we consider that Nursing is a millenary practice, the development of its theories
is very recent, when nurses started to question and discuss the traditional
basis of nursing practice.
From then on, concern
in organizing knowledge in theoretical and conceptual models emerges. In the
1960s this concern considerably strengthens and nursing seeks for defining itself
as a profession, with its practice rooted at its own theoretical basis. At that
time, one started the development of nursing knowledge, that is, the development
of its theories.
The definitions of theory
varied according to some authors, but they are in general articulated descriptions
of phenomena that are used to guide nursing practice and research.1,2,3 Nursing theory is a concept
of some aspects of reality in order to describe and explain the relations between
the phenomena, foresee consequences or prescrib nursing care.3
develop concepts that, once articulated, form a general structure of the theory
and explain the phenomena. The concept is something conceived in the mind, a
thought or an action. This represents the reality and facilitates our capacity
to communicate with it.
Nursing is formed by
four basic concepts or meta-paradigms: person, health, environment and nursing.
These concepts vary according to the context to which the theorist is linked
and are used in almost all theories.
concepts can be presented in different ways, for they represent an abstraction
of reality. A person, therefore, is the one who receives nursing care, which
can be an individual, a family, a community or all mankind. Nursing is the science
and the art of discipline; health means well being, involving both nurse and
client; and the environment can represent the place where the service is delivered,
a community or the universe.1
Theories and their concepts are being
constantly tested and subjected to critical thoughts of other professionals,
being then refused or strengthened in their use.
are many methods of analysis and evaluation of nursing theories. "The analysis
of a theory generally refers to the exam of its contents, whereas its evaluation
refers to the criticism or judgement about the theory".1
order to contribute to this critical thought, and considering that understanding
concepts is of extreme importance when one wants to understand theories, this
work seeks for analyzing the "environment" concept of the humanistic nursing
theory developed by Paterson e Zderad,4
using the Meleis'3
model for the analysis of concepts. We will analyze the context in which the
concept was developed.
The Meleis' model for the
analysis of theories
need to be criticized and analyzed to be improved. Aiming at that, many meta-theorists
developed and recommended models of which criteria may vary from author to author,
but when well defined, and once used, they may contribute to the improvement
of the analysis and criticism of those theories.
objective and critical evaluation of theories is as much complex as a subjective
evaluation and the criteria used in each of these processes are numerous and
distinct. The models of evaluation of nursing theories have had strong influence
of sociology and psychology and even though some are appropriate to the nursing
discipline, many are not and do not reflect neither their nature, nor their
is defined as a process to identifying parts and components of the theory and
exam them in the light of a number of defined criteria. Among those parts and
components we find the concepts, of which analysis is useful to the cycle of
development and evaluation of theories.3
model for the analysis of theories is detailed. In short, it is based on a general
structure that is composed of the analysis of concepts, testing, support, description
and criticism of the theory. Each of these points of the general structure is
analyzed in detail by other aspects, which provides even greater refinement
than what was intended to be evaluated or analyzed.3
definition of concepts is an important phase in the process of investigation
and development of theories. This work requires mental elaboration in order
to express the ideas of the author in a clear, organized way.
also experience variations concerning their definition, but there is commonsense
in the necessity of being structured in a clear, organized way. Some authors
define them as a basic unit of the language of thought. They correspond to one
of the points that compose the structure of analysis, a useful process for the
development of the theory.1
are identified within something continuous, from the empiric to the abstract,
being all, therefore, empiric and abstract.2
Its analysis requires intense intellectual exercise, which shows only a strategy
in the development of a theory.5
the Meleis' model for analysis, the elaboration of a concept consists of a process
of identifying parts and components of the theory and examining them in the
light of a number of defined criteria. In this process one includes the analysis
of concept and the analysis of theory. The analysis of concepts, object of study
of this work, is considered a useful phase in the cycle of development and evaluation
of the theory.3:255
concept shall be analyzed in three ways:3
Semantic analysis, which is the analysis of the linguistic meaning of the classification
given to the concept.
- Analysis of logical
derivation, which consists of the logical progression of identification, support
and classification of the concept.
of the context, which includes the conditions in which the concept is manifested.
Any inference about the concept should be analyzed in its origins, that is,
where they were conceived, identifying whether they are logical or empirically
therefore, the "environment" a meta-paradigm of nursing theories, its definition
is a relevant aspect in all of them. This work seeks for analyzing this concept
in the Paterson and Zderad's4
humanistic theory using the model of analysis proposed by Meleis.3
We will focus specifically on the third aspect that broaches the analysis of
the concept's context including the conditions in which it is presented.
The Paterson e Zderad's Humanistic
humanistic nursing theory emphasizes the relation established between the nurse
and the person who receives nursing care, seeking for answering the phenomenological
situations experienced by both. In this meeting, they are affected in a reciprocal
way and the relation goes much beyond a technical appointment between subject
and object. From this point of view, nursing is defined as an existential experience
between nurse and patient.4
the logical progression of the theory, the meta-paradigms, the concepts and
sub-concepts are defined, which form the structure of the theory when brought
may define the human beings, health and nursing as meta-paradigms in this theory,
and dialogue, community and phenomenological nursing as concepts. The authors
still make use of sub-concepts of dialogue that are: meeting, relationship,
presence, call and reply.
Human beings from
this point of view are considered people capable of making responsible choices
in life; health is understood as a state of becoming, where, even in conditions
of adversity the human being find a meaning to keep living and phenomenological
nursing is defined as a provider of this reply to the client's needs, helping
him in his choices.5
is a "living dialogue", an existential situation experienced between human beings,
a responsible search, a transactional relation, a particular way of human dialogue.4
way, the elements of the humanistic nursing structure can be described as:
individuals (patient and nurse) in a meeting (being and becoming) towards a
goal (nourishing well-being and the becoming) in an inter-subjective transaction
(being with and doing to) occurring in time and space (as measured and lived
by patient and nurse) in a world of individuals and things.4
this interaction, which goes much beyond being physically together, both have
the opportunity to share experiences, driving to inter-subjectivity, to a being
with. For being with, it is necessary to develop the understanding in which
"it is necessary that the active subject does not limit himself to the role
of an observer but that he takes the place of the passive subject and sees the
world and experiences as the latter sees, penetrating into his emotional world".
The nurse can contribute to the client's process
of "becoming" when he also faces the very same process of "becoming". His self-acceptation,
personal awareness and updating potential allow him to interact with the other
and help him to "be more".
This way there
is an actual "meeting" or sharing. This moment broadens the conscience of both
and offers opportunity for human development, providing an increasingly "becoming".
Mutual growth takes place and both, nurse and client, transform.8
The use of this approach requires coherence and authenticity between the thinking
and the making by the professional nurse.9
These attitudes demand from the professional an open posture and availability
concerning the other, which characterizes a genuine presence and actual sharing.4
community for Paterson and Zderad is considered an abstract term that has a
wide range of meanings and is difficult to define. It does not necessarily mean
a physical space, but a place where interaction and inter-subjective interchange
occur. It is the space where two or more people together share efforts, live,
suffer and die.
It is through this social coexistence
in community, through this exchange, that apprenticeship occurs and the human
being finds reasons for his existence. The man, therefore, although unique,
has many aspects that coincide with those of other men.4
nursing is a situation experienced between two human beings.4
It represents a facilitating reply of a person, in the case the nurse and the
other one who needs care. It aims at providing people's well being, which, therefore,
involves it into a human context where both feel the influence of this meeting.
Thoughts on the Environment
in the Paterson and Zderad's Humanistic Theory
the course of the readings on the Paterson and Zderad's humanistic theory, with
which we certainly agree, we noticed that an approach concerning the physical
environment as a provider for a greater or lesser possibility of the "being
with", of the "communion", was missing. This question led us to a thought about
the professional experience in the assistance of people with sexually transmissible
diseases, of those who wish to take the anti-HIV test or who are about to receive
the result of the referred exam.
the assistance of those people, one has always sought for a physical space capable
of providing privacy, secrecy assurance and that was free from any external
interference, since this service involves the discussion about subjects of difficult
approach and about themes generally broached with much prejudice by society.
the publication of works that used the referred theory we also noticed that
the emphasis of the researchers was generally centered much more at the interpersonal
relation between the nurse and the client and the few references concerning
the environment presented it as a place that favored communion and mutual growth.9-10,11
physical environment so became object of analysis during the reading sessions
in search for understanding the meaning of it for the authors and other scholars
who used the referred theory.
We noticed that
the environment concept is not defined, but although it is not clearly expressed,
it is present and fundaments the theory. It is something subjectively conceived,
that transcends and goes much beyond a physical space. This way, that concept
reinforces the idea of existence and phenomenology, which consider the man as
a whole and also as someone singular. "Each man, each family and each community
have been different and the same at least once".4:47
relation of inter-subjective interaction can exist between the nurse and the
client "individually" and in community as well. This is what the authors call
living dialogue, that is, being in common, in group, involved, that independent
of the place where it occurs, it can start a process of growth in all the participants
of that interaction.9-10-11-12-13
those thoughts were reinforced by a recent situation during the delivery of
the result of an anti-HIV exam, when we could experience that moment of communion
and notice that the physical space, despite being extremely important, is not
a determiner for that communion to occur.
the experience of that moment we defended that, for an actual interpersonal
relation to occur, a favorable physical environment is necessary, with no interruption
and the assurance of information privacy. It is also important that the environment
provide an atmosphere that encourages the complement of such a relation.
is clear that we are not underestimating the importance and necessity of a private
physical space, especially in that particular situation, which arouses questions
about a person's intimate life.
a more rational way and free from personal involvement with the question, it
becomes clear that there was confusion between the necessity of entering the
client's intimacy and the communion expressed by the theorists.
therefore, exceeds the level of physical space, for what interests in the situation
reported is the extent of the degree of involvement between the participants
in order to reach that full inter-subjective relation. A private environment
by itself is not a guarantee for that communion to occur.
the communion really occurs, some attitudes by the professional are necessary,
which express his guidelines for life and his belief in man as a being capable
of evolving towards growth. The speech by itself does not assure that the process
takes place. It is necessary the existence of a relation, for it is through
it that men become more, that is, evolve, grow, form the "US". It is being existentially
and genuinely present with the other.4
favorable physical environment by itself does not represent the assurance that
the goals will be achieved. The professional brings with himself prejudicing
values, beliefs and attitudes that may interfere with the assistance. Thus,
practice cannot be isolated from the person who carries it out, for it is that
practice that is involved with the client. The nurse, therefore, actually needs
to identify himself with the theory adopted, assuming a congruent posture with
the theoretical referential to start all this process of "becoming".
the existentialist view, the man has the capacity for self-growth and self-fulfillment.
So that that capacity become reality, favorable environmental conditions are
necessary. He reacts to the environment in accordance with his perceptions.14
If it is threatening, he tends to be in the defensive.
think that this environment shall dispense with any attitude of judgement, evaluation
and restriction by the nurse. He shall create a favorable environment so that
the patient feels fully comfortable.
start to be noticed in the client to the extent that the nurse provides necessary
and sufficient conditions so that both can be in communion and the time for
those changes to take place may vary from person to person.
physical space is not an aspect of much relevance for the theory, considering
that the act of doing in nursing is not restricted to the action of physical
care. It is much more complex. It involves the "becoming", that can occur in
a private or collective environment. The nurse-client relation is fundamental
for that process of development to occur.
environment represents, therefore, the development of a facilitating atmosphere
in which emphasis is on the quality of the meeting. It is necessary that the
professional believe that human beings are capable of developing and going towards
their own personal growth, as well as towards the growth of the others when
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