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Humanistic Nursing Theory: Josephine Paterson and Loretta Zd

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on 13 December 2014

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Transcript of Humanistic Nursing Theory: Josephine Paterson and Loretta Zd

Based on humanistic theory, environment is a place where the event is happening or happened
Environment is considered time and space (Paterson and Zderad, 1988) TIME
Can be an event or can be actual for nurse and client during communication .
Time may feel differently for patients than for nurse.
Time experiences are unique based on their
Understanding of the situation SPACE
Part of the world surrounding nurse and patient.
It can be a hospital room,a bed,and visiting area
The environment can influence the patient`s comfort and the mutual understanding between nurse and patient
Depends on the environment the person is in, he/she can feel as comfortable as being home or out of place(Paterson and Zderad, 1988).
Environment at End-of-Life
The patient no longer feels that he/she is apart of this Earth or society (Wu and Volker, 2012).
The patient has severe difficulty in functioning properly in society since his/her environment has been altered
Patient feels the lack of ability to engage with peers and do routine work
Environment Continued
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).
Person Continued
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

Person Continued
The nurse focuses not only on the patient’s body but rather on the patient as Personhood (Tahseen Nizam Silva, 2013).
Presence is necessary, being the key element in achieving doing with and being with rather than doing for(Tahseen Nizam Silva, 2013).
The patient is to be respected, valued, nurtured, understood, with the right to make informed decisions about its own health(http://humanisticnursing.weebly.com/the-theory.html)
The values brought by the parties involved will be reflected in the quality of the experience nurse-patient(Tahseen, 2013)

Practical Application:
Wit (2001)
Humanistic Nursing Theory
In order to truly comprehend Paterson and Zderad’s nursing theory it is essential to understand the Humanistic Nursing Theory.
The Humanistic Nursing Theory was first developed in 1976 it is grounded on two ideas; existentialism and phenomenology (Santos, Pagliuca & Fernandes, 2007)
Existentialism: “A philosophical theory or approach which emphasizes the existence of the individual person as free and responsible agent determining their own development through act of the will.” (Oxford University Press, 2014)
Phenomenology: “An approach that concentrates on the study of consciousness and the object of direct experiences” (Oxford University Press, 2014)

What's to Come
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.

A New Perspective
Over the years, the nursing profession has made dramatic strides, moving from a purely medical based approach into an autonomous practice comprised of its own nursing theories.
One of the most widely recognized nursing theories is Paterson and Zderad’s Humanistic Nursing Theory
Humanistic Nursing Theory: Josephine Paterson and Loretta Zderad
Humanistic Nursing Theory Continued
Person in Humanistic Theory
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)
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)

Paterson and Zderad
Paterson and Zderad (1988) view health as an entity beyond the mere absence of disease
“Nursing, then, as a human response, implies the valuing of some human potential beyond the narrow concept of health taken as absence of disease” (Paterson & Zderad, 1988)
Health is also not seen as an end attainable goal, especially for patients whom are palliative or have terminal illnesses, but rather a resource which patients can use to realize their own potential
Paterson and Zderad (1988) stipulate that the humanistic nursing effort is concerned with increasing one’s possibilities of making responsible choices, which in turn help an individual toward more-being
From the humanist perspective, every person is categorized according to their unique being and becoming in their situation, rather than viewing them as a mere biopyschosocial organism

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).

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.
Please be mindful of:
the degree to which the nurse advocates for the patient
Nurse-Patient Relationship
(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?
Humanistic Nursing Theory as Depicted in the "Wit"
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.
Person Continued
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 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.

Nursing Continued
The nurses presence is investigated from the following four dimensions:
Openness - the nurse is being open with the patient by sharing memories of her childhood in addition to sharing the full extent of the progression of her cancer
Receptivity - the nurse is being receptive by listening to the patients concerns about her fears of dying
Readiness - The nurse is being proactive by asking the patient to think about her code status
Availability - The nurse shows she is available with a genuine presence by bringing her chair closer to the patients bedside and comforting her in a broad sense.
Intersubjective Transaction
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.
Health at End-of-Life
At end of life, traditionally individuals are seen as having poor health and intense suffering caused by disease
From the humanistic perspective of Paterson and Zderad’s theory, the individual can still be considered healthy even if they are living with a terminal illness (Vassallo, 2001)
The individual’s wellness is heavily influenced by their quality of being fulfilled in body and mind

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
"Nursing is a purposeful 'call-and-response' in which the nurse responds to the call by caring for the person who has health-related unmet needs (Paterson and Zderad, 1988)."
Nursing is a live dualistic dialogue between nurse and patient. "The transaction involves meeting, relating and presence in a world of people, things, time and space (Paterson and Zderad, 1988)".
"Paterson and Zderad, describe nursing as both a mode of doing something and being with patients (Paterson and Zderad, 1988)". Thus, the nurse supports the patient’s goal by engaging in specific action, in addition to be displaying a genuine presence (Vassallo, 2001).

Benefits of Humanistic Nursing Theory
Limitations of Humanistic Nursing Theory
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.
Nursing at End-of-Life
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).
Communication barriers - patients who are not able to communicate with their nurses effectively (ex. spoken language differences) are not able to engage in a nursing dialogue (Santos, Fernandes and Pagliuca, 2007)
Presence - a nurses presence may be severely diminished by external factors which can not be controlled including a high nurse-to-patient ratio, high volume of medical personnel on day shift and poor working conditions (Vassallo, 2001)
Nurse incompetence - the nurse-patient relationship may not be able to flourish due to the limited abilities of the nurse (ex. nurse may be suffering from burnout)
Holistic - the theory is patient-centred focusing on the holistic person not just the medical condition (Santos, Pagliuca and Fernandes, 2007, p. 353)
Concepts of the theory are easily understood which allows it to be applied appropriately to different situations
Universality - the theory can be applied to a wide range of nursing applications (ex. palliative nursing, hospice nursing, oncology and community health nursing)

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

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