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The nurse explores health from the perspective of living a worthy life versus an undignified death. The nurse describes an undignified death as being hooked up to several machines in order to prolong a life with no further potential. The patient relates to this understanding by requesting a DNR.
Time: The patient reflects on her past experiences by attributing her life's meaning to her time spent as a scholar. A shift in thinking occurs when she stops reminiscing and realizes that her current condition prevents her from achieving her full potential as a scholar.
Space: In analyzing the patients environment, her individuality is not expressed, only her current depressed state. The room contains no personal memorabilia such as photos, framed certificates or flowers.
Call & Response: At the patients end of life stages, she asks the nurse if she is still going to take care of her and the nurse responds affirmatively and genuinely. The nurse has an authentic presence which the patient recognizes.
The nurses presence is investigated from the following four dimensions:
The sharing of the popsicle is symbolic to both the nurse and patient. For the nurse, the popsicle is significant since it brings back childhood memories and for the patient it is significant since it soothes her suffering. Taken together, the popsicle is seen as a symbolic representation of a last memory shared between friends.
Please be mindful of:
(1) How did Vivian cope with the news of her new diagnosis?
(2) How did the doctor treat the patient at her end-of-life moments?
(3) Why do you think the doctor chose to dishonor the patients autonomy?
(4) Why was the nurse so adamant in honoring the patients DNR status?
The nurse respects the patients autonomy by asking her to think about her code status. She goes further by describing the two different code statuses (full code and DNR) in order to elicit an informed decision from the patient.
The nurse affords the patient with utmost respect and dignity by treating her as a valued individual as opposed to the doctors which treat her as a research subject. The nurse accomplishes this by acknowledging her fears which demonstrates that the patient is being understood.
Vivian: "I feel scared"
Susie: "Of course you are"
The nurse is reassuring the patient that her concerns are valid and not simply dismissing them.
Synopsis: Vivian Bearing, an English professor, is diagnosed with terminal ovarian cancer. Throughout the duration of the film, she reflects on the progression of her cancer treatments as well as significant life events. The doctors minimize her existence to a research subject, but she gains a life of meaning through her nurse, Susie, who advocates on her behalf.
Overall, if one truly examines this theory for its intricacies, one may begin to perceive how this theory transcends the biomedical mode of care, the pathophysiology of a patient, and their circumstances of the patient, to see the underlying humanity in the individual. Ultimately is this not what everyone wants, to be seen as a human despite their difference, stages in life, social status, and interests. This commitment to understand, to empathize with and touch the humanity in an individual, is what makes this theory vital to the soul of nursing, and ultimately healthcare in our present times.
A special caring person
You are to me
Tender memories
Forever with me be
Caring and compassion
Came from your heart
These are qualities
That can’t be taught
You saw me suffer
You ease my pain
With care and compassion
So humane
My days are numbered
The end is near
I am ready, do not despair
I am not in pain
You don’t have to ask
Or fluff my pillow
Or any task
The light is fading
And I must go
You are so special
You have to know
You’re a special nurse
And I hope one day I’ll see
This loving caring person
Who took good care of me
-Written by the Group
Nursing is the expression of the nurse’s authentic, existential commitment to the nurturing of human potential (Wu and Volker, 2012). Potentials include ‘well-being’ and ‘more-being,’ a course of becoming more in the limits of one’s current life situation (Vassallo, 2001). More being is especially important issue in end-of-life-care; patients have a short period of time and space to achieve their last goals before they pass away (Vassallo, 2001).
de Sá França, J. R. F., da Costa, S. F. G., da Nóbrega, M. M. L., &
Lopes, M. E. L. (2014). Cuidados paliativos à criança com câncer [Palliative care to child with cancer]. Revista Enfermagem UERJ, 21(6), 779-784
Kleiman, S., and Kleiman, A. (2002). Humanistic
Nursing Web site. www.humanistic-nursing.com . Retrieved from http://www.humanistic-nursing.com/
McCamant, K. L. (2006). Humanistic Nursing,
Interpersonal Relations Theory and the Empathy-Altruism Hypothesis. University of Delaware School of Nursing, Newark, Delaware
Oxford University Press. (2014). Existentialism: definition of
existentialism in Oxford dictionary (British & World English). Retrieved from http://www.oxforddictionaries.com/words/about.
Oxford University Press. (2014). Phenomenology: definition of
Phenomenology in Oxford dictionary (British & World English). Retrieved from http://www.oxforddictionaries.com/words/about.
Paterson, J., Zderad, L. (1988). Humanistic Nursing.
National League for Nursing: New York.
Santos, M. C. L., Pagliuca, L. M. F., & Fernandes, A. F. C.
(2007). Palliative care to the cancer patient: reflections according to Paterson and Zderad's view. Revista latino-americana de enfermagem, 15(2), 350-354.
Silva, T. N. (2013). Paterson and Zderad's humanistic
Theory: Entering the between Through Being When Called Upon. Nursing Science Quarterly 26(2) 132-135
Vassallo, B. M. (2001). The Spiritual Aspects of Dying at
Home. Holistic Nursing Practice, 15(2), 17-29.
Wu, H., & Volker, D. L. (2012). Humanistic nursing
theory: Application to hospice and palliative care. Journal of Advanced Nursing,68(2), 471
The Centre of the holistic caring and nurturing is the complex interaction between the nurse and the patient, a call and response relationship (McCamant, 2006).
The Relationship nurse-patient changes all parties involved(Tahseen Nizam Silva, 2013).
The Experience is person-focused (Tahseen Nizam Silva, 2013)
During the process of interaction, the nurse brings professional identity, experience, education, other life experiences.The patient, viewed as unique human being, brings its own potential and life experiences( including educational, emotional, social, spiritual and physical experiences)(Kleiman, 2010)
In the following presentation we will provide a brief overview of Paterson and Zderad’s Humanistic Nursing Theory with respects to the four metaparadigms of nursing (person, environment, health and nursing) and will illustrate it's use through a practical application.
Suffering is increased even more because he/she became limited in doing everything. The person thinks that his/her time in this world is done (Wu and Volker, 2012).
In order to truly comprehend Paterson and Zderad’s nursing theory it is essential to understand the Humanistic Nursing Theory.
Paterson and Zderad developed their own humanistic nursing theory which borders on the belief that the most vital aspects in nursing is the nurse-patient relationship. This is further exemplified by enhancing human potential, being and becoming through intersubjective relating, a purposeful call and response as well as recognizing individuality (Paterson & Zderad, 1988). This is accomplished through what is described as a “nursing dialogue” (Paterson & Zderad, 1988). Through the lived dialogue along with the nurse’s presence, the patient will be valued, respected, understood and their autonomy would be honored (Patterson and Zderad, 1988).
Dr. Josephine Paterson, was raised in the east coast where she earned a BScN . She began her graduate work at Johns Hopkin University(Kleiman, & Kleiman, 2002)
Dr. Loretta Zderad was raised in the mid-west where she earned her BScN. She began graduate work at Catholic University (Kleiman, & Kleiman, 2002)
They both met in the 1950s when they were commissioned by the Catholic University to work on programs that would bring both community health and psychiatric components together (Kleiman, & Kleiman, 2002)
They both continued on to their doctorates (Kleiman, & Kleiman, 2002)
It was not until 1976 when Paterson and Zderad published their first book Humanistic Nursing (Kleiman, & Kleiman, 2002)
*****Interesting Fact: They maintained a friendship which flourished over 40 years (Kleiman, & Kleiman, 2002)
Human beings are holistic:
- all are special
- all have unique experiences
- they are multidimensional
- they represent more than the sum of their parts
- they are capable of empathy, creativity, caring, communication, responsibility
(http://humanisticnursing.weebly.com/the-theory.html)