python-data-1-warmup.ipynb

      "thoughts, I took the risk, and my courage had the upper hand.\n",
      "\n",
      "Nevertheless, another choice had to be made since now I was not willing\n",
      "\n",
      "to invest this much time on conceptualizing \"ambivalence\" as so relevant\n",
      "\n",
      "to nursing. Perhaps this signified that my own ambivalence had\n",
      "\n",
      "dissipated. And again, I faced the question, what term would I want to\n",
      "\n",
      "develop as a synthetic construct?\n",
      "\n",
      "\n",
      "\n",
      "The next question that occurred to me was, what term would indicate why,\n",
      "\n",
      "as a nurse, I am in the clinical health-nursing situation? Did I view my\n",
      "\n",
      "value mainly as growth, health, freedom, or openness promotion? I worked\n",
      "\n",
      "for a while with each of these terms and eventually discarded them. Some\n",
      "\n",
      "long-hospitalized persons with whom I was working on a demonstration\n",
      "\n",
      "psychiatric unit to prepare them for a more independent and appropriate\n",
      "\n",
      "form of community living would never be stably balanced in health,\n",
      "\n",
      "growing, freedom or openness. For many, these could be only flitting\n",
      "\n",
      "memorable beautiful moments. Still I believed I was very much there in\n",
      "\n",
      "the nursing situation for these persons, as well as for those who moved\n",
      "\n",
      "into the community and found work and social satisfactions. Something\n",
      "\n",
      "occurred between all of these 15 patients and myself--and that was\n",
      "\n",
      "nursing.\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "COMFORT: WHY\n",
      "\n",
      "\n",
      "\n",
      "While considering what construct to conceptualize, I was in the process\n",
      "\n",
      "of recording my three-hour, twice a week interactions in the\n",
      "\n",
      "demonstration unit. I reflected on these interactions and waited for the\n",
      "\n",
      "data to reveal to me the major value underlying my nursing practice.\n",
      "\n",
      "Then the term \"comfort\" came {99} to mind. Perhaps at this point I\n",
      "\n",
      "became comfortable in this unit, or perhaps the unit, itself, became a\n",
      "\n",
      "more comfortable setting. When I had first begun my experience with this\n",
      "\n",
      "demonstration unit, it was still being planned and the hospital was new\n",
      "\n",
      "to me. However, the term \"comfort\" has long been associated with\n",
      "\n",
      "nursing. One can find it as a historical constant throughout the\n",
      "\n",
      "professional nursing literature. The term had been used recently in an\n",
      "\n",
      "ANA publication.[2] When I considered the idea of comforting in nursing\n",
      "\n",
      "practice I felt such experiences had fulfilled and satisfied me, made me\n",
      "\n",
      "feel adequate. I could recall specific experiences that went back to my\n",
      "\n",
      "initial nursing practice settings. I could conceive of comfort as an\n",
      "\n",
      "umbrella under which all the other terms--growth, health, freedom, and\n",
      "\n",
      "openness--could be sheltered. Some of my contemporaries scoffed and\n",
      "\n",
      "viewed this term as much too trivial.\n",
      "\n",
      "\n",
      "\n",
      "Now, again reviewing my months of gathered clinical data, I sorted out\n",
      "\n",
      "12 nurse behaviors that I viewed as aiming toward patient comfort. They\n",
      "\n",
      "were:\n",
      "\n",
      "\n",
      "\n",
      "     1. I focused on recognizing patients by name, being certain I\n",
      "\n",
      "     was correct about their names, and using their names often and\n",
      "\n",
      "     appropriately. I also introduced myself. Names were viewed as\n",
      "\n",
      "     supportive to the internalization of personal identification,\n",
      "\n",
      "     dignity, and worth.\n",
      "\n",
      "\n",
      "\n",
      "     2. I interpreted, taught, and gave as much honest information\n",
      "\n",
      "     as I could about patients' situations when it was sought or\n",
      "\n",
      "     when puzzlement was apparent. This was based in the belief that\n",
      "\n",
      "     it was their life, and choice was their prerogative as they\n",
      "\n",
      "     were their own projects.\n",
      "\n",
      "\n",
      "\n",
      "     3. I verbalized my acceptance of patients' expressions of\n",
      "\n",
      "     feeling with explanations of why I experienced these feelings\n",
      "\n",
      "     of acceptance when I could do this authentically and\n",
      "\n",
      "     appropriately.\n",
      "\n",
      "\n",
      "\n",
      "     4. When verbalizations of acceptance were not appropriate, I\n",
      "\n",
      "     acted out this acceptance by staying with or doing for when\n",
      "\n",
      "     appropriate.\n",
      "\n",
      "\n",
      "\n",
      "     5. I expressed purposely, to burst asunder negative\n",
      "\n",
      "     self-concepts, my authentic human tender feelings for patients\n",
      "\n",
      "     when appropriate and acceptable.\n",
      "\n",
      "\n",
      "\n",
      "     6. I supported patients' rights to agape-type love\n",
      "\n",
      "     relationships with others: families, other staff, and other\n",
      "\n",
      "     patients.\n",
      "\n",
      "\n",
      "\n",
      "     7. I showed respect for patients as persons with the right to\n",
      "\n",
      "     make as many choices for themselves as their current\n",
      "\n",
      "     capabilities allowed.\n",
      "\n",
      "\n",
      "\n",
      "     8. I attempted to help patients consider their currently\n",
      "\n",
      "     expressed feelings and behaviors in light of past life\n",
      "\n",
      "     experiences and patterns, like and unlike their current ones.\n",
      "\n",
      "     {100}\n",
      "\n",
      "\n",
      "\n",
      "     9. I encouraged patients' expression to better understand their\n",
      "\n",
      "     behavioral messages and to enable me to respond overtly as\n",
      "\n",
      "     therapeutically as possible.\n",
      "\n",
      "\n",
      "\n",
      "     10. I verified my intuitive grasp of how patients were\n",
      "\n",
      "     experiencing events by questions and comments and being alert\n",
      "\n",
      "     to their responses.\n",
      "\n",
      "\n",
      "\n",
      "     11. I attempted to encourage hope realistically through\n",
      "\n",
      "     discussing individual therapeutic gains that could be derived\n",
      "\n",
      "     from patients' investment in therapeutic opportunities\n",
      "\n",
      "     available to them.\n",
      "\n",
      "\n",
      "\n",
      "     12. I supported appropriate patient self-images with as many\n",
      "\n",
      "     concrete \"hard to denies\" as possible.\n",
      "\n",
      "\n",
      "\n",
      "Each of these nurse behaviors was repeatedly evident in the months of\n",
      "\n",
      "recording patient-nurse interactions. For the conceptualization of the\n",
      "\n",
      "term \"comfort,\" a representative clinical example was given to enhance\n",
      "\n",
      "the meaning of the behavior cited (see Appendix). When compiling\n",
      "\n",
      "materials for the conceptualization of this term, I found 12 assumptions\n",
      "\n",
      "about psychiatric nursing that I had written for the theory course in\n",
      "\n",
      "one of the first class sessions. Although these assumptions were\n",
      "\n",
      "expressed in different words, their congruence with my 12 selected\n",
      "\n",
      "behaviors made me believe that these behaviors were somehow verified\n",
      "\n",
      "both in my conceptualized philosophy of psychiatric nursing and in my\n",
      "\n",
      "behavior while being a psychiatric nurse.\n",
      "\n",
      "\n",
      "\n",
      "Next I struggled with an idealistic conception of comfort as opposed to\n",
      "\n",
      "a continuum of behavior which would indicate a person's degree or state\n",
      "\n",
      "of discomfort-comfort. Again, reflecting on and teasing out aspects of\n",
      "\n",
      "my data, I set up four behaviorally recognizable criteria for estimating\n",
      "\n",
      "a person's discomfort-comfort state:\n",
      "\n",
      "\n",
      "\n",
      "     1. Relationships with other persons which confirm one as an\n",
      "\n",
      "     existent important person.\n",
      "\n",
      "\n",
      "\n",
      "     2. Affective adaptation to the environment in accord with\n",
      "\n",
      "     knowledge, potential, and values.\n",
      "\n",
      "\n",
      "\n",
      "     3. Awareness of and response to the reality of the now with\n",
      "\n",
      "     understanding of the influence of and separation from the past.\n",
      "\n",
      "\n",
      "\n",
      "     4. Appreciation and recognition of both powers and limitations\n",
      "\n",
      "     which enlighten the alternatives of the future.\n",
      "\n",
      "\n",
      "\n",
      "These behavioral criteria, too, could each be spread on a continuum to\n",
      "\n",
      "evaluate the effects of this aim of nursing on a patient's actual\n",
      "\n",
      "comfort status at any particular point in time.\n",
      "\n",
      "\n",
      "\n",
      "Considering the concept of comfort as a proper aim of psychiatric\n",
      "\n",
      "nursing brought forth the necessity of considering its opposite,\n",
      "\n",
      "discomfort, as a concept. Evidence for the existence of discomfort could\n",
      "\n",
      "be inferred in the absence of the above behavioral criteria. {101}\n",
      "\n",
      "\n",
      "\n",
      "The basic foundation to justify the concept of comfort as a proper aim\n",
      "\n",
      "of psychiatric nursing would be both organic and environmental. In our\n",
      "\n",
      "culture, among the species man, we are moving toward being able to\n",
      "\n",
      "effect some organic conditions by genetic controls and surgical and\n",
      "\n",
      "chemical means. The professions have struggled long years to influence\n",
      "\n",
      "environmental deterrents to comfort. If an individual as a fetus, or as\n",
      "\n",
      "an infant, or young child never internalizes comfort of any kind from\n",
      "\n",
      "his environs, the probability of initiating a continuum within himself\n",
      "\n",
      "as an adult that is propelled toward comfort seems unlikely. Such\n",
      "\n",
      "individuals, lacking any potential capacity for comfort, I suspect are\n",
      "\n",
      "rare. There is evidence for the existence of this dormant seed of\n",
      "\n",
      "comfort in persons with schizophrenia in the hospital setting. Consider\n",
      "\n",
      "how repetitively and ambivalently they \"reach out\" to authority figures.\n",
      "\n",
      "This dormant comfort seed requires nourishment of a high quality for\n",
      "\n",
      "testing whether it can develop and bear the fruits of health, growth,\n",
      "\n",
      "freedom, and openness.\n",
      "\n",
      "\n",
      "\n",
      "When the development of this synthetic construct of comfort was\n",
      "\n",
      "discussed in the theory course a question was raised: Is a person who\n",
      "\n",
      "denies all feeling, presents himself as emotionally dead, comfortable?\n",
      "\n",
      "If feelings are not relegated to the mind alone, as the effects of a\n",
      "\n",
      "peptic ulcer cannot be relegated to the stomach, if feelings are an\n",
      "\n",
      "essential of the nature of humanness, a human who denies this essential\n",
      "\n",
      "of his nature would not fit into this concept as comfortable. This\n",
      "\n",
      "synthetic construct of comfort, like its synonym contentment, described\n",
      "\n",
      "by Plutarch A.D. 46-120, does not imply passivity, resignation,\n",
      "\n",
      "retirement, or a simple avoiding of trouble. Plutarch said, \"Contentment\n",
      "\n",
      "comes very dear if its price is inactivity.\"[3] I would perceive of\n",
      "\n",
      "comfort or contentment as implying that a human being was all he could\n",
      "\n",
      "be in accordance with his potential at any particular time in any\n",
      "\n",
      "particular situation.\n",
      "\n",
      "\n",
      "\n",
      "Continuing the aforementioned twelve nurse behaviors, observing behavior\n",
      "\n",
      "through the four established criteria and conceptualizing the construct\n",
      "\n",
      "of comfort, I began to wonder. Was I seeing what I had decided was the\n",
      "\n",
      "state of psychiatric patients' conditions of being? Was I projecting\n",
      "\n",
      "discomfort onto patients? I did not expect straight answers.\n",
      "\n",
      "Nonetheless, I decided to ask patients about their discomfort-comfort\n",
      "\n",
      "states to verify my perception of the condition of their beings. All\n",
      "\n",
      "fourteen patients I asked assured me by their responses that I was not\n",
      "\n",
      "projecting or seeing discomfort where it did not exist.\n",
      "\n",
      "\n",
      "\n",
      "Some described physical discomfort and sought the cause within and\n",
      "\n",
      "outside themselves (either another caused it, or another could cure it,\n",
      "\n",
      "pills would cure it), negatively viewed self-images, guilt based in\n",
      "\n",
      "their behaviors or thoughts. One patient defined comfort by analogy and\n",
      "\n",
      "stated directly to my surprise that he seldom felt comfortable and that\n",
      "\n",
      "his excessive ritualistic behavior was his way of coping with his\n",
      "\n",
      "discomfort. One repetitively stated a happy illusion that he seemed to\n",
      "\n",
      "hang on to for dear life. When I asked what he would do if this illusion\n",
      "\n",
      "was not truth, he said that he had never considered {102} this\n",
      "\n",
      "possibility. I knew he had been confronted with the truth of his\n",
      "\n",
      "situation many times in many ways. One patient merely looked directly at\n",
      "\n",
      "me and walked away.\n",
      "\n",
      "\n",
      "\n",
      "Then I again reviewed my clinical recorded data to see what kinds of\n",
      "\n",
      "knowledge nursing with an aim to comfort would infer as necessary.\n",
      "\n",
      "Fifty-two items of knowledge were extrapolated from the clinical\n",
      "\n",
      "examples selected as representative of the twelve nurse behaviors. These\n",
      "\n",
      "items were categorized under broad cognitive and affective domains. This\n",
      "\n",
      "was an arbitrary point of separation. They were teased apart simply as\n",
      "\n",
      "an aid to conceptualization and understanding. If these knowledge\n",
      "\n",
      "domains had related to one another in a simple direct manner, I would\n",
      "\n",
      "have conveyed them in a table in which each would have been across from\n",
      "\n",
      "its mate. Their relationships to one another were far too complex to be\n",
      "\n",
      "handled in any such a way. The affective domain knowledge areas were a\n",
      "\n",
      "dynamic internalized synthesis of several knowledge areas from the\n",
      "\n",
      "cognitive domain. Thus, the expression of these affective knowledge\n",
      "\n",
      "areas was evidence of the practice of nursing as an artful form of\n",
      "\n",
      "expressing cognitive knowing.\n",
      "\n",
      "\n",
      "\n",
      "In looking directly at the discomfort of long-term hospitalized\n",
      "\n",
      "psychiatric patients, I found myself faced with behaviors that resulted\n",
      "\n",
      "possibly from a muddle of many contributories. What in the behavior\n",
      "\n",
      "resulted from lifetime environmental influences and compounded responses\n",
      "\n",
      "that deepened scars? What resulted from long-term hospitalization? How\n",
      "\n",
      "many varieties of ills superimposed like layers on the above were\n",
      "\n",
      "expressed in what I saw as discomfort in these psychiatric patients?\n",
      "\n",
      "Diagnostic classifications are necessary for statistical economic\n",
      "\n",
      "planning reasons. Still, how naively and superficially they convey the\n",
      "\n",
      "human therapeutic care needs of each person.\n",
      "\n",
      "\n",
      "\n",
      "At this point of construct development I saw a positive relationship in\n",
      "\n",
      "my thinking about comfort as a proper aim of psychiatric nursing and\n",
      "\n",
      "Viktor Frankl's description of his aim in logotherapy toward meaning. I\n",
      "\n",
      "had struggled with the idea of aiming at comfort while with patients who\n",
      "\n",
      "possessed ability and a favorable prognosis, often purposefully and\n",
      "\n",
      "deliberately asking them to consider ideas that caused them immediate\n",
      "\n",
      "greater discomfort. Frankl's quotes from Nietzsche and Goethe supported\n",
      "\n",
      "my altruistic intention. Nietzsche said:\n",
      "\n",
      "\n",
      "\n",
      "     \"He who has a why to live can bear almost any how.\"[4]\n",
      "\n",
      "\n",
      "\n",
      "Goethe said:\n",
      "\n",
      "\n",
      "\n",
      "     \"When we take man as he is, we make him worse; but when we take\n",
      "\n",
      "     man as if he were already what he should be, we promote him to\n",
      "\n",
      "     what he can be.\"[5]\n",
      "\n",
      "\n",
      "\n",
      "In conclusion to this stage of development of a synthetic construct of\n",
      "\n",
      "comfort as an aim of psychiatric nursing I can say: Comfort is an aim\n",
      "\n",
      "toward {103} which persons' conditions of being move through\n",
      "\n",
      "relationship with others by internalizing freedom from painful\n",
      "\n",
      "controlling effects of the past. These effects have inhibited their\n",
      "\n",
      "self-control, realistic planning, and prevented them from being all that\n",
      "\n",
      "they could be in accordance with their potential at any particular time\n",
      "\n",
      "in any particular situation. I would project this as an aim for nursing\n",
      "\n",
      "in all situations although the data for constructing this\n",
      "\n",
      "conceptualization were gathered in a clinical psychiatric setting.\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "CLINICAL: HOW\n",
      "\n",
      "\n",
      "\n",
      "As a component of my doctoral examinations I was faced with having to\n",
      "\n",
      "rewrite a clinical paper. This led to my deliberately and personally\n",
      "\n",
      "choosing to conceptualize a synthetic construct of \"clinical.\" This was\n",
      "\n",
      "my decision. It speaks well for the value of having had the experience\n",
      "\n",
      "of conceptualizing \"comfort.\" Often it is said that man repeats that\n",
      "\n",
      "which he finds as meaningful and good. This choice also signifies a real\n",
      "\n",
      "overcoming of my resistance and ambivalence toward synthetic construct\n",
      "\n",
      "development in a year's time.\n",
      "\n",
      "\n",
      "\n",
      "\"Clinical\" was developed as a synthetic construct in 1968. It was a\n",
      "\n",
      "conceptualized response to a dialectical process within myself. If I am\n",
      "\n",
      "a clinician, then \"how\" I am in the health-nursing situation would\n",
      "\n",
      "equate to \"clinical.\" In conceptualizing this construct I teased out of\n",
      "\n",
      "my lived-nursing-world the \"how\" of my working toward my own and others'\n",
      "\n",
      "comfort.\n",
      "\n",
      "\n",
      "\n",
      "Confusion, over what was meant when persons casually and currently\n",
      "\n",
      "popularly attributed the term \"clinical\" to situations and persons,\n",
      "\n",
      "called forth this conceptualization. It grew out of comparing and\n",
      "\n",
      "contrasting two nursing consultation experiences in the\n",
      "\n",
      "psychiatric-mental health area. Beginning this conceptualization I would\n",
      "\n",
      "have referred to both these experiences as \"clinical.\" At the\n",
      "\n",
      "termination of the conceptualization they were both \"clinical.\" They\n",
      "\n",
      "were very different experiences for me, and yet of equal value in my\n",
      "\n",
      "advancement toward my more of being. Prior to this conceptualization\n",
      "\n",
      "because my attending emotions were so disturbing and unacceptable to me\n",
      "\n",
      "in relation to one of these experiences, automatically I repressed part\n",
      "\n",
      "of them and found reasons to suppress the rest of them. Unfortunately,\n",
      "\n",
      "all else that was of value to me in having lived this experience was\n",
      "\n",
      "integrally enmeshed with these emotions. This, too, became unavailable\n",
      "\n",
      "to my conscious awareness. Conceptualization made recall and reflection\n",
      "\n",
      "a necessity. Clinical includes inherently a process of experiencing\n",
      "\n",
      "awarely and then recalling, looking at, reflecting on, and sorting out\n",
      "\n",
      "to come to knowing.\n",
      "\n",
      "\n",
      "\n",
      "Before knowing how to approach the rewriting of my clinical paper as a\n",
      "\n",
      "partial requirement for receiving my doctoral degree I experienced a\n",
      "\n",
      "depression. I felt frightened, angry, and inadequate. The original\n",
      "\n",
      "clinical paper had been judged as more intellectual and scholarly than\n",
      "\n",
      "clinical. I could conceive of only two alternatives. Both seemed\n",
      "\n",
      "self-defeating. One, I could revise my former clinical paper into a more\n",
      "\n",
      "intellectual and scholarly paper that still {104} would not be clinical\n",
      "\n",
      "and would still leave my \"I\" out. Or, two, I could revise my former\n",
      "\n",
      "clinical paper, dump all my feelings in the situational experience,\n",
      "\n",
      "blame everyone else for these feelings, and culminate at least with my\n",
      "\n",
      "clinical passions visible. Conflict resulted from my considering\n",
      "\n",
      "pursuing either of these routes. I was immobilized for a time. A time\n",
      "\n",
      "limitation and time passing pushed me to begin somewhere. I began.\n",
      "\n",
      "Choosing the second alternative in the belief that at least through\n",
      "\n",
      "writing I would better understand what I had lived in the experience.\n",
      "\n",
      "\n",
      "\n",
      "I could support the value of dredging up these old feelings and looking\n",
      "\n",
      "at them. Authentically letting myself be aware of what I had\n",
      "\n",
      "experienced, not necessarily communicating this or acting out in\n",
      "\n",
      "accordance with these redredged feelings; just really looking at them\n",
      "\n",
      "might allow me choice in how I wanted to live with them. One support for\n",
      "\n",
      "the value of looking at these old feelings was my own past three and\n",
      "\n",
      "one-half years in psychoanalysis in which I profited through such a\n",
      "\n",
      "process. The other support was my readings of the past two years. These\n",
      "\n",
      "included works of Russell,[6] Nietzsche,[7] Plato,[8] Popper,[9]\n",
      "\n",
      "Dewey,[10] Buber,[11] Bergson,[12] Cousins,[13] and de Chardin.[14]\n",
      "\n",
      "\n",
      "\n",
      "As this experience became in shape and meaning through my writing, I\n",
      "\n",
      "began to view this product as like an existential play filled with\n",
      "\n",
      "blatant atrocities and absurdities that had to be nonrealities. This\n",
      "\n",
      "production, also, made visible beautiful raw data. As meaning in this\n",
      "\n",
      "clinical nursing consultation experience as a graduate student became\n",
      "\n",
      "evident, comparison of it with the meaning of clinical work experiences\n",
      "\n",
      "in nursing consultation situations flowed naturally. Then joy, it was\n",
      "\n",
      "like sunshine burst forth and warmed my spirit.\n",
      "\n",
      "\n",
      "\n",
      "Before entering school, I was, for two years, a mental health\n",
      "\n",
      "psychiatric clinical nurse consultant to a staff of forty-five visiting\n",
      "\n",
      "nurses. I had become intrigued {105} with what I had come to understand\n",
      "\n",
      "about consultation related to clinical situations. I wrote a paper for\n",
      "\n",
      "publication on the subject. Busy in the process of returning to school,\n",
      "\n",
      "and awaiting the publication of two other papers--both of these\n",
      "\n",
      "proceedings feeling unreal and out of my control, not to mention\n",
      "\n",
      "self-exposing--I merely filed in my desk the typed submittable rendition\n",
      "\n",
      "of this consultation paper. Now, I dug it out. This meant that I had two\n",
      "\n",
      "conceptualized presentations of similar type personal experiences in\n",
      "\n",
      "nursing consultation to compare and contrast. From these, my\n",
      "\n",
      "conceptualization of clinical, and the values on which my clinical\n",
      "\n",
      "practice rests, could be extrapolated.\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "A Student Consultation Experience Becomes Clinical\n",
      "\n",
      "\n",
      "\n",
      "In the graduate student nurse consultation experience I felt helpless,\n",
      "\n",
      "confused, unwanted, guilty, anxious, and unimportant. It was a\n",
      "\n",
      "passion-filled experience for me. As a nurse-student consultant among\n",
      "\n",
      "interdisciplinary nonstudent-consultants I experienced dependency for my\n",
      "\n",
      "being and doing on persons I viewed as anxious, critical, nonempathetic,\n",
      "\n",
      "and inadequate. We were attempting to offer consultation to a\n",
      "\n",
      "professional group of nonpsychiatric mental health oriented consultees\n",
      "\n",
      "who were anxious and felt inadequate in this area. I felt forced into an\n",
      "\n",
      "observer rather than participant mode of being, and my recorded data\n",
      "\n",
      "support this. Impotency comes to mind when I recall this experience, as\n"
     ]
    },
    {
     "name": "stdout",
     "output_type": "stream",
     "text": [
      "\n",
      "well as a racking rage and suffering that obliterates feelings of love,\n",
      "\n",
      "good-will, tenderness, or hope. About that time I was reading\n",
      "\n",
      "Nietzsche's eternal recurrence phenomenon[15] and viewed it most\n",
      "\n",
      "pessimistically--all was awful, it would continue to be awful, life was\n",
      "\n",
      "just a vicious cycle of awfulness.\n",
      "\n",
      "\n",
      "\n",
      "Defense or health, it is questionable. Suddenly, perhaps it was having\n",
      "\n",
      "hit feelings of rock bottom, I began to view Nietzsche's eternal\n",
      "\n",
      "recurrence phenomenon optimistically. Did the polarization of my\n",
      "\n",
      "negative feelings magnetically call forth my opposite feelings? All,\n",
      "\n",
      "now, contained the new, it would continue to contain the new, life was a\n",
      "\n",
      "series of similar and yet different cycles that always contained the\n",
      "\n",
      "new.\n",
      "\n",
      "\n",
      "\n",
      "Now my reflections let in hope, positiveness, comradeship, good\n",
      "\n",
      "feelings, and progress made by myself and others in our year and a half\n",
      "\n",
      "together as consultants. During this period we met with the consultees\n",
      "\n",
      "for an hour once or twice a week. The group had continued over this\n",
      "\n",
      "period despite its components of psychiatric mental health professionals\n",
      "\n",
      "and nonpsychiatric mental health profession culturally, professionally,\n",
      "\n",
      "and historically having been quite alienated from one another.\n",
      "\n",
      "Attendance had improved some over time. Toward the end of the year and a\n",
      "\n",
      "half, during the last three months, the focus of discussion was on\n",
      "\n",
      "patients and their worlds for longer periods of time. There was less\n",
      "\n",
      "defensive acting out in which things, fees, time, and mechanics consumed\n",
      "\n",
      "the hour.\n",
      "\n",
      "\n",
      "\n",
      "{106}\n",
      "\n",
      "\n",
      "\n",
      "Toward the end of these sessions the consultant chief found more\n",
      "\n",
      "acceptable space in which to meet for the consultation. Eating lunch\n",
      "\n",
      "became part of the session. Food can be looked at in many ways. In this\n",
      "\n",
      "case it seemed to be a cohesive force, rather than a distracting,\n",
      "\n",
      "socializing force. Was this because of the underlying meanings food had\n",
      "\n",
      "for these people? Or was the meaning of food in this situation concrete?\n",
      "\n",
      "Now the consultees could have their lunch served to them while receiving\n",
      "\n",
      "consultation. This latter saved their time and meant money to them. This\n",
      "\n",
      "was a giving gesture on the part of the consultants even though the\n",
      "\n",
      "lunch monies did come out of the project funding source. The meaning of\n",
      "\n",
      "food was never discussed in the group. I wonder if this feeding was done\n",
      "\n",
      "with deliberate awareness or was just serendipitous.\n",
      "\n",
      "\n",
      "\n",
      "During the last three months of meeting I began to feel related on a\n",
      "\n",
      "deeper level with a few of the participants, consultants and consultees.\n",
      "\n",
      "Individual to individual we began to communicate collaboratively with\n",
      "\n",
      "one another as professional colleagues. We discussed both patients'\n",
      "\n",
      "lived worlds and the meaning of psychiatric mental health terms and\n",
      "\n",
      "ideas. I can conceive, now, that this may have occurred between other\n",
      "\n",
      "group members before or after sessions. Initially there were often only\n",
      "\n",
      "two to three consultees to five or six consultants. Later the total\n",
      "\n",
      "group contained fifteen to sixteen people. Now I would project that the\n",
      "\n",
      "very existence of this group could influence future groups positively.\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "A Clinical Work Consultation Experience\n",
      "\n",
      "\n",
      "\n",
      "In this work consultation experience my feelings were openness,\n",
      "\n",
      "reflectiveness, pain, helpfulness, alertness, searchfulness,\n",
      "\n",
      "appreciativeness, receptiveness, responsiveness, wantedness, competence,\n",
      "\n",
      "joy, and importance. It was both a passionate and a dispassionate\n",
      "\n",
      "experience. As a working consultant I met with consultees either alone\n",
      "\n",
      "or as part of a collaborating team of consultants. Often the situations\n",
      "\n",
      "the consultees presented which they struggled with and stayed in struck\n",
      "\n",
      "me with awe. They aroused my humility while making me feel whole and\n",
      "\n",
      "fulfilled in my participation with the consultees. In my explorations of\n",
      "\n",
      "and with the consultees my presence, thereness, and authenticity were\n",
      "\n",
      "all important. Buber would say that my aim in consultation was to\n",
      "\n",
      "\"imagine the real\" of what the consultee and the patients and families\n",
      "\n",
      "she discussed with me \"could be.\"[16] This was my initial disposition. I\n",
      "\n",
      "aimed to be open to and accept the potentials of these others.\n",
      "\n",
      "\n",
      "\n",
      "In initial receptiveness, grounded in my comfort, was the \"key\" to the\n",
      "\n",
      "\"door\" of the consultant-consultee \"I-Thou\" relation in which I could\n",
      "\n",
      "come to know intuitively the experience of this particular other\n",
      "\n",
      "nurse-in-her-lived-nursing-world. The consultees offered their\n",
      "\n",
      "lived-nursing-worlds each in their unique ways. Some discussed directly\n",
      "\n",
      "their pains, joys, adequacies, and inadequacies. Some discussed\n",
      "\n",
      "indirectly their panic, success, action, and immobilization. Some beyond\n",
      "\n",
      "being able to discuss their lived-worlds {107} spontaneously acted out\n",
      "\n",
      "their lived-worlds. For example, these often behaved toward me as their\n",
      "\n",
      "patients and families behaved toward them. These kinds of acted out\n",
      "\n",
      "lived-worlds I had to sense my way into to understand. When I began to\n",
      "\n",
      "wonder what it was that they wanted from consultation to take back to\n",
      "\n",
      "their lived-nursing-worlds, I would pull out of the \"I-Thou\" form of\n",
      "\n",
      "relating. This wonderment became my conscious clue. It was time to\n",
      "\n",
      "reflect and look at what my explorations had uncovered.\n",
      "\n",
      "\n",
      "\n",
      "At this point transcending this \"I-Thou\" relation, I would look at \"It.\"\n",
      "\n",
      "Seeing, now, what was within me, what the condition of my being was that\n",
      "\n",
      "I had intuitively taken on from the consultee, I would set it apart from\n",
      "\n",
      "myself, and see it as an empathic response. I knew that these feelings I\n",
      "\n",
      "experienced which I received existentially, globally through the\n",
      "\n",
      "compound of the consultee's words, tone inflection, volume, facial\n",
      "\n",
      "expression, posture, and positioning to me were what she experienced in\n",
      "\n",
      "her-nursing world. Verbalization of this empathized understanding\n",
      "\n",
      "fulfilled several purposes: (1) it conveyed my sympathy or joy with, and\n",
      "\n",
      "always my caring, (2) it validated that I saw it as it was for this\n",
      "\n",
      "nurse, and (3) it opened the door to our working through the possible\n",
      "\n",
      "meanings of the nurse's experience and to speculating about outcomes of\n",
      "\n",
      "alternative future nurse actions and behaviors.\n",
      "\n",
      "\n",
      "\n",
      "Cognitively the range of these consultation discussions was broad. Some\n",
      "\n",
      "common themes were social and health histories of families, pertinent\n",
      "\n",
      "psychological growth and development factors of persons in the families\n",
      "\n",
      "of concern to the consultees, relationships between persons within the\n",
      "\n",
      "situations, resources available to the families, ways the consultees\n",
      "\n",
      "could relate with the parents and patients' families, friends, and other\n",
      "\n",
      "professionals in the situation, and the meaning of all these themes to\n",
      "\n",
      "the particular consultee.\n",
      "\n",
      "\n",
      "\n",
      "This clinical consultation experience necessitated my being certain\n",
      "\n",
      "ways. It necessitated my being authentic with myself with regard to what\n",
      "\n",
      "responses were called forth in me in relating with a particular\n",
      "\n",
      "consultee. I viewed honesty with the consultee as a value necessary to\n",
      "\n",
      "the consultation process. In approaching the consultation I needed to be\n",
      "\n",
      "open to the consultee's angular view and predisposed toward an \"I-Thou\"\n",
      "\n",
      "relationship. The \"I-Thou\" relating necessitated subsequent scientific\n",
      "\n",
      "understanding extrapolated from it through reflection on it as \"I-It.\"\n",
      "\n",
      "My hope in consultation was to offer both a cognitive, as well as, an\n",
      "\n",
      "ontic experience in which a mutual feeling apart from and toward the\n",
      "\n",
      "other would exist. This latter seemed most important to me. If the\n",
      "\n",
      "consultee experienced my being authentically present with her, she then\n",
      "\n",
      "would be apt to offer this type of relationship to the patients and\n",
      "\n",
      "families of concern to her.\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "Results of Comparison\n",
      "\n",
      "\n",
      "\n",
      "The two clinical consultation experiences were juxtaposed, contrasted,\n",
      "\n",
      "questioned, related, and synthesized to envision their unified\n",
      "\n",
      "contribution to the construct of \"clinical.\" The synthetic construct of\n",
      "\n",
      "\"clinical\" is not viewed as a mere juxtaposing, a disintegrating, or\n",
      "\n",
      "reconstructing of the contributions {108} to my knowing from either of\n",
      "\n",
      "these experiences. This comparison is viewed as a facing of the\n",
      "\n",
      "multiplicities they both present. The synthesis is an illumination of\n",
      "\n",
      "both experiences with each transfigured through their mutual presence in\n",
      "\n",
      "the \"knowing place\" of the comparer.[17]\n",
      "\n",
      "\n",
      "\n",
      "In this comparison my appreciation grew of how I had uniquely\n",
      "\n",
      "implemented and conceptualized clinical consultation in my work\n",
      "\n",
      "experience. I recognized through the comparison that adequate clinical\n",
      "\n",
      "consultation demands both a passionate and dispassionate phase of\n",
      "\n",
      "\"I-Thou\" and \"I-It\" relating. Without either of these forms of\n",
      "\n",
      "consultant being-in-the-situation we degrade the term \"clinical\" if we\n",
      "\n",
      "employ it. Consultation lends itself naturally to a collaborative\n",
      "\n",
      "cooperative relationship. The consultant is dependent on the consultee\n",
      "\n",