Considering the complexity of each man"s being and becoming, it is surprising that we come to understand each other in community at all, rather than the reverse.
How can we hope for a sustained thereness, presences of nurses with other man (patients, patients" families, professional colleagues, and other health service personnel) as "We" in an ongoing struggle of community considering their mult.i.tudinous differences? Norman Cousins, in _Who Speaks for Man_, comments on man"s inability to respond affirmatively to those he experiences as different from himself.[14] For the human community to progress he suggests federation. A unity in which differences would be valued as promoting thought, human evolvement, and community advancement. Cousins gives examples of man"s inhumanity to man based on differences viewed as nonvalues. The prevalence of this latter view of differences is very evident in our commonplace health-nursing world. Can nurses and other health care maintainers look at the ways they respond to differences consciously, and can they deliberately choose to be open to responding to them as valuable? Can we conceive of there being value in that which we see as "not right," "untrue,"
"wrong?"
The ability to be there, to stay involved in community with my fellows, is a problem worthy of concern to me as a nurse. How do I stay in an existential way with my contemporaries, patients, patients" families when their values in reality are so different from my own? How do I go beyond a negative judgmental to a prizing att.i.tude that would open the possibility of seeing strengths in others" views perhaps lost, discarded, or never previously existent in my own? Nonsuperimposing of my own value system through recognizing and bracketing it is a difficult professional goal. And yet, a goal that if coupled with the courage for personal existence, could sustain me in the health-nursing community.
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So for a health-nursing community to truly be actualized each nurse would prepare to be all it was possible for her to be as a nurse. Then, through exploration there would be a recognition of the reality of the existent community. Over time a merger of the values of the nurse and of the existing community would be reflected as moreness in each. The nurse would be more through her relation with the community; the community would be more through its relation with the nurse. Each would make an important difference in the other. The macrocosm, the community, would reflect the nurse"s quality of presence. The microcosm, the nurse, would reflect the presence of the community with her. Each unique man becomes in community through communication with other uniquely different men.
FOOTNOTES:
[1] Plato, _The Republic_, trans. Francis MacDonald Cornford (New York: Oxford University Press, 1945).
[2] Wilfrid Desan, _Planetary Man_ (New York: The Macmillan Company, 1972).
[3] John Hersey, _A Single Pebble_ (New York: Alfred A. Knopf, 1956), p.
18.
[4] Hermann Hesse, _Steppenwolf_ (New York: Holt, Rinehart and Winston, 1966), p. 60.
[5] Gabriel Marcel, _h.o.m.o Viator_ (New York: Harper & Row, Publishers, Harper Torchbooks, 1962), p. 121.
[6] Teilhard de Chardin, _The Phenomenon of Man_ (New York: Harper & Row, Publishers, 1961).
[7] Norman Kiell, _The Universal Experience of Adolescence_ (New York: International Universities Press, 1964), pp. 22-44.
[8] Martin Buber, _I and Thou_, 2nd ed., trans. Ronald Gregor Smith (New York: Charles Schribner"s Sons, 1958).
[9] Hesse, _Steppenwolf_, p. 60.
[10] Plato, _The Republic_.
[11] Robert A. Heinlein, _Time Enough for Love_ (New York: G. P.
Putnam"s Sons. 1973).
[12] Frederich Nietzsche, "Beyond Good and Evil," trans. Helen Zimmern, in _The Philosophy of Nietzsche_ (New York: Random House, 1927) and "Thus Spoke Zarathustra." trans. Thomas Common, in the _Philosophy of Nietzsche_ (New York: Random House, 1927).
[13] Martin Buber, _Between Man and Man_, trans. Ronald Gregor Smith (Boston: Beacon Press, 1955).
[14] Norman Cousins, _Who Speaks for Man?_ (New York: The Macmillan Company, 1953).
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Part 2
METHODOLOGY--A PROCESS OF BEING {50} {51}
5
TOWARD A RESPONSIBLE FREE RESEARCH NURSE IN THE HEALTH ARENA
ANGULAR VIEW
Research is an inherent component of humanistic nursing. What condition of humanness is necessary in the nurse for the actualization of nursing"s research potential? This chapter will attempt to share some brooding and mulling on this problem.
Nurses practice within ever-moving, changing settings where formulated plans frequently and suddenly go awry. Unexpected patient needs arise.
Powerful others make both reasonable and unreasonable demands. Depended on others fail us due to human frailty or lack of dependability. The nurse"s setting, her researchable area, is the extreme opposite of her colleague"s, the laboratory investigator"s. Her area is beyond research control measures. Too, it lacks the quiet isolated atmosphere conducive to contemplation and creative thinking a.s.sociated with research.
Conversely, it is oversaturated with the "stuff" of meaningful existence. It can stimulate questions to the frenzy of immobilization.
The human nurse"s system can become overloaded. Such overloading reflects the humanness of the nurse; like all man she can envision possibilities beyond any human being"s ability of fulfillment.
Nurses know there are events in their commonplace worlds that scream for human interpretation, understanding, and attestation. The question becomes "how." This "how" depends on more than concretes and events in the nurse"s setting. This "how" depends on relevant "ifs." The meaningfulness of the nursing world will be actualized conceptually "if"
this is supported by inst.i.tutional economic and administrative planners, other nurses, and intradisciplinary colleagues. For knowledge available and visible to nurses in the health setting to be preserved, conceptualized for durability, it needs to be valued by the inst.i.tutional health community. Still, most necessary to its duration is the appreciating of this knowledge by the nurse, herself. {52}
HUMAN CONDITION OF BEING: NURSE RESEARCHER
Initiation of a Nurse Researcher
The nurse student, recently arrived in her experiential world, is awed with the need to be cognizant of mult.i.tudinous factors. At this initial introductory phase one could say her "being" as a nurse is programmed or imprinted with: It is your responsibility to report and attend all the things that influence the response and comfort of those for whom you care. This programming supports and is supported by any already existing tendencies within the nurse student toward unrealistic, perfectionistic expectations of self.
Then in research courses, usually positivistically geared, her programming jams. Her system is fed: Select out, isolate, focus down on a single question, limit your variables, establish a protocol of operation, control for reliability and validity, tunnel your vision, and safeguard objectivity. The jamming is the result of the human nurse"s capacity to see relationships between the part and the whole. Human intelligence, as a condition of humanness, demands this relating of one thing to another. Often such relating is intuitive, human, based on much thinking for purposes of understanding and solution. Yet, often it cannot be substantiated fully and conceptualized logically at specific times, therefore it is subjective.
To highlight the obvious in the above I attempted facetiousness. Many nurses acutely aware of the complexities, contradictions, and inconsistencies of their nursing worlds have struggled and used the positivistic method in research studies. Hence, they have isolated a researchable question, stated their basic a.s.sumptions, hypothesized outcomes, selected samples, established experimental and control groups, formulated methodologies, searched out and utilized appropriate findings, and have made recommendations. Usually these research efforts have advanced scientific knowing and knowledge of existents within the health-nursing situation. And yet, often these efforts have discouraged the research wonderment of the nurse interested in the nature and meaning of the nursing act and how the event of nursing is lived, experienced, and responded to by the partic.i.p.ants. These positivistic research methods have made available answers. Still, they have not answered the questions most relevant to nursing practice and to nurses.
These nurses were certain that man generally could not be prescribed for interpersonally; he was not predictable, not yet an automaton. Faced with alternatives men often surprised. Consequently these positivistic approaches to studying human events, unless one forced one"s data crowbar style, always terminated with a kind of miscellaneous category.
Man"s undeterminedness makes him all-at-once frustrating to study, impossible to distinctly categorize, and excitingly mysterious and the most worthy focus of nursing research. {53}
A Nurse Researcher"s Presence in the Nursing-Health Setting
The existent, a nurse labeled researcher, in the health world brings a disquiet that has to be understood and endured. Necessities for scientific study in the nurse"s world of the nursing event or situation are wonderment, concern, and responsibility. Open adherence to such qualities frequently startles others into speculating about the researcher. She, herself, becomes an oddity. Persons ponder the possibility of her study"s having a hidden agenda that involves them.
Over time these persons generally accept or reject the searcher"s efforts. If rejected the searcher is often labeled a worthless nosey troublemaker. Subtly it is conveyed among those involved that she is to be interfered with often by mechanisms of ignoring or forgetting or righteously setting "patient"s needs" above conforming to the study plan. For instance, how often have research nurses met with responses from staff at the time of their planned arrival on a unit to work with a patient, "Oh, he seemed to need activity, he was restless, I forgot you were coming, I sent him to the gym," or "Oh, (surprise) did you want to give the patient his morning care? That was done a while ago; we give care early." If accepted the searcher is often labeled an interested, interesting person whose efforts are to be fostered because her findings will enhance situation nursing. The distinction frequently is based in staffs" responses to the searcher"s personality more than in the value of the issues of the investigation.
Significant to negative staff responses toward a nurse searcher is the necessity for her to withhold information. This withholding may be necessary to protect the study results. For example, it is necessary when a special type of patient care is being tested against usual patient care or when confidentiality is an issue. Confidentiality requires a nurse, searcher or not, to censor communications when personal knowledge of individuals make them identifiable. The need for confidentiality can be determined by the nurse"s considering the knowledge gained in view of whether it will or will not influence the over-all treatment plan. If it will affect the plan, there is reason to reveal it; then it must be related in a manner that insures the patient"s continued protection and, if possible, with his permission. If over-all treatment is not influenced, one must censor the knowledge gained to check one"s own free communications. Would the patient want it revealed; is it knowledge of a quality that brings ridicule, is looked at negatively or nonacceptably in our particular culture generally? Is it of a sensitive nature and therefore knowledge we do not just reveal to anyone?
Other patient care givers may sense this withholding by the nurse searcher. They may reasonably accept it or unreasonably not accept it.
The researcher may or may not be aware of or concern herself with her colleagues" sensitivity. This would depend on the searcher"s usual modus operandi and on the importance she a.s.sociates with her colleagues" sway in her investigation. The latter can be much greater than is obvious.
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Confidentiality--Description: Humanistic Nursing
Humanistic nursing practice theory proposes phenomenology, a descriptive approach to partic.i.p.ants in the nursing situation as a method for studying, interpreting, and attesting the nature and meaning of the lived events. Humane nursing is not humanistic nursing within this theory unless that which becomes visible to the nurse in the nursing situation is shared in a durable form with colleagues.
Confidentiality, then, becomes an important issue in humanistic nursing.
No scientific methodology of research is affixed with "ought" or "should" virtues regarding knowledge gained. In nursing, a professional helping realm, a pract.i.tioner or researcher is wed to "ought" and "should" virtues. The knowledge gained "ought" to be dispersed to colleagues for their increased understanding. It "should" enhance the constructive force of the profession. To so enhance it "must" be communicated in a manner that allows understanding while protecting distinct individuals and groups. Words and conceptualized ideas are the tools of phenomenology. Protection of distinct persons and meaningful communication can be augmented through the utilization of abstractions, metaphors, a.n.a.logies, and parables. So humanistic nurses, as pract.i.tioners and researchers, are inherently responsible for their manner of being, responding, and consciously sculpturing knowledge into words.