ (New York: The Macmillan Company, 1972), p. 77.
[20] _Ibid._
[21] _Ibid._, p. 80.
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7
A PHENOMENOLOGICAL APPROACH TO HUMANISTIC NURSING THEORY
Humanistic nursing is dialogical in the theoretical as well as the practical realm. Just as the meaning of humanistic nursing is found in the existential intersubjective act, that is, in the dialogue as it is lived out by nurse and patient in the real world, so the theory of humanistic nursing is formed, in the dialogical interplay of articulated experiences shared by searching, abstracting, conceptualizing nurses.
The theory of humanistic nursing originates from and is continually revitalized and refined by actual nursing experience. But each nurse, as a unique human being, necessarily experiences the nursing dialogue and her nursing world in a unique way. So the development of humanistic nursing theory rests on the sharing of individual unique angular views.
And the theory as a totality will become richer, more consonant with reality, as it represents more and more nurses" views.
So often nurses, even nurses who know that their clinical expertise grew out of their practice, hesitate to share their nursing experiences. They are apt to say deprecatingly, "Oh, that"s _only_ my _personal_ experience." Yet that is precisely where the value lies, in the uniqueness of human experience. Since each nurse"s description of her nursing experience is a glimpse of a real nursing world, the views cannot justifiably be judged as right or wrong; they simply are. Once the various views are expressed, they can be compared and contrasted, not for the purpose of accepting some and rejecting others but rather in the interest of clarifying each in relation to the other. Such a dialogue of experientially based conceptualizations can result in a complementary synthesis. The process calls for not only a true appreciation of personal experience by each nurse but also commitment to a collaborative effort of open sharing by a genuine community of nurses.
This view, that the development of humanistic nursing practice theory is a dialogical process, has led to our valuing (in fact, insisting on) the description {78} of nursing phenomena. We see phenomenological description as a basic and essential step in theory building. Indeed, considering the "state-of-the-art" of nursing theory development, it is the most crucial and immediate need.
Looking back at the historical evolvement of our humanistic nursing approach, it is obvious that we had been using and developing a phenomenological approach for a number of years before we graced our efforts with the impressive label, "Phenomenological Psychiatric Mental Health Nursing," in a course offered to a group of nurses at Northport Veterans Administration Hospital in April 1972. Although we were aware much earlier that our interests and work were flowing in the general stream of phenomenology, we usually refrained from using the label because it did little to clarify our position.[1] The term has grown less precise with the extension of its use in different disciplines and with variations in methodology.
When we began applying the term "phenomenological" to our work, we learned that to many persons it sounds strange, unp.r.o.nounceable, foreign; to some forbidding; to others enticing. We later coined the t.i.tle "humanistic nursing" as being more suitable for it encompa.s.ses our general existential bent. However, this change in t.i.tle does not imply any abandonment of our phenomenological approach. The description of nursing phenomena is as highly prized now as ever. In humanistic nursing, phenomenological and existential currents interrelate. Having an existential view of nursing as a living dialogue influences which phenomena one becomes aware of, experiences, values, studies, and describes. Reciprocally, as one discovers and struggles to describe and develop meaningful ways of describing nursing phenomena, the lived nursing dialogue itself will be continually perfected.
It is more precise to speak of phenomenological methods (in the plural) rather than phenomenological method (in the singular), for, since Edmund Husserl"s original work, the approach has been used by different disciplines. With its spread there has developed a corresponding variation in methodology. This, in a sense, is the beauty of phenomenology: it thrives on variety of perspective; it allows, perhaps requires, individual creativeness; it is always open. In this spirit, ideas are offered here with the hope of stimulating imaginative, critical response, and further development of methodology.
This chapter considers some of the more concrete details of phenomenological methodology as they relate to humanistic nursing. The general approach and procedures discussed below have been used, individually {79} and collaboratively, by Dr. Josephine Paterson and myself with individual and groups of nurses to explore and describe their nursing experiences. They have helped nurses in various levels and types of nursing service to take a fresh look at their practice and make desirable changes. We have lived through the process with graduate students in nursing, and it has led both the students and us to new conceptualizations and reconceptualizations of nursing phenomena. We have found this to be a fruitful research method when applied to clinical nursing phenomena personally experienced and/or reported in the literature. And we are currently exploring its potentials with interested nurses at Northport Veterans Administration Hospital.
A PHENOMENOLOGICAL APPROACH
The method may be characterized generally as descriptive but it is not a simple cataloguing of qualities or counting of elements. Basically, it involves an openness to nursing phenomena, a spirit of receptivity, readiness for surprise, the courage to experience the unknown. Equally important is awareness of one"s own perspective and of personal biases.
The methodological process is subjective-objective and intuitive-a.n.a.lytic.
Besides subjective knowing or personal experiencing of the phenomenon, rigorous a.n.a.lysis also is required. This being-with (subjective, intuitive knowing and experiencing) and looking at (objective a.n.a.lyzing) the phenomenon all at once sparks a creative synthesis, a conceptualization from which emanates insightful description.
More specifically, the method entails _an intuitive grasp of the phenomenon, a.n.a.lytic examination of its occurrences, synthesis, and description_. In actuality, as the method is carried out, one does not necessarily recognize or focus on these processes as distinct phases or steps. In the flow of the experience, at times, some seem to occur simultaneously or in oscillation. Bearing this in mind, the processes will be considered in more detail.