HUMANISTIC NURSING

THEORY
Dr. Josephine Paterson
Dr. Loretta Zderad

BIOGRAPHY

DR. JOSEPHINE PATERSON

BIOGRAPHY
Josephine Paterson was born on the 1st of September
1924 in Freeport, New York.
She had graduated in August 1945 with a diploma from
Lenox Hill School of Nursing
Nine years later (1954, August) she received
her masters degree from John Hopkins School
of Hygiene and Public Health, Baltimore,
Maryland
Her Doctor for Nursing is from Boston University
School of Nursing, Boston, Massachusetts,
where she specialized in psychiatric nursing

 Dr. Paterson conceptualized and taught

humanistic nursing to graduate students, faculty,
and staff in a variety of settings
She also served on the faculty of the State
University of New York at Stonybrook
She retired in 1985 as a clinical nurse specialist at
Northport Veterans Administration Medical
Center at Northport, New York

DR. LORETTA ZDERAD

 Zderad is a graduate of St. Bernards Hospital School of

Nursing and Loyola University
She received her Master of Science degree from Catholic
University, Washington, DC, and a doctor of Philosophy
(1968) from Georgetown University, Washington, DC
She has taught in several universities and has led groups
on humanistic nursing
Dr. Zderad also served on the faculty of the State
University of New York at Stonybrook
She retired in 1985 as the Associate Chief for Nursing
Education at the Northport Veterans Administration
Medical Center, Northport, New York

 Paterson and Zderad met in the 1950s while

working at Catholic University, where their task was
to create a new program that would include
psychiatric and community health.
Friendship that has lasted over 35 years.

HUMANISTIC NURSING
Embraces more than a benevolent
technically competent subject-object oneway 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 other (Paterson & Zderad)

Introduction

Humanistic Nursing Theory is based on the idea that nursing is an

inter-subjective transactional relationship between a nurse and a
patient who are human beings existing in the world.

The conceptual framework of the theory is existentialism and it

presents a phenomenological method of inquiry that can be used by
nurses to examine and understand their everyday practice.

The theory serves as a vehicle to describe the essences of everyday

nursing experiences.
Paterson and Zderad (1988) addressed three central questions: What
is the meaning of nursing? How do nurses and patients interact?
How can nurses develop the knowledge base for the act of nursing?

They use a phenomenological perspective as the basis for a

dialogue about lived experiences to uncover answers to the
questions. The sum total of all these experiences will enhance
the development of the science of nursing.

Paterson and Zderad believed that a simple, scientific

approach to nursing education would not be sufficient to
create truly effective and content nurses.

IMPLICIT ASSUMPTIONS
Nursing involves two human beings who are willing
to enter into an existential relationship with each
other.
Nurses and patients as human beings are unique
and total biopsychosocial beings with the potential
for becoming through choice and intersubjectivity.
Every encounter with another human being is an
open and profound one, with a great deal of
intimacy that deeply and humanistically influences
members in the encounter.

Human beings are free and are expected to be involved in their

own care and in decisions involving them.

All nursing acts influence the quality of a persons living and

dying.

Nurses and patients coexist; they are independent and

interdependent.

A nurse has to accept and believe in the chaos of existence as

lived and experienced by each man despite the shadows he casts,
interpreted as poise, control, order, and joy (Paterson and
Zderad, 1988,p. 56).

Human beings have an innate force that moves them to know

their angular views and others angular views of the world
(Paterson and Zderad, 1976; Zderad, 1969).

THEORETICAL
ASSERTIONS

Through the Humanistic Theory, the nurse is able to connect

with the patient and their struggle, enabling them to gain a
deeper understanding of their situation and face the battle
together.

Humanistic nursing practice is developed from the lived

experiences of the nurse and the person receiving care.

The practice of nursing is rooted from EXISTENTIALISM.

It is a philosophical approach to understanding life. Individuals
are faced with possibilities when making choices. These choices
determine the direction and meaning in ones life.

 The purpose of the nurse-patient relationship, or

inter-subjective relating, is, nurturing the wellbeing and more-being of persons in need.
Humanistic nursing focuses on the inter-subjectivity
experience, the most important activity for the nurse
to engage in may be the use of self, or presence with
the patient.

3 CONCEPTS PROVIDING THE

BASIS OF NURSING
1)

DIALOGUE
Nursing is a lived dialogue. It is a nurse-nursed relating
creatively.
Meeting
Presence
Response
Relating
Meeting
is characterized by the expectation that there will be
a nurse and a nursed

 Relating
is a process of nurse-nursed doing with each other
Subject Subject Relating
"I-Thou" is a coming to know the other and the self in
relation, intuitively.
Subject Object Relating
"I-It" is an authentic analyzing, synthesizing, and
interpreting of the "I-Thou" relation through
reflection.

 Presence
is the quality of being open, receptive, ready, and
available to another person
Call and Response
nurses and clients call and respond to each other both
verbally and nonverball

Call and response relationship is where the client call for

assistance and the nurses hear the call and respond with
their knowledge, life experience, and skills to help the
caller with the health related need. What happens
during this dialogue, the and in the call and
response, the between, is nursing.

2)

COMMUNITY
Meaning comes from the realization that it is through each
other that we more fully participate in and expand our lives
Two or more persons struggling together toward a center
(Paterson & Zderad, 1976)

Through openness, sharing, and caring, we each will expand

our angular views, each becoming more than before.
Subsequently, we take back into our nursing community these
expanded selves, which in turn will touch our patients, other
colleagues, and the world of health care.

According to Humanistic Nursing Theory, there is an inherent

obligation of nurses to one another and to the community of
nurses. That which enhances one of us, enhances all of us.

3) PHENOMENOLOGIC NURSOLOGY
Methodology for understanding and describing
nursing situations
Assumes a perceived health need by the individual
who is involved in an interaction with a health care
provider
Concerned with the nature of the facts and what they
mean to individuals

5 PHASES OF HUMANISTIC NURSING

INQUIRY
Preparation of the nurse knower for coming
to know
Preparing to get to know the patients point-of-view. This
means the nurse uses her education and life experiences to
prepare to relate with patients. Your experience
communicating with different types of people
with different personalities helps you prepare to
communicate with patients.

 Nurse knowing the other intuitively

Moving the other back and forth between the impressions
the nurse becomes aware of herself and recollected real
experience of the other (Paterson & Zderad, 1976)
It is conceptualized as dialectic (investigating) between the
impression and the real. This shifting back and forth allows
for sudden insights on the nurses part, a new overall grasp,
which manifests itself in a clearer, or perhaps a new,
understanding. These understandings generate further
development of the process

 The nurse gains knowledge of the patient through intuitive

impressions and learning about the patients experiences
At this time, the nurses general impressions are in a dialogue
with her unbracketed view

 Nurse knowing the other scientifically

The nurse gains scientific knowledge of the patient by

(phenomenological process) pondering, analyzing, sorting,
comparing, contrasting, relating, interpreting, naming,
and categorizing data (therapeutic techniques:
clarification and verification)
Collect information about the patient, for example age,
pulse and blood pressure

 Nurse complementarily synthesizing known

others
The nurse combines the subjective and objective
information to gain perspective on the situation
Nurse as noetic loci or knowing places. The nurse
examines the communication with the patient and the
information collected in light of her education (theoretical
foundation) and personal experience. The nurse uses all the
information from the patient and from her experiences to
form a conclusion. For example, maybe the nurse had a
patient before who had the same complaint.

 Succession within the nurse from the many to

the paradoxical one
The nurse arrives at a new truth, a concept that includes all
the information gained, refined into a descriptive construct
(Kleiman, 2006)
The nurse makes a conclusion about what is the best way to
improve the patients well-being.
Paradoxical one: descriptive theoretical construct of
nursing

NURSING
METAPARADIGM

 NURSING
Is a nurturing response of one person to another
in a time of need that aims toward the
development of well-being and more being
Helping to increase responsible choices
Nursing is concerned with the individuals unique
being and striving towards becoming, focusing on
the whole
Is a lived dialogue that incorporates the
intersubjective in which a nurse and a patient
meet, relate, and are totally present in an
existential way that includes intimacy and
mutuality

 HEALTH
Matter of personal survival. It is a process of
experiencing ones potential for well-being and
more-being, a quality of living and dying.
well-being: steady state (maintenance of quality)
or more than absence of disease
more well-being: process of becoming all that is
humanly possible
Finding meaning in life

MAN
Human beings are characterized as being capable, open to
options, person with values, and the unique manifestation
of their past, present, and future

ENVIRONMENT
Community: The phenomenon of society or environment
Two or more persons struggling together toward a center
It is only through our community that we are able to reach
our full potential

CONCEPTUAL MODEL

CONCEPTUAL
FRAMEWORK

Nursing Application of
Humanistic Theory

34

Case study
Alia is 16-years old high school student who participates in a
variety of school activities, appreciated by both parents and
teachers. She is friend with the number of students in the
school. She has to come to the nursing unit after a recent unit
in health class about reproductive care that include topic
related to abstinence, pregnancy prevention and sexually
transmitted diseases.
She tells you that she has a friend who asked her to find out
some additional information . She asked you where her friend
could go if she needed to find out if she was pregnant.
You know that Alia has been steadily dating a male student.
You suspect that she may be talking about her self.

35

As we use phenomenological approach in humanistic

nursing so, before proceeding towards nursing process we
consider these two steps of phenomenological study for
subjective data collection of this patient. Given as:
1)
2)

Preparation of the nurse knower for coming to know:

Nurse knowing the others intuitively.

36

1. Preparation of the nurse knower for coming to know:

In the case of the adolescent client, the nurse need to
understand the cognitive development as well as the physical
and psychosocial changes experienced by the adolescent.
Knowing about the need to meet the developmental
challenges of adolescence helps the nurse be aware of the kind
of behaviours that are often encountered.

2. Nursing Knowing the other intuitively:

. Being with the adolescent client nurse determines the
adolescent's level of comfort in making her Call for help to
the nurse.
. Does she appear relaxed, inquisitive, defensive, scared,
relieved or happy?
. Alia appears inquisitive and a bit nervous.
37

Assessment phase
(Nurse knowing the others scientifically)
In the phenomenological method of nursology the call comes
first, followed by intuition and assessment than analysis.
So in this case:
The call is the Alias's approach to the nurse with questions,
intuition is the nurse suspecting the friend is Alia.
That is why assessment include:
Alia or client says that her friend has
one missed period and is going to the
bathroom more often,
She added that frequently her
friend feel nauseated accompanied with
complain of constipation. Alia is looking
anxious and nervous while providing
history regarding her friend.
38

Diagnosis phase
(Succession within the nurse from the many to the
paradoxical one)
Possible nursing Diagnosis in Alias's case would be:
1.

2.

Knowledge deficit regarding normal progression of pregnancy

related to lack of knowledge of physiological and psychological
challenges during pregnancy as evidenced by request for
information.
Constipation related to excessive water absorption from GIT
tract as evidenced by patient verbalizes difficulty in defecation and
normal elimination pattern

39

DIAGNOSIS
(Dialogue)

Planning
(Dialogue)

1. Knowledge deficit regarding normal

After 2-3 hours of nursing session the client
progression of pregnancy related to lack of
will be able to:
knowledge of physiological and psychological 1. Explain normal physiological/psychological
challenges during pregnancy as evidenced by
changes associated with the first trimester.
request for information.
2. Describe behaviours that promote wellness
and Identify danger signs of pregnancy.

2.

Constipation related to excessive water

absorption from GIT tract as evidenced by
patient verbalizes difficulty in defecation and
normal elimination pattern

After 2-3 hours of counselling session the

client will able to:
3. Identify individual contributing factors/risk
behaviours.
4. Report adoption of individually appropriate
behaviours to promote elimination

40

Implementation for
knowledge deficit

Rational

1. Establish an ongoing and supportive nurse- 1.

client relationship.
2. Evaluate current knowledge and cultural
beliefs regarding normal
physical/psychological changes of
pregnancy, as well as beliefs about
activities, self-care, and so forth.
3.

Clarify misconceptions.

4. Maintain open attitude towards the belief

of client.
5. Explain office visit routine and rational for
interventions (Urine testing, B.p
monitoring etc)
6.

Using pictures discuss fetal development

process.

2.

The role of teacher/counselor can provide

anticipatory guidance and promote
individual responsibility for wellness.
Provides information to assist in identifying
needs and creating a plan of care.

3.

Fears usually arise out of misinformation

and may interfere with further learning
4. Acceptance is important to developing and
client/couple .maintaining relationship,
supporting independence.
5. Reinforces relationship between health
assessment interventions.
6. Visualization increases strengthen of child
reality and enhance learning.

41

Implementation for
Constipation
1. Determine pregravid elimination habits,
noting alteration in pregnancy.
2.

Provide dietary information about

vegetables, fresh fruits, grains, fiber,
roughage, and adequate fluid intake.

3.

Provide information regarding regular,

non-strenous exercises . Note cultural
beliefs about exercises.

4.

Discuss cautious use of stool softner or

bulk producing agents if exercises is not
comfortable.

Rational

1.

Usual elimination pattern need to be

maintained, when possible. Increasing
progesterone level relaxes smooth muscle
within the GI tract, resulting in reduced
peristalsis and increased reabsorption of
water and electrolytes.

2. Adequate bulk and consistency in diet choices

help vegetables, grains, fiber, roughage, and
adequate promote effective bowel pattern.
3. promotes peristalsis and assist in prevention
of constipation.
4. May be necessary in combating persistent
constipation and establish a regular routine.

42

Evaluation
Goal is achieved.....
After 2-3 hours of nursing session:
1. Client has explain normal physiological/psychological
changes associated with the first trimester danger signs of
pregnancy.
2. Report adoption of individually appropriate behaviours to
promote elimination

43