Nursing Theory Critique Nursing Theorist:

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 major concepts and prepositions of the theory Duldt's intention was to make communication the focus of the nursing process. Duldt believed that communication was essential to making the patient a more active and involved party in healing. In Duldt's conceptualization of humanistic nursing communication, nurse and patient are viewed as existing in a state of oneness and positive dialogue. Communication is seen as essential to nursing and to a patient having an effective sense of 'being' in the world.

Duldt believed "the purpose of nursing is to intervene, to support, to maintain, and to augment the client's state of health" through the nursing processes of planning, implementing, and evaluating (Essendelft & Suzanne Woolard, 1996, p.5). A client system includes the patient and also the patient's support system, such as family members.

This idea is a more specific formulation of nursing than earlier nursing theories, such as Virginia Henderson's, which simply defined nursing as "doing things for patients that they would do for themselves if they could, that is if they were physically able or had the required knowledge" (Skelley 2006).

Like Duldt, Henderson conceptualized nursing as client-centered, and communication was one of the core functions of the nursing process which was designed to enable people to eat and drink; breathe; move; sleep; dress themselves; work; maintain a normal body temperature; excrete; clean themselves; engage in leisure and in worship; avoid hurting themselves or hurting others; to learn and discover; and finally to communicate (Skelley 2006).

Duldt defined the facilitation of human optimization through nursing in more narrow terms than Henderson and earlier nursing theorists to facilitate clarity: "survival is based on one's ability to share feelings and facts about the environment and ways of coping" (Essendelft & Suzanne Woolard, 1996, p.6). Sharing is an internal psychological process, versus the more exterior processes emphasized by Henderson. Perhaps most controversially, Duldt asserts: "The way in which a person communicates determines what that person becomes" (Essendelft & Suzanne Woolard, 1996, p.6).

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.