Humanness of Caring in Nursing - Essay Example

Humanness of Caring in Nursing Introduction The phenomenal strides that science and technology has made in the recent years have relegated human factor to insignificance in all the facets of human life. The profession of nursing also has joined the new bandwagon. The technology driven feature of modern nursing blurred the beauty and charm of the human face of nursing and in a way deviated from the original spirit of loving care of the person to merely cure of ailments. The impact of this shift has much more ramification in nursing than in other departments of life. Nursing, par excellence, is a total commitment to more or less helpless men and women, and devoid of humanness, the profession cannot be done at all. Recently the profession of health care has undergone amazing changes and the development of science and technology has given the nurses varied tools in the service of mankind. However, without an attitude of loving and humane care giving, all the efforts of the nurses will only be exercises in futility. The paper sets forth to analyze the historical origins of nursing as a profession of loving and humane caring and the need to revitalize those aspects in a world of reckless competition, consumerism and anonymity of the human person. Ethical Roots of Loving Care Historians point out that the early nurses were women and the motivating factor to serve as nurse is deeply entrenched in the maternal instinct of woman. Therefore, from time immemorial the nursing care has been loving care. The maternal instinct provided that strong impulse or motive necessary to care for those who were suffering or helpless. Women, because of their maternal instinct, were considered "born nurses." (Donahue, 1996, p. 5) It was only gradually that nursing started developing as a profession. In the early days, nursing was regarded as a calling for those who had given up the world. The intense religious motive that translates ones love of God towards fellow human beings in loving care is marked by self-sacrifice (Donahue, 1996). This other-centeredness of nursing resulted always in the uncanny knack to perform ones service in an attitude of humane care. Ancient nursing caregivers were somewhat ill equipped to render professional service but their enthusiasm and commitment alleviated the helpless condition of the patient. This attitude of loving care sprang from the realization of the other as God’ child. In the passage of time, this attitude has dimmed and there is apprehension that nurses will not care completely unless and until they care in a spirit of humane and loving care. Aims of Analysis In the past care, giving was intrinsically associated with the profession of nurses and ‘nurses care’ has become a slogan. However, the present-day social and commercial forces have made it difficult to give the undivided care in real time nursing practice. This has raised a question about the ethic of caring as practiced by the nurses today. The nurses by concentrating on the technical aspect of healthcare have neglected its caring aspect .The detached, uncaring and distant nursing intervention might cure the body but might crush the soul (Kelly 1988). Our culture is distinguished by it hurry in everything. However caring is time consuming and if the ethos of the society is for speed, caring nursing is the fist casualty in such culture. Naturally nurses who believe in their ethical role as care providers, find themselves in a central dilemma in their life and careers, feeling odd in a milieu where hospitals are thought of as industries for curing a predetermined number of patients every month. The purpose of this analysis is to validate the traditional role of humanness in caring on the part of nurses and the need to integrate technical skills with humanness essential for relating to patients and their families. (Hutchinson 1984). . Uses of Concepts Knowledge itself has been subjected to philosophic enquiry and accordingly there are three cardinal theories about it. They are rationalism, empiricism and historicism. Rationalism is theorizing in the first place followed by validating the theory by experiments and inferences. Einstein’s theory of relativity provides with an excellent example of this. His theories were formulated long ago and later development provided tools to test if the theory was proved right. In contrast to rationalism, empiricism is gaining knowledge derived from observation of phenomenon and then formulating theories about it. The theory of empiricism has undergone lot modification, and in its modified form, is still regarded as a scientific approach in sciences like biology, physics and chemistry. Historicism accepts that there are many aspects to knowledge that are subjective. It recognizes the fact that we stand on the shoulders of our tradition and we construct the world of reality based on our own experience. McKenna (1997) has summarized this approach to knowledge: Historicism recognizes that we are all influenced by our history and the experiences, values and beliefs we have thereby acquired. Because we construct our own realities and interpret events based upon our personal construction of the world. (p. 31) The philosophic enquiry about knowledge has taken away the smug satisfaction of putting the process of concept formulation in convenient boxes. The realization has softened philosophy and more that ever there is greater willingness to accept the differences between sciences and the different concepts required to understand each branch of enquiry. Different sciences and their way of arriving at formulation of concepts have influenced the ways of knowing in nursing too. One of the early realizations ever since nursing became a discipline is the need to possess the knowledge needed to do nursing in a proper system. However, the body of knowledge in the field of nursing is not entirely derived as in the case of other sciences either from a process of philosophic formulation or through the method of experiment, observation and inference. At the same time, the field of nursing does not preclude those methods. The dilemma in nursing is that it is a science but it has an art to it. This is a puzzling situation to the eager scholar who wants to put all knowledge in easily recognizable labels. This knowledge of know how is explained by McKenna (1997): Experienced practitioners know intuitively what is good practice but they often have difficulty explaining exactly what they do. It is also possible that ‘experienced’ patients also know what constitutes good practice but they too have difficulty explaining what it is. (p. 37) Faced with this inability to articulate what constitutes the reason for the success of many nurses in their career of caring, some theorist argue that caring is an interpersonal activity and self-awareness and knowledge about how we relate to others is essential for success. The active empathic participation in the lives of the client is essential to caring. Theories are derived from ideas and they come from hunches, insights and intuitions. The theory of caring is very subtle and can be understood in a milieu of ethics, aesthetics and personal knowing. It is in this context that Watson (1985) uses terms like ‘inner self’ and ‘essence’ in his theory of caring. Humanness in Caring, the Paradigm Shift Though the very idea of nursing has sprung from the eagerness to care for the other there has been a paucity of literature in the aspect of caring. However recently the trend has been to recapture the lost ideal of caring as essential to nursing. This is reflected in the studies that are being churned out by the academia. Gaut (1981) sees the rise of this vision of caring not only among the practitioners of care but also among those who study the process of nursing. The author sees the emerging vision of a holistic approach to nursing. The caring approach brings about a societal transformation, as well as, change in the individual. Leininger (1990), well versed not only in nursing but also in the science of anthropology captures the centrality caring in nurse’s profession. She sums up her convictions at times in the spirit of a zealot: For more than three decades, it has been my theoretical posture that caring is the essence of nursing and the explanadum for health and well-being. It is also the explanadum for the survival of human cultures and civilizations. (P.19) Caring is considered the highest moral ideal that directs the nurses, and caring with skill is highest form of commitment. Nevertheless, this has to be exercised recognizing the commonalities between people that build healthy bonds between people. The recognizing of the sameness of the aspirations across the world is necessary for appreciating the commonalties of human drama. This is called the transpersonal way of viewing people which gauds the nurse to approach caring holistically. (Watson 1998). . After the Second World War, the innovations in all aspects of human life became highly complicated with the intervention of technology everywhere. Health care was no exception in this. Nurse’s need for becoming technically competent in fact made a lot of infringement on the very nature of nursing as a vocation of care giving. This had the danger of nursing becoming an impersonalized work in a complex system of multiple health care personnel, throughout the industrialized world. The protection of the human factor and the patients’ right to get humane care became cardinal issues in nursing literature (Fry 1988). Though caring is a universal phenomenon, many factors influence its articulation in real time practice. There are cultural aspects to care, and different value systems follow different styles of caring. Cost and maturational levels of clients and caregivers are other factors that have to be taken into consideration (Bevis 1981). Theorists identify the reason for the deviation from humane caring, as the tendency to engage in the activity without conscious intent or awareness of purpose. Now a days hospitals seem tobe testing the theory that nurses can work forever with no time to recover. Long hours of work, truckloads of paper work etc push the nurse to the limits of endurance and produces burnout. This has been described as running out of sources of energy as a result work becomes mechanical without any positive feelings like sympathy or respect for the clients. The negative effects of burnout are rudeness, sarcasm and insult to the patients. While some burnout cases are irrationally angry, others become introverted and move to an unfortunate phase of depression. The burnout also affects their relation in the family and the result is a non-caring behavior on the part of nurses (Maslach 1982). The caring mission of the nurses is related the development of stereotypes due to historic reasons. According to Reverby (1987), "nursing throughout the colonial era and most of the nineteenth century took place within the family" (p. 5). Medical profession was one of the learned one and those received it gave advise and left much of the care to the housewife and other women in the neighborhood. The mundane aspect of caring was left to women and it was they who were in close association with the patients, and their activities involved, apart from curative aspect, empathy, care and identification with the suffering person. However, the central dilemma today is that the society knows the value of caring but refuses to value it. (Reverby 1987). Scholarly studies have also hit upon the distinction between caring and uncaring nursing. Hutchinson (1984) claims that nurses create meaning emotionally, technically and rationally. They express their meaning by emotionally investing in the patients and their families. This is done by a delicate mechanism of attracting to and detaching from patients/families. The technical repertoire of the nurses helps them to give sophisticated care. They create meaning rationally by justifying by application of reason that their painful procedures are necessary for the well being of the patients. So three ways of creating meaning according to Hutchinson are essential to practice nursing with humane care. Towards a Philosophy of Humane Caring The thrust of literature related to caring is that it is essentially the human mode of existing. There is need to explore the possibility of formulating a philosophy of caring. There is a perceptible shift in values in industrialized countries, as a result, the essential aspect of caring is in the way out. Since nursing profession will reflect the value system of the social milieu one need not be surprised to see an erosion of care in nursing also. To salvage nursing career from the present crisis a much more powerfully articulated stand, that caring is the most common and abiding signs of humanness, is needed. The very growth of a person to mature manhood or woman hood is through the mutual exchange of care for one another. This includes not only the expression of care but also the graceful receiving of care. It is a human tragedy that there is nobody to give care and to receive care. What is the ramification of the acceptance that caring is essential to humanness? A theory should find its way into the society and any education program in health care has to be integrated in such a way the caring becomes the essential of practices of nurses. There seems to be a dichotomy between the professions of medicine and nursing. The schism is not warranted. There are different modalities for giving care. Cure and care go hand in hand. In Nouwen’s (1972) observation, care is the precondition of all cure. Conclusion Through educational program cardinal qualities of caring in nursing, like compassion, competence, confidence, conscience and commitment have to be inculcated. These elements form the ethical foundation for a nursing based on humane caring. The ramifications of these are all the more important, in the training of the nurses and their curriculum development. In the backdrop of eroding humanness in caring it is essential that we emphasis the urgency of bringing back the original hallmark of nursing profession, humanness in care. The nurse administrators who formulate and implement policy, together with nurse educators, should see that adequate changes in curriculum is brought about so that the ethical dimension in the future nurses be implanted. When it comes to the active practice of their profession, the nurses should have the autonomy to implement their convictions of the sacred duty of caring, independent of the investors, who are likely to be goaded by profit from hospital care. This is possible only if the governments distinguish hospital work as an essential service and insist on benchmarks of auditable care from those who hope to profit from health care work. =================== References Bevis E.O. (1981) Caring: a life force. In Caring. An Essential Human Need: Proceedings of Three National Caring Conferences (Leininger M. ed.), Charles B. Slack, Thorofare, NJ, pp. 49–60. Donahue M.Patricia (1996)Nursing, the Finest Art: An Illustrated History. Mosby. St. Louis, MO. . Page Number: 5. Fry S.T. (1988) The ethic of caring: can it survive in nursing? Nursing Outlook 36(1), 48. Gaut D.A. (1981) Conceptual analysis of caring: research method. InCaring, An Essential Human Need: Proceedings of Three NationalCaring Conferences (Leininger M. ed.), Charles B. Slack,Thorofare, NJ, pp. 17–20. Hutchinson S.A. (1984) Creating meaning out of horror. Nursing Outlook 32(2), 86-90 Kelly L. (1988) The ethic of caring: has it been discarded? Nursing Outlook 36(1), 17 Leininger,M. (1990) ‘Historic and epistemologic dimensions of care and caring with future directions’, in Knowledge about Care and Caring, eds J.S. Stevenson and T. Tripp-Reimer, Kansas City, MO: American Academy of Nursing. 19-31. Maslach C. (1982) Burnout: The Costs of Caring. Prentice Hall, Englewood Cliffs, NJ. Mckenna Hugh.(1997)Nursing Theories and Models. Routledge. London. 31. Nouwen Henri J. M.(1972) The Wounded Healer. Ministry in Contemporary Society. New York: Doubleday, 95. Reverby S. (1987) A caring dilemma: womanhood and nursing in historical perspective. Nursing Research 36, 5–11. Watson J. (1998) : Florence Nightingale and the enduring legacy of transpersonal human caring, J Holistic Nurs 16(2):292. =============== Read More