HUMANISTIC/BEHAVIOURIST THEORIES AND HOW IT IS

RELEVANT IN HEALTH AND SOCIAL CARE

According to Duldt`s Humanistic Nursing Communication theory, the basic unit of

measurement is the single communication "act" or behavior, which is any observable
verbal or non-verbal interpersonal communication. You record your perception of
three aspects of a single communication "act":

a. the message as being either fact or feeling,

b. conveyed with a humanizing or dehumanizing attitude, and

c. the pattern of interaction in which it occurs.

The specific content of the message is not recorded other than to identify it as either
facts or

feelings.

The unit of measurement, the message, may be verbal or nonverbal. The verbal
message may be

a fragment of a conversation, such as "Well" or "Hu-hum," indicating thoughtfulness

or

hesitation. The nonverbal may be a slow shaking of the head with a sideways
glance. Together,

these probably mean disagreement or "No." The message may be primarily verbal
and three

seconds in length. Or it may be divided into two or more themes, such as agreeing
and giving

information, all within in one time span. You may consider such messages as two
separate

messages so that the change in theme can be scored in the appropriate categories
on the NCOT.

RECORDING COMMUNICATION ACTS

The process of recording is as follows. You record the frequency of acts by placing
a mark, a
"/", for each message in the column for the speaker, e.g., the client, and in the row
for one of the

twelve categories which seems to best describe the communication act as you
understand it. You use the codes indicated at the top of the form for the patterns of
interaction in a similar manner:

"C" for communing; "A" for asserting; "N" for confronting; "X" for conflicting; and "S"
for separating

After a period of observation, the relative frequencies of the various categories can
provide you information about the degree to which facts or feelings are being
expressed, humanizing or dehumanizing attitudes are being communicated as well
as the patterns of interaction occurring between two or more people.

ANALYSIS OF DATA (Approaches)

You can study these data to determine whether or not the nursing goals are being
met and whether or not a change in attitude or pattern of interaction is indicated. For
example, Rodri (1986) used the original version of this tool to study the
communication occurring in the labor room between 20 laboring maternity clients on
fetal monitors and their nurses. This study was designed to determine whether the
nurses tended to be dehumanizing to the expectant mothers by "nursing the
machinery" rather than communicating in a humanizing manner to the client in this

critical life situation. Incidentally, the data analysis indicated direction in that the
nurses had some, but not statistically significant (p = > 0.15), inclination to
communicate in a humanizing manner to the expectant mother, rather than focus on
the machinery.

DEVELOPING OBSERVER SKILLS

In learning to use this tool, it will be helpful for you, with several other nurses, to
observe and collect data on a common experience, such as a videotape. Television
offers another rich source of data. For example, after observing a five or ten minute
segment of "Dallas," you and your colleagues might work together and compare your
initial efforts. Through discussion, further data collection and comparisons, you all
can become proficient in using and understanding the tool. You and two others may
practice observing only for facts and feelings a few times, next only for the attitudes,
and finally for the patterns of interaction. This will develop your proficiency for each
of the three aspects.

As you gain experience in using the NCOT, you will probably find yourself
developing an increased sensitivity to the occurrence and effects of humanizing and
dehumanizing communication. The television actors tend to talk slowly, and the
interactions are exaggerated

so that you can be amazed and delighted at the results. While such data as this
cannot be "right," it does provide "approximately correct" data which enables you to
make individual, subjective judgments about communication behavior generally and
your own nursing communication behavior specifically.

You and your colleagues may want to become "specialists" in observing for one
aspect only, pooling the data later for a composite of your observations. This
approach is probably most helpful when initially learning to use the tool and working
in groups of three or four within a larger group, such as in a class or workshop. This
enables individuals to become familiar with the tool in small steps, and gives
opportunity for comparison of decisions and discussion within the larger group, so
that each individual's diagnosis of the communication acts is developed within a
group norm. The "intra-rater reliability," or the degree of agreement you have with

yourself in scoring one video on different times, is one way to meet reliability criteria
often necessary in reporting findings.

Using the NCOT provides you with an opportunity to think about your own
communication behaviors, and to discuss them with your colleagues, and to develop
an awareness about the interpersonal meaning of your messages and how you are
"coming across." You and each individual must ultimately determine for yourself
whether you would like to change your own behavior. If you want to become a
humanistic nurse, then as a nurse, you must decide whether or not you need to
intervene to break a client's dehumanizing communication behavior and attempt to
change the client's messages, attitudes, and patterns of interaction to a more

humanizing mode.

Observations of interpersonal communication behavior may be analyzed by

tabulating the data according to each of the twelve categories. Judgments can be
made by looking at the total percentage distribution for each individual and for all
individuals observed. By making multiple observations, such as 20 observations of
the same nurse or nurses interacting with patients, an NCOT profile can be
developed of an individual nurse's behavior or that of a group of nurses,

e.g., ICU or clinic nurses.

You can describe the interpersonal communication behavior of a nurse's or client's

Message as moving Forward and focusing on Facts (problem solving) or moving
Backward and focusing on Sentiment (love, grief, joy, fear, anger, etc.); Attitudes
moving positively and humanizing or negatively and dehumanizing; and Patterns of
Interaction moving Inward (toward Communing or intimacy) or Outward (toward
Separation or isolation). Bales identified twenty-six brief descriptions within this
system to evaluate a members' contribution to group progress. Perhaps a
similar system might eventually be developed for the NCOT if it would be of value in
research

and education.

APPLICATIONS OF DULDTS THEORY

Duldt perspective of communication which can be useful in all situations in nursing

practice. The theory aids the nurse in coping with the negativity experienced in the
practice of nursing. This nursing theory can be utilized in conjunction with other
nursing theories to provide a unique perspective of the communication dimension of
interpersonal interactions.

Duldt THEORY recognizes the dehumanizing aspects of communication with

nurses, clients, and others. It provides the nurse with an option for escape from
negative patterns of communication and the potential to change relationships into
humanizing interaction patterns and attitudes.

BF Skinner, Behavioralism, & Language Behavior

Behaviorist Theory & Language Learning

Core to all of behaviorism is the assumption that human and animal behaviors are
determined by learning and reinforcement.  Whether by classical conditioning or
operatant conditioning, species acquire new skills, deepening on the effects these
skills have on the specie's environment.  If an action proves to have a positive
outcome (e.g., if by pressing a button, a rat receives food), the organism is more
likely to continue to repeat this behavior. However, if the outcome is negative (e.g., if
by pressing a button, a rat rat receives a shock), the organism is less likely to repeat
the behavior.

Skinner, and Stimulus-Response (S-R) adherents, believed that behaviorist theory

could be used to infer a learning history.  They held that one could take an animal or
person, observe its/his/her behavior, and figure out what had been reinforced
previously.  Behaviorist reduced all responses to associations, to a pattern of
positive and negative reinforcement that establishes links between stimuli and their
environmental antecedents and consequences.  Responses that were reinforced
would be repeated, and those that were punished would not.  Thus, if a dog brought
its human a ball and the human pet it, the dog’s behavior would be reinforced, and it
would be more apt to getting the ball in the future.  Likewise, if the dog brought its
human a ball and the human kicked it, the dog’s behavior would be punished, and it
would be less likely to do it. 

These associations between stimuli, actions, and responses could explain virtually
every aspect of human and animal behavior and interaction, but one seemed
particularly problematic for the behaviorist theory: language.  
 A basic assumption of his was that all language, including private, internal
discourse, was a behavior that developed in the same manner as other skills.  He
believed that a sentence is merely part of “a behavior chain, each element of which
provides a conditional stimulus for the production of the succeeding element” (Fodor,
Bever, & Garrett, p25).  The probability of a verbal response was contingent on four
things: reinforcement, stimulus control, deprivation, and aversive stimulation.  The
interaction of these things in a child’s environment would lead to particular
associations, the basis of all language.

Skinner proposed that language could be categorized by the way it was

reinforced.  He claimed that there were four general types of speech: echoic
behavior, mand, tact,interverbals and autoclitic. 

Echoic behavior is the primary form of verbal behavior of language learners.  These

verbalizations include repeated utterances, as in (1)

In health and Social Care settings Eg A nursing Home, Residential Home or Hospital
the following example could be used to show echoic behaviour in speech

(1)    Carer: [pointing to cookie] That’s a cookie. Can you say ‘cookie’?

Client: Cooookie

Mands (short for deMANDS) are defined as utterances that are reinforced by the
elevation of deprivation.  So for instance, if a client were hungry or cold, her requests
(as in (2))

(2)   Cookie.

Directives such as “Stop,” “Go,” and “Wait” also count as mands.

However, in (3), the client may be simply naming the object or stating what she likes.

            (3) Cookie!

Utterances that are produced when the speaker is not deprived are called tact (short
for conTACT).  Tacts are verbalizations that the speaker produces to provide
information instead of attending to states of deprivation.  While on the surface, tacts
and mands may seem similar, their underlying motivations (stimuli) and their
reinforcements  are different. When a mand is reinforced, the need is sated.  When a
tact is reinforced, there is no need to sate.

The fourth type of utterance is the interverbals.  These include such things as

“Please” and “Thank you.”  These utterances are not necessary to provide
information. Rather, they are used in discourse situation and pertain to the
interactive nature of dialog. So for example, in (4), the second utterance, the
response to the question, is an interverbal.  Likewise, the associative response in
number (5) is also an interverbal.

            (4) Carer A: Who’s your favorite actor?

                 Client B: You
            (5) WORD: CAT
                 RESPONSE: Dog

With the final category, autoclitics, Skinner attempted to deal with internal speech, or
thought.  Autoclitics, by his account, are subject to the same effects of reinforcement
as verbalized speech and that previously reinforced internal, or thought behaviors,
will influence not only current and future thought but also current and future verbal
behavior.

Whether the speech was internal or dialogic, reinforced positively or negatively, all
language can be considered behavior that is conditioned and learned.  When
Skinner wrote Verbal Behavior he attempted to explain the most complex human
behavior: communication.  This included all forms of language comprehension, from
dialog to thought. 

Though a tribute to the behaviorist paradigm, Skinner’s book generated more

questions and concerns than it explained.  After his book was published and
critiqued by Noam Chomsky, Skinner failed to respond immediately to the issues and
problems raised.  His slow response coupled with both a growing disdain for the
behaviorist paradigm and the influence of technology, computers, and information
processing led to the strengthening of the cognitive movement in psychology and
other social sciences.

References & Resources

Fodor, JA; Bever, TG; & Garrett, MF. (1975) The Psychology of Language: An
Introduction to Psycholinguistics and Generative Grammar. New York: McGraw-Hill.

Lana, Robert E. The cognitive approach to language and thought. Journal of Mind &
Behavior. Vol 23(1-2) Win-Spr 2002, 51-67. Inst of Mind & Behavior, US