R E V I TA L I Z I N G the Humanistic Imperative

in Nursing Education

A
SUSAN KLEIMAN

LL STUDENTS, ON mentals, medical-surgical, psychiatric- medication dosages, and demonstrate

THEIR FIRST DAY OF mental health nursing, anatomy and skills such as taking blood pressure, giv-
CLASS IN NURSING physiology, microbiology, pharmacology, ing injections, doing sterile dressings,
SCHOOL, are introduced to the maxim and courses specifically designed to teach suctioning, and catheterization. Supple-
that nursing is a service profession critical thinking skills. In these courses, mentary are lessons in interpersonal and
responsible to society to provide compe- the emphasis is on illnesses, systems, communications skills intended, in large
tent, skilled, and humane care. This organs, and pathology. Learning objec- part, to enable students to collect health
maxim is echoed in nurse practice acts, tives center around specified sets of histories and obtain physical examina-
codes of ethics, social policy statements, interventions that have been tried in the tion data that they will analyze according
and standards of practice, all of which past with varying degrees of success or to the nursing process in order to for-
focus on nurses’ obligations to provide failure. • For the most part, although mulate a care plan. The content of these
competent patient care and attend to not entirely, the learning activities of lessons and the myriad details learned
patients’ human responses to health care these courses are fact and skill oriented. from them can be characterized as sci-
needs. From this starting point, nursing Students are required to learn parameters entific knowledge, that is, knowledge
curricula evolve around a technically of normal values, identify and describe that can be demonstrated, taught, and
focused set of courses, including funda- signs and symptoms, calculate or verify consequently learned.
Photograph by Carol Toussie Weingarten, PhD, RN

• Where does the NURSING STUDENT LEARN the human-centered aspects

of patient care? How does the nursing student learn to provide the necessary response
to the health-related needs of the PATIENT IN A HUMANISTIC MANNER ?
ABSTRACT This article describes a teaching strategy that focuses students’ attention on the humanistic imperative in nursing practice.The Humanis-

tic Teaching Method provides a framework for adapting nursing courses to accommodate person-to-person, human-centered nursing care alongside sci-
entific and technological competencies. Through this approach, students integrate concepts such as humanism, existentialism, and phenomenology into
patient interactions. In addition to producing a favorable effect on patients and colleagues, this approach contributes to personal gratification in making a
difference in the lives of others. Pedagogical strategies currently in use may need to be modified to accommodate the humanistic conceptual framework.

July / August 2007 Vol. 2 8 N o . 4 209

 HUMANISTIC TEACHING

The Humanistic Teaching Model Responding to the imbal- standing of the meanings and values embedded in those experi-
ance that exists between the scientific/technological and human- ences (1-6). The Table provides a succinct definition of these
istic imperatives in nursing education and practice, the author concepts and how they can be used for applications in nursing.
formulated and tested the Humanistic Teaching Model at a large The Humanistic Teaching Model engenders possibilities for
university in New York City. This involved reconceptualizing enhancing students’ ability to absorb and learn course-specific
several core nursing courses within the humanistic teaching content. It consists of basic constituents as follows:
framework, including Foundations, Nursing as a Human Science, • A primary relationship or connection between student and
and Psychiatric Mental Health, both in the classroom and in clin- teacher is established that evolves through intersubjective
ical settings. Students were generic undergraduate students, exchanges.
graduate students, and registered nurses studying for their bac- • The teacher assumes an attitude of dialogic openness and is
calaureate degrees. ready to listen, ready to engage.
Each course adhered to the Humanistic Teaching Model • The teacher and student engage in a dialectic journey of dis-
despite differences in theoretical and clinical content. Based on covery.
the academic level and characteristics of the students, there were • To discover and illuminate values and meanings central to
also differences in depth and content of topical materials. each person’s life world, the emphasis is on the individual’s
Notwithstanding these differences, all classes responded in the modes of being in the world with others. Dialogue is cultivated
same way to this new teaching method. between teacher and student, student and student, and potentially
student and patient and communities of students and teacher.
Teaching Within the Basic Structure of the Model The • Commonalities and differences of the participants are equally
Humanistic Teaching Model is organized under the constructs of celebrated as means of mutual support and growth.
humanism, existentialism, and phenomenology. The tenets of
humanism illuminate the value of the individual and the respon- Phenomenological Reflection on Experience From the ini-
sibility that human beings have toward one another. Those indi- tial class, students are introduced to the idea of phenomenologi-
viduals who choose to become nurses fulfill that responsibility cal reflection on experience as a way of coming to know and
through their professional interactions with patients. understand the nature of their nursing. Reflections are made
The Humanistic Teaching Model integrates humanism with an within the context of the conceptual framework of humanistic
existential understanding of the patient’s and nurse’s “lived-in- teaching and are referred to and reinforced in subsequent dis-
world” experiences and the meanings that they ascribe to their cussions. In this way, theory is seamlessly integrated first into the
experiences. Phenomenological interpretation facilitates reflec- learning process and subsequently into nursing practice.
tion by nurses on everyday experiences and leads to an under- This is distinct from reflection as looking back on or reviewing

Table. Concepts of Humanistic Teaching

HUMANISM EXISTENTIALISM PHENOMENOLOGY
CONCEPT

Definition Humanism is concerned with contributing Nurses take a stand toward, and accept Phenomenology provides a way to discover
to the dignity, happiness, and well-being of responsibility for, their situations as well as and illuminate the very nature of the nursing
persons with whom we interact. the choices they make relative to being in experience and to bring forth the values and
the world and participating in projects with meanings central to those experiences.
others.

Application to Nurses express this responsibility and con- Existentialism is characterized by compe- Reflecting on everyday experiences helps

Nursing cern for the individual’s worth and dignity tently intervening for patients or serving as nurses to recognize, define, and grow from
through interactions with persons who have their advocate. Pertains essentially to an that which gives value and meaning to their
health care needs. As members of the nurs- authentic valuing that emphasizes the exis- practice. Through the articulation process,
ing profession, these responsibilities are pre- tence of the other as a unique person, not there is clarification and an increased ability
scribed. the “what” (disease or condition) with to express themselves, thereby adding to the
which a person is occupied. collective voice of the nursing profession.

2 1 0 Nursing Education Perspectives

 HUMANISTIC TEACHING

what was done in a particular situation in order to improve nurs- making choices, and taking responsibility for those choices.
ing quality or productivity. Using phenomenological reflection on Interwoven into their arguments, students present their own val-
experience, all students become researchers with the ability to ues and beliefs.
examine their own nursing throughout their careers. Graduate as Through such analysis and discussion, students explore the
well as undergraduate students are often quite surprised and theoretical and practical aspects of issues that arise during nurs-
pleased when they learn that they are doing research. ing occasions, and lessons come alive. The process allows stu-
How does phenomenological reflection differ from reflection dents to become astute at defining and describing issues from
as a generic concept? Phenomenological reflection is a mode of both theoretical and practical standpoints. Engaging in this
inquiry, a search for the essential nature of phenomena (5,7,8). It process complements a research orientation. That is, a research
is directed toward knowing the self as a way to know others. question is formulated with theoretical and empirical components
There are many styles of reflection, or journaling, that exhibit as well as guidelines for the application of observations or data as
a broad range of features. Johns’s (9) model of reflective prac- evidence in the elucidation of a particular phenomenon. By shar-
tice, for example, has been used in evaluation and supervision. ing their own experiences with the class, students become aware
And Manthey (10) describes a two-part process: 1) students of the unpredictability of, and many possibilities for, differing
enter nursing activities in a reflective journal, log, or diary, a human responses to nursing situations. Students are encouraged
common practice among nursing students, and 2) they reflect on to integrate and expand the ideas discovered in such lessons
these nursing activities to become more effective and efficient while engaging in interactions and relationships with patients and
as students or practitioners at the patient’s bedside. Lauterbach health care professionals.
and Hentz offer a more elaborate conceptualization (11). They
use reflection as a process and activity in developing the nurse Integrating the Humanistic Teaching Method into Curricula
as person. The following plan was used by the author to integrate the
While the Lauterbach and Hentz concept approaches the Humanistic Teaching Method into nursing school curricula. It is
method used in the Humanistic Teaching Model, it has limita- offered as a guide, with the understanding that it must be tailored
tions. First, it does not present a precisely defined theoretical or to each course, level of students, and the general philosophy of a
conceptual framework (12), and second, it does not enable nurs- nursing department or school.
ing students to become researchers in their own right. The purpose is to introduce students to concepts embedded in
One of the most important duties of a teacher is to give stu- their experiences that will help them gain insight into human
dents the wherewithal to examine their own nursing experiences responses to health care issues and instill in them curiosity and a
in order to derive the values and meanings central to their per- desire to enrich their acquired experiential wisdom. Each lesson
sonal identities. With humanistic teaching, each class is a mini- introduces, defines, and describes certain points of emphasis,
research adventure for students and teacher. Each uses the elucidating terms such as humanism, existentialism, phenome-
experience of the class or clinic as a possibility for phenomeno- nology, pathic relationship, culture, ethics, communications,
logical reflection and personal growth. group dynamics, critical thinking, and conflict resolution. These
The following is an example of a reflective exercise with ethi- are either the primary topics in fundamentals or introductory
cal dimensions that have been integrated into the nursing pro- courses, or they are embedded in topical courses such as pedi-
gram. The exercise is introduced through a nurse’s story of a 10- atrics, psychiatric-mental health, and emergency care. These
year-old child who is dying of cancer. “The child expresses a desire points of emphasis are closely interrelated, so that, while high-
to die rather than to go through the pain of more therapies that will only lighting a particular point or points in the context of a nursing
prolong his life for a brief period.The child asks the nurse to stand in for occasion, other relevant aspects of nursing are always more or
him and to advocate on his behalf with the institution and his parents. less present.
Both the institution and the parents oppose this choice for different rea- Pertinent articles selected from the scholarly nursing litera-
sons.The nurse elects to advocate for the boy and describes the interac- ture are used to support the focal points of each lesson. The arti-
tions that take place” (13). cles selected present examples of actual practice situations that
Presented with this multifaceted dilemma, students, as illustrate the issue or issues being discussed in the current les-
expected, respond in various ways, explaining their responses on son. The articles are discussed in open sessions where students
the basis of the existential priorities of standing in for patients, relate experiences from situations in which they engaged with

July / August 2007 Vol. 2 8 N o . 4 211

 HUMANISTIC TEACHING

patients, students, teachers, and others. good job. The patient also murmured, “nice touch.” I experienced a great
Students bring into these discussions their values, their per- feeling because I put into practice the lesson I learned of seeing patients as
ceptions of the situation, and theoretical interpretations that may humans and not as work objects. I will always keep in mind that the pathic
agree or conflict with those of the subjects in the case study — relationship is always unique.
patients, families, or institutions. All students tend to color the ON EXISTENTIAL CONCEPTS OF “BEING THERE” AND
situation a little differently by virtue of their own backgrounds “BEING WITH” Sometimes touching patients on the arm or holding
and acquired experiential wisdom. Students are also required to their hand in response to their call for nursing care reassures them in
place the situation in the context of professional practice, paying times of fear and uncertainty. I became aware of this as I reflected on an
particular attention to nurses’ social policy statements, codes of experience with a patient who was mentally retarded. I touched him on
ethics, patients’ bills of rights, and professional and legal stan- his head while he was having an emotional disturbance and it calmed him
dards. As a follow-up to the material presented and discussed in down. His calmness in response to my touch gave me the experience of
class, students are then required to write self-reflections on their feeling myself as another human being reaching out to my patient and it
interactions with patients, some of which they voluntarily share in made me feel very good about the gesture. I intend to use touch as a
open class presentations. These self-reflections are not graded. means of connecting with my patients in order to foster the kind of rela-
tionship I want in my nursing activities.
Outcomes of This Approach to Teaching, Expected and ON HUMANISM AND TECHNOLOGY I believe technological
Observed It is expected that students will learn from these advancement has played a major role in dehumanizing nursing care. Most
methods both theoretical and practical aspects of a human-cen- times I feel like a mechanical toy instead of a warm, caregiving being. I once
tered approach to patient care. They will demonstrate an under- worked a 12-hour shift with a post-op patient and at the end of the tour
standing and be able to include the concepts of humanism, exis- I could not recognize her. I was consumed the whole time with ensuring
tentialism, and phenomenology in their way of thinking about that all the four machines that were connected to her were functioning,
nursing. It is expected that students will integrate a humanistic and so I was taking care of machines and a name without a face. I think
approach into patient interactions and report that this approach that my nursing care function is being stretched to a level where you can-
produced a favorable effect on patients and colleagues, and con- not see the patient, only the computer screen and all the red and green
tributed to personal, self-actualized gratification in making a dif- lights around him. The sound that beckons is not the scared voice of old
ference in the lives of others. Mr. John Doe but the alarm on the machine that demands my attention.
Excerpts from students’ writings give testimony to what they Many of us are disillusioned because direct patient care is limited and our
learned from studying within a humanistic teaching framework role as caregivers is delegated to extensions of ourselves in the form of
and the possibilities that the Humanistic Teaching Method pre- nursing attendants, assistants, or technicians.
sent for enhancing high quality patient care and personal and I N T E G R AT I N G HUMANISTIC CONCEPTS INTO PAT I E N T
professional growth and satisfaction. CARE The young couple came in with their four-months-old baby boy.
ON THE PATHIC RELATIONSHIP Three days ago I had a learning He was born with Down syndrome. My instructor needed to explain to
experience at the hospital where I work as a lab technician. I was assigned them the outcome of their tests. They were here for counseling and also
to work in the intensive care unit (ICU) to perform all the blood cultures for the baby’s general check-up.The young parents looked anxious. Their
for that unit. My everyday routine allows me a very short time to com- baby sensed it and was getting uneasy.This was my first encounter with a
plete my duties. I go to the room, introduce myself, check the patient’s baby with this syndrome. Of course, I was curious and eager to apply my
identification, look for a good vein from where to take the blood, and run knowledge and perform all the routine tests to evaluate and grade his defi-
to the next patient. However, on Thursday, one day after taking the ciency and normal development. Yet the mother’s eyes were desperately
Humanistic Nursing class, I felt different. asking for a momentary relief.They were speaking from her heart. In that
When I entered the ICU to perform my job, I thought that I had to moment I read from a human- to-human approach, “Please, he is my first
spend an extra minute to practice what I was trained to do in class. I son, not a guinea pig.” I empathically looked at her. I could see her pain,
entered the room of my first patient, introduced myself, checked the her anger, her frustration. I extended my arms toward her and offered to
patient’s identification, and looked at her face. I noticed that the patient had hold her son while she and her husband talked with the doctor.
an expression of discomfort. I approached her bed, rubbed her hand, and I held that baby like my own. I spoke to that child with tender love. He
told her that I would try my best not to hurt her. This patient could not and I became buddies right away.We had connected. I wasn’t performing a
talk to me because she had a tracheotomy, but she made a circle with her physical exam. I was healing an unseen pain. I was not rejecting or preju-
thumb and index finger and shook her hand as an indication that I did a dicing this child. I was there just to hold and alleviate the anxiety of a

2 1 2 Nursing Education Perspectives

 HUMANISTIC TEACHING

whole family. Or maybe, I was just treating my own anxiety.That day I felt feed but no one took the time to teach her the proper way. Maybe she
beautiful. I had made contact. I had healed. I had not cured. was not doing it correctly.
O N P H E N O M E N O L O G I C A L R E F L E C T I O N A S A WAY O F This situation also brought tears to my eyes as she thanked me over and
VALUING NURSING EXPERIENCES Many positive changes have over again.This experience gave me a sense of self-fulfillment, and made me
started in my life in conjunction with phenomenological inquiry. I am feel that my job as a nurse once again was accomplished. I have provided
learning. I am growing. I have started applying the reflection techniques in someone with an experience that she so dearly desired, leading her to her
my daily practices. I have gained awareness of the effect of my reactions on own level of self-worth.This goes to show that a little patience can lead to
my son primarily and on other people. self-fulfillment for oneself as well as for the others involved.
ON SELF-ACTUALIZATION As a nurse I encounter many different
situations that leave me with what I consider learning experiences. These Conclusion The Humanistic Teaching Method presents possi-
encounters have turned out to be beneficial for me as well as beneficial bilities for valuing nursing and the nursing profession and
for my patients. I am happy to have gone through these experiences enhances opportunities for giving high quality care. Self-actu-
because later on in life, I can look back on them and smile. alization occurs in response to participation in classes grounded
A few months ago I had a patient who was in labor. She was in the in this method. The outcomes support the premise that integrat-
process of having her second child. Although in pain, this woman was very ing theory and practice is not only possible, but also practical
appreciative of the care she was receiving. After hours of laboring, she and beneficial for students at all levels. Students, through the
finally delivered a beautiful, healthy baby girl. As part of labor and delivery integration process, are able to understand sophisticated con-
nursing, we encourage the mothers to immediately start bonding with cepts and theories, include them in their practices, and are
their infants as well as the immediate initiation of breast-feeding. gratified in coming to those understandings. The Humanistic
I quickly suggested to her that she start to breast-feed.To my surprise, Teaching Method can be used as a template for teachers of all
her whole facial expression changed to one of sadness, and she declined. levels of students in various courses to help create a balance
I questioned her response, and she told me that with her first child she between scientific and technical aspects of nursing and the
attempted to breast-feed and was disappointed that it didn't work. She ever-important human-centered aspects, which illuminate the
strongly believed in breast-feeding but her child didn’t like it. primordial nature of nursing.
I felt for this woman, and could see in her eyes how important this was
to her. I felt that I had to do something, so I suggested that we try it again. About the Author Susan Kleiman, PhD, RN, is a an assistant
I explained to her the benefits of breast-feeding and talked about breast professor in the Department of Nursing, Lehman College, City Uni-
and nipple care. I reviewed with her techniques of breast-feeding, and han- versity of New York, Bronx, New York. For more information, con-
dling of the baby while breast-feeding. After cleaning the nipple and tact Dr. Kleiman at [email protected] or
putting the infant to the breast, the baby quickly latched on. [email protected].
This woman instantly began to cry. Her husband was standing at the
bedside and he had tears in his eyes as well. I was confused, but she quickly Key Words Humanism – Existentialism – Phenomenology – Humanistic
explained that they were tears of joy. She had always wanted to breast- Teaching

References search for meaning. Nurse Researcher, 11(4), 7-19. Advanced Nursing, 27, 1269-1277.
1. Heidegger, M. (1962). Being and time (J. Staum- 6. Kleiman, S. (2005). Discourse on humanism in 10. Manthey, M. (2001). Reflective practice. Creative
baugh,Trans.). New York: Harper Rowe. (Original nursing. International Journal for Human Caring, 9(1), Nursing, 7(2), 3-5.
work published 1927) 9-15. 11. Lauterbach, S. S., & Hentz, P. B. (2005). Journaling
2. Paterson, J., & Zderad, L. (1976). Humanistic nurs- 7. Giorgi, A. (1997).The theory, practice, and evalua- to learn: A strategy in nursing education for devel-
ing. New York: John Wiley & Sons. tion of the phenomenological method as a qualita- oping the nurse as person and person as nurse.
3. Sartre, J.-P. (1946). Existentialism is a humanism. tive research procedure. Journal of Phenomenological International Journal for Human Caring, 9(1), 29-35.
[Lecture]. [Online]. Available: www.marxists.org Psychology, 28(2), 235-261. 12. Schutz, A. (1970). On phenomenology and social
/reference/archive/sartre/works/exist/sartre.htm. 8. Merleau-Ponty, M. (1962) Phenomenology of per- relations: Selected writings. Chicago: University of
4. Giorgi, A. (2005).The phenomenological move- ception (C. Smith,Trans). London: Routledge & Chicago Press.
ment and research in the human sciences. Nursing Kegan Paul. (Original work published 1945) 13.Woods, M. (1999). A nursing ethic:The moral
Science Quarterly, 18(1), 75-82. 9. Johns, C. (1996).Visualizing and realizing caring in voice of experienced nurses. Nursing Ethics, 6(5),
5. Kleiman, S. (2004). Phenomenology:To wonder and practice through guided reflection. Journal of 423-433.

July / August 2007 Vol. 2 8 N o . 4 213

Copyright of Nursing Education Perspectives is the property of National League for Nursing and its content
may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express
written permission. However, users may print, download, or email articles for individual use.