SEMINER ON PATERSON AND

ZDERAD HUMANISTIC
NURSING THEORY

SUBMITTED TO: Mam Mrs.Sunita Sharma

SUBMITTED BY: NAVKIRAN KAUR
(MSc.Nsg 1st yr.)
 PATERSON AND ZDERAD
HUMANISTIC NURSING THEORY

BIOGRAPHICAL SKETCHES OF THE NURSE THEORISTS:

Josephine G.Paterson (DNS, RN)

Born: 1, 1924, in Freeport, New York

Position: Retired from nursing , 1985, position prior to retirement as “nursologist” at the
Northport veterans administration hospital in Northport, New York

Diploma: Lenox Hill Hospital School Of Nursing, New York, August 1945

BS Nursing Education, St. John’s University, Brooklyn, New York, August 1954

MPH, John’s Hopkins School of Hygiene and Public health, Baltimore, Maryland, June 1955

Speciality: Mental health; fieldwork completed April 1956

DNS, Boston University, 1969; speciality: Psychiatric mental health

Lorreta Zderad (PhD, RN)

Born: June 7, 1925, Chicago , Illinois

Position: Retired from nursing, 1985; position prior to retirement as “nursologist” at Northport
Veterans Administration Hospital, Northport, New York

Diploma: St. Bernard’s Hospital School of Nursing, Chicago, Illinois, June 1947

BS Nursing Education, Loyola University, Chicago, Illinois, June 1947

MS Nursing Education, Catholic university, psychiatric nursing major, June 1952

MA Philosophy, Georgetown University

PhD Philosophy, Georgetown University, 1968

Josephine Paterson and Lorreta Zderad met in the mid-1950s while working at Catholic
University. Their joint project was to create a new program that would encompass the
community health component and the psychiatric component of the graduate program. This
started a collaboration. They shared and developed their concepts, approaches, and experiences
of “existancial phenomenology,” which evolved into the formal theory of Humanistic Nursing.
They incorporated these concepts into their work as educators and shared them across the
country in seminars and workshops on Humanistic Nursing Theory.

The Humanistic Nursing Theory was originally formulated as a way for nurses to define
nursing. That is, a way to illuminate the values and meanings central to nursing experiences.
Paterson and Zderad were nursing visionaries who emphasize synthesis and wholeness rather
than reduction and logical/mathematical analysis. They challenged the notion that
reductionistic approach is the touchstone of explanatory power, and they postulated an “all-at-
once” character of existence in nurse’s experiences of being in the world. They led the way to
many of the contemporary nursing theories that emphasize the caring aspects of nursing
(Benner, 1984; Parse, 1981; Watson, 1988).

INTRODUCING THE THEORY

Humanistic nursing theory is multidimensional. It speaks to the essences of nursing and

embraces the dynamics of being, becoming, and change. It is an interactive nursing theory that
provides a methodology for reflection and articulation of nursing essences. It is also a theory
that provides a methodological bridge between theory and practice by providing a broad guide
for nursing “dialogue” in a myriad of settings.

Humanistic theory as a metatheory of nursing provides highly developed viewpoints on the two
metaparadigm elements of nursing and person and less well-developed views of health and
environment. The development of the view of nursing as a particular kind of human relating is
perhaps its major contribution. The essence of metatheory provides,“ a perspective of nursing
as a happening between two persons, an approach to nursing as extential presence and
awareness and a method of describing nursing as a phenomology.” (Paterson,1978)

This statement provides insight on the assumptions that are implicit within the metatheory.

Nursing, as seen through Humanistic nursing theory, is the ability to struggle with another
through “peak experiences related to health and suffering in which the participants are and
become in accordance with their human potential” (Paterson & Zderad,1976). The struggle
evolves within a dialogue between the participants, illuminating the possibility for each to
“become” in concert with the other. According to Josephine Paterson and Lorreta Zderad, in
nursing, the purpose of this dialogue, or intersubjective relating , is “nurturing the wellbeing
and more being of persons in need”.

According to the Humanistic Nursing Theory, there is a call from a person, a family, a
community, or from humanity for help with some health related issue. A nurse, a group of
nurses, or the community of nurses hearing and recognizing that call respond in a manner that
is intended 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. It is the “between” that Paterson
and Zderad conceive of as nursing. They share with other nurses their method for exploring
this “between”. The method is phenomological inquiry. Engaging in the phenomological process
sensitizes the inquiring nurse to the excitement, anticipation, and uncertainity of approaching
the nursing situation openly. Through the spirit of receptivity, a readiness for surprise, and the
courage to experience the unknown, there is an opportunity for authentic relating and
intersubjectivity. “The process leads one naturally to repeated experiencing of and reflective
immersion in the lived phenomena” (Zderad,1978).

This immersion into the intersubjective experience and the phenomologiocal process helps to
guide the nurse in the responsive interchange. During this interchange, the nurse calls forth all
that she is (education, skills, life experiences, intuition, etc.) and integrate it into her response.a
common misconception is that the it asserts that the nurse must provide what it is that the
patient is calling for. But the reality is that the nurse’s response is guided by all that she is. This
includes his/her professional roles, ethics and competencies.
 CONCEPTUAL FRAMEWORK

The conceptual framework of the theory helps to explain and illustrate some of the basic
concepts and assumptions.

HUMANISTIC NURSING

nurturing towards well being and more being

Patient call Nurse response

Dialogue

Being and becoming through

Intersubjective relating(being with and doing with)

Figure: World of others and things

Humanistic nursing is a moving process that occurs in the living context of human beings,
who interface and interact with others and other things in the world. In the world of
Humanistic Nursing Theory, when we speak about the human beings, we mean patients (e.g;
individuals, members of families, members of communities, or members of human race) and
nurses. A person becomes patient when he or she sends a call for help with some health related
problem. The person hearing or recognizing the call is a nurse. A nurse has made a
commitment to help others with health related needs.
In humanistic nursing theory, each nurse and each patient is taken to be a unique human
being with his/her own particular gestalt. Geastalt, representing all that particular human
beings are which include all the past experiences, all current being, and all hopes, dreams,
fears of future that are experienced in one’s own space-time dimension. As illustrated this
gestalt includes all the past and current social relationship, as well as gender, race, religion,
education, work and whatever individualized patterns for coping a person has developed. It
also includes the person’s past experiences with health care system and a patient’s images and
expectations of those persons. Our gestalt is a unique expression of our individuality.
Accordingly, a nurse and a patient perceive and respond to each other as a gestalt. In
Humanistic Nursing Theory we say that each person is perceived as existing ”all at once”.

PHILOSOPHICAL AND METHODOLOGICAL BACKGROUND

PHENOMENOLOGICAL DESCRIPTION

Phenomenology directs us to the study of the "thing itself." The existential literature,
descriptions of what man has come to know and understand in his experience, has evolved
from the use of the phenomenological approach. In the humanistic nursing practice theory the
"thing itself" is the existentially experienced nursing situation. Both phenomenology and
existentialism value experience, man's capacities for surprise and knowing, and honor the
evolving of the "new."

Phenomologists proposed that human beings, the world, and experiences of their world as
inseparable. Humanistic nursing theory lends itself to phenomological inquiry rather than
reductionalism, which attempts to remove subjective humanness and strives to involve
detached objectivity. Phenomology is not only a philosophy but is also a method- a method that
can be integrated into a general approach and a way of viewing the world. Nurses who can
relate this method are inclined to cultivate it and make it a part of their everyday approach to
nursing. The phenomological approach is based on descript[tion, intuition, analysis, and
synthesis. In phenomology, a statement’s validity is based on whether or not it describes the
phenomenon accurately. The truth of all the statements resulting from the critical analysis of
each phenomenon described can be verified by examining the phenomenon itself.

Dr. Paterson and Dr. Zderad describe 5 phases to their phenomological study of nursing. The
phases are interwoven and there is a continues flow between, in all the directions and all at
once emanating toward a centre that is nursing. The phases are:

 Preparation of the nurse knower for coming to know

 Nurse knowing the other intuitively
 Nurse knowing the other scientifically
 Nurse complimentarily synthesizing known others
 Succession within nurse from the many to the paradoxical one.

PREPARATION OF THE NURSE KNOWER FOR COMING TO KNOW:

In the first phase, the inquirer tries to open herself up to the unknown and to the possibly
different. She consciously and conscientiously struggles with understanding and identifying
her own “angular view.” Angular view involves the gestalt of the unique person. By identifying
our angular view we are then able to bracket it purposefully so that we do not superimpose it
on the experience we are trying to relate to. When we bracket, it means, we inyentionaly hold
our own thoughts, experiences and beliefs in abeyance. This “holding in abeyance” means
temporarily suspending our ownself so that we can better understand the other’s in his or her
own uniqueness.

Bracketing prepares the inquirer to enter the uncharted world of the other without
expectations and preconceived ideas. It helps one to be open to the authentic, to the true
experience of the other.

NURSE KNOWING THE OTHER INTUITIVELY

Knowing the other intuitively is described by Dr. Paterson and Dr. Zderad as “moving forth and
back between the impressions the nurse becomes aware of in herself and the recollected real
experience of the other.” It can be obtained by being unbiased being with the other. This
process of bracketing versus intuiting is not contradictory. Both are necessary and interwoven
parts of the phenomological process. This shifting back and forth allows for sudden insights on
the nurse’s part, a new overall grasp, which manifests itself in a clearer, or perhaps a new
understanding.

NURSE KNOWING THE OTHER SCIENTIFICALLY

In the next phase, objectivity is needed as the nurse comes to know the other scientifically.
Standing outside the phenomenon the nurse examines it through analysis. She comes to know
it through its parts or elements that are symbolic and known. This phase incorporates the
nurse’s ability to be conscious of herself and that which she has taken in, merged with, and
made part of herself. “This is the time when the nurse mulls over, analysis, sorts out, compares,
contrasts, relates, interprets, gives a name to and categorizes.” (Paterson and Zderad 1976)

Figure: Nurse knowing the other scientifically

NURSE COMPLEMENTARILY SYNTHESIZING KNOWN OTHERS

At this point the nurse personifies what has been described by Dr. Paterson and Dr. Zderad as a
“noetic locus,” a “knowing place”. According to this concept, the greatest gift a human being
can have is the ability to relate to others, to wonder, search and imagine about experience and
to create out of what has become known. Seeing themselves as “knowing places” inspires nurses
to continue to develop and expand their community of world thinkers through their educative
and practical experiences, which then become a part of their angular view. This self expansion,
through the internalization of what others have come to know, dynamically interrelates with
the nurse’s human capacity to be conscious of her own lived experiences. Through this
interrelationship, the subjective and objective world of nursing can be reflected upon by each
nurse, who is aware of and values herself as a “knowing place”.

Dialectic

A new overall grasp

Sudden insights

Synthesizes

Subjective Objective

Noetic Loci

“knowing place”

Figure: Nurses complementarily synthesizing knowing others

SYNTHESIZING WITHIN THE NURSE FROM THE MANY TO THE PARADOXICAL ONE
This is the birth of the new from the existing patterns, themes and categories. It is in this phase
that the nurse “comes up with a conception or abstraction that is inclusive of and beyond the
multiplicities and contradictions” (Paterson and Zderad, 1976) in a process that corrects and
expands her own angular view. This is the pattern of thee dialectic process, which is reflected
throughout Humanistic Nursing Theory. In the dialectic process there is a repetitive patern of
organizing the dissimilar into a higher level. At this higher level, differences are assimilated to
create the new.

The pervasive theme of dialectic assimilation speaks to universal interrelatedness from the
simplest to the most complex level. Human beings, by virtue of their ability to self observe, have
the unique capacity to transcend themselves and reflect on their relationship to the universe.
This dialectic process has a pattern similar to that of the call-and-response paradigm of
Humanistic Nursing Theory. This paradigm speaks to the interactive dialogue between two
different human beings. The nursing interaction is limited in time and space but the
internalization of that experience adds something new to each person’s angular view.

THE CONCEPT OF COMMUNITY

The definition of community presented by Dr. Paterson and Dr. Zderad is: “Two or more
persons struggling together toward a centre”. In any community there is the individual and the
collective known as the “community”. Plato points to the microcosm and the macrocosm and
proposed that one is reflective of the many. Similarly, Humanistic Nursing Theory proposes that
the interaction of one nurse is the reflection of the recurrent pattern of nursing and therefore
worth reflecting upon and valuing. 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. Through openness, sharing, 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.
 APPLICATIONS

PRACTICE: CLINICAL SUPERVISION

The humanistic nursing approach is useful in clinical supervision. In the process of supervision
we try to understand the “call” of the nurses which is usually connected to the “call” of the
patient. For example, the nurse can recognize the patient calling out for support which is
sometimes not recognized by the doctor. The nurse can explore the patient’s perception of
reaching out. For this she can clearly explain the disease process to the patient. In this way she
can explore her experience of hearing this call. As the nurse explores her angular view, she
will be able to identify the areas that are unknown. By bracketing her thoughts and judgments
she can understand patient’s needs and fears. Once the nurse finds the choices to be
humanizing, she began to explore the need for support systems. And so to expand her own
capability of being a “knowing place” and expanding her angular view, she can take the help
from other nurse practitioners.

Paterson and Zderad (1978) describe the process of nursing as “quality caring based on the
concept of community,” which presupposes adequate knowledge and skill. They state that, from
the simplest greeting of a patient to the most advanced resuscitation, nurses act as “imaginative
artists” calling forth the actualities of patients by being open to the unique possibilities in the
situation. This calling forth can be seen as a form of assessment and planning that takes place
with the patient. The “intervention” phase is always occurring because assessment is ongoing;
nonetheless, for purposes of understanding , this phase is similar to the point in which the
envisioned potentials are brought forth and realized. This realization might take the form of an
increased feeling of well-being, more being, comfort or growth. Thus “intervention” is
accomplished by presence. Nurses help patients make choices from within the realities of their
situations by sharing their knowledge and expertise and nurturing a patient’s responsible
choosing. The nurse and the nursed together search for the meaning in the health-illness
situation. Clinical nursing can therefore be seen as comfort promotion by means of a process of
presenting.
In this way the nurse’s experience grow from her experience with the patients. The process
enfolded in Humanistic Nursing Theory is beneficial to the supervisors and self reflective
practitioners in all areas of nursing. Patients call to us both verbally and non-verbally, with all
sorts of health related needs. It is important to hear the calls and know the process that lets us
understand them. In hearing the calls, and searching our own experiences of who we are, our
personal angular view, we may progress as humanistic nurses.

RESEARCH

In an effort to better understand why some patients stayed in the day hospital and others left
prematurely, the nursing staff can conduct a phenomenological study that can investigate
experiences of the patients as they entered and become engaged in treatment in a day hospital
system.

The initial step in the process of preparing the nurses for this study is to expand their angular
view by educating them in the phenomenological; method and the unstructured interview
style. In order to promote the openness of the interviewers to the experience of the patients, we
should use the group nursing meetings. They also help in bracketing our angular views. In
these group meetings, we can raise our consciousness through articulation of our own angular
views. By opening ourselves to one another’s experiences and points of view, we can open
ourselves to the world of other possibilities. The patients experience can be obtained by
interviewing. Once the description of the patients experiences are obtained, the
phenomenological method of reflecting, intuiting, analyzing and synthesizing can be used to
interpret the descriptions.

Let us suppose we find that there were many anxiety producing experiences on the first day in
the day hospital, but very few anxiety reducing experiences that offered the patient comfort
and support. Some patients may leave the study because they find no anxiety producing
experiences at all. Thus, recommendations can be made to pay particular attention to reducing
the anxiety of the patient on the first day. In this way, the corrective measures can be
formulated and outcomes can be tested.
Through this research project the nurses may come to experience increase awareness of the
need to be open to the patient’s expressions of themselves. For example, some of the nurse may
recognize that her initial impression that a patient she was working with is hostile and
withholding had given way to realization that this patient as a result of the negative symptoms
of schizophrenia-was quite empty and was really giving us all that she had to give. In future
interactions with this patient, the nurse was empathic and supportive rather than judgmental
and angry.

POLICY: DEVELOPING A COMMUNITY OF NURSES

Another group experience in which Humanistic Nursing Theory can be utilized is the
formation of a community of nurses who are mutually struggling with changes in their
nursing roles. In the Humanistic Nursing Theory, sharing within the community of nurses
allows each nurse and the community to become more. The call and challenge being posed to
nurses is to help to create the needed changes in the health care system today. For while the
importance of organized nursing power cannot be overemphasized, it is the individual nurse in
her day to day practice who can actualize or undermine the power of the profession. As a
group we should strive to acknowledge and support one another as individuals of worth so that
we in turn could maximize our influence as a profession.

In settings, such as hospitals, the time pressure, the unending tasks, the emotional strain, and
the conflicts do not allow the nurses to relate, reflect, and support one another in their struggle
towards a centre that is nursing. This isolation does not allow for the development of either a
personal or professional voice. Within our community of nursing one thing has been made
clear that developing individual voices is our first task. Talking and listening to one another
about our nursing worlds allowed us to become more articulate and clear about function and
value as nurses. Group members can offer alternative approaches to various situations that can
be utilized and subsequently brought back to the group. In this way, each member can share
the experience. That experience can therefore become available to all as they individually
formulate their own knowledge base and expanded their angular view.
Through openness and sharing we become able to differentiate our strengths. Through this
reflection, members become internalized and then can project a competent image of
themselves. They can reflect back to each other the image of competence and power. They, as a
community of nurses can empower each other. We as nurse must strive to do this with our
patients and also for one another and the profession of nursing.

J Adv Nurs. 2012 Feb;68(2):471-9. doi: 10.1111/j.1365-2648.2011.05770.x. Epub 2011 Jul 20.

Humanistic Nursing Theory: application to

hospice and palliative care.
Wu HL, Volker DL.

Source

Hung-Lan Wu PhD RN Associate Professor Nursing Department, Meiho University Neipu,

Pingtung, Taiwan Deborah L. Volker PhD RN AOCN Associate Professor School of Nursing,
The University of Texas at Austin Texas, USA.

Abstract

wu h.-l. & Humanistic Nursing Theory: application to volker d.l. (2012) hospice and palliative
care. Journal of Advanced Nursing 68(2), 471-479. This article presents a discussion of the
relevance of ABSTRACT: Aim.  Humanistic Nursing Theory to hospice and palliative care
nursing. Background. The World Health Organization has characterized the need for expert,
palliative and end-of-life care as a top priority for global health care. The specialty of hospice
and palliative care nursing embraces a humanistic caring and holistic approach to patient care.
As this resonates with Paterson and Zderad's Humanistic Nursing Theory, an understanding of
hospice nurses' experiences can be investigated by application of relevant constructs in the
theory. Data This article is based on Paterson and Zderad's publications and other sources.
theoretical and research articles and books focused on Humanistic Nursing Theory (1976-2009),
and data from a phenomenological study of the lived experience of Theoretical concepts 
Taiwanese hospice nurses conducted in 2007. Discussion. relevant to hospice and palliative
nursing included moreness-choice, call-and-response, intersubjective transaction, uniqueness-
otherness, being and The philosophical perspectives doing and community. Implications for
nursing. of Humanistic Nursing Theory are relevant to the practice of hospice and palliative care
nursing. By 'being with and doing with', hospice and palliative nurses can work with patients to
achieve their final goals in the last phase of Use of core concepts from Humanistic Nursing
Theory can life. Conclusion. provide a unifying language for planning care and describing
interventions. Future research efforts in hospice and palliative nursing should define and evaluate
these concepts for efficacy in practice settings.

© 2011 Blackwell Publishing Ltd.

PMID:
21771046
[PubMed - in process]
ARTICLE

Paterson and Zderad's humanistic nursing theory is discussed in this slim, yet thorough,
volume. Within the framework of the theory, nursing is viewed as an authentic dialogue
involving meeting, relating, and presencing in a world of people, things, time, and space. These
concepts are explained in detail by the author who also delineates the existential foundations of
humanistic nursing. The concepts of presence and dialogue are presented, as are the origins of
the humanistic nursing theory, the underlying assumptions, propositions of the conceptual
model, and examples for application to practice and research. This interesting book also
includes a bibliography of classic works, critiques, and a glossary of important terms. An
informative and comprehensive volume, Paterson and Zderad will be invaluable to nursing
students and nursing professionals in the allied health fields. "A concise and well-organized
resource, with background information that familiarizes the reader with theorists Paterson and
Zderad. The intellectual undergraduate student, graduate students, and faculty interested in a
concise reference would benefit from this resource." --Choice "The text is informative and
encapsulates a vast amount of detail about this particular nursing perspective. . . . The text has
been well-referenced using the Harvard system to provide evidence for points made in the text
and to enable the reader to access the academic sources of information for further reflection
and study. . . the text is primarily designed for nurses studying at degree level and the
information contained in this small book may prove to be invaluable to them." --Journal of
Advanced Nursing.

REFERENCES

 Nancy O’ Connor. Paterson and Zderad. Humanistic nursing theory.1993,Edition 1st.

SAGE Publications. New Delhi. Pp.3-43.
 Marilyn E. Parker. Nursing Theories and Nursing Practice.2007, Edition 2nd Jaypee
Brothers Medical Publishers. New Delhi. Pp. 126-137.
 www.humanistic-nursing.com
 http://www.ncbi.n/m.nih.gov/pubmed/21771046
 http://www.gutenberg.org/files/25020/25020-8txt
 Paterson, J.G. (1977). Living until death, my perspective. Paper presented at the Syracuse
Veteran’s Administration Hospital, New York.
