Susan Kleiman, PhD., RN, CS, PNP

Frequently Asked Questions:

What is Humanistic Nursing Theory?

Humanistic Nursing Theory, formulated by Josephine Paterson and Loretta Zderad, aims at the development of nursing theory through the study of the existence and reality of nursing. Humanistic Nursing Theory is based on the idea that nursing is an intersubjective transactional relationship between a nurse and a patient who are human beings existing in the world. The conceptual framework of the theory is existentialism and it presents a phenomenological method of inquiry that can be used by nurses to examine and understand their everyday practice. The theory serves as a vehicle to describe the essences of everyday nursing experiences. It is an inductive approach to theory building through exploration and description.

Within the theory, humanistic nursing, viewed as a lived dialogue, offers a frame of orientation that places the center of the nurse’s universe at the nurse-patient intersubjective transaction. Insightful recognition of the lived nursing act as the point around which all nursing functions revolve, requires a paradigm shift in orientation for some nurses.

Who are Josephine Paterson and Loretta Zderad?

Dr. Josephine Paterson is originally from the east coast and Dr. Loretta Zderad is from the mid-west. They both were graduates of diploma schools and subsequently earned their bachelor's degree in Nursing Education. Dr. Paterson did her graduate work at Johns Hopkins and Dr. Zderad did hers at Catholic University. In the mid-fifties they were both employed at The Catholic University and were assigned the task of working together to create a new program that would encompass the community health component and the psychiatric component of the graduate program. Subsequently they developed a collaboration and dialogue and friendship that have lasted for almost 40 years.

Josephine Paterson recalls that while she was a faculty member (1959-1964) she experienced an inward restlessness related to her perception that, "Teaching in nursing was an offering of multitudinous theories developed in and for other disciplines using nursing examples (Paterson & Zderad, p. 96)." She experienced the approach as fragmenting rather than providing a unifying base that could heuristically accommodate a better understanding of the nature of nursing. It was in the 1960s as they each pursued their doctorate degrees that Josephine Paterson and Loretta Zderad began reflecting on their lived nursing experience and found that they could not communicate their experiential view of nursing through the positivistic scientific approach. They soon realized as they began to interweave their shared interest in phenomenological and existential philosophies that the process by which they could articulate, and believed others could articulate their personal theories of nursing was through a phenomenological approach.

It was in this spirit that Josephine Paterson and Loretta Zderad began to examine their experiences as nurses and developed the Humanistic Nursing Theory. As Josephine Paterson has told Dr. Kleiman, "It has grown out of my nursing practice experience, my reflecting, relating, describing, and synthesizing. This is heuristic culmination of much mulling over my lived world of nursing.” She recalls that the first time she spontaneously articulated this theory of nursing was during a presentation on concept formation in 1971.

It was that same year, 1971, that Dr. Paterson and Dr. Zderad's career paths led them to the Veterans Administration Hospital in Northport, New York. Dr. Paterson and Dr. Zderad used a three-pronged approach that integrated clinical practice, education, and research. Their theory of humanistic nursing presented a method for nurses in clinical practice to examine their experiences. They believed that by examining these experiences they could be analyzed, synthesized, and subsequently formulated into theoretical propositions which can become resourceful guides for nursing practitioners (Zderad, 1978, p. 4)."

Subsequently Dr. Paterson and Dr. Zderad began to integrate the concepts of Humanistic Nursing into a series of courses that they conducted around the country. During these courses they encouraged other nurses to articulate and describe their experiences of nursing. It is from these descriptions that the eleven essences, awareness, openness, empathy, caring, touching, understanding, responsibility, trust, acceptance, self-recognition, and dialogue, emerged. Humanistic nursing theory proposes that these clusters of phenomena can be ordered as common beliefs-values to nursing practice for these nurses. These beliefs-values can then be presented as the underlying elements of nursing, which endure for them despite the ever-evolving superficial function-place changes inherent in nursing practice (Paterson, 1979, p. 4).

Josephine Paterson and Loretta Zderad retired in 1985 and moved South where they are currently enjoying life. Although they are no longer active, they are pleased at the on going interest in their theory.

Who is Susan Kleiman?

Susan is currently Assistant Professor of Nursing at Lehman College, City University of New York. Her interest in Humanistic Nursing began when she was a student studying under Josephine Paterson at the V.A. Medical Center in Northport, New York. Dr. Paterson introduced her to Dr. Zderad, who was in charge of nursing education, and they both introduced her to the concepts and applications of "Being and Becoming," "Noetic Locus," "Angular View," "Call and Response," and a host of other ideas about nursing and the manner and demeanor in which nursing care is delivered. For over 20 years she has learned from and collaborated with Paterson and Zderad and is proud to be considered by them to be not only a friend but as colleague who has expanded their work by integrating the theory of Humanistic Nursing into the clinical and educational settings. They have said of Dr. Kleiman, “She knows our theory better than we do. She’s been using it. She’s developed it further.” Dr. Kleiman’s dissertation is characterized by Paterson and Zderad as a meta-theoretical handling of the concepts they presented in their classic work. This was their vision for their theory from the start. That is, those other nurses following them would take their work and expand and use it for the benefit of all nurses.

Paterson and Zderad frequently refer inquiries about their theory to Dr. Kleiman as they actively pursue only their retirement interests. See publications page for some references.

Is Humanistic Nursing Theory a middle range theory?

I sometimes ask myself, Are these designations; “grand theory,” “mid-range-theory,” and meta-theory” just inconsequential ramblings about theoretical processes that have no relevance to nursing and no place in theory development in general.

These terms were introduced in Sociology in the discussion of abstract versus empirical analysis of social systems (see C. Wright Mills, The Sociological Imagination). the term “grand theory” is usually used in a pejorative way to refer to theoretical ideas that are disconnected from empirical evidence.

“Mid range theory” is associated with the ideas of Robert Merton, another sociologist, and refers to his ideas of theory articulation that are grounded in and based on evidence. Mid range theory is also sometimes referred to as the “meso-level (between macro and micro)

“Meta theory” refers to “theory about theory”. The best analogy for “meta-theory” is, according to Dr. Robert Alford, Distinguished Professor of Sociology, City University of New York; “A meta-conversation with one’s wife or husband, where one is talking about the process of communication, rather that the substantive issue at hand.”

Now, about whether Humanistic Nursing Theory is considered a middle range theory! Some people, including myself are not comfortable with breaking down nursing theory into grand or middle range theory categories.

If you take the view of middle range theory as one that describes discrete aspects of empirically observable events and take that to mean that Humanistic Nursing Theory focuses on examining and explaining particular phenomenon that occur in nursing practice, e.g., the relationship between the nurse and the patient (as described by Hildegard Peplau) then the label might fit.

If however, you take the theory from the perspective that it proposes that through the articulation of the essences of that relationship you are defining nursing as a whole, then I believe you could make a case for calling it a grand theory. If you take it from the perspective that it is a theory about defining a theory of nursing through existentialism and phenomenology then you might consider it a meta-theory. Paterson and Zderad define their theory as a meta-theory.

Is Humanistic Nursing Theory applicable to the nurse-nurse manager relationship?

Yes, most definitely. When this theory was first articulated by Paterson and Zderad it was used in the context of nurse administrators helping nurses to define themselves, their relationships and their practice in another period of time when there was significant changes that were creating unrest and tension.

I quote from Loretta Zderad where she said; “For me, the way I am with patients, I have some of the same way of being with students or being with staff in an in-service. I think the goal is always the same. It’s like a trying to understand where that other person 'is' and then trying to relate in our here and now situation where we would have a meeting.”

I am planning an updated version of the Humanistic Nursing Theory book that will address application of the theory in various aspects of nursing such as management, administration, policymaking, and education.

This web page is part of the project of continuing and expanding the work of Josephine Paterson and Loretta Zderad. I invite you to submit your questions and comments to me.

Susan Kleiman