Ethics and Discovering New Meanings With Metaphors

Historical Meanings of Hands-On

The metaphor hands-on has been used throughout the history of nursing, highlighting tensions and potential conflict reflecting the importance of the nurse-with-person engagements. The term has been used to denote what is considered real nursing from something less authentic. The term has historical roots and association with hands-on as manual labor, hands-on as technological expertise, and hands-on as healing. Metaphors underlie theories in disciplines and are devoted to the description of what is known as widespread phenomena of interest. These shared, conventional understandings have significance to members of the discipline of nursing. Indeed, nurse scholars have struggled to articulate concepts and reflect insights of phenomena known to members of the discipline of nursing. Scholars of the discipline have not consistently articulated the ethical responsibilities of those who provide nurse services in myriad settings. Nurses serve society in complex settings of practice, research, and education. The metaphor hands-on deserves a straight-thinking ethical discussion and should be defined with emerging meanings reflective of the disciplines’ paradigmatic theoretical views, assumptions, and beliefs.

Physical anthropology recognizes the hand as one of the primary features that distinguishes human beings from other species. The functions of the hand are both biologically and symbolically central to the experience of being human. Hands have been used for healing throughout the centuries and are recorded in early writings and graphics from across the globe including India, Africa, Europe, and China, along with Native American pictographs (Engebretson, 2002).

The term hand and the metaphor hands-on have many uses beyond the description of a physical part of the human body. Hand is associated and denotes assistance or work, such as in the phrase give me a hand. It is also used to indicate a connection and potential control, such as have my hands on or in good hands. Reliability or trust is inferred with I give you my hand. Skill is conveyed by the term handmade (Engebretson, 2002). The American Heritage Dictionary of the English language (Morris, 1971) also lists fidelity, cooperation, intimacy, and blessing as being conveyed by the use of the hand.

As a persistent metaphor in nursing, hands-on has carried different meanings that reflect changes in society and in the work of nurses. The term has been embedded in the social realms where nurses have practiced, reflecting the shifting values of Western society. Thus, there remains a value for those who practice in institutions, at the bed side, where hands-on nursing services take place.

The Metaphor Hands-On and Humanbecoming: A New Conceptualization

The author, however, muses with curiosity for possible meanings of hands-on, from the ethical perspective of the humanbecoming paradigm (Parse, 2014). Emergent meanings of metaphors arise from investigating humanuniverse living experiences with humanbecoming sciencing. A deepening understanding of human dignity, the ethos of humanbecoming, with conceptualizing hands-on enhances understanding of the living experiences of reverence, awe, betrayal, and shame (Parse, 2014).

“Reverence is solemn regard for human presence” (Parse, 2014, p. 27). It is an inherent virtue and one that is demonstrated in the deep-rooted respect for the other. Hands-on is languaging solemn regard with an insightful awareness of the uniqueness of others. It is a venerating trust in nurse-with-person as persons reveal-conceal that which is most important to them as expressed in their hopes and dreams in living quality. Nurses may choose to touch another as the nurse-with-person unfolds with deep regard. Hands-on signifies a commitment of presence, trust, and worth as a member of the discipline of nursing. It is honoring others while being in true presence. Nurses should live an abiding appreciation for others’ hopes and dreams as they are living truth for the moment.

While being with others in solemn regard, awe is expressed in the hands-on experience as nurses relish the wonderments of humanuniverse existence while beholding others. Surprises unfold as different meanings of living quality surface in the becoming visible-invisible becoming of the emerging now. Hands-on is a vigilant undertaking in standing with others with discerning curiosity as the mystery of humanuniverse life and living quality unfold. As persons make their wishes known, it is with awe, respect, and hands-on vigilance that nurses regard the living quality of others.

With hands-on commitment, betrayal and shame are ever-lurking possibilities in that there may be a breach of trust or confidence shattering the trust-mistrust rhythm. It goes to the core of the being as betrayal of another may be shown explicitly-tacitly in speech, silence, movement, and stillness as messages are given and taken. Betraying others shifts nurse-with-person, nurse-with-family, and nurse-with-community engagements. It may occur when nurses fail to acknowledge or follow the requests and wishes of those we serve. In failing the expectations of others in the hands-on experience, nurses and those who receive our services may express shame with uncomfortable feelings of mistrust and betrayal. These living experiences coexist and are ever-present possibilities in the hands-on commitment of solemn regard as persons choose ways of being with others living the ethos of honoring human dignity.

Metaphors are fundamental to the human quest for knowledge and understanding. Metaphors create new meaning, provide new insights, and transform what is familiar with new emerging meanings and insights. Metaphors are embedded in theories of the discipline. It is encouraged that scholars of the discipline continue the work of conceptualizing metaphors and unearthing novel meanings. Since we rely upon them so heavily, let us explicate them with an ethos of human dignity, fortifying the scholarship of the discipline of nursing and the relationships with those we serve.