WPC, u/:̒Vg.ؚDkqib8J0]f Tx*=}5KTZ2LW”+u?<,UEo^n;nѱHOğunuAE?yUowAp;+c$@DVG )F8ӥiLvX'FgQjSSSД//:BuVV={gtzV XXApril19,1996,BonnieWeaverDuldt.C:\writing\telte.wpd.(ConvertedtoWP6.0August21,1999)(3$ !  TABLE B \\R'3 Letter Landscape\ɔ(  \\R'3 Letter Landscape\U((3$ !      0  (#$  0   $    1    _H> XXDuldt,B.W.(1995).Integratingnursingtheoryandethics.PerspectivesinPsychiatricCare,31(2),410. $    2    _H> XXDuldt,B.W.(1994).Cannursinghaveitsowntheoryofethics?GuestEditorial.Perspectivesinpsychiatriccare,30(3),3. d1, 2, 3,Level 1Level 2Level 3Level 4Level 5B?V21, 2, 3,NumbersR1  .R0  TABLE ITABLE JTABLE H !  _8JXXdd8   XXTRP$'3 Letter LandscapeX3' Letter'3 Letter Landscape3'T  Theory: EthicsofHumanizingNursingCommunication  #  1      "P #  2       h ̀ Theorist: BonnieW._Duldt_,Ph.D.,R.N.  8  Phenomenon: Ethicsof_Interpersonal_ԀCommunicationbetweenNurse&Client,Peers,and   Colleagues. <     XJX    `     h      p      x  l _*$ ddd Xdd Xdd X.., dd , dd , dd , dd +    ~XXJAssumptions d &%~DerivedfromExistentialist  p Philosophy  D 1.Humanbeingsexisthereand  nowfromwhichthereisno p  escape. D  2.Humanbeingsareconcerned  <  withexistentialelements:being,    becoming,choice,freedom,    responsibility,solitude, h  loneliness,pain,struggle, <  tragedy,meaning,dread, `  uncertainty,despair,anddeath. 4  3.Allelementsofexistential   beingsandthecommunication ` imperativearesalientissuestobe 4 dealtwithincriticallife X situations. ,     ~%&Concepts d &%~1.HumanBeings: Humansare  p livingbeingscapableof D symbolizing,perceivingthe  negative,transcendingthe  environmentbyinventions, p  orderingtheenvironment, D  strivingforperfection,making  h choices,andengaginginself  < reflection.     CharacteristicsofHumans: h " a.living: abletofunction < # biologicallyandphysiologically ` $ asananimalistic,viableentity. 4 %  b.Communicating: abletolabel  & thingsandtotalkaboutthem  ' whentheyaren'tpresent. `(  c.Negativing: abletotalkabout 4) thesymbolicnegative(1,no, X* none,  ,+  RelationshipStatements  d, 1.Thedegreetowhichone 8- receiveshumanizing  . communicationfromothers,to / thatdegreeonewilltendtofeel d0 recognizedandacceptedasa 8 1 humanbeing.  \2 2.Tothedegreethatonerespects  4 onesownandotherspersonal  5 theoryoftheworld,tothat \ 6 degreeonetendstobehave 0 7 ethically. T 8 3.Tothedegreeonerespectsand  : usesthetraditionalprinciplesof  ; autonomy,beneficence,justice, T < veracity,confidentiality,and (x= fidelityinmakingchoices,tothat L> degreeonetendstomakemoral  ? decisionstoresolveethical @ dilemmas.  xA  ~%&Evaluation dB XJX~&%XXJ1.Parsimony  VD Notveryparsimonious,butmost F statementsaredetailedand  G relativelycomplete,using V H terminologydefinedin * zI contemporaryvernacular.  NJ Thistheoryofethicsisderived  L fromthetheoryofHumanizing z M NursingCommunication,inmost N N casesusingthesame "r O assumptions,concepts,and F P similarrelationshipstatements.  Q Maintainsthesymbolic rS interactionmodelasaworld FT viewsothatallstatementsare jU consistentwithinthismodel. >V Structureofrelationship X statementsareconduciveto jY researchandtesting. >Z   6\ * $ dd dd dd dd dd $.., dd , dd , dd , dd +   4.Growthandchangearisefrom d withintheindividualandtoa 8 considerabledegreedependupon   one'schoice.  Ѐ d  5.Thenurseshareswiththe 8  clientallcharacteristicsofbeing  \ human.  0  SpecificallyRelatedtoEthics     6.Eachpersonassumefull 0  responsibilityforoutcomesof T  choices,forthoughts,feelings (  andactions.   7."Reality"isoutthereandcan T  beknownthroughlife (x experiencesorsituations. L 8.Theindividualconstruesor  interpretstheexperiencesor x situationssothatapersonal L theoryabouttheworldis  p developed. D 9..Apersonaltheoryoftheworld  isdevelopedthroughoutlife p whichdiffersfrom"reality."  D not),makerules(lawsregarding d the thoushaltnots)worry 8 aboutwhatmaynothappenand    consideronesownnon ! existence. d"  d.Inventing: abletobeaware  \$ of,know,anddothingsbeyond  0% hisorherimmediate  & environment,toinventthings,  ' andtochangeone'srelationship \ ( totheenvironment. 0 )  e.Ordering: abletodevelop T * categoriesandhierarchies ( + accordingtosomevalueof  , theme;givesstructureandsystem  - toone'senvironment. T .  f.Dreaming: abletodreamof (x/ howthingscouldbeifallwere L0 perfect;expectations,hopesfor  1 thefuture. 2  g.Choosing: abletoconsider x3 numerousalternativesand L4 implicationsforthefuture.  p5  h.Selfreflecting: abletothink D6 aboutandtalkaboutself,reflect 7 onone'sownbehaviorand 8 understandself,body,behaviors, p9 etc.Consciousof  D: 4.Tothedegreethenurseand d; patientexploresthepatients 8< viewoftheworldandareaware  = ofthenursesownworldtheory, > tothatdegreetheinterpersonal d? communicationwilltendtobe 8 @ ethical.  \A 5.Tothedegreethenurse  C challengesthoseaspectsofthe  D patientspersonaltheoryofthe \ E worldwhichareproducing 0 F problemsforthepatient,tothat T G degreethenurseis ( H communicatingethically.  I 6.Tothedegreethechanges T K occurringintheclientspersonal (xL theoryoftheworldandaccepts LM responsibilityfortheoutcomesof  N onesownactions,tothatdegree O thenursepatientinterpersonal xP communicationistherapeuticand LQ ethical.  pR   U  2.Scope  dV AparadigmvariationofBubers  X  IThou,itoffersanexistential Y frameworkfortheethical dZ analysisofmoralhealthcare 8 [ dilemmas.  \\ Contemporaryapproachinthatit  ^ emphasizestheindividuals  _ responsibilityforonesown \ ` choices,andthe proofor 0 a  justificationofthesechoicesis T b theoutcome. ( c ̀  (xg  TRP$'3 Letter LandscapeP$'3 Letter Landscape'3 Letter Landscape'3 Letter LandscapeT   *$ dd dd dd dd dd $ .., dd , dd , dd , dd +   10.Ethicaljustificationof d choicesisfoundinoutcomesthe 8 waythingsturnoutisthesole   "proof"ofrightorwrong,good   orevil. d 11.Humanbeingsareneither  \ goodorevil,butdevelop  0 "essence"throughthechoices    madeandactionstaken.     Derivedfromcommunication: 0   12.Survivalisbasedonone's (  abilitytosharefeelingsandfacts   abouttheenvironmentand   developstrategiesofcoping. T  13.Theenvironmentisa L "booming,bussing"worldof   strangesensationsthatmustbe  sortedouttodeterminewhichare x themostimportant;thissortingis L achievedthroughcommunication  p withotherpeople. D 14.Theneedtocommunicate   existentialelements. d  2.Roles :positionsinsociety.    a.Nurse: ahumanbeingwho  practicesnursing,intervening d  throughtheapplicationofthe 8 ! nursingprocesstodevelopaplan  \" ofcareforaspecificclientor  0# groupofclients.Thenurse  $ possessesspecialeducationaland  % licensurecredentialsasrequired \ & bysociety. 0 '  b.Client: ahumanbeingwhois T ( experiencingacriticallife ( ) situation,potentialoractual,and  * isinneedoftheservicesofthe  + nurseandisthefocusofthe T , nursingprocess.Theclientcan (x- alsobeseentoincludethe L. supportsystemofthefamily,  / friends,andsoon. 0  c.Peer: anursehavingequal x1 standingorstatustoanother L2 nurse.  p3  d.Colleague: member(s)of D4 anotherprofessionwithwhom 5 nursescoordinateandcollaborate 6 inthepracticeofnursing,i.e., p7 physicians,  D8 7.Tothedegreethenursehelps d9 theclientanalyzelife 8: experiencesanddiscover  ; meaningincritical,ethical < dilemmas,tothatdegreethe d= nursecommunicatesethically. 8 > 8.Tothedegreethenurse  0@ respectstheclientshealthand  A lifedecisionsand seestheclient  B throughtheoutcomesofsuch \ C choices,tothatdegreethenurse 0 D communicatesethically. T E 9.Tothedegreethenursecannot  G agreewiththeclientschoices  H duetothenursesownbeliefs, T I rights,ethicsorothervalid (xJ reasonswhichsetlimitstothe LK scopeofonespractice,AND,  L thenurserevealsthistotheclient M inadialogical,humanizingand xN caringmanner,tothatdegreethe LO nursebehavesinanethical  pP manner,enablingother DQ arrangementstobemadeto R providetheneededcareand S avoidingclientabandonment.  pT  3.Limitations.  dU Resolvingethicaldilemmas  W involvesfocusingonthepresent X situationandhowonefeels,the dY choicesonemakes,withmoral 8 Z justificationlyingintheoutcome.  \[  4.Applicability.  \ _ Potentiallyusefulinallclinical T a areasofnursing.  ( b *$ dd dd dd dd dd $.., dd , dd , dd , dd +   isaninnateimperativeforhuman d beings. 8 15.Duetoinnatefallacies,   humanbeingsuseandmisuseall d capabilities,especiallytheability 8  tocommunicate.  \ 16.Thewayinwhichaperson    communicatesdetermineswhat    thatpersonbecomes. \   17.Interpersonalcommunication T  isahumanizingfactorthatisan (  innateelementofthenursing   processandofthe   communicationthatoccurs T  betweennursesandclients,and (x nursesandprofessional L colleagues.   18.Evaluationofaperson'sown x communicationskillsis L subjective;eachindividualmust  p makehis/herowndecisionsand D choicesaboutcommunication  behavior,choosingtochange,  dependinguponone'sabilityto p utilize  D administrators,ministers,and d othermembersofthehealthcare 8 professionsandcommunity    serviceagencies. !  3.Nursing: theartandscienceof 8 # positive,humanizing  \$ interventionsinthechanging  0% healthstatusofhumanbeings  & interactingintheenvironmentof  ' criticallifesituations.Its Setof \ ( elements : 0 )  a.Communicating,  T * 1)Usingabroadrangeof ( + humanizinganddehumanizing  , attitudesandinteractionpatterns.  - 2) Providesauthenticfeedback. T . 3)Listensactively. (x/  b.Coaching:  L0 1)Useslogic,criticalthinking,  1 andargumentationskillsto 2 approachdilemmasofcriticallife x3 situationsinhealthrelated L4 situations.  p5 2) Providesauthenticfeedback. D6  c.Caring:  7 1)Providespersonalcare  8  EthicsfortheNurses d9 CommunicatorRole:  8: 10.Tothedegreethenurse < communicatesusingaboard d= rangeofhumanizingand 8 > dehumanizingattitudesand  \? interactionpatterns,tothat  0@ degreethenursebehaves  A ethically.  B 11.Tothedegreethenurse 0 D behavesethicallyinproviding T E authenticfeedbacksothatthe ( F clienttendstomovetowarda  G betterhealthstatus,tothatdegree  H thenursetendstomake T I morallycorrectchoices. (xJ 12.Tothedegreethenurse  L engagesinactivelisteningsothat M theclienttendstomovetowarda xN betterhealthstatus,tothatdegree LO thenursetendstomakeethical  pP choices.  DQ  "pm "*$ dd dd dd dd dd $.., dd , dd , dd , dd +   feedback. d  DerivedfromNursing     19.Thepurposeofnursingisto d intervenetosupport,tomaintain, 8  andtoaugmenttheclient'sstate  \ ofhealth.  0 20.Ahumanbeingfunctionsasa    uniquewhole,respondingtothe \   world"reality"asperceived 0  throughone'sownpersonal T  theoryoftheworld. (  21.Health,satisfactionand   successinaperson'slifeand T  workinotherwords,that (x person'sstateofbeingisderived L fromfeelinghuman.   22.Duetothebureaucraticand x complexnatureofthehealthcare L deliveryindustry,thereisa  p tendencyforclientsand D professionalstobetreatedina  dehumanizingmannerandto  relatetooneanotherina p dehumanizingmanner. D   h servicestothoseunabletocare d forthemselves:caring for. 8  2.Conveysaconcernforthe  ! individual:caring about. " 3.Maintainsawarm,positive d# regardforothers. 8 $ 4.Isanactivelistener,tolerantof  \% ambuigity,andpatientinwaiting  0& forchangeandgrowth.  ' 5)Istrustworthy,keepspromises,  ( isloyal,andmaintains \ ) confidentialities. 0 * 6)Maintainsanawarenessand T + sensitivitytotheworkof ( , searchingformeaningincritical  - lifesituations.  .  Moralviewofpersons: (x0  1.Respectsownandother's L1 personaltheoryoftheworld.  2 2.Respectsandoftenuses 3 traditionalethicalprinciplesof x4 autonomy,beneficence,justice, L5 veracity,confidentiality,and  p6 fidelityinmakingchoicesin D7 resolvingethicaldilemmas. 8   p:  EthicsfortheNurses d; CoachingRole  8< 13.Tothedegreethenurse > coachesthepatientusinglogic, d? criticalthinkingand 8 @ argumentationskillstoapproach  \A dilemmasofcriticallife  0B decisionsinhealthrelated  C situations,tothatdegreethe  D nursetendstomakeethical \ E choices. 0 F 14.Tothedegreethenurse ( H behavesethicallyinproviding  I authenticfeedbacksothatthe  J clienttendstomovetowarda T K betterhealthstatus,tothatdegree (xL thenursetendstomake LM morallycorrectchoices.  N  EthicsfortheNursesCaring xP Role  LQ 15.Tothedegreethenurse DS providespersonalcaretothose T unabletocareforthemselves,i.e. U  caringfor,tothatdegreethe pV nursetendstomakeethical DW choices.  hX  5.Generalizabilityand dY AgreementwithKnownData.  8Z Consistentwithexpectationsfor \  outcomesinclinicalcase d] managementandin 8 ^ administrationofhealthcare  \_ agencies.  0`    a *$ dd dd dd dd dd $.., dd , dd , dd , dd +   23.Humanizingpatternsof d communicationcanbelearned 8 andcanenhancethenurses    awarenessofasensitivityto  theclient'sstateofbeingandof d becoming. 8  24.Thegoalofthehumanizing  0 nurseistobreakthe    communicationcycleofde    humanizingattitudesand \   interactionpatterns,replacing 0  thesewithattitudesandpatterns T  whichtendtohumanize. (  25.Interpersonalcommunication   isthemeansbywhichthenurse T  becomesincreasinglysensitiveto (x andawareoftheclient'sstateof L being,ofthedynamic   relationshipbetweentheclient  andhisorherenvironmentandof x theclient'spotential.  L  4.NursingProcess:  d a.Assessinganddiagnosing. 8 b.Planning   c.Implementing  d.Evaluating. d  5.Health: Onesstateofbeing,  \ ofbecoming,ofselfawareness.  0 Itisindicativeofonescoping    abilities.  !  6.Environment: Ones 0 # time/space/relationshipcontext T $ orsituation. ( %  7.CriticalLifeSituation: a  ' situationinwhichthereisa T ( perceivedthreattooneshealth (x) state,inwhichonesexistential L* stateofbeingissalient,asin  + cancer,childbirth,accidents,and , soon. x-  8.Communication: adynamic  p/ interpersonalprocessinvolving D0 continualadaptationand 1 adjustmentsbetweentwoormore 2 humanbeingsengagedinfaceto p3 faceinteractionsduringwhich D4 eachpersoniscontin  h5 16.Tothedegreethenurse d6 conveysaconcernforthe 87 individual,i.e., caringabout,to  8 thatdegreethenursetendsto 9 makeethicalchoices. d: 17.Tothedegreethenurse  \< maintainsawarm,positiveregard  0= fortheclient,tothatdegreethe  > nursetendstomakeethical  ? choices. \ @ 18.Tothedegreethenurseisan T B activelistener,tolerantof ( C ambiguity,andpatientinwaiting  D forsignsofpositivechangeand  E growth,tothatdegreethenurse T F tendstomakeethicalchoices. (xG 19.Tothedegreethenurseis  I trustworthy,keepspromises,is J loyal,andmaintains xK confidentialities,tothatdegree LL thenursetendstomakeethical  pM choices. DN ̀ P   DR  6.RelevantResearch.  dS   ӀNospecificresearchinprogress  U asofthisdate(Dec.,1995). "V "* $ dd dd dd dd dd $.., dd , dd , dd , dd +     d uallyawareoftheother(s). d Aprocesscharacterizedbybeing 8 existentialinnature,involvingan    exchangeofmeaning,concerning  factandfeelings,andinvolving d dialogicalcommunicating.It 8  containsthehumanizingand  \ dehumanizingsetofattitudeson  0  acontinuumandasetofpatterns    ofinteraction(skills).     9.ContinuumofAttitudes : 0  Humanizing....DeHumanizing T  DialogueMonologue (  IndividualCategories   HolisticParts   ChoiceDirectives T  EqualityDegradation (x PositiveRegardDisregard L AcceptanceJudgment   EmpathyTolerance  AuthenticityRoleplaying x Ѐ(offeelings) L CaringCareless  p IrreplaceableExpendability D IntimacyIsolation  CopingHelpless  PowerPowerless  p 20.Tothedegreethenurse d maintainsanawarenessand 8 sensitivitytotheclientsworkof    searchingformeaningincritical ! lifesituations,tothatdegreethe d" nursetendstomakeethical 8 # choices.   \$   d% *T$idd dd dd dd dd $ .., dd , dd , dd , dd +     d  Humanizingcommunication  d involvesanawarenessofthe 8 eightuniquecharacteristicsof   beinghuman; dehumanizing  communication ignoresthese d  eightcharacteristics. 8   10.PatternsofInteractions:   0   a.Communing: dialogical,    intimatecommunicationbetween \   twoormorepeople;thenatureor 0  essenceofhumanizingor T  humanisticcommunication. (  ̀ Listening :isthecoreof   communinganditinvolvesa T  consciousefforttoattendtowhat (x anothepersonissaying, L particulrlytoexpressionsof   feelings,meanings,andperceived  implications. x  Thecentraltripod of  p communingistrust,self D disclosure&feedback.    D   d  7.ImportancetotheDiscipline d  andProfession.  8! Representsafirsteffortin # developingatheoryofethicsfor d$ nursingaloneandnotdependent 8 % uponbiologicalormedical  \& ethicalapproaches.  0' Potentialformakingasignificant  ) contribution.Onlytimewill \ * provideanswers.  0 + *I$jdd dd dd dd dd T$i.., dd , dd , dd , dd +     d 1) Trust :onepersonrelyingon d another,riskingpotentiallossin 8 attemptingtoachieveagoal,   whentheoutcomeisuncertain;   andthepotentialforlossis d greaterthanforgainifthetrustis 8  violated.  \ 2. SelfDisclosure :risking    rejectionintellinghowonefeels,    thinks,andsoon,regarding here \   andnowevents. 0  3. Feedback: describing (  anothersbehavior,beliefsandso   on,plusgivingonesevaluation   orfeelings. T   b.Assertiveness :Expressing L onesneeds,thoughts,feelingsor   beliefsinadirect,honest,  confidentmannerwhilebeing x respectfulofanothersthoughts, L feelingsorbeliefs; asserting  p withauthenticity. D   p   d   d   TRP$'3 Letter LandscapeP$'3 Letter Landscape'3 Letter Landscape'3 Letter LandscapeT   *U$kdd dd dd dd dd I$j.., dd , dd , dd , dd +     d  c.Confrontation: providing d feedbackaboutanotherplus 8 requestingachangeinhisorher   behavior; confrontingwith  caring. d  d.Conflict: requiresadecision  \ overanissueinwhichthereis  0  riskoflossaswellaspossible    gain,inwhichtwoormore    Ѐalternativescanbeselected,and \   inwhichonesvaluesare 0  involved, conflictingwith T  dialogue. (   e.Separation: theendofa   relationshipduetochange, T  choice,oroutsidecommitments; (x  separationwithsadness.  L   d  d