Often in nursing it is necessary to focus my attention on some aspect of
the patient's body or behavior. The patient may or may not have the same
focus of attention. At least momentarily then, or even for a prolonged
period, I place some aspect of the patient before or opposite myself
(that is, objectify it). And to the extent that this detail absorbs my
attention, I lose my sight of and my relatedness to the whole person who
happens to be the patient. While I know this focusing on details to be a
necessary step in the nursing process, sometimes I find myself abruptly
refocusing my attention on the whole person with almost a twinge of
guilt for having abandoned him. (Patients have described this
uncomfortable intersubjective experience as feeling "looked at" or
"watched" by staff.) At other times, on reflection, I find my attention
was oscillating between the detail and the person, or focusing on both
relating one to the other. From these experiences it is evident that
dialogical presence is complicated in the nursing situation. It is
inhibited when the focus of attention (of one or both participants) is
on the patient's body itself or on his behavior. Yet the body is an
integral part of the person and his behavior is an expression of his
mode of existence or his way of being in the world. Man is an embodied
being, and the nurse, in nurturing the patient's well-being and
more-being, must relate to him and his body in their mysterious
interrelatedness.
Call and Response
The dialogical character of nursing may be explored further by
considering it in the general sense of a call and response. Nursing is a
purposeful call and response, that is, it is related to some particular
kind of help in the domain of health and illness. A patient calls for a
nurse with the expectation of being cared for, of having his need met.
He is asking for something. A nurse responds to a patient for the
purpose of meeting his need, of caring for him. The nurse expects to be
needed.
In reflecting on nursing experiences, it becomes obvious that the call
and response in the nursing dialogue goes both ways for nursing is
transactional. Both patient and nurse call and respond. The pattern of
the dialogue is complex. It continues over time, from moments to years,
in an ongoing sequence that either patient or nurse may begin,
interrupt, resume, or end. For instance, {30} the patient turns on his
call light to ask for something. This is not only a call but also a
response to the nurse's previously stated suggestion that he use the
signal if he needs her help. Or again, a nurse may stop and talk with a
patient during a chance meeting recalling that he previously had
expressed feelings of loneliness, boredom, pain, or joy. Also, other
persons or events may interrupt or end a nursing dialogue. For instance,
the nurse is called away to help in another situation, the patient is
discharged on the nurse's day off, the patient expires.
Public-domain text, read in full here on John Shaqi.
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