Bonnie Duldt's humanistic nursing communication theory and its applications

Nursing Theory Critique

Nursing theorist: Bonnie Duldt's humanistic nursing communication theory

Nursing theorists: Bonnie Duldt's humanistic nursing communication theory

Bonnie Duldt's humanistic nursing communication theory is unique in the manner in which it emphasizes academic philosophy: specifically it is derived from schools of humanistic and existential philosophy. Like the great humanistic theologian Martin Buber, Duldt stresses the 'I-thou' relationship of commonality between nurse and patient. Like existential philosophy, Duldt's theory stresses the inescapable nature of the human condition. However, unlike these philosophies, humanistic nursing communications is practical: "It defines the human being as applicable to nursing practice. It provides easily testable relationship statements that are clearly stated. It provides a structured body of knowledge that can be implemented into the educational cognates of a nursing education program" (Essendelft & Suzanne Woolard, 1996, p.5). This paper will examine Duldt's unique and revolutionary theory, as compared with older theories of nursing such as Virginia Henderson's, in terms of its major concepts and prepositions, utility, applications, and clarity.

Describe the usefulness of the theory in nursing practice

Duldt's theory reflects what many nurses may consider an essential, lived truth, namely that it is not enough to 'do' things to a patient, past a certain point -- the patient must understand why certain nursing interventions are being performed so he or she will be motivated as well as able to perform self-care. While Duldt would not fundamentally disagree with Henderson's assertions, Duldt's conceptualization is more useful when nurses must function as health teachers in the community: someone who is diagnosed with type II diabetes must know how to feed him or herself and use medication, diet, and exercise to manage his or her condition. It is not enough that the nurse merely knows these aspects of self-care are essential for the patient's health; the nurse must communicate this fact to the patient. The nurse herself must be a good listener as well as a good instructor. The nurse must understand why certain health-promoting behaviors may prove more difficult for some patients, due to economic or personal circumstances, and work to overcome these difficulties in an individualistic fashion.

The philosophy of humanism is manifest in Duldt's theory by its stress upon the 'I-thou' relationship. In the so-called 'I-thou' relationship, the dyad of human beings is in a state of oneness, facilitated by the communications process. Humanistic philosophy stresses that true relationality comes about when one human being does not do something 'to' another human being, but that the human dyad exists in a state of oneness and mutual communication. This stands in contrast to Henderson's theory, and earlier nursing theories, where nursing was a process done 'to' the patient. According to Henderson: "nursing helps the patient become healthy or die peacefully, and also helps people work toward independence, so that they can begin to perform the relevant activities for themselves as quickly as possible" (Skelley 2006). While nursing must be empowering for the patient in Henderson's theory, the nurse is clearly in the 'driver's seat,' affecting the patient during the process of nursing intervention. In contrast, Duldt believes the nurse and patient exist in an interpersonal relationship of "trust, self-disclosure, and feedback" (Essendelft & Suzanne Woolard, 1996, p.6).

Discuss recommendations for use of the theory in the future

Duldt's theory seems more reflective of modern theoretical notions of nursing, which stress the need to be culturally sensitive and to be respectful of individual patient differences. However, in some instances, such as busy hospital environment where nurses must place health-promotion at the top of their priorities, a theory such as Henderson's theory might be more useful on a daily, practical basis.

Include an assessment of the clarity of the theory

This is not to deny the hands-on relevancy of the Duldt approach, given that when patients must rapidly transition to self-care and outpatient care, a focus upon an effective communications is essential, to enable the patient to continue on his or her path to wellness. Henderson, of course, also stresses the need for self-care, although in a more externalized fashion. While Duldt and older nursing theorists such as Henderson have slightly different emphases, they should be ultimately viewed as complementary, rather than in opposition to one another.