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Ideas of Caring in Nursing Practice

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294 views5 pages

Ideas of Caring in Nursing Practice

journal

Uploaded by

Noor Afifah
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Received: 29 March 2020    Revised: 14 June 2020    Accepted: 30 July 2020

DOI: 10.1111/nup.12325

PHILOSOPHERS FOR NURSING

Ideas of caring in nursing practice

Margareta Karlsson RN MNSc PhD, Senior Lecturer in Caring Science  |


Sandra Pennbrant RN, MNSc, PhD, Professor in Caring Science

Department of Health Sciences, University


West, Trollhättan, Sweden Abstract
In nursing practice, awareness of ethical inner values and a common understanding
Correspondence
Margareta Karlsson, Department of Health of nursing and caring are needed. It is therefore important to highlight ideas of car-
Sciences, University West, SE 46186 ing in nursing practice. The aim of this paper was to illuminate nursing, caring and
Trollhättan, Sweden.
Email: [email protected] ethical inner values in caring and caring in nursing practice. By being attentive, open,
respectful and treating the patient as a person, nurses can enhance both their own
and the patient's sense of personal meaning in the caring relationship. Nurses can
use self-reflection to create an awareness of nursing, caring and ethical inner values
in caring.

KEYWORDS

ethics, ethics of care, philosophy of nursing, qualitative, theory–practice

1 |  I NTRO D U C TI O N & Schofenhofer, 1993; Leininger, 1995), middle range nursing theo-
ries (e.g. Beck, 1993; Swanson, 1993) and nursing philosophies (e.g.
Due to the increased complex care for patients and lack of time, Eriksson, 1990; Martinsen, 2003; Watson, 2008), all of which have
there is a risk that nursing practice will become more technical with- been important for the development of nursing practice. Alligood
out a caring substance. Caring requires nurses who focus on the (2017) stated that theoretical works on nursing have been of essen-
relationship with the human being by seeing, understanding and tial for both education and nursing practice. Nursing has moved from
taking responsibility. In professional nursing practice, a common a focus on nurses’ function in nursing (what nurses do) to a focus on
understanding of nursing, caring and an awareness of ethical inner knowledge (knowing how to use knowledge) in nursing (Alligood, 2017).
values are necessary. It is therefore important to highlight ideas of To prevent the nursing of persons becoming too technical in today's
caring in nursing that can strengthen nurses’ self-reflection on eth- effective and high-tech care environment, it must contain a core of
ical inner values and promote a deeper understanding of caring in caring with a caring ethos. One way to promote the ideas of caring
nursing practice. in nursing practice is to highlight caring from Eriksson's point of view
To understand the development of nursing, it can be important (Eriksson, 2018). The aim of this paper was to illuminate nursing, caring
to be familiar with some of the theorists who have historically con- and ethical inner values in caring and caring in nursing practice.
tributed to this development. Modern nursing started with Florence In the first part of this paper, we illuminate nursing and nursing
Nightingale, whose theory focused on the concepts of ventilation, practice, caring as a phenomenon, ethical values in caring science
warmth, light, diet, cleanliness and noise (Pfettcher, 2017). Different and caring in nursing practice. In the second and final part, the clos-
types of theoretical works have evolved, such as conceptual nursing ing reflections, we illuminate caring in nursing practice inspired by
models (e.g. Orem, 2001; Rogers, 1989), nursing theories (e.g. Boykin Eriksson's point of view.

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in
any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
© 2020 The Authors. Nursing Philosophy published by John Wiley & Sons Ltd

Nursing Philosophy. 2020;00:e12325.  |


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2 |  A N U N D E R S TA N D I N G O F N U R S I N G , is to be considered good care, it should reflect the core of caring,


C A R I N G A N D E TH I C A L VA LU E S O F C A R I N G as even if it is technically good it is not necessarily caring. “Nursing
I N N U R S I N G PR AC TI C E nursing” is built on the nursing process and the systematic planning
of patient care. If it does not contain a core of caring, there is a risk
In order to support nurses' perceptions of caring in nursing practice, that nursing will become an administrative and technical structure.
it is important to understand nursing and nursing practice from a Together, these three perspectives can be seen as necessary for
theoretical perspective: caring as a phenomenon and ethical values good nursing care (Eriksson, 1997).
in caring science.

2.2 | Caring as a phenomenon
2.1 | Nursing and nursing practice
In caring science, the focus is on the caring phenomenon and not
According to Florence Nightingale, the goal of nursing is to place on the profession (Eriksson, 2002). Caring science as an academic
the patient in the best possible condition for nature to act. The discipline explores and develops new knowledge about care that
environment was considered the source of illness, while nurs- can be used as a basis for care in different forms and contexts
ing was the activity that promoted health and well-being and (Eriksson, 2001). Caring science is essentially for science about
enabled the patient to use her/his resources as much as possi- human beings. In order to develop caring science, one must search
ble (Pfettcher, 2017). Nightingale states that the word "nursing" for knowledge about the innermost essence of the caring reality.
is associated with a certain ambiguity and has several meanings. The relationship between systematic and clinical caring science is
"Nursing" means the care that people give each other and the care interesting, because there are different caring contexts and differ-
received by people who need help. In health care, "nursing" can ent human care situations, all of which are unique. However, there
be practised by other professions. However, professional care is may still be similarities in the general knowledge of caring science,
practiced by nurses (Kirkevold, 1994). Henderson's (1978) theory which can open an understanding in each unique concrete situation
is similar and involves helping both healthy and sick patients. Cody (Eriksson & Lindström, 2000). Caring science as a human science in-
(2000) states that besides knowledge about diseases, medicine, volves a choice of perspective as well as an understanding of knowl-
technology and communication about what to do in actual nursing edge that studies the human being in different contexts related to
situations, genuine professional values are of importance in nurs- life and death, health and suffering (Eriksson, 2001). In Martinsen's
ing. According to the International Council of Nurses (2002), the philosophy of caring, caring is seen as relational, practical and moral.
definition of nursing is: Relation in caring is understood as essential and requires at least two
people, where one takes care of the other who suffers. Practical car-
…autonomous and collaborative care of individuals ing involves concrete action that can be learned and trained through
of all ages, families, groups and communities, sick or practice. Moral in caring means to see and confirm the other in the
well and in all settings. Nursing includes the promo- light of her/his situation (Alvsvåg, 2017). The basic motive in car-
tion of health, prevention of illness and the care of ill, ing science is caritas, where ethos is the power that supports and
disabled and dying people. Advocacy, promotion of a holds together the caring phenomenon in various contexts (Eriksson
safe environment, research, participation in shaping & Lindström, 2003).
health policy and in patient and health systems man-
agement and education are also key nursing roles.
(https://www.icn.ch/nursi ​ n g-polic ​ y/nursi ​ n g-defin​ 2.3 | Ethical values in caring science
itions)
On an ontological level, ethical issues are related to the perception of
Nursing also involves processes, dynamics and interactions that the human being or the patient and how nurses relate to themselves,
are most effective when the five knowing patterns of empirics, eth- to the patient and the position of the patient and caring (Eriksson,
ics, aesthetics, personal knowing and emancipatory knowing come 1995). Ethical caring occurs when the patient and the nurse touch
together (Chinn & Kramer, 2018, pp. 2). each other and it is sensitivity to the other person's vulnerability
Nursing can be understood as a basic science where nursing prac- “that creates a nourishing relationship” (Lévinas, 1985).
tice is the art (Barret, 2002). According to Eriksson (1997), it is not The ethos of caring science searches for the true, the good and
obvious that nursing involves caring. Eriksson (1997) distinguishes the beautiful, where the human being consists of a unity of body,
between the three perspectives: “caring nursing,” “nursing care” and mind and spirit. It implies an ethic in which the human being has
“nursing nursing.” “Caring nursing” consists of an innermost core of absolute dignity (Eriksson, 2001). Kemp (1991) argues that ethics
caring that sees the patient without prejudice and emphasizes her/ is about the good life and good conduct and assumes a sense of
his suffering and needs. “Nursing care” is related to the nursing pro- being present. Ethics presupposes the emotional human being who
cess and aims to systematically meet patient needs. If nursing care can perceive and interpret the world by means of dedication and
KARLSSON et al. |
      3 of 5

openness. It implies being emotional and having emotions both for identified relationships, action, attitude, acceptance and variability
one's own situation and for other people. as core attributes of nursing caring.
Ethics and ethos belong together and are a set of values that con- Different professions are involved in caring, which may hide
stitute a way to relate and take responsibility. The concept “good” the true reality, which Schopenhauer (1912) terms "Maya's veil."
is included in the ethical values, and Eriksson (2001) states that Maya's Veil prevents human beings from seeing the true reality. In
good care is true care. According to Hilli (2007), the human being the empirical reality, there are clear structures for how care should
is complete and integrated when she/he is in touch with her/his be performed, for example by methods. But methods, which must
inner rooms and ethos. Ethos relates to a home that provides shel- be followed, can hinder nurses’ insight and hide the true reality. It
ter and rest where the human being can find safety and strength. is therefore important that nurses are aware that the reality is be-
Ethos also makes the human being sensitive to what the inner voice coming increasingly technical and can hide the essence of caring
says (Kemp, 1991). The human being's inner ethical dimension, the (Eriksson, 2003). With a conscious ethos and caritas, nurses can cre-
innermost room, can be called a home, an ethos. People who are in ate a posture where they are caring and responsible in the power of
contact with their ethos feel at home and have the courage to follow love (Eriksson, 2018b).
their heart's inner voice. If nurses feel at home in themselves, they In professional nursing practice, a core of caring is necessary
may be more likely to invite patients to caring relationships (Hilli & for it to become nurturing and to do what is best for the patient.
Eriksson, 2019). Furthermore, a common understanding of caring, suffering, health,
Health science work is permeated by the caritas idea, which the environment and the person as a human being is required. Anåker
gives meaning to the ethos (Eriksson, 2001). In a caritative posture and Elf (2014) posit that the nursing profession needs awareness of
in caring, nurses feel responsible, want to help and show that they how care activities interact with the environment. Ethos in the form
are there for the patient. True caring is good and can be compared of internal values should be inherent in caring nursing practice and
to the good that nurses do. Through responsibility, which is the support the care. Karlsson, Nyström, and Bergbom (2012) state that
core of ethics, love gains strength in caring. If ethics is not rooted seeing the patients in nursing practice is to see their vulnerability
in ethos, it becomes more formal, which manifests itself in the care and allow them to be the persons they are and wish to be.
(Eriksson, 2001). There may be various obstacles that prevent nurses
from seeing or providing in caring, but most often the barriers are
in the human being her/himself (Eriksson, 1995). Caritative care is 2.5 | Closing reflections
real care founded on love together with people (Eriksson, 1990). This
means participation in caring, which implies being in a community This paper aimed to illuminate nursing, caring, ethical inner values
where both rest and motion are inherent in the presence. Caring in caring and caring in nursing practice. The use of caring inspired
means tending, playing and learning, which can generate trust, meet by Eriksson's view can contribute to the development of nursing
the patient's needs, provide physical and spiritual well-being and practice with a caring substance. In order for nurses to understand
create a feeling of being in development to support the health pro- nursing, it is necessary to have a theoretical understanding of caring
cesses (Eriksson, 1997). in nursing practice. Caring nursing consists of an innermost core of
caring that sees the patient as a human being without prejudice and
emphasizes her/his suffering and needs. In nursing practice, nurses’
2.4 | Caring in nursing practice self-knowledge and awareness of their own inner values (ethos) en-
able them to be present in the concrete unique situation with the
Caring can be understood as the core of nursing practice suffering human being. It concerns being committed, having a will-
(Eriksson, 2018a). The concept "caring" is used to highlight the ingness to invest something in the meeting with the other and doing
fact that the focus is on the innermost core of nursing, where the what is best for the other. It requires a focus on both commitment
concept “nursing” relates to nurses’ concrete work, the profession and presence (Martinsen, 2010).
(Eriksson, 1997). Ethos and caritas are the foundational force that Eriksson's (2018b) ethical caring mantra; “I was there, I saw, I
maintains the nurturing phenomenon in different contexts (Eriksson witnessed and I became responsible” (pp. 15) can be helpful when re-
& Lindström, 2003). Ethos is where the inner values in the nourish- flecting on nursing the patient. Nurses who are present in the caring
ing conduct have their own language. To develop an ethical and evi- situation see and observe the person's suffering and understand that
dence-based care, knowledge that is anchored in the caring ethos is they are responsible for acting in the person's best interest. If nurses
required (Eriksson, 2002). encounter the patient face to face in a presence of love, it can alle-
Theoretical knowledge alone is not enough in nursing, and there viate the patient's suffering (Kasén, 2002). To look in the patient's
is also a need for self-knowledge and awareness of one's own values face can be a way to meet the patients' vulnerability and suffering
and attitudes towards other people (Eriksson, 2002). According to (Sæterstrand & Rudolfsson, 2019).
Buber (1989), only the good can be done wholeheartedly. Good and A person's integrity is vulnerable and sensitive to interference. If
evil are related to human freedom, where freedom means being re- nurses see humans as objects, they may appear strange and mean-
sponsible for not causing suffering. Brilowsky and Wendler (2005) ingless, which can eliminate privacy. Integrity can be preserved by
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