Guest Editorial: Is care still the ‘essence’ of nursing?

Abstract

Much has been written about care and nursing and care in nursing. Caring has been defined in numerous ways. Do we ‘care about’, ‘care with’, and/or ‘care for’? Care is a word often used in most walks of life and yet nursing has claimed it as being ‘the essence’ of nursing. We all care about someone and probably most of us care for someone; we may even be quite enlightened and care with. The issue is that it is possible to feel and provide all of these types of care without touching the essence of nursing as I see it and I believe Stephen Wright and Jean Watson conceive it. Wright and Watson write eloquently about the sacredness of caring, and as I read them, the need for nurses to care and respect their own and their colleagues unique Being before they can truly care in the way that is the essence of nursing. It is that genuine connectedness –Being with another when they are Being most vulnerable, perhaps dying. It is the ‘I–Thou’ relationship rather than ‘I–It’. To me relating to a patient/resident as ‘It’ is task or disease-focused nursing practice. We may have the very best technical skills but we lack the capacity to put the person in the best healing environment. I am not suggesting that nurses all need to Be sacred in the religious sense; rather that the essence of each person is sacred and when we ‘do’ nursing without connecting with this essence we are not nurses but technicians. I have heard people say they do not ‘do’ person-centred care because they do not have time; as if it is a task to add to a busy day. If we are practising nursing and caring is the essence of nursing then how we practise by definition must be person-centred. I wonder how many nursing programmes still include the philosophy, science and art of caring. With crowded curricula this is often replaced by more high-tech skills. I would argue that the latter can easily be learned on the job but the former requires the critical enquiry, debate and personal development that a good university education offers. Certainly, it must also be learned through apprenticeship with expert practitioners; however, they are often less able to explain the philosophy, science and art that informs their expertise. With the ever-increasing e-communication and robotics invading aged care the need for human Being and Be-connection has never been greater. Of course there are great nurses and examples of nursing, but the catalysts for me considering this were, as is often the case, negative and worrying. I was told on several occasions about older patients being advised that there was not time to take them to the toilet and they should ‘use the pad’ in the bed; time and again I heard complaints of older people being unable to reach food placed too far away from them by domestic staff and taken away untouched without the nurses observing. I saw too often the clearly uncomfortable positions older people were left in as nurses walked by without apparently noticing. Still I hear people referred to by bed number! Caring for is undertaking tasks for the ‘dementia’s’; it is feeding and washing and ensuring good physical care without connecting with the humanity of the person for whom these tasks are done. One can care for and about while removing all choice, objectifying (the dementia’s) infantilising and getting the job done. Many years ago I defined this as ‘Benevolent Oppression’– or killing with kindness. Most nurses have the best will in the world but that is not enough – nor are top shelf technical skills. The caring that I see as the essence of nursing draws on all the best science and has contemporary competencies but most importantly uses this through the connectedness and caring with the patient/resident Being in the world as described by the great philosopher Heidegger. Sometimes I think better in rhyme so I will conclude my ruminating with a recent piece I wrote: