Trauma nursing practice today and the demands placed on technical and knowledge-based skill sets may tend to undermine the holistic needs of the patient. Technology employed in health care should not trivialize the need to encounter the patient in a manner that fosters trust and relationship (Almerud, Alapack, Fridlund, & Ekebergh, 2008). The social, cultural, educational, and economic contexts specific to the patient as well as previous life experiences should be completely understood to provide a care that caters for the totality of the person (Moreira & Sales, 2010). In addition, with intricate patient acuity, it is the expectation that the trauma nurse meets clinical expertise complex trauma patient characteristic requires (Walter & Curtis, 2015).

The incident of severe traumatic injury elicits various emotions in patients; the suddenness may significantly alter the planned life course of the patient and family. The threat of death from the impact of trauma is often devastating to all affected by the unexpected event. Confronting death and uncertainties in life is an everyday reminder of what is inherent in human existence. For philosopher Martin Heidegger, human beings exist in the experiences that govern human existence and the experience of a challenging traumatic phenomenon is one of such numerous life situations that make one human (Joensuu, 2012).

Heidegger's analysis of human existence is utilized to explain how human beings are confronted with unexpected, life-changing, and uncontrollable situations such as being involved in a traumatic injury. The role of the trauma nurse is pivotal in the continuum of trauma care. The nurse in Heidegger's analysis encounters the world of the trauma patient through the caring relationship, brings solicitude to the care environment, and highlights the essence of not separating the human perspective from the professional standpoint (Sampaio, Comassetto, Faro, Dos Santos, & Monteiro, 2015). Heidegger's human analysis could be used as a framework in trauma nursing to actualize and understand human experiences of trauma.

BACKGROUND

Martin Heidegger (1889-1976) was one of the most influential philosophers in the twentieth century. His work focused on ontology, the philosophy of the nature of existence and becoming, setting him apart from other leading philosophers of his time. An innovative and controversial thinker, Heidegger changed mainstream philosophy by defining its fundamental task in asking the question, what is the "meaning of being." For Heidegger, the essence of phenomenology, or study of the meaning of experience, is ontological, which answers questions such as, "What is being?" and "What is being in the world?" (Heidegger, 1962, p. 26). Heidegger's 1927 major and most important work, Sein und Zeit was translated to Being and Time, in 1962. This publication transcended beyond philosophy to impact other disciplines such as nursing, ecology, sociology, and architecture (Hoffman, 2006).

Phenomenology

In Being and Time, Heidegger's strategy is to provide a phenomenological analysis of the human being or being-in-the-world and seeks to understand life in the historical context of a person's worldview. Heidegger called attention to the fact that a human being is worthwhile because of existence in the world where there are other entities (Heidegger, 1962). This work influenced many areas of thought that include phenomenology, hermeneutics, political theory, existentialism, among others.

Heidegger's Elements of Thought

Heidegger utilized existential components in his ontological discourse of the being. He constructed an elaborate set of interrelated concepts: temporality, care, thrownness or facticity, authenticity, inauthenticity, and the end of possibilities. These notions, among others, offer an in-depth phenomenological meaning to man's existence in the world (Bonevac, 2014).

Temporality

Human temporality is formulated through an underlying pattern inherent in the world that relates to the past, the present, and the future. Humans are virtually subsumed daily in their world. Time becomes an integral part of existence that must be considered in planning daily routines. Life events are linked with time concepts. Humans use time configuration, and this enables them to communicate with other entities in the world in a uniquely human way. It is the awareness of temporality that solidifies human relationships with the world (Hoffman, 2006).

Care

His analysis presents the perspective that humans exist in the world when they are concerned and care for each other (Griffin, 1983). Heidegger distinguishes care as an ontological phenomenon and conceives it as a means of transcendence surpassing human understanding (Tratter, 2013). It includes the things we care about and concerns for others as being in the world. This is the structure of the care he characterizes as the totality of human make-up (Scott, 2014). Care signifies a way of being ahead of oneself encountering and interacting with one's surroundings. In Heidegger's human existence analysis, care is paramount and its presence structures the world and its human inhabitants (Heidegger, 1962).

Thrownness and Facticity

Heidegger's thrownness and facticity concepts describe the unification of human beings and the world through being completely embedded in the world, referencing that man's basic life is not under his control. He believes an individual is thrown into existence amid the context of specific time and world. The expression thrownness is meant to suggest the individual is delivered over or exposed to different life situations (Bonevac, 2014). Thrownness manifests as things going on in life at any given time, which could be negative or positive (Kisiel, 2014). It may also pertain to attending to something, giving up something, letting something go, accomplishing, or being involved in an unexpected event that may threaten life. These ways of being, as Heidegger would refer to them, are fundamentally related because they are issues that matter or concern us (Sheehan, 2014).

Authenticity and Inauthenticity

The structure of being admits to normative success (authenticity) or failure (inauthenticity) in Heidegger's analysis of the human existence. Humans are capable of making independent choices (Crowell, 2007). Authenticity denotes capability of making wise independent choices in life, whereas inauthenticity connotes following worldly standards and societal beliefs that culminate in making bad decisions. Inauthenticity is crucial to self-recollection and challenges one toward being truly human (Scott, 2014).

The End of Possibilities

Heidegger uses the experience of anxiety as the intuition that heightens the awareness the end of existence or death. The ever-present threat of death is what Heidegger referred to as indefiniteness, as it is not limited to any specific moment (Heidegger, 1962). Humans, argues Heidegger, relate to themselves as beings with limited possibility or capable of dying and are apprehensive toward it. Death helps humans to realize an ontological understanding of the self as a being completely susceptible to it.

APPLICATION TO PRACTICE

The Acute Trauma Patient

Most of the time, the incident of trauma will necessitate alteration in an already planned trajectory. For Heidegger, the threat of death when properly put in perspective is a constant and ever-present reminder of why we are human beings. The patient fantasizes over what could have happened especially when faced with the inevitable. As a result, the patient's concerns of having been in a traumatic event and the subsequent need for recovery are both grounded in care because it is care that determines all human experiences (Hoffman, 2006).

Being involved in an unforeseen trauma is being thrown into the world in a particular way. In this instance, the unexpected and unprepared nature makes it justifiable. In Heidegger's view, thrownness is not just factuality (or fact), but the facticity of everyday life and experiencing trauma can be related to this perspective (Heidegger, 1962). The need for admission and treatments required for complete recovery may take an extended time. In addition, the thought of anticipated surgical procedures or other invasive treatments, coupled with the loss of personal time, could be daunting. This sudden turn of events may evoke feelings of being abandoned, and preoccupied by the thoughts of getting back on track. The impulse to feel connected once more and the refusal to accept the facticity of life could impair the healing and recovery process if taken to extreme (Churchill, 2013).

As the patient takes stock, Heidegger recommends patient uses "thrown projection" to project self forward from the impact of trauma and move on from the past to embrace the present (Heidegger, 1962). Avoiding obsession with the untoward effects of the injury helps to reconcile factually the situation at hand and cultivates hope toward a positive outlook. The first step toward authenticity is the ability of the patient to stay present at the awkward situations of life, and it is one remarkable step toward finding one's way into the future (Churchill, 2013).

The Nurse's Role

Feeling the gaps of the patient's disconnection with the world, abandonment, uncertainty, and despair associated with unexpected traumatic injury would require more than the patient's motivation. In the prospects of a lengthy recovery dampened with questionable quality of life, the patient would need, in addition to supportive family members, a caring nurse as well as other health care team experts. Heidegger in his analysis of Being and Time emphasized care as the essence of being and the basis of all motivation (Polt, 1999). This fundamental ideology guides the nurse to consider the trauma patient as a being who deserves attention, respect, and comfort (Sampaio et al., 2015).

Caring can be viewed from numerous perspectives, but the unifying factor is the communicative interaction between the nurse and the patient. Caring is invalidated in the absence of any of the three defining concepts: the nurse, the patient, and the interaction. This interaction is based on the premises of inherent expectations from the patient because of human vulnerability and the need for the nurse's considerateness (Sumner, 2006). The goal of care stakeholders is to understand the whole being of the patient as it relates to specific life contexts and not just the injury sustained (Moreira & Sales, 2010). The trauma nurse reaches out to the patient in the care environment through an interconnectedness approach to be in the life world of the patient (Walters, 1995).

The Practice Environment

The trauma unit consists of technological devices that contribute to the patient's recovery and, as such, is an integral element of care. Safety of the patient is ensured in transition to diagnostic units, from critical care units to regular units, through carefully overseeing that monitoring devices needed are communicated (Garlow, Day, & Payne, 2015). The technological equipment permits continuous hemodynamic status monitoring and evaluating the patient's response to treatments (Alasad, 2002). Technological use in nursing as a component of care gives the nurse a sense of control and may have the tendency to cause neglect of basic care of the patient. Caring could be lost due to undue reliance on medical devices and may portray the nurse as insensitive to the patient's feelings.

The equipment employed in practice and caring should reflect interconnectedness and balance in nursing care as both are relevant, indispensable, and complementary (Almerud et al., 2008). Bonevac (2014) referred to Heidegger's description of two ways of thinking (present-at-hand and ready-at-hand) in relation to the function of medical equipment in the care environment. When the equipment malfunctions, it takes on the present-at-hand existence because it cannot be used for the intended purpose. The equipment then becomes a hindrance to interconnectedness. The functioning equipment takes on the ready-at-hand mode.

Often nurses practicing on the trauma unit are confronted with barriers that constrain the caring process, such as poor collaboration, inadequate staffing, and insufficient time. These negative work experiences jeopardize collegiality and could create dissenting emotions, which may lead to low job productivity and, as a result, adversely impact patient outcomes (Mace-Vadjunec et al., 2015).

CONCLUSION

This article utilized Heidegger's fundamental concepts clinically to illustrate the being-in-the world of the acute trauma patient and care processes involved. Heidegger argues that, for human beings, it is acceptable to experience circumstances into which they are thrown. It is in thoroughly undergoing such experiences rather than viewing them as obstructions, which fosters the path to recovery. He urges people to project themselves forward from the points of life's mishaps and use them as anchors to move forward in life. The understanding of Heidegger reveals that the authentic patient builds and evolves the self as the past is let go and this is something that can be experienced in the process of trauma patient care.

KEY POINTS

* Care is characterized as the totality of human existence, the essence of being, and the bedrock of compassion for one another. This concept manifests in the context that is relatable to caring for the sick.

* Facticity is the different life situations we see ourselves. It is a normal part of human existence. The refusal to accept the facticity of life in moments of ill-health could impair the healing and recovery process.

* Interconnectedness identifies the nurse, the patient, and the care team interactions as interrelated. The nurse reaches out to the patient in the practice environment through an approach of interconnectedness to understand the patient's needs.

REFERENCES