Understanding Humanism in Nursing
We can trace the ideas of Humanism to the ancient Greeks by noting the importance that they placed on understanding human inter-relationships especially within the context of social order. Socrates (470-399 BCE), Plato (384-345 BCE), and Aristotle (384-322 BCE) believed that we can glean an understanding of human nature by studying what humans do and the way they inter-act, especially inter-actions that are directed to doing good or evil towards others. The Greeks elaborated on the concepts of free choice and responsibility for one’s actions relative to those “free” choices. Free choice and responsibility are both central to a discussion of Humanism.
More recently Corliss Lamont (1997), a noted scholar of humanism for over 50 years advanced the simple proposition that the chief end of human life is to work for the happiness of humans within the confines of the natural world. The “philosophy of enjoying, developing, and making available to everyone the abundant material, cultural, and spiritual goods of this natural world is profound in its implications, yet easy to understand and congenial to common sense” (p. 38). The American Humanist Association (2002) describes humanism “as a progressive life stance, free of supernaturalism, which affirms our ability and responsibility to lead meaningful, ethical lives that add to the greater good of humanity” (p. 1).
The phrase “free of supernaturalism” has at times been misinterpreted to mean that proponents of Humanism are anti-religious or anti-spiritual. For the reader who wishes to take up this controversial issue of religiosity or spirituality in Humanism, which is beyond the scope of this article, you are referred to two books of the Old Testament, which elucidate Humanist ideals. These are Ecclesiastes, focusing on a theme of enjoying life while one is able, even though all human happiness and achievement are transient, and The Song of Solomon, an allegorical roadmap for finding and giving happiness through human to human relationships in the world.
Although humanism is not unique to nursing, it is a philosophy that is strongly held as a value of the profession (Benner & Wrubel, 1989; Green-Hernandez, 1992; Leininger, 2000; Paterson & Zderad, 1976; Watson, 1988). The human-centered theory of life is easily recognized in the views of the earliest nursing professionals who described nursing as personalized, humanistic care, or a way of caring for the patient as a unique person. (Henderson, 1964; Nightingale, 1946).
Florence Nightingale (1946) claimed that the essence of nursing rested on the nurse’s capacity to provide humane, sensitive care to the sick, which she believed would allow healing. This approach is depicted through the well-known image of the lady with the lamp tending to soldiers in the middle of the night.
In 1948, Hildegard Peplau (1965) introduced her Theory of Interpersonal Relations, which focused on the human connection between nurse and patient. She explained, “It seems to me that interpersonal relation is the core of nursing. Basically, nursing practice always involves a relationship between at least two real people, a nurse and a patient” (p. 18).
Commonly referred to as the “American Florence Nightingale,” and deeply concerned with humanistic values in nursing, Virginia Henderson (1964) characterized her view of modern nursing as embracing “self understanding and a universal sympathy for an understanding of diverse human beings” (p. 67). Henderson noted that the practice of nursing inherently contained the human element, since one human being, whose intentional actions were directed in some manner toward involvement with other humans, performed nursing.
Josephine Paterson and Loretta Zderad were the first to combine the concepts of Humanism with the philosophical and methodological framework of Existentialism
and Phenomenology as a way of examining experiences of the nurse-patient relationship. They portrayed the nurse as being in participation with the patient and brought attention to the inter-subjective experiences of the nurse. The central idea of humanistic nursing, according to Paterson and Zderad, is that of a lived dialogue, which offers a frame of orientation that places the center of the nurse’s universe at the nurse-patient, that is, human-to-human, intersubjective transaction.
Nursing takes place within an economic, social, and technological context that may influence the way nurses practice and the ways they interact with patients. Certain aspects of the health care milieu are not congruent with a humanistic agenda in nursing. Some of these infelicities are:
(1) Managed care as an intermediary between nurse and patient.
(2) High technology in the form of computers, diagnostic equipment and pharmaceutical cures.
(3) Robots as analogs to nurses which are given names! Penelope the scrub nurse!!!
After all is said and done the impact of economic, social or technological issues does not entail a change or modulation in the humanistic values held dear by nurses (Kleiman, 2002). However, nurses and patients are not closed off from the world. Despite today’s myopic vision for the way health care should be delivered there is no evidence that nurses’ views of themselves and society’s view of nurses have changed.
In today’s health care environment the imperative of the humanistic relationship (each person recognizing the other as a subjective human being like themselves)
is sometimes overlooked in deference to technology, like the computer monitor that registers information about a patient’s vital signs but cannot reflect information that is vital and relevant to the patient as a person. The challenge is to integrate technology into the humanistic approach to patient care rather than technology dominating or replacing patient-centered care.
❓ About the Author
Dr. Susan Kleiman is an internationally renowned scholar — the author of the Book of the Year in Nursing Education “Human Centered Nursing: the foundation of quality care” — the founder of the International Institute for Human Centered Caring and the standard-bearer of Humanistic Nursing Theory as formulated, articulated, and handed down by Josephine Paterson and Loretta Zderad.
- Barnard A. (1997). A critical review of the belief that technology is a neutral object and nurses are its master. Journal of Advanced Nursing, 26, pp. 126-131.
- Benner, P. and Wrubel, J. (1989). The primacy of caring. New York: Addison Wesley.
- Doyle, R. (1999). By the numbers: Health care costs. Scientific American, 4, 280.
- Bostock, D.(2000). Aristotle’s Ethics. New York : Oxford University Press.
- Green-Hernandez C.(1992). Being there and caring: a philosophical analysis and theoretical model of professional nurse caring in rural environments In: Rural health nursing: stories of creativity, commitment, and connectedness. (Winstead-Fry P et al) National League for Nursing Publications Publisher: 1992 #21-2408 (pp 31-53) (40 ref).
- Heidegger, M. (1927/1962). Being and time. Translator, Joan Staumbaugh. New York: Harper Rowe.
- Hospital Accreditation Standards of the Joint Commission on the Accreditation of HealthCare Organizations (2002). Sec. RI.1, Sec. RI.1.1. Public Law 336.
- Heller, B. R., Oros, M. T., & Durney-Crowley, J. (2000). The future of nursing education: 10 trends to watch. Nursing and Health Care Perspectives, 21(1),9-13.
- Henderson, V. (1964). The nature of nursing. American Journal of Nursing, 64(8): 62-67.
- Irwin, T.(1995). Plato’s Ethics. New York : Oxford University Press.
- Katz-Rothman, B. (1987). The tentative pregnancy: Prenatal diagnosis and the future of motherhood. New York: Penguin.
- Kleiman, S. (2002). The Lived-experiences of Nurse Practitioner’s Interacting with their Patients. (Doctoral dissertation, Adelphi University, 2002). University Microfilms International UMI Number 3051569.
- Lamont, C. (1997). The philosophy of humanism, 8th Ed. Amherst, NY: Humanist Press
- Leininger, M. (2001). A mini journey into transcultural nursing with its founder. Nebraska Nurse, 34, 2, p. 16-7.
- Nightingale, Florence (1946). Notes on nursing: What it is and what it is not. Philadelphia: J. P. Lippincott.
- Paterson, J. G., & Zderad, L. T. (1976) Humanistic nursing. New York: John Wiley & Sons.
- Peplau, H. E. (1965). The heart of nursing: Interpersonal relations. Canadian Nurse, 61, pp. 273-275.
- VlastosG. , Ed.(1971). The Philosophy of Socrates . San Angelo, Tx: Anchor.
- Vlastos, G., Ed.(1971). Plato: A Collection of Critical Essays. Volume I: Metaphysics and Epistemology. Volume II: Ethics. San Angelo, Tx: Anchor.
- Watson, J. (1988). Nursing: Human Science and Human Care. New York: National League for Nursing.