python-data-1-warmup.ipynb

      "for presentation of the specifics of particular situations. The\n",
      "\n",
      "consultee is dependent on the consultant for the tailoring of general\n",
      "\n",
      "knowledge to the consultees' particular situations. The relationship if\n",
      "\n",
      "appropriately called consultation is then of necessity interdependent.\n",
      "\n",
      "In being separate from the other while feeling with the other the\n",
      "\n",
      "consultant does not lose the ability to question. Passion undealt with\n",
      "\n",
      "or identification with the consultee inhibits the clinical purpose of\n",
      "\n",
      "the consultant and of the consultation. In identification one feels as\n",
      "\n",
      "if he were the other, rather than turning to the other and feeling with\n",
      "\n",
      "him. The degree of anxiety this provokes in the consultant can prevent\n",
      "\n",
      "looking at the consultation situation and issues in an \"I-It\" manner.\n",
      "\n",
      "The consultant loses the ability to question.\n",
      "\n",
      "\n",
      "\n",
      "Through this comparison I was able to reflect on the graduate student\n",
      "\n",
      "nursing consultation experience in an \"I-It\" way. At this time it became\n",
      "\n",
      "a \"clinical\" experience for me. The lack of this reflective phase in\n",
      "\n",
      "this experience highlighted the reflective phase already existent in the\n",
      "\n",
      "working clinical consultation experience. The existence of this phase in\n",
      "\n",
      "the working clinical consultation experience highlighted its absence in\n",
      "\n",
      "the graduate student nursing consultation experience. My commonplace\n",
      "\n",
      "nursing world through this comparison became awarely meaningful and\n",
      "\n",
      "availed itself for conceptualization. A situation is not a \"clinical\"\n",
      "\n",
      "experience until the \"would be\" clinician can reflect, analyze,\n",
      "\n",
      "categorize, and synthesize it.\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "Clinical Is\n",
      "\n",
      "\n",
      "\n",
      "A potentially clinical psychiatric mental health situation becomes\n",
      "\n",
      "\"clinical\" if the clinician relates to the helpee to awaken his unique\n",
      "\n",
      "potential or ontic wholeness, and noetically transcending this relating\n",
      "\n",
      "conceptualizes its meaning.\n",
      "\n",
      "\n",
      "\n",
      "Clinician signifies a particular mode of being and a particular kind of\n",
      "\n",
      "cognitive knowledge. With all his human capacity the clinician relates\n",
      "\n",
      "with his clinical-world consciously and deliberately in \"I-Thou,\" and\n",
      "\n",
      "\"I-It.\"\n",
      "\n",
      "\n",
      "\n",
      "Relating in \"I-Thou\" with the other in-his-clinical-world the clinician\n",
      "\n",
      "gives himself and receives back the other and himself in the sphere of\n",
      "\n",
      "\"the between.\" {109} He knows the other and the more of himself in this\n",
      "\n",
      "relating. He is confirmed and confirms the other through the other's\n",
      "\n",
      "presence with him. Thus, he calls forth the other's actualizing of self\n",
      "\n",
      "through the clinical relationship. In accepting the other as he is the\n",
      "\n",
      "clinician imagines and responds to the reality of his potential for\n",
      "\n",
      "becoming, becoming according to his unique capacity for humanness.\n",
      "\n",
      "\n",
      "\n",
      "Relating in \"I-It\" with his clinical world the clinician noetically\n",
      "\n",
      "transcends himself, objectifies himself, and studies his \"I-Thou\"\n",
      "\n",
      "knowing. He teases it apart. He classifies and studies it. He asks it\n",
      "\n",
      "questions. He compares and contrasts it to other clinical experiences.\n",
      "\n",
      "He discusses its many aspects in dialogue with his \"inward,\" and\n",
      "\n",
      "possibly \"outward\" \"Thous.\" He reorders its parts. He shapes, creates,\n",
      "\n",
      "plans from and for its clinical existence. Thus, he ever augments a\n",
      "\n",
      "world of heuristic knowing.\n",
      "\n",
      "\n",
      "\n",
      "This \"how\" allows the clinical fulfillment of my nursing \"why.\" Comfort\n",
      "\n",
      "is \"why\" I, as a nurse, am in the health-nursing situation. As\n",
      "\n",
      "conceptualized \"comfort\" is being able to freely control and plan for\n",
      "\n",
      "one's self, being fully in accord at a particular time, in a particular\n",
      "\n",
      "situation, with one's unique potential. Now, \"what\" is the nature of the\n",
      "\n",
      "nurse's world, the health-nursing situation?\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "ALL-AT-ONCE: WHAT\n",
      "\n",
      "\n",
      "\n",
      "The term \"all-at-once,\" arose within me as a construct that would\n",
      "\n",
      "metaphorically describe the multifarious multiplicities that exist\n",
      "\n",
      "within nursing situations. Completing my comparison of Gilbert's and\n",
      "\n",
      "Muller's written works to grasp how they viewed the nature of\n",
      "\n",
      "psychiatric mental health nursing I found myself mulling over and\n",
      "\n",
      "fussing.[18] Your question is probably, mulling and fussing over what?\n",
      "\n",
      "While I mulled over and fussed I believe I, too, was perplexed. Why was\n",
      "\n",
      "I unsatisfied?\n",
      "\n",
      "\n",
      "\n",
      "I had compared Gilbert's and Muller's writing styles, their conceptions\n",
      "\n",
      "of man, approaches to nursing, nursing education, supervision, and\n",
      "\n",
      "consultation. Their similarities and differences were noted, and how\n",
      "\n",
      "each presented herself predominantly. Then I cited the nursing\n",
      "\n",
      "communities they sought to influence and those in which they were while\n",
      "\n",
      "writing. Through reviewing their bibliographies and biographies I\n",
      "\n",
      "indicated the sources that had influenced them.\n",
      "\n",
      "\n",
      "\n",
      "Still I mulled over, fussed, and was perplexed. I awakened in the middle\n",
      "\n",
      "of one night in 1969 understanding what had been causing my struggle.\n",
      "\n",
      "The \"all-at-once\" was my answer.\n",
      "\n",
      "\n",
      "\n",
      "The description of single constructs and single examples originally had\n",
      "\n",
      "felt unrelated to the reality of the nurse's world. They oversimplified\n",
      "\n",
      "its complexity. The nature of nursing was complex. It seemed to me that\n",
      "\n",
      "we needed, as a profession, constructs that simplified and allowed clear\n",
      "\n",
      "communications. We, also, needed constructs that conveyed the reality\n",
      "\n",
      "and complexity of the {110} worlds in which nurses nursed. Perhaps a\n",
      "\n",
      "description of what \"all-at-once\" expressed for me would convey to\n",
      "\n",
      "others the lived-unobservable-worlds of nurses.\n",
      "\n",
      "\n",
      "\n",
      "Nurses relate to other man in situations of \"all-at-once.\" The\n",
      "\n",
      "\"all-at-once\" is equated by me to Buber's \"I-Thou\" and \"I-It\" occurring\n",
      "\n",
      "simultaneously and not only in sequence as he expressed it. These two\n",
      "\n",
      "ways that man can relate to and come to know his world and himself\n",
      "\n",
      "demand sequential expression for clear communication. However, the\n",
      "\n",
      "responsible authentic nurse in the nursing arena lives them\n",
      "\n",
      "\"all-at-once.\" Aware of the multifarious multiplicities of her responses\n",
      "\n",
      "to another and at once to the surrounding field of action, the nurse\n",
      "\n",
      "selects and overtly expresses her responses that actualize the purpose,\n",
      "\n",
      "values, and potential of the artful science of professional nursing.\n",
      "\n",
      "\n",
      "\n",
      "Awareness of the multifarious multiplicities affecting the other and the\n",
      "\n",
      "self in the nursing arena is a component of \"I-Thou\" relating.\n",
      "\n",
      "Selectively overtly expressing concordantly with the purpose, values,\n",
      "\n",
      "and potential of nursing necessitates a looking at, which is a component\n",
      "\n",
      "of \"I-It\" relating, while acting and being. Therefore both \"I-Thou and\n",
      "\n",
      "I-It\" modes of being are \"all-at-once.\"\n",
      "\n",
      "\n",
      "\n",
      "This necessity for a nurse's duality in her mode of being came to my\n",
      "\n",
      "awareness through comparing Gilbert' and Muller's works, studying\n",
      "\n",
      "Buber's conceptions of man, and considering them in relation to my\n",
      "\n",
      "current and past lived-experiences in the nursing-arena. In my nursing\n",
      "\n",
      "world of \"I-Thou\" relating reflection is called forth prior to my overt\n",
      "\n",
      "response to allow response selection concordant with my nursing purpose.\n",
      "\n",
      "The very character of multifarious multiplicities of the nursing world\n",
      "\n",
      "undoubtedly has called for nurses to develop their human capacity for\n",
      "\n",
      "duality in their mode of being.\n",
      "\n",
      "\n",
      "\n",
      "To make these \"multifarious multiplicities\" explicit I would like to\n",
      "\n",
      "offer a description of a recent, personal nursing experience. In a\n",
      "\n",
      "community psychiatric mental health psychosocial clinic, I sat across\n",
      "\n",
      "from and focused on relating with a psychiatric client. After long years\n",
      "\n",
      "of hospitalization he was now living in a community foster home and\n",
      "\n",
      "visiting the clinic three days a week. When there was no special clinic\n",
      "\n",
      "activity in progress and often even when there was, he sat by himself\n",
      "\n",
      "and played poker. He told me about his game many times, over weeks and\n",
      "\n",
      "months. He dealt out five poker hands. Each hand was dealt to a member\n",
      "\n",
      "of his family, long dead. He did not accept their deadness. One day\n",
      "\n",
      "while describing the poker games and his relatives, he intermittently\n",
      "\n",
      "expressed his fantasies which he projected on to a sweet cheerful\n",
      "\n",
      "65-year-old community volunteer. She was somewhat deaf. His fantasies\n",
      "\n",
      "were angry. When he gestured toward her, she in a motherly way came over\n",
      "\n",
      "to him, put her arm around him, and her ear down to his mouth. It was a\n",
      "\n",
      "moment of possible client explosion. With my eyes I attempted to\n",
      "\n",
      "communicate with her. This, and the tone of the patient's voice warned\n",
      "\n",
      "her to move away. While this was occurring another patient jealous of my\n",
      "\n",
      "attentions to this patient walked up and down, and in passing negatively\n",
      "\n",
      "commented on the religious background of the man I was sitting with. In\n",
      "\n",
      "the rear of the room a dietician was conducting a group on obesity. And\n",
      "\n",
      "all of this was set to the {111} melodious, sanguine strains of \"If I\n",
      "\n",
      "Loved You\" being poorly beat out on a piano about ten feet away by\n",
      "\n",
      "another volunteer accompanied in song by a few clients. Meanwhile two\n",
      "\n",
      "staff nurses were observing my part in all this since I was labeled\n",
      "\n",
      "\"expert.\" The client did support me that day and responded to my staying\n",
      "\n",
      "with him. Much to my surprise he began playing poker with me. He dealt\n",
      "\n",
      "me out a hand. This was, at this time, a new behavior on his part. It\n",
      "\n",
      "was movement toward his potential for relating to live persons in his\n",
      "\n",
      "current world. This, again, is just one example of the multifarious\n",
      "\n",
      "multiplicities of one very common type of nursing situation.\n",
      "\n",
      "\n",
      "\n",
      "The inference from the above is that professional artistic-scientific\n",
      "\n",
      "nurses relate in \"I-Thou, I-It, all-at-once\" to the specific general,\n",
      "\n",
      "critical nonconsequential, and the healthy ill. This presents a\n",
      "\n",
      "paradoxical dilemma. Nurses, as human beings, have a highly developed\n",
      "\n",
      "capacity for living \"all-at-once\" in and with the flow of the\n",
      "\n",
      "multifarious multiplicities of their worlds. Nurses, as human beings,\n",
      "\n",
      "like all other human beings, are limited to thinking, interpreting, and\n",
      "\n",
      "expressing conceptually only in succession.\n",
      "\n",
      "\n",
      "\n",
      "This metaphoric synthetic construct, \"all-at-once,\" has allowed me to\n",
      "\n",
      "better convey how I experience the health nursing situation. It also has\n",
      "\n",
      "aided my understanding of the multifarious multiplicity of angular views\n",
      "\n",
      "expressed by several professionals in responding to and describing a\n",
      "\n",
      "similar situation. I can accept each description as truth for each\n",
      "\n",
      "responder. Each responds with his uniqueness in the situation.\n",
      "\n",
      "Comparing, contrasting, and complementarily synthesizing these multiple\n",
      "\n",
      "views inclusive of their inconsistencies and contradictions, none\n",
      "\n",
      "negating the other, allows a better understanding of man-in-his-world in\n",
      "\n",
      "the health situation than the so frequently presented oversimplifications.\n",
      "\n",
      "These oversimplified presentations usually deal only with what is\n",
      "\n",
      "occurring that is important to the particular interests of the reporter.\n",
      "\n",
      "And they are offered only after the selected material has been put\n",
      "\n",
      "through a process of interpretation and logical sequencing to emphasize\n",
      "\n",
      "the reporter's particular point. In such reporting the existent in the\n",
      "\n",
      "situation labeled unimportant, unacceptable, or unrelated is not\n",
      "\n",
      "considered. Such existents, nonetheless, may control the patients, the\n",
      "\n",
      "families, the nurses and health professionals generally. Their control\n",
      "\n",
      "may well be more powerful than any erudite oversimplification or its\n",
      "\n",
      "presentation.\n",
      "\n",
      "\n",
      "\n",
      "Humanistic nursing practice theory in asking for phenomenological\n",
      "\n",
      "descriptions of the nurse's lived-world of experiencing proposes\n",
      "\n",
      "authentic awareness with the self of what is existent in the situation\n",
      "\n",
      "prior to conceptualization for dispersal. Unless nurses appreciate and\n",
      "\n",
      "give recognition to the dynamic meaningful breadth, depth, and future\n",
      "\n",
      "influence of their worlds the actualization of the potential thrust of\n",
      "\n",
      "the nursing professional will never be or become.\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "A THEORY OF NURSING\n",
      "\n",
      "\n",
      "\n",
      "A human nurse nurses through a clinical process of \"I-Thou, I-It,\n",
      "\n",
      "all-at-once to comfort.\" {112}\n",
      "\n",
      "\n",
      "\n",
      "\"I-Thou\" is a coming to know the other and the self in relation,\n",
      "\n",
      "intuitively.\n",
      "\n",
      "\n",
      "\n",
      "\"I-It\" is an authentic analyzing, synthesizing, and interpreting of the\n",
      "\n",
      "\"I-Thou\" relation through reflection.\n",
      "\n",
      "\n",
      "\n",
      "The \"all-at-once\" symbolizes the multifarious multiplicities of extremes\n",
      "\n",
      "(incommensurables, criticals, nonconsequentials, contradictions, and\n",
      "\n",
      "inconsistencies) as metaphorically representative of what exists in the\n",
      "\n",
      "nurse's world.\n",
      "\n",
      "\n",
      "\n",
      "\"Comfort\" is a state valued by a nurse as an aim in which a person is\n",
      "\n",
      "free to be and become, controlling and planning his own destiny, in\n",
      "\n",
      "accordance with his potential at a particular time in a particular\n",
      "\n",
      "situation.\n",
      "\n",
      "\n",
      "\n",
      "FOOTNOTES:\n",
      "\n",
      "\n",
      "\n",
      "[1] Josephine G. Paterson, \"A Perspective on Teaching Nursing: How\n",
      "\n",
      "Concepts Become,\" in _A Conceptual Approach to the Teaching of Nursing\n",
      "\n",
      "in Baccalaureate Programs_, a report of a project directed by Rose M.\n",
      "\n",
      "Herrera (Washington, D.C.: The Catholic University of America, School of\n",
      "\n",
      "Nursing, 1973), pp. 17-27.\n",
      "\n",
      "\n",
      "\n",
      "[2] American Nurses' Association, Division on Psychiatric-Mental Health\n",
      "\n",
      "Nursing, _Statement on Psychiatric Nursing Practice_ (New York: American\n",
      "\n",
      "Nurses' Association, 1967), p. IV.\n",
      "\n",
      "\n",
      "\n",
      "[3] Plutarch, \"Contentment,\" in _Gateway to the Great Books_, Vol. 10,\n",
      "\n",
      "_Philosophical Essays_ (Chicago: Encyclopaedia Britannica, 1963), p.\n",
      "\n",
      "265.\n",
      "\n",
      "\n",
      "\n",
      "[4] Viktor E. Frankl, _From Death-Camp to Existentialism_ (Boston:\n",
      "\n",
      "Beacon Press, 1961), p. 103.\n",
      "\n",
      "\n",
      "\n",
      "[5] _Ibid._, p. 110.\n",
      "\n",
      "\n",
      "\n",
      "[6] Bertrand Russell, _The Autobiography of Bertrand Russell_ (Boston:\n",
      "\n",
      "Little, Brown and Company, 1968) and _An Outline of Philosophy_\n",
      "\n",
      "(Cleveland: The World Publishing Company, 1967).\n",
      "\n",
      "\n",
      "\n",
      "[7] Frederick Nietzsche, \"Beyond Good and Evil,\" trans. Helen Zimmern,\n",
      "\n",
      "in _The Philosophy of Nietzsche_ (New York: The Modern Library, 1927)\n",
      "\n",
      "and \"Thus Spake Zarathustra,\" trans. Thomas Common, in _The Philosophy\n",
      "\n",
      "of Nietzsche_ (New York: The Modern Library, 1927).\n",
      "\n",
      "\n",
      "\n",
      "[8] Plato, _The Republic_, trans. Francis MacDonald Cornford (New York,\n",
      "\n",
      "Oxford University Press, 1945).\n",
      "\n",
      "\n",
      "\n",
      "[9] Karl Popper, _Conjectures and Refutations_ (New York: Basic Books,\n",
      "\n",
      "Publishers, 1963).\n",
      "\n",
      "\n",
      "\n",
      "[10] John Dewey, _The Knowing and the Known_ (Boston: The Beacon Press,\n",
      "\n",
      "1949) and \"The Process of Thought from How We Think,\" in _Gateway to the\n",
      "\n",
      "Great Books_, ed. Robert W. Hutchins, et al. (Chicago: Encyclopaedia\n",
      "\n",
      "Britannica, 1963).\n",
      "\n",
      "\n",
      "\n",
      "[11] Martin Buber, _Between Man and Man_, trans. Ronald Gregor Smith\n",
      "\n",
      "(Boston: Beacon Press, 1955); _I and Thou_, 2nd ed., trans. Ronald\n",
      "\n",
      "Gregor Smith (New York: Charles Scribner's Sons, 1958); _The Knowledge\n",
      "\n",
      "of Man_, ed. Maurice Friedman (New York: Harper & Row, Publishers,\n",
      "\n",
      "1965).\n",
      "\n",
      "\n",
      "\n",
      "[12] Henri Bergson, \"Introduction to Metaphysics,\" in _Philosophy in the\n",
      "\n",
      "Twentieth Century_, Vol. III, ed. William Barrett and Henry D. Aiken\n",
      "\n",
      "(New York: Random House, 1962) and \"Time in the History of Western\n",
      "\n",
      "Philosophy,\" in _Philosophy in the Twentieth Century_, Vol. III, ed.\n",
      "\n",
      "William Barrett and Henry D. Aiken (New York: Random House, 1962).\n",
      "\n",
      "\n",
      "\n",
      "[13] Norman Cousins, _Who Speaks for Man_ (New York: The Macmillan\n",
      "\n",
      "Company, 1953).\n",
      "\n",
      "\n",
      "\n",
      "[14] Pierre Teilhard de Chardin, _Letters from a Traveler_, (New York:\n",
      "\n",
      "Harper & Row, Publishers, 1962) and _The Phenomenon of Man_ (New York:\n",
      "\n",
      "Harper Torchbooks, Harper & Row, Publishers, 1961).\n",
      "\n",
      "\n",
      "\n",
      "[15] Nietzsche, _The Philosophy of Nietzsche_, p. 441.\n",
      "\n",
      "\n",
      "\n",
      "[16] Buber, _The Knowledge of Man_, Appendix, p. 168.\n",
      "\n",
      "\n",
      "\n",
      "[17] Wilfrid Desan, _Planetary Man_ (New York: The Macmillan Company,\n",
      "\n",
      "1972), p. 77.\n",
      "\n",
      "\n",
      "\n",
      "[18] Josephine G. Paterson, \"Echo into Tomorrow: A Mental Health\n",
      "\n",
      "Psychiatric Philosophical Conceptualization of Nursing\" (D.N.Sc.\n",
      "\n",
      "dissertation, Boston University, 1969).\n",
      "\n",
      "\n",
      "\n",
      "{113}\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "APPENDIX\n",
      "\n",
      "\n",
      "\n",
      "NURSE BEHAVIORS EXTRACTED FROM CLINICAL DATA\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "In pursuing the idea of conceptualizing comfort as a proper aim of\n",
      "\n",
      "psychiatric nursing I extracted 12 nurse behaviors from my clinical data\n",
      "\n",
      "that were used repeatedly to increase patient comfort. I quantified\n",
      "\n",
      "these behaviors for two months. The following are a list of these\n",
      "\n",
      "behaviors with a representative example of all but the first. The first\n",
      "\n",
      "was too general and continuous for example.\n",
      "\n",
      "\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 feelings of\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 on the belief that\n",
      "\n",
      "     it was their life, and choice was their prerogative since they\n",
      "\n",
      "     were their own projects.\n",
      "\n",
      "\n",
      "\n",
      "_Examples_\n",
      "\n",
      "\n",
      "\n",
      "(a) While drinking coffee with a few patients at the dining room table\n",
      "\n",
      "suddenly we could hear Sidney, in his customary way, wailing, moaning,\n",
      "\n",
      "and muttering in another room. It is a sad sound. I was about to get up\n",
      "\n",
      "and go to him as I often do, when Arthur, who was sitting next to me,\n",
      "\n",
      "face working, and tense posture-wise, aggravatedly said, \"Sidney doesn't\n",
      "\n",
      "have to do that, he should control himself, the rest of us control\n",
      "\n",
      "ourselves.\" I said, \"When others express how miserable they feel, it\n",
      "\n",
      "sometimes arouses our own feelings about our misery.\" This was an\n",
      "\n",
      "attempt to provoke 32-year-old Arthur to work on his own {114} feelings\n",
      "\n",
      "of misery and to deter his projection of anger at himself out onto\n",
      "\n",
      "Sidney. Arthur looked at me sharply, like he had gotten the message, and\n",
      "\n",
      "agreed by relaxedly nodding his head.\n",
      "\n",
      "\n",
      "\n",
      "(b) Alice, diagnosed as manic depressive, has been depressed. This\n",
      "\n",
      "depression dates from her going out to a department store and asking for\n",
      "\n",
      "a job. She was hired for a five-day-a-week job. This was done on her\n",
      "\n",
      "own. Later her readiness for a five-day-a-week job and her participation\n",
      "\n",
      "in the unit were questioned. Then Alice became depressed.\n",
      "\n",
      "\n",
      "\n",
      "Alice was sitting in the dayroom. I sat down next to her. She looked\n",
      "\n",
      "very sad, her eyelids as well as her mouth, drooped. Her mouth worked as\n",
      "\n",
      "if she wanted to talk, but she was quiet. I asked her about her job\n",
      "\n",
      "decision. She said that she had not taken it. I said, \"You look so sad\n",
      "\n",
      "that I feel like holding your hand.\" Her hands were in her coat pockets,\n",
      "\n",
      "but she looked at me and smiled weakly. I said, \"Sometimes a conflict of\n",
      "\n",
      "wanting to do two things at once in the present and not being able to\n",
      "\n",
      "can bring up the feelings of a past very much more important similar\n",
      "\n",
      "experience.\" Alice just shook her head up and down and looked at me.\n",
      "\n",
      "Alice is in her mid-forties. Later I was walking down the hall to leave\n",
      "\n",
      "saying goodbyes to various people. Alice came out of a side room, put\n",
      "\n",
      "both her hands out to me, and said, \"goodbye and thank you.\" In a\n",
      "\n",
      "previous contact Alice had discussed her suicidal thoughts with me.\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "     3. I verbalized my acceptance of patients' expressions of\n",
      "\n",
      "     feelings 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",
      "_Example_\n",
      "\n",
      "\n",
      "\n",
      "I met a new patient at coffee. Later she was the only patient in the\n",
      "\n",
      "dayroom when I went in. She had not spoken at coffee. Now she sat very\n",
      "\n",
      "stiffly in her chair. I sat down next to her and reintroduced myself.\n",
      "\n",
      "She looked scared but told me her name. Her shifting eyes reminded me of\n",
      "\n",
      "a cornered animal. She blurted out, \"I don't believe I've met you.\" It\n",
      "\n",
      "was like she had said, \"go away.\" I smiled at her and said, \"We were\n",
      "\n",
      "introduced at coffee, but with so many new people it's hard to\n",
      "\n",
      "remember.\" Conversation continued to be tense. At one point Marion\n",
      "\n",
      "bolted from her chair toward the door. I thought she was going to leave.\n",
      "\n",
      "I stayed in my chair. She went to the fish bowl in the corner. We\n",
      "\n",
      "continued to talk about the fish. Marion came back and sat down a few\n",
      "\n",
      "seats away from me. I said that I felt I'd been asking her an awful lot\n",
      "\n",
      "of questions but that I was only trying to get to know her. Marion\n",
      "\n",
      "seemed to relax in her chair and gave a great deal of information about\n",
      "\n",
      "herself in a strange stiff sort of way often inserting a word that did\n",
      "\n",
      "not have meaning for me. I encouraged, supported and showed my interest.\n",
      "\n",
      "Finally she said that she {115} had been admitted to McLean in her\n",
      "\n",
      "third year of nurses' training just before her psychiatric experience.\n",
      "\n",
      "She had been in therapy there, one-to-one for a couple of years. I\n",
      "\n",
      "teased her about knowing the ropes, yet giving me a difficult time. This\n",
      "\n",
      "was an attempt to increase her feelings of adequacy by bringing out the\n",
      "\n",
      "similarities of the old situation which she knew and this new situation.\n",
      "\n",
      "For the first time she really grinned at me, almost laughed. Marion is\n",
      "\n",
      "in her early thirties.\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "     4. When verbalizations of acceptance were not appropriate, I\n",
      "\n",
      "     acted out this acceptance by my behavior of staying with or\n",
      "\n",
      "     doing for when appropriate.\n",
      "\n",
      "\n",
      "\n",
      "_Example_\n",
      "\n",
      "\n",
      "\n",
      "Mary is a middle-aged patient who, on her first days in the unit, was\n",
      "\n",
      "liberally gobbling her food with alertness for only more to be had. Her\n",
      "\n",
      "only rather loud, irrelevant, smiling expression was about her daughter\n",
      "\n",
      "who was a go-go dancer, had three children, and whom she had visited\n",
      "\n",
      "twice by bus in California. This day she approached me and asked if I\n",
      "\n",
      "would file her nails. I said that I would but asked if she knew if there\n",
      "\n",
      "was a file in the unit. Another patient offered his. We sat down and I\n",
      "\n",
      "filed. The patient poured out a life story full of misery. This was a\n",
      "\n",
      "side of this patient that I had not perceived. I listened, nodded, and\n",
      "\n",
      "filed. The story started in the 1930s about her husband and\n",
      "\n",
      "mother-in-law's behavior; their marital separation; his being killed in\n",
      "\n",
      "World War II; their two children; their son, now thirty, was born with\n",
      "\n",
      "cerebral palsy, is blind and mute, and has been institutionalized since\n",
      "\n",
      "eleven months old; their daughter's husband left her with three children\n",
      "\n",
      "after fourteen years of marriage. I silently wondered what old feeling\n",
      "\n",
      "might have been aroused in her by her daughter's marital separation. Her\n",
      "\n",
      "daughter is so busy that she is unable to write regularly. She has told\n",
      "\n",
      "Mary not to worry if she doesn't hear from her. Mary then expressed\n",
      "\n",
      "concern over not receiving her usual letter this week from her mother,\n",
      "\n",
      "whom she visits. Mary had tried to reach her by phone and would again. I\n",
      "\n",
      "inquired if her mother lived alone. Yes, but next to relatives. She then\n",
      "\n",
      "related the drastic physical problems of a relative. I felt the sadness\n",
      "\n",
      "of this woman as she talked and empathized with the tough time she had\n",
      "\n",
      "had.\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "     5. I expressed purposely, to burst asunder negative self\n",
      "\n",
      "     concepts, my authentic human tender feelings for patients when\n",
      "\n",
      "     appropriate and acceptable.\n",
      "\n",
      "\n",
      "\n",
      "_Example_\n",
      "\n",
      "\n",
      "\n",
      "I was sitting in a rather large group of patients in the dayroom. A\n",
      "\n",
      "casual conversation ensued about Thanksgiving as it had been and\n",
      "\n",
      "Christmas as it might be. There was talk of having been at home and\n",
      "\n",
      "plans for being at home. I supported and encouraged the discussion\n",
      "\n",
      "because of the meaningfulness of holidays, past and present. Snow was\n",
      "\n",
      "initiated as a {116} topic. I said, \"It would be nice to have a white\n",
      "\n",
      "Christmas, but not too white.\" Vincent, a stiff, exact, ritualistic\n",
      "\n",
      "person who avoids stepping in an obvious fashion on thresholds, does\n",
      "\n",
      "little jiggle-like dance steps before sitting down, and again before\n",
      "\n",
      "settling in his chair, suddenly spoke. \"Josephine, I beg your pardon,\n",
      "\n",
      "but I must take issue with you.\" I encouraged his unusual behavioral\n",
      "\n",
      "expression. He went on and on about the importance of a white Christmas.\n",
      "\n",
      "I let my mind flow with his jumbled discourse trying to decipher what he\n",
      "\n",
      "was getting at rather than each specific rapidly mentioned issue. He\n",
      "\n",
      "went from white to black, day to night, goodness to badness, love to\n",
      "\n",
      "hate, this side of the world to the other side of the world (Vietnam). I\n",
      "\n",
      "expressed that he seemed to keep mentioning two sides of things and that\n",
      "\n",
      "for some reason I could not help thinking of boys and girls. I said that\n",
      "\n",
      "he was over on that side of the world (room) and that I was over on this\n",
      "\n",
      "side of the world. I asked why he did not come over to my side, paused a\n",
      "\n",
      "minute, felt this was asking too much of this patient, and said, \"Well\n",
      "\n",
      "I'll come over to your side then.\" When I sat down next to Vincent, he\n",
      "\n",
      "giggled as he does. Arthur, a younger patient, made a critical jealous\n",
      "\n",
      "type comment about Vincent's age (50ish). Arthur has done this before\n",
      "\n",
      "when I give attention to Vincent. Has Arthur a stereotype of father\n",
      "\n",
      "images and perhaps mother images? I said to Vincent \"you have beautiful\n",
      "\n",
      "white hair, and big, brown, smiling Italian eyes.\" Vincent sat back\n",
      "\n",
      "smiling shyly but comfortably and the discussion of the group continued.\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "     6. I supported patients' rights to loving relationships with\n",
      "\n",
      "     others: families, other staff, and other patients.\n",
      "\n",
      "\n",
      "\n",
      "_Example_\n",
      "\n",
      "\n",
      "\n",
      "Alice M. said that she was sad to be back at the hospital after her\n",
      "\n",
      "weekend at home. Alice is a quiet, bland, soft-spoken person about\n",
      "\n",
      "fifty. She wears a worried expression even when she smiles and strikes\n",
      "\n",
      "me like she is \"turned inside\" herself. I encouraged her to talk about\n",
      "\n",
      "her time at home. She told me about how they had painted the living room\n",
      "\n",
      "with what for her was a show of real excitement. I said that her wish to\n",
      "\n",
      "be at home was very understandable. I did this because this patient\n",
      "\n",
      "almost whispers her wish to be at home and, generally, no one responds\n",
      "\n",
      "to it. Alice talked on with encouragement about the single sister whom\n",
      "\n",
      "she visits and the pleasure it gives her to be with this sister.\n",
      "\n",
      "\n",
      "\n",
      "[I have other examples of this nurse behavior that indicate supporting\n",
      "\n",
      "of relationships between patients and between patients and other\n",
      "\n",
      "personnel.]\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "     7. I showed respect for patients as persons with the rights to\n",
      "\n",
      "     make as many choices for themselves as their current\n",
      "\n",
      "     capabilities allowed.\n",
      "\n",
      "\n",
      "\n",
      "_Example_\n",
      "\n",
      "\n",
      "\n",
      "Discussion of group at coffee revolved around Carolyn's needing a new\n",
      "\n",
      "pair of shoes. The issues were where these might be gotten (Carolyn has\n",
      "\n",
      "{117} money), what kind she should get, and who and when someone would\n",
      "\n",
      "take her for them. It struck me as if Carolyn might not have been\n",
      "\n",
      "present. I asked Carolyn what kind of shoes she would like. Carolyn\n",
      "\n",
      "responded that she did not know whether she should buy regular shoes, or\n",
      "\n",
      "sneakers, or canvas shoes like Marilyn had gotten. She beamed. Since,\n",
      "\n",
      "she has come up to me several times and discussed the two pairs of\n",
      "\n",
      "different kinds of shoes she bought and why. Carolyn is a sweet, simple,\n",
      "\n",
      "retarded, deaf sixty year old whose behavior resembles an eight year\n",
      "\n",
      "old.\n",
      "\n",
      "\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",
      "\n",
      "\n",
      "_Example_\n",
      "\n",
      "\n",
      "\n",