Humanistic Nursing Theory: application to hospice and palliative care

Categories: Research.

Recently, the World Health Organization has voiced an opinion that, “expert, palliative and end-of-life care are a top priority for global health care” (Wu, Volker, 2011).  According to the researchers of this study, the specialties required of both hospice and palliative care lend themselves well towards adapting a humanistic and holistic model (Wu, Volker, 2011).  This study examines the philosophical viewpoints and approach of Humanistic Nursing Theory (HNT) within the realms of hospice and palliative care.

As opposed to direct medical intervention, hospice and palliative care focus on the comfort of the patient while providing compassionate attentiveness.  Within the interdisciplinary hospice team, nurses play a vital role as they are charged with providing care on a regular basis and interact with patients and families regularly.  The researchers state in their study that, “hospice and palliative care nursing embraces a humanistic caring and holistic approach to patient care.”  The research being discussed explores the usefulness of HNT to hospice and palliative care in the field of nursing (We, Volker, 2011).

Humanistic Nursing Theory

Although the original theory is considerably older, modern humanistic Nursing Theory has continued to develop over the course of thirteen years across three independent studies authored by O’Connor (1992), Kleiman, (2001) and McCamant (2006).  HNT examines in, “the phenomenon of nursing as it is experienced in the everyday world” (Paterson & Zderad, 1976).  HNT follows a step by step approach which reads,

“nurse-patient relationship is characterized by interaction designed to promote well-being and existential growth in the context of the lived world.  The nurse cares for the patient by presence or being with the patient, and other nursing actions or activities” (Wu, Volker, 2011).

HNT examines the relationship of the nurse to the patient and the importance that both are unique individuals, but are working towards the same end goal.  The relationship between the patient and the nurse and the ability to be open and interact are crucial in providing effective humanistic nursing.  Every relationship is different and nurses and patients may differ in opinion on a wide variety of topics ranging from values to expectations.

An additional characteristic of HNT is the idea of the nurse fulfilling a role of availability.  In HNT, it is important for the nurse to be a dependable presence for the patient.   This not only provides the patient with a pillar on which to lean on, but it also encourages positive interactions between the patient and nurse.

The idea of community is highlighted in modern HNT.  The researchers define community in the context of HNT as, “two or more people struggling together toward a shared center”.  Although this community can begin with the patient and the nurse, HNT (if applied properly) should expand to include all other willing parties such as families, friends, colleagues and other medical staff.  The nurse’s role is to encourage and facilitate the growth of the community while simultaneously remaining present for the patient (fulfilling the availability role).

The Role of Self-Reflection in Humanistic Nursing Theory

The researchers continue to define aspects of HNT throughout the study.  Another aspect of HNT is that, “humanistic nursing is experienced in the real world, and it is characterized by existential, nurturing, intersubjective and transactional relationships between nurses and patients and nurses and community”.  Within HNT, nurses are charged with nurturing “human potential”.  Nurses will inevitably share a bond with patients (some stronger than others) which will influence patient care.  Being cared for and providing care makes the nurse/patient relationship an intimate one.  If utilizing effective practice of HNT, nurses will have a need for self-reflection in order to better understand the patient and the patient/nurse relationship.  By re-assessing motivations and goals, nurses can provide more empathetic care and even overcome significant differences that may exist between the patient and themselves.

Humanistic Nursing Theory – Real World Application

There have been numerous studies regarding the application of Humanistic Nursing Theory over the last several decades.  HNT differs from other schools of thought in that it is not as regimented thus, more difficult to document in terms of success and failure.  Some important findings over the years are highlighted below:

•    Advanced breast cancer patients under HNT nurses reported that due to their care experience they experience an increased personal growth, self-worth and changed sense of purpose in life (Coward, 1990).

•    An additional study on women with advanced breast cancer under the care of nurses practicing HNT found a high and positive relationship between self-transcendence and emotional well-being, this served to decrease illness-related distress (Coward, 1991).

•    A study examining patients in the end-stages of life-limiting diseases being treated by nurses utilizing the HNT model reported that patients felt comfortable, valued and less isolated as a result of the care provided by the nurses (Hopkinson & Hallett, 2001).

Defining Characteristics of Humanistic Nursing Theory

After implementing HNT in a wide variety of settings, certain elements of HNT care became evident to researchers and were given more specific definition.  Each will be outlined in the following.

Moreness-choice – When surveyed, many hospice and palliative care nurses utilizing the HNT model expressed their motivations and reasons for practicing in the particular field.  Many nurses expressed the same motivations for working in hospice (alleviate suffering, provide holistic care, etc.).  “Moreness-choice” refers to each individual nurses preferences on how to respond to situations in the field.  Generally, HNT finds that these nurses choose to work in the hospice field as well as a desire for a feeling of “moreness” (helping others) as key components to the success of the HNT model.

Call and response – “Call and Response” is referred to as the relationship between the patient and nurse in the context of the patient asking for care.  It is a very specific situation because (1) the patient is experiencing a form of discomfort or pain, (2) the patient is actively asking for treatment to alleviate said symptoms and (3) the nurse reacts in a context-specific manner by providing quality care to the best of their efforts.

Inter-subjective Transaction – According to the researchers, when care begins, patients and nurses, “hold their own ‘angular’ or unique views through which to experience the world.  The nurse and the patient each experience the transaction (need for care -> providing care) differently.  However, it is outlined in HNT that the two independent individuals (nurse and patient) reach a trusting and supportive relationship so that the nurse may promote “comfort, self-determination and an enhanced sense of dignity” (Wu, Volker, 2011).  This relationship may be strengthened by demonstrating compassion, reliability and establishing a good rapport.

Uniqueness-otherness – The HNT model encourages and focuses on the nurse at the individual level.  Nurses are encouraged to reflect on their own feelings and biases which cause them to face some of their own fears, insecurities and vulnerabilities (Wu, Volker, 2011).   HNT argues that this helps the nurse understand themselves better as care providers, allowing them to be more effectual in patient care situations.

Results and Publication Information

One of the most important results in this study was that it identified Humanistic Nursing Theory as being a valid and useful model for how to better the quality of hospice and palliative care.  The main components of Humanistic Nursing Theory (listed in the previous section) are useful concepts to utilize by those providing hospice and palliative care.

This summary recounted useful information on Wu and Volker’s research.  However, the full and far more comprehensive study provides details on modern Humanistic Nursing Theory and its possible application to the fields of hospice and palliative care which was not included in NHPCO’s summary.  Readers are encouraged to access the study’s full-text to gain additional insight into this topic using the information provided below.

Title: Humanistic Theory: application to hospice and palliative care

Authors:

•    Hung-Lan Wu

•    Deborah L. Volker (dvolker@mail.nur.utexas.edu)

Publication Material: Journal of Advanced Nursing 68(2), 471-479

DOI: 10.1111/j.1365-2648.2011.05770.x

URL: http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2648

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