Part 16 (2/2)

relations.h.i.+p. The ”I-Thou” relating necessitated subsequent scientific understanding extrapolated from it through reflection on it as ”I-It.”

My hope in consultation was to offer both a cognitive, as well as, an ontic experience in which a mutual feeling apart from and toward the other would exist. This latter seemed most important to me. If the consultee experienced my being authentically present with her, she then would be apt to offer this type of relations.h.i.+p to the patients and families of concern to her.

Results of Comparison

The two clinical consultation experiences were juxtaposed, contrasted, questioned, related, and synthesized to envision their unified contribution to the construct of ”clinical.” The synthetic construct of ”clinical” is not viewed as a mere juxtaposing, a disintegrating, or reconstructing of the contributions {108} to my knowing from either of these experiences. This comparison is viewed as a facing of the multiplicities they both present. The synthesis is an illumination of both experiences with each transfigured through their mutual presence in the ”knowing place” of the comparer.[17]

In this comparison my appreciation grew of how I had uniquely implemented and conceptualized clinical consultation in my work experience. I recognized through the comparison that adequate clinical consultation demands both a pa.s.sionate and dispa.s.sionate phase of ”I-Thou” and ”I-It” relating. Without either of these forms of consultant being-in-the-situation we degrade the term ”clinical” if we employ it. Consultation lends itself naturally to a collaborative cooperative relations.h.i.+p. The consultant is dependent on the consultee for presentation of the specifics of particular situations. The consultee is dependent on the consultant for the tailoring of general knowledge to the consultees' particular situations. The relations.h.i.+p if appropriately called consultation is then of necessity interdependent.

In being separate from the other while feeling with the other the consultant does not lose the ability to question. Pa.s.sion undealt with or identification with the consultee inhibits the clinical purpose of the consultant and of the consultation. In identification one feels as if he were the other, rather than turning to the other and feeling with him. The degree of anxiety this provokes in the consultant can prevent looking at the consultation situation and issues in an ”I-It” manner.

The consultant loses the ability to question.

Through this comparison I was able to reflect on the graduate student nursing consultation experience in an ”I-It” way. At this time it became a ”clinical” experience for me. The lack of this reflective phase in this experience highlighted the reflective phase already existent in the working clinical consultation experience. The existence of this phase in the working clinical consultation experience highlighted its absence in the graduate student nursing consultation experience. My commonplace nursing world through this comparison became awarely meaningful and availed itself for conceptualization. A situation is not a ”clinical”

experience until the ”would be” clinician can reflect, a.n.a.lyze, categorize, and synthesize it.

Clinical Is

A potentially clinical psychiatric mental health situation becomes ”clinical” if the clinician relates to the helpee to awaken his unique potential or ontic wholeness, and noetically transcending this relating conceptualizes its meaning.

Clinician signifies a particular mode of being and a particular kind of cognitive knowledge. With all his human capacity the clinician relates with his clinical-world consciously and deliberately in ”I-Thou,” and ”I-It.”

Relating in ”I-Thou” with the other in-his-clinical-world the clinician gives himself and receives back the other and himself in the sphere of ”the between.” {109} He knows the other and the more of himself in this relating. He is confirmed and confirms the other through the other's presence with him. Thus, he calls forth the other's actualizing of self through the clinical relations.h.i.+p. In accepting the other as he is the clinician imagines and responds to the reality of his potential for becoming, becoming according to his unique capacity for humanness.

Relating in ”I-It” with his clinical world the clinician noetically transcends himself, objectifies himself, and studies his ”I-Thou”

knowing. He teases it apart. He cla.s.sifies and studies it. He asks it questions. He compares and contrasts it to other clinical experiences.

He discusses its many aspects in dialogue with his ”inward,” and possibly ”outward” ”Thous.” He reorders its parts. He shapes, creates, plans from and for its clinical existence. Thus, he ever augments a world of heuristic knowing.

This ”how” allows the clinical fulfillment of my nursing ”why.” Comfort is ”why” I, as a nurse, am in the health-nursing situation. As conceptualized ”comfort” is being able to freely control and plan for one's self, being fully in accord at a particular time, in a particular situation, with one's unique potential. Now, ”what” is the nature of the nurse's world, the health-nursing situation?

ALL-AT-ONCE: WHAT

The term ”all-at-once,” arose within me as a construct that would metaphorically describe the multifarious multiplicities that exist within nursing situations. Completing my comparison of Gilbert's and Muller's written works to grasp how they viewed the nature of psychiatric mental health nursing I found myself mulling over and fussing.[18] Your question is probably, mulling and fussing over what?

While I mulled over and fussed I believe I, too, was perplexed. Why was I unsatisfied?

I had compared Gilbert's and Muller's writing styles, their conceptions of man, approaches to nursing, nursing education, supervision, and consultation. Their similarities and differences were noted, and how each presented herself predominantly. Then I cited the nursing communities they sought to influence and those in which they were while writing. Through reviewing their bibliographies and biographies I indicated the sources that had influenced them.

Still I mulled over, fussed, and was perplexed. I awakened in the middle of one night in 1969 understanding what had been causing my struggle.

The ”all-at-once” was my answer.

The description of single constructs and single examples originally had felt unrelated to the reality of the nurse's world. They oversimplified its complexity. The nature of nursing was complex. It seemed to me that we needed, as a profession, constructs that simplified and allowed clear communications. We, also, needed constructs that conveyed the reality and complexity of the {110} worlds in which nurses nursed. Perhaps a description of what ”all-at-once” expressed for me would convey to others the lived-un.o.bservable-worlds of nurses.

Nurses relate to other man in situations of ”all-at-once.” The ”all-at-once” is equated by me to Buber's ”I-Thou” and ”I-It” occurring simultaneously and not only in sequence as he expressed it. These two ways that man can relate to and come to know his world and himself demand sequential expression for clear communication. However, the responsible authentic nurse in the nursing arena lives them ”all-at-once.” Aware of the multifarious multiplicities of her responses to another and at once to the surrounding field of action, the nurse selects and overtly expresses her responses that actualize the purpose, values, and potential of the artful science of professional nursing.

Awareness of the multifarious multiplicities affecting the other and the self in the nursing arena is a component of ”I-Thou” relating.

Selectively overtly expressing concordantly with the purpose, values, and potential of nursing necessitates a looking at, which is a component of ”I-It” relating, while acting and being. Therefore both ”I-Thou and I-It” modes of being are ”all-at-once.”

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