Transpersonal Human Caring and Healing
Janet F. Quinn
Portions of this chapter have been published as: J. Quinn, “Healing: A Model for an Integrative Health Care System,” Advanced Practice Nursing Quarterly 3, no. 1 (1997): 1-7, by permission of Aspen Publishers.
Nurse Healer OBJECTIVES
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Theoretical
Define transpersonal human caring.
Define healing.
Compare and contrast the processes of healing and curing.
Discuss the nature of “right relationship” as it relates to healing.
Clinical
Apply the elements of a “caring occasion” to facilitate healing.
Describe examples of healing at the body, mind, and spirit levels of human experience that you have observed in practice.
Begin to imagine how your own clinical practice setting might evolve to become a “Habitat for Healing.”
Personal
Imagine what right relationship would look like and feel like when applied to something you want to heal in yourself.
Identify ways in which you can create your own healing environment.
DEFINITIONS
Habitats for Healing: Healthcare practice environments that provide a context of caring, for the purpose of healing, which may include curing.1
Healing: The emergence of right relationship at one or more levels of the bodymindspirit system.2
Healing system: A true healthcare system in which people can receive adequate, nontoxic, and noninvasive assistance in maintaining wellness and in healing for body, mind, and spirit, together with the most sophisticated, aggressive curing technologies available.
Human caring: The moral ideal of nursing in which the nurse brings his or her whole self into relationship with the whole self of the patient or client, to protect the vulnerability and preserve the humanity and dignity of the one caring and the one cared for.3
Right relationship: A process of connection among or between parts of the whole that increases energy, coherence, and creativity in the bodymindspirit system.
Transpersonal: That which transcends the limits and boundaries of individual ego identities and possibilities to include acknowledgment and appreciation of something greater. Transpersonal may refer to consciousness, intrapersonal dynamics,
interpersonal relationships, and lived experiences of connection, unity, and oneness with the larger environment, cosmos, or Spirit.
interpersonal relationships, and lived experiences of connection, unity, and oneness with the larger environment, cosmos, or Spirit.
▪ THEORY AND RESEARCH
Within the discipline of nursing, there is widespread acceptance of the concept of caring as central to practice.4,5 However, there is no widespread consensus as to what caring is. Morse and her colleagues, in their now classic paper, reported that five basic conceptualizations, or perspectives, on caring can be identified in the nursing literature: (1) caring as a human trait, (2) caring as a moral imperative or ideal, (3) caring as an affect, (4) caring as an interpersonal relationship, and (5) caring as a therapeutic intervention.6
The term transpersonal human caring is most often associated with Jean Watson’s theory of nursing as the art and science of human caring.7,8,9 Watson defines human caring as the moral ideal of nursing, in which the relationship between the whole self of the nurse and the whole self of the patient or client protects the vulnerability and preserves the humanity and dignity of the patient or client. This emphasis on the whole self—the whole person of both nurse and patient—requires the addition of the term transpersonal in Watson’s framework and in the discussion of human caring as it relates to holistic nursing practice. Within a transpersonal perspective, people are more than the body physical and the mind as contained in that body. A transpersonal perspective acknowledges that all people are body, mind, and spirit or soul, and that interactions between people engage each of these aspects of the self. A nurse with a transpersonal perspective recognizes that this is a fact of human interaction, not an optional event. A holistic nurse recognizes, as Watson suggests, that there is something beyond the personal, separate selves of the nurse and the patient involved in the act of caring.
When nurses enter into caring-healing relationships with patients, bringing with them an acknowledgment and appreciation of the body, mind, and spirit dimensions of their own human existence, they are engaged in a transpersonal human caring process. In this type of relationship, they know themselves to be interconnected with the patient and with the larger environment and cosmos. They know that they are walking on sacred ground when they walk this path with their patients, and they recognize that neither one will be the same afterward. For that moment, they are joined with the other who is patient or client, and so become part of something larger than either alone. In this transpersonal healing process, they are each changed.10
Watson calls these healing encounters “caring occasions” and suggests that they actually transcend the bounds of space and time. The field of consciousness created in and through the caring-healing relationship has the potential to continue healing the patient long after the physical separation of nurse and patient. Moreover, the nurse, following engagement in a true caring occasion, will also continue to benefit from the mutual process. When nurses are able to engage their full, caring selves in the art of nursing, it is both energizing and satisfying.
It is often assumed that nurses burn out as a result of caring too much. However, today’s nurses are far more likely to burn out for a different reason: the difficulty in finding the time to care for patients with their whole selves within healthcare systems that do not value caring.11
▪ HEALING: THE GOAL OF HOLISTIC NURSING
Although caring is the context for holistic nursing, healing is the goal. The origin of the word heal is the Anglo-Saxon word haelan, which means to be or to become whole. Defining what it means to be or become whole is a challenging task. For example, is wholeness a goal, an end point that is something to work toward but is rarely achieved? Is wholeness a state of perfection of body, mind, and spirit? Is wholeness something that people either have or do not have, something that people can obtain and hold on to, or something that comes and goes? Is it a state or a process? Is wholeness dependent on the structure and functioning of the body? Can one ever be not whole; that is, can one ever be other than wholly who or what one is at any point in space and time? If one cannot be not whole, then how is it possible to talk about becoming whole? Each holistic nurse should spend some time thinking about what this means to her or him
because a nurse’s perspective on wholeness will influence everything that she or he does.
because a nurse’s perspective on wholeness will influence everything that she or he does.
Healing as the Emergence of Right Relationship
Wholeness is frequently described as harmony of body, mind, and spirit, while harmony is defined as an ordered or aesthetically pleasing set of relationships among the elements of the whole. This simple definition illustrates the implications of associating harmony with healing. First, wholeness involves more than the intactness of physical structure and function, or the status of isolated parts of a person. Second, if healing is about harmony, it is necessary to expand the ways of knowing about healing to include the aesthetic as well as the scientific.
Synonyms for the word harmony include unity, integrity, connection, reconciliation, congruence, and cohesion. Taken together, these terms begin to suggest that wholeness is not necessarily a state of any kind, but a process that is fundamentally about relationship. Wholeness is about the relationship of the parts of a system to one another and to the larger systems of which they are a part. When the theoretical physicist David Bohm was asked, “How can anything become more whole if everything is already part of the indivisible wholeness of the implicit order of the universe?” he responded with one word. “Coherence,” he said, creating no doubt that wholeness was not about adding and subtracting parts, but about how those parts related to each other.12 Increasing the wholeness of a system is about establishing a pattern of relationships among its elements that is more and more coherent.
Healing, if it is a process of being or becoming whole, must be an emerging pattern of relationships among the elements of the whole person that leads to greater integrity, connection, and cohesion of the whole system. This pattern of relationships can be called right relationship. Thus, healing is the emergence of right relationship at or between or among any and all levels of the human experience. It is a process rather than a state. It is dynamic, and it always affects the whole person, no matter at what level the shift actually occurs. Key to an understanding of the effects of a shift into right relationship at any level are theories about how systems, particularly living systems, work.13,14,15,16 The new sciences are “known collectively as the sciences of complexity, including general systems theory (Bertalanffy, Weiss), cybernetics (Wiener), nonequilibrium thermodynamics (Prigogine), cellular automata theory (von Neumann), catastrophe theory (Thom), autopoietic system theory (Maturana and Varela), dynamic systems theory (Shaw, Abraham), and chaos theories, among others.”17p14 Within a systems perspective, human beings are simultaneously autonomous wholes and parts of larger wholes. Each “holon” is embedded in an “irreversible hierarchy of increasing wholeness, increasing holism, increasing unity and integration.”18
Several principles related to the nature of systems are fundamental to all these theories and have direct implications for the understanding of healing. The first and most basic is that a system is more than and different from the sum of its parts. It is “more than” its parts because the pattern of relationships among the parts of the whole gives the system its own unique identity. “A pattern of organization [is] a configuration of relationships characteristic of a particular system.”19p80
A second principle is that a change in the part always leads to a change in the whole. Because human beings are living systems governed by these principles, any shift, no matter how small or at what level it appears, will always affect the whole bodymindspirit. Furthermore, because every person is simultaneously a part of the larger whole of family, society, the ecosystem, and the universe, a change in an individual bodymindspirit leads to a change in all of these as well. This awareness is, of course, part of the teaching of virtually every spiritual tradition, and it affirms that nurses’ individual healing work matters to far more than just the nurses.
The third principle that relates directly to healing is that the nature of the change in the whole cannot be predicted by the nature of the change in the part. “The new state [of a system] is decided neither by initial conditions in the system nor by changes in the critical values of environmental parameters; when a dynamic system is fundamentally destabilized, it acts indeterminately.”20
Human beings as living systems are selforganizing systems, capable of—indeed, striving toward—order, self-transcendence, and
transformation.21 “We are beginning to recognize the creative unfolding of life in forms of ever-increasing diversity and complexity as an inherent characteristic of all living systems.”19p222 Thus, the healing process itself is inherent within the person. This urge toward healing, toward right relationship, when manifested, may be thought of as the “haelan effect.”22
transformation.21 “We are beginning to recognize the creative unfolding of life in forms of ever-increasing diversity and complexity as an inherent characteristic of all living systems.”19p222 Thus, the healing process itself is inherent within the person. This urge toward healing, toward right relationship, when manifested, may be thought of as the “haelan effect.”22
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