Theory: Humanistic Nursing Communication Theory



Theory: Humanistic Nursing Communication Theory[1] [2]

Theorist: Bonnie W. Duldt, Ph.D., R.N.

Phenomenon: Interpersonal Communication Between Nurse & Client, Peers and Colleagues

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|Theory: Humanistic Nursing Communication Theorist: Bonnie Weaver Duldt |

|Phenomenon: Interpersonal Communication between Nurse & Client, Peers, and Colleagues |

|Text: Duldt, B. W., & K. Giffin. (1985). Theoretical Perspectives for Nursing. Boston: Little Brown and Company. |

|Analysis by: Monique Van Essendelft and Suzanne Woolard; edited by B. W. Duldt |

| | | | |

|Assumptions |Concepts |Relationship Statements |Evaluation |

| | | | |

|DERIVED FROM PHILOSOPHY (from humanistic and |1. Human Beings. Man is a living being capable|1. The degree to which one receives humanizing |1. Parsimony. |

|existential thought): |of symbolizing, perceiving the negative, |communication from others, to that degree one | |

| |transcending his environment by his inventions,|will tend to feel recognized and accepted as a |Duldt’s theory is organized into consecutive |

|1. Human beings exist here and now--from which |ordering his environment, striving for |human being. |elements. The elements are devised into |

|there is no escape. |perfection, making choices, and | |subsets so that the assumptions are grouped |

| |self-reflecting. |a. While applying the nursing process, the |with the discipline from which they are |

|2. Human beings are concerned with existential | |degree to which a nurse is able to use |derived. |

|elements: being, becoming, choice, freedom, |Characteristics of humans: |humanizing communication, to that degree will | |

|responsibility, solitude, loneliness, pain, | |the client, peer, or colleague tend to feel |The concepts’ definitions are clear cut and to |

|struggle, tragedy, meaning, dread, uncertainty,|a. Living: able to function biologically and |recognized and accepted as a human being. |the point. The assumptions, concepts and |

|despair, and death. |physiologically as an animalistic, viable | |relationship statements are all interlocking |

| |entity. |b. In a given environment, if a critical life |and relevant. As new concepts are introduced, |

|3. All elements of existential beings are the | |situation develops for a client, to the degree |they have importance in supporting her theory. |

|communication imperative and salient issues to |b. Communicating: able to label things and to |the nurse uses humanizing communication | |

|be dealt with in critical life situations. |talk about them when they are not present. |attitudes and patterns while applying the |The structure of the relationship statements in|

| | |nursing process, to a similar degree will the |conjunction with the models offers a vehicle |

|4. Growth and change arise from within the |c. Negativing: able to talk about |health of the client tend to move in a positive|for statistical analysis and research designs. |

|individual and to a considerable degree depend |the symbolic negative (-1, no, none, not), make|direction. |The relationship statements that she uses are |

|upon |rules (laws regarding the “thou shalt not’s”), | |in the form of correlational, deterministic or |

|one’s choice. |worry about what may not happen, and consider | |probable statements. statements |

| |one’s own non-existence. | | |

| | | | |

|5. The nurse shares with the client all the |d. Inventing: able to be aware of, know, and do|2. To the degree that trust, self disclosure, |2. Scope: |

|characteristics of being human. |things beyond his or her relationship to the |and feedback occur, to that degree humanizing | |

| |environment. |communication or communing also occurs. |Duldt’s theory is a paradigm variation of the |

|DERIVED FROM COMMUNICATION: | | |“I-Thou” theory by Buber, and of the Humanistic|

| |e. Ordering: able to develop categories and |3. In the event one tends to experience |Nursing Theory by Pattern and Zderad. It |

|6. Survival is based on one’s ability to share |hierarchies according to some value or theme; |dehumanizing communication--that is, |differs in the following ways: |

|feelings and facts about the environment and |gives structure and system to one’s |monological rather than dialogical | |

|ways of coping. |environment. |communication, categorical rather than |a. It defines the human being as applicable to |

| | |individualistic, and so on--then one tends to |nursing practice. |

|7. The environment is a “booming, buzzing” |f. Dreaming: able to dream of how things could |move outward (on the model) to the next pattern| |

|world of strange sensations that must be sorted|be if all were perfect; expectations, hopes for|of interaction. |b. It provides easily testable relationship |

|out to determine which are the most important; |the future. | |statements that are clearly stated. |

|this sorting is achieved through communication | |4. In an interpersonal relationship of trust, | |

|with other people. |g. Choosing: able to consider numerous |self-disclosure, and feedback, to the degree |c. It provides a structured body of knowledge |

| |alternatives, implications for the future. |that dehumanizing communication attitudes are |that can be implemented into the educational |

|8. The need to communicate is an innate | |expressed by another, to that degree one tends |cognates of a nursing education program. |

|imperative for human beings. |h. Self-reflecting: able to think about and |to use assertiveness as a pattern of | |

| |talk about self, reflect on one’s own behavior |interaction. |Duldt’s theory is generalized in scope, not to |

|9. Due to innate fallacies, human beings use |and understand self, body, behaviors, etc. | |say that it is simple. It is broad so that it |

|and misuse all capabilities, especially the |Conscious of the existential elements (see |5. To the degree that assertiveness tends not |can cover the area of communication. The |

|ability to communicate. |Assumption #2). |to re-establish trust, self-disclosure, and |specifics in her model speak to the nurse and |

| | |feedback, and to the degree that dehumanizing |some other person (specifically, nurse-client, |

|10. The way in which a person communicates |2. Roles: positions in society. |attitudes are expressed by another, to that |nurse-peer, and nurse-colleagues) and their |

|determines what that person becomes. | |degree one tends to use assertiveness as a |interactions. |

| |a. Nurse: a human being who practices nursing, |pattern of | |

| |intervening through the application of the | | |

| | | | |

|11. Interpersonal communication is a humanizing|nursing process to develop a plan of nursing |of interaction. |The concepts are Operationalized in such a way |

|factor that is an innate element of the nursing|care for a specific client or group of clients.| |as to provide a simplified means of testing and|

|process (assessment, planning, intervention, |The nurse possesses special educational and |6. To the degree that confrontation tends not |measuring abstract ideas. |

|and evaluation) and of the communication that |licensure credentials as required by society. |to re-establish trust, self-disclosure or | |

|occurs between nurses and clients, and nurses | |feedback, and to the degree that dehumanizing |The theorist builds, supports, and expands the |

|and professional colleagues. |b. Client: a human being who is experiencing a |communication attitudes continue to be |concepts on previous works by Kenneth Burke |

| |critical life situation, potential or actual. |expressed by another, to that degree one tends |(1966), Jourard (1971);, Berlo (1960), |

|12. Evaluation of a person’s own communication |He or she has need of the services of the nurse|to use conflict resolution as a pattern of |Patterson and Zderad (1976); Yura and Walsh |

|skills is subjective; each individual must make|and is the focus of the nursing process. The |interaction. |(1973), Kierkegaard (1957), A. Maslow (1954), |

|his own decisions and choices about |client can also be seen to include the support | |Mead (1934), Rogers and Truax (1971), Sartre |

|communication behavior and choose to change, |system of family, friends, and so on. |7. To the degree that conflict tends not to |(1957), Patton and Giffin (1977), and others. |

|depending upon his ability to utilize feedback.| |reestablish trust, self-disclosure, and | |

| |c. Peer: a nurse having equal standing or |feedback, and to the degree that dehumanizing |3. Limitations: This interpersonal |

|DERIVED FROM NURSING: |status to another nurse. |communication attitudes continue to be |communication theory is primarily applicable to|

| | |expressed b another, to that degree one tends |relationships between two or three people, |

|13. The purpose of nursing is to intervene to |d. Colleague: a member of another profession |to terminate the relationship by separation. |i.e., dyads or triads. Thus, it is believed |

|support, to maintain, and to augment the |with whom nurses coordinate and collaborate in | |applicable to the nurse-patient and perhaps a |

|client’s state of health. |the practice of nursing--that is, physicians, |8. To the degree that humanizing communication |family member such as a parent or spouse. It |

| |administrators, and members of health care |attitudes occur in a relationship, in the event|is not applicable to groups, organizations or |

|14. A human being functions as a unique, whole |professions and community service agencies. |of separation, the relationship can be resumed |systems, This limitation is typical of |

|being responding openly to the environment. | |to the same degree of closeness regardless of |existential and symbolic interaction |

| |3. Nursing: the art and science of positive, |the separation. |philosophical perspectives. |

| |humanistic intervention | | |

| |. |9. To the degree to which a nurse uses | |

| |. .. |humanizing communication, to that degree will | |

| | |be nurse receive | |

| | | | |

|SPECIFIC ASSUMPTIONS TO THIS THEORY: |in the changing health status of human beings |humanizing communication from others--clients, |4. Applicability |

| |interacting in the environment of critical |peers, colleagues, and leaders. | |

|15. Health, satisfaction and success in a |life. | |Duldt’s theory provides a perspective of |

|person’s life and work--in other words, that |situations. Its elements are communicating, |10. To the degree that one is aware of one’s |communication which can be useful in all |

|person’s state of being--is derived from |caring, and coaching. |own choice (and motives) about interaction |situations in nursing practice. |

|feeling human. | |patterns, to that degree one is able to develop| |

| |4. Nursing Process: consists of a) assessing |communication skills and habits which tend to |The theory aids the nurse in coping with the |

|16. Due to the bureaucratic and complex nature |and diagnosing, |have predictable results in establishing, |negativity experienced in the practice of |

|of the present health-care delivery systems, |b) planning |maintaining and terminating interpersonal |nursing. |

|there is a tendency for clients and |c) implementing, and |relationships. | |

|professionals to be treated in a dehumanizing |d) evaluating. | |This nursing theory can be utilized in |

|manner and to relate to one another in a | | |conjunction with other nursing theories to |

|dehumanizing manner. |5. Health: one’s state of being, of becoming: | |provide a unique perspective of the |

| |of self-awareness. It is indicative of one’s | |communication dimension of interpersonal |

|17. Humanizing patterns of communication can be|adaptation to the environment. | |interactions. |

|learned and can enhance the nurse’s awareness | | | |

|of a sensitivity to the client’s state of being|6. Environment: One’s time/space/environment | |Duldt’s theory is realistic in that it |

|and of becoming. |context. | |recognizes the dehumanizing aspects of |

| | | |communication with nurses, clients, and others.|

|18. The goal of the humanistic nurse is to |7. Critical Life Situation: a situation in | |Her theory is an “is” rather than a “should be”|

|break the communication cycle of dehumanizing |which there is a perceived thereat to one’s | |theory. It provides the nurse with an option |

|attitudes and interaction patterns, replacing |health state, in which one’s existential state | |for escape from negative patterns of |

|these with attitudes and patterns that |of being is salient, ad in cancer, childbirth, | |communication and the potential to change |

|humanize. |accidents, and so on. | |relationships into humanizing interaction |

| | | |patterns and attitudes. |

| |8. Communication: a dynamic interpersonal | | |

| |process involving continual adaptation and | |While Duldt’s theory is easily understandable |

| | | |for clinical |

| | | | |

|19. Interpersonal communication |adjustments between two or more human beings | |nurses, it is not widely used presently; it is |

|is the means by which the nurse |engaged in face-to-face interactions during | |relatively new and warrants further research |

|becomes ;increasingly sensitive to and aware of|which each person is continually aware of the | |for supportive for data. |

|the client’s state of being, of the dynamic |other(s). | | |

|relationship between the client and his or her |Communication is a process characterized by | |Referring to the GRID (Duldt & Giffin, 1985, p.|

|environment, and of the client’s potential. |being existential in nature, involving an | |231 ), Duldt’s adaptation of the definition of |

| |exchange of meaning, concerning fact and | |human beings in relation to the nursing process|

| |feelings, and involving dialogical communing. | |can be implemented into the curriculum of |

| | | |professional nursing. |

| |Two dimensions of communication are the | | |

| |a) attitude with which one communicates and | |The Manual for using the Nursing Communication |

| |b) skills or patterns of interaction one uses | |Observation Tool (NCOT) has been published |

| |to communicate. | |giving directions for collecting data for |

| | | |education, assessment and research purposes. |

| |Humanizing communication involves an awareness | |The tool is validated by congruence of |

| |of the unique characteristics of being human. | |judgments of trained observers. The tool is |

| | | |based on the well known Interaction Process |

| |Dehumanizing communication ignores the unique | |Analysis by Professor Robert F. Bales of Yale |

| |characteristics of being human. | |University. |

| | | | |

| | | |5. Generalizability and agreement with known |

| | | |data. |

| | | | |

| | | |Duldt’s theory, which fits in the |

| | | |symbolic-interaction model, pulls from |

| | | |disciplines other than |

| | | | |

| |9. Continuum of Attitudes | |nursing and utilizes these |

| | | |concepts to build this theory. Her theory |

| |Humanizing------Dehumanizing | |implies “certain populations, experimental |

| |Dialogue Monologue | |treatment variables, and methods of measuring |

| |Individual Categories | |these variables.” Duldt & Giffin, 1985, pp. |

| |Holistic Parts | |228-230). |

| |Choice Directives | | |

| |Equality Degradation | |Duldt’s theory has potential generally since it|

| |Positive Regard Disregard | |is a new theory and not widely tested, although|

| |Acceptance Judgment | |efforts have recently been instituted. Her |

| |Empathy Tolerance | |theory is congruent with other theorists, yet |

| |Authenticity Role-playing | |differs somewhat. For example, Pilette states |

| |Caring Careless | |that dialogue does not require special |

| |Irreplaceable Expendability | |techniques. Duldt takes the opposite position |

| |Intimacy Isolation | |and states that to maintain dialogue, it is |

| |Coping Helpless | |imperative skills and attitudes in communing, |

| |Power Powerless | |for example, be learned, particularly in the |

| | | |health care professions. |

| |10. Patterns of interactions or skills: | | |

| | | |Carkhuff and Truax theorized that training |

| |a. Communing: Dialogical, intimate | |programs for health care professionals resulted|

| |communication between two or more people; the | |in increased levels of empathy, respect, and |

| |heart of humanistic communication. | |genuineness; these concepts are included in |

| | | |Duldt’s theory. |

| |Listening: is the core of communing and | | |

| |involves making a conscious effort to attend to| | |

| |what another person is saying, particularly to | | |

| |expressions of feelings, meanings, and | | |

| |perceived implications. | | |

| | | | |

| |The central tripod of communing is trust, | |LaMonica identified positive attitudes as |

| |self-disclosure, and feedback. | |determinants of behavior; this is congruent |

| | | |with humanistic nursing. King and Gerwig drew |

| |Trust is one person relying on another, risking| |on humanistic education and psychology of |

| |potential loss in attempting to achieve a goal,| |humanistic nursing education. (Duldt & Giffin,|

| |when the outcome is uncertain; and the | |1985, pp. 235-6). |

| |potential for loss is greater than for gain if | | |

| |the trust is violated. | |Duldt drew from all these theorists’ concepts |

| | | |and supporting data and implemented change in |

| |Self-disclosure is risking rejection in telling| |her theory as warranted and supported by data. |

| |how one feels, thinks, and so on, regarding | | |

| |“here and now” or existential events | |6. Relevant research. |

| | | | |

| |Feedback is describing another’s behavior, | |A number of research studies tend to support |

| |beliefs, and so on, plus giving one’s | |the theoretical statements. These are listed |

| |evaluation or feelings. | |on the following pages. |

| | | | |

| |b. Assertiveness: expressing one’s needs, | |7. Importance to the discipline and profession.|

| |thoughts, feelings or beliefs in a direct, | | |

| |honest, confident manner while being respectful| |The theory defines human beings specific for |

| |of other’s thoughts, feelings or beliefs; | |the scope of nursing, in a wholistic and |

| |“asserting with authenticity.” | |existentialist manner.. It also defines the |

| | | |roles and function of nurses. |

| |c. Confrontation: providing feedback about | | |

| |another plus requesting a change in his or her | | |

| |behavior; “confronting with caring.” | | |

| | | | |

| | | | |

|s |d. Conflict: requires a decision over an issue | |The theory serves as a guide for research in |

| |in which there is risk of loss as well as | |the area of communication in nursing and |

| |possible gain, in which two or more | |potentially in other health care disciplines. |

| |alternatives can be selected, and in which | | |

| |one’s values are involved; “conflicting with | | |

| |dialogue.” | | |

| | | | |

| |e. Separation: occurs at the end of a | | |

| |relationship due to change, choice, or outside | | |

| |commitments; “separation with sadness.” | | |

| |

|Supporting Research |

| |

|Boyd, Betty (1986). Relationship of nursing behavior and trust. (Unpublished master’s research report.) Greenville, N.C.: East Carolina University School of Nursing. |

|Identified some specific behaviors of nurses’ which increased client’s trust in the nurse. |

| |

|Eberhardt, Gary (1987) The relationship of hospice nurses’ behavior and primary care giver behavior. (Master’s research report) |

|Identified some nursing behaviors which promote the development of trust of nurses by hospice care givers. Eberhardt & Duldt, (1988). “Trusting the hospice nurse. American |

|Journal of Hospice Care, 6(6), 29-32. |

| |

|Rodri, Joanne. (1986). Descriptive study of the communication between nurses and clients on electronic fetal monitoring. (Unpublished Master’s research). Greenville, N.C.: |

|East Carolina University School of Nursing. Developed the initial form of the NCOT and used it to obtain descriptive data. |

| |

|Dunn, Ann. (1987). The effect of reminiscence on the degree of humanizing communication of the elderly. (Master’s thesis). Greenville, N.C.: East Carolina University School of|

|Nursing. |

| |

|Perkins, Ann (1986). Communication with patients requiring mechanical ventilation. (Unpublished master’s research). Greenville, N.C.: East Carolina University School of Nursing. |

|Found differences in patients’ and nurses’ perceptions. |

| |

|Longest, Robin. (1986). Analysis of non-communicative behaviors between nurses and patients on mechanical ventilators. (Thesis) Greenville, N.C.: East Carolina |

|University School of Nursing. Descriptive of the reciprocity of interactions occurring between nurses and patients. |

| |

|Jones, Susan. (1985). Job satisfaction and expressed anger. (Unpublished master’s research report). Greenville, N.C.: East Carolina University School of Nursing. |

|Descriptive and supportive of Duldt’s theory of anger (unpublished). |

| |

|Currin, Candice. (1987). Modes of coping with anger in individuals with schizophrenia. (Master’s thesis) Greenville, N.C.: East Carolina University School of Nursing. Compared|

|modes of handling anger in families with and without schizophrenia. |

| |

|Duldt, Bonnie Weaver. (1982). Helping nurses to cope with the anger-dismay syndrome. Nursing Outlook, June, pp. 168-174. |

|Identified the anger dismay syndrome, a complex of communicative behaviors nurses tend to display when receiving destructive angry mode messages from others, especially from perceived |

|superiors. |

References

Berlo, David K. (1960). The process of communication. San Francisco: Rinehart.

Burke, Kenneth. (1968). Language as Symbolic Action. Berkeley: University of California Press, p. 3.

Carkhuff, Robert R. And Traux, Charles. (1965). Training in counseling and psychotherapy: An evaluation of an integrated didactic and experiential approach. Journal of Consulting Psychology, 29, 333-336.

Egan, Gerald. (1970). Encounter: Group process for interpersonal growth. Belmont, Calif.: Brooks/Cole.

Egan, Gerald. (1971). Encounter Groups: Basic readings. Belmont, Calif.: Brooks/Cole.

Giffin, Kim. (1967). The contribution of studies of source credibility to a theory of interpersonal trust in the communication process. Psychological Bulletin, 68: 104-120.

Giffin, Kim, and Bobby R. Patton. (1974) Personal communication in human relations. Columbus, Ohio: Charles E. Merrill.

Jourard, Sidney M. (1971). The transparent self. 2nd ed. New York: Van Nostrand.

Kierkegaard, Soren Aabge. (1957). The concept of dread. Translated with introduction and notes by Walter Lowrie, 2nd. Ed. Princeton: Princeton University Press.

LaMonica, Elaine L. (1979). The nursing process: A humanistic approach. Menlo Park, Calif.: Addison Wesley, p. 456.

Maslow, Abraham H. (1954) Motivation and Personality. New York: Harper and Brothers.

Mead, George H. (1934). Mind, Self, and Society. Edited by Charles W. Morris. Chicago: University of Chicago Press.

Patterson, Josephine G., and Loretta T. Zderad. (1976). Humanistic Nursing. New York: Wiley.

Patton, Bobby g., and Kim Giffin. (1977). Interpersonal communication in action. New York: Harper and Row.

Pilette, Patricia Chehy. (1980). The nurse as a humanistic artist. In: Arlyne B. Saperstein and Margaret A. Frazier: Introduction to nursing practice. Philadelphia: F. A. Davis Company.

Rogers, Carl R., and Truax, Charles B. (1971). The therapeutic conditions antecedent to change: A theoretical view. In: Gerald Egan: Encounter Groups: Basic Readings. Belmont, Calif.: Brooks/Cole Publishing Company, pp. 264-276.

Sartre, Jean-Paul. (1957). Existentialism and Humanism. Translated and with an introduction by Philip Mairet. Brooklyn: Hastings House.

Yura, Helen and Walsh, M. B. (1973). The nursing process: Assessing, planning, implementing, and evaluating. 2nd ed. Norwalk, Conn.: s Appleton-Century-Crofts.

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[1]Duldt, B. W. And K. Giffin. (1985). Theoretical perspectives for nursing. Boston: Little, Brown and Company.

[2]Duldt, B. W. (1991). “I-Thou”: Research supporting humanistic nursing communication theory. Perspectives of psychiatric care, 27(3), 5-12.

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