Caring and Contemporary Nursing

Within healthcare, attention to caring is perhaps most evident within nursing. Emphasizing caring as a central value within nursing often provides a basis for arguing that nursing requires its own description, possesses its own phenomena, and retains its own method for clarification of its own concepts and their meanings, relationships, and context (Jameton; Fry, 1989a, 1989b; Watson; Swanson; Reverby, 1987a, 1987b). For example, Jean Watson holds that nurses should reject the impersonal, objective models that she says currently dominate ethics and choose instead an ethic that emphasizes caring.

Those who invoke caring in developing a theory of nursing ethics often assign caring a privileged or foundational role. For example, Sarah Fry posits caring as "a foundational, rather than a derivative, value among persons" (1989b, p. 20-21). She argues that other ethical values, such as personhood and human dignity, are an outgrowth of nurses's caring activity. Similarly, Benner and Wrubel argue for the primacy of caring on the grounds that skillful technique and scientific knowledge do not suffice to establish ethical nursing in the absence of a basic level of caring and attachment.

Like Fry, Kristen Swanson regards caring as central to nursing ethics. According to her analysis, caring requires acting in a way that preserves human dignity, restores humanity, and avoids reducing persons to the moral status of objects. Specifically, caring requires:

1. knowing, or striving to understand an event as it has meaning in the life of the other;

2. being with, which means being emotionally present to the other;

3. doing for, defined as doing for the other as he or she would do for himself or herself if that were possible;

4. enabling, or facilitating the other's passage through life transitions and unfamiliar events; and

5. maintaining belief, which refers to sustaining faith in the other's capacity to get through an event or transition and to face a future of fulfillment.

Susan Reverby finds caring to be a central ethic throughout nursing's history. Tracing the history of nursing to its domestic roots during the colonial era, when nursing took place within the family, Reverby argues that caring for the sick was originally a duty rather than a freely chosen vocation for women. Reverby suggests that nurses today possess "some deep understandings of the limited promise of equality and autonomy in a healthcare system. In an often implicit way, such nurses recognize that those who claim the autonomy of rights often run the risk of rejecting altruism and caring itself" (1987a, p. 10).

Some have challenged the proposal to consider care as a foundational or unique concept for nursing ethics. Invoking a Nietzchean method of analysis, John Paley rejects the idea that caring is the core of nursing on the ground that it bears a striking resemblance to a slave morality and thus deteriorates into a celebration of weakness. He urges nursing to aspire instead to noble values, including competence in the management of recovery and rehabilitation. Other approaches do not reject a care ethic outright, but question the attempt to regard an ethic of care as unique to nursing. Robert M. Veach, for example, suggests that care is essential to human relationships generally. Others hold that care itself is still too broad a concept to demarcate what is unique about ethics in nursing, and instead identify nursing with maternal practice, a specific kind of caring activity (Newton; O'Brien). For example, Patricia O'Brien defends the importance of nursing's maternal function by noting that historically the source of nurses' prestige has been the manner in which nurses blend home and hospital. That is, nursing's strength has come from nurses' skill at the traditionally female tasks of feeding, bathing, cleaning, coaching, and cajoling those in one's care. Just as mothers make a home, it is female nurses who have been able to make a home of the hospital, to personalize an increasingly impersonal environment.

Critics of the maternal paradigm for nursing fault this approach as casting women in traditional and stifling roles. Historically, for example, nurses were socialized into the healthcare field to know their place and were relegated to the bottom of the pyramid and taught not to ask questions (Murphy). Casting nursing practice in terms of mothering potentially reverses progress made in the late 1970s when nurses began to see themselves as shared-decision makers rather than handmaidens to physicians (Stein et al.).

A further objection to identifying ethical ideals of nursing with ethical ideals of mothering holds that nurses's proper function is to serve as patients's advocates, rather than as patients' parents. Gerald Winslow, for example, argues that advocacy of patients' autonomy, rather than paternalistic promotion of patient benefit, should guide nursing ethics.

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