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Analysis of Context on the Environment Concept in the Paterson and Zderad's Humanistic Theory1

Maria Alix Leite Araújo2, Lorita Marlena Freitag Pagluica3
1
Work presented to the Discipline of Critical Analysis on Nursing Theories of the Nursing Post-Graduation Program of the Ceara Federal University - Ph.D. level. 2Nurse, taking Ph.D. in Nursing at the Ceara Federal University, Professor at the Fortaleza University - UNIFOR. 3Nurse, Ph.D. in Nursing, Titular Professor at the DENF/FFOE/Ceara Federal University

Manuscript received by 15.12.2004
Manuscrito accepted by 27.07.2004

Index de Enfermería [Index Enferm] 2005; 48-49: 42-45 (original version in Spanish, printed issue)

 

 

 

 

 

 

 

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Leite Araújo MA, Freitag Pagluica LM. Analysis of Context on the Environment Concept in the Paterson and Zderad's Humanistic Theory. Index de Enfermería [Index Enferm] (digital edition) 2005; 48-49. In </index-enfermeria/48-49revista/e42-45.php> Consulted

 

 

 

Abstract

Starting from the elaboration of theories, Nursing is defined as a profession and a science. Theories need to be tested and evaluated in order to be either improved or rejected. One aims at analyzing the context of the "environment" concept in the Paterson and Zederad's Humanistic Theory using the Meleis analysis model. This concept is present and bases the theory and is conceived in a subjective, transcendent way. It represents communion, inter-subjective relation, which can occur between the nurse and the client individually, as well as in community. It is a living dialogue, that is, being in common, in group, involved. The physical space is not relevant, considering that the nurse's act is not restricted to the physical care act, but to a becoming, which can take place in either a private or collective environment.
Descriptors: Nursing theory, Evaluation of theories.
 

 

 

 

 

 

 

 

Introduction

     If 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
     Theorists 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.
     These 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.
     There 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
     In 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

     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.
     An 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 objectives.
3
     Analysis 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
     The 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
     The 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.
     Concepts 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
     Concepts 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
     In 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
     The 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.
     - Analysis 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 derived.
3.
     Being, 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's
4 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 Nursing Theory

     The 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
     In 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 together.
1
     One 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
     Nursing is a "living dialogue", an existential situation experienced between human beings, a responsible search, a transactional relation, a particular way of human dialogue.
4
     This way, the elements of the humanistic nursing structure can be described as:
     Incorporating 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
     In 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".
6:61
     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
     The 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
     Phenomenological 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

     In 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.  
     During 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.
     In 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
     The 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
     This 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
     And 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.
     Until 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.
     It 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.
     Analyzing in 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.
     Interaction, 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.
     So 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
     A 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".

Final considerations

     From 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.
     We 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.
     Changes 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.
     The 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.
     The 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 in community.

References

1. George JB. Teorías de enfermería: de los fundamentos a la práctica profesional. 4ª ed. Porto Alegre: Artes Médicas, 2000.
2. Chinn PL, Kramer, MK. Teoría y Enfermería: abordaje sistemático, 2ª ed. St.Louis: C.V.Mosby, 1991.
3. Meleis AL. Desarrollo y Progreso de la teoría de enfermería. 3ª ed. Philadelphia: Lippincont, 1997.
4. Paterson J, Zderad L. Enfermería Humanística. New York: Asociación Nacional de Enfermería, 1988 (publicado originalmente en 1976, Wiley).
5. Wright MGM. Metodología de elaboración de las bases de un marco conceptual: relato de una experiencia. - Seminario Nacional- El Perfil  y la Competitividad del Enfermero. Anais. Brasilia,1987.
6. Scheefer R. Aconsejar Psicológico. 7ª ed. São Paulo: Atlas, 1987.
7. Mondin B. El hombre: ¿quién es él? Elementos de la antropología filosófica. 8ª ed. São Paulo: Paulus, 1980 (Colección Filosofía, 1).
8. Moreira RVO,  Alves MDS,  Farias MCAD. El fenómeno de las Relaciones y la teoría humanística. En: Moreira RVO,  Barreto JAE (Org). La otra margen: filosofía, teorías de enfermería y cuidado humano. Fortaleza: Casa José de Alencar: 200 (Colección Alagadiço Novo).
9. Cardoso  MVLML, Pagliuca LMF.  Camino de la luz: la deficiencia visual y la familia. Fortaleza: FCPC, 1999.
10. Sousa AS, Kantorski LP, Bieleman VLM, Ornellas CP. El ser humano con SIDA y la convivencia en familia. Texto & Contexto Enfermería, Florianópolis 2000: 9 (2pt.1): 186-196.
11. Muñiz MM,Santana MG,Serqueira HCH. El cuidado de la enfermería con el ser humano adulto, joven, portador de enfermedad crónica, la luz de la teoría de enfermería humanística de Paterson y Zderad. Texto & Contexto Enfermería, Florianópolis 2000; 9 (2pt.1):158-168.
12. Silveira IP. Dividir: la enfermería y la humanización del cuidado de enfermería (disertación). Fortaleza: Facultad de Farmacia, Odontología y Enfermería/UFC, 2003.
13. Campos ACS. El significado de ser madre de un recién nacido bajo fototerapia: Un abordaje humanístico (disertación).  Fortaleza: Facultad de Farmacia, Odontología y Enfermería/UFC; 2003.
14. Sceeffer R. Teorías para aconsejar. São Paulo: Atlas, 1986.
 

 

 

 

 

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