Care Relationships Research Articles

Earth Care and Recovery in Kerri ní Dochartaigh’s Thin Places (2021)

Thin Places (2021) is a piece of work which defies categorization. It is partly a memoir filled with traumatic personal events, partly a reflection on loss in all its manifest forms (physical, familial, linguistic, environmental), and partly an uplifting plea for allowing the exploration of our natural surroundings to function as a meaningful form of care. Kerri ní Dochartaigh uses the materiality of the sentient beings that surround us, and deep care for our ecosystem, as a means of recovery. Earth care as self-care. Ní Dochartaigh is concerned with both the materiality and the immateriality of objects of care and manages to incorporate both through her interest in “the liminal space between things”, to borrow the title of an article by Timothy Morton (2014). The narrator foregrounds her mental health difficulties brought on by a violent and traumatic childhood in Northern Ireland yet also places the focus on the ways in which Ireland’s natural habitat, its material reality and its immaterial Celtic portals, “hold us” (2022: 228) in unsuspected care relationships. In the process, “[a]rt happens […] in the liminal space(s) between things, in conversations between metal and sky, humans and metal, era and era, heaven and earth” (Morton 2014: 270-1). A poignant process of recovery is recounted, highlighting firstly the refusal of care before slowly moving towards co-constituted acts of care: as ní Dochartaigh gradually recovers her lost mother tongue, and pays attention to the beauty of her natural surroundings, as she begins to care for both, she also starts to feel cared for. The sensory experience of loss, gain, and care in Thin Places is predicated upon several ecologies and resonates strongly with Joan Tronto’s definition of care as ultimately “a species activity that includes everything that we do to maintain, continue, and repair our ‘world’ so that we can live in it as well as possible. That world includes our bodies, our selves (sic.), and our environment, all of which we seek to interweave in a complex, life-sustaining web” (1993: 103; original emphasis). Kerri ní Dochartaigh celebrates, in the most understated manner, the full complexity of this “life-sustaining web” and this article proposes to unpack all of the above elements to show how her very singular aesthetics places the emphasis on the coloniality of loss and the restorative power of stories.

Care and services partnership in Quebec birthing centres: myth or reality?

ContextWorking with women to best meet their needs has always been central to midwifery in Quebec, Canada. The creation of birthing centres at the end of the 1990s consolidated this desire to prioritize women’s involvement in perinatal care and was intended to encourage the establishment of a care and services partnership between care providers and users. The aim of this pilot study is to evaluate the perceptions of clients, midwives and birth assistants of the way in which women are involved in partnership working in Quebec birthing centres.MethodsA single qualitative case and pilot study was conducted with midwives (n = 5), birth assistants (n = 4), a manager (n = 1), clients (n = 5) and members of the users’ committee (n = 2) at a birthing centre in Quebec, Canada in July and August 2023. The partnership was evaluated using the dimensions of a validated CADICEE questionnaire.ResultsThe women and professionals stressed that the relationship was established in a climate of trust. The caregivers also attached importance to autonomy, information sharing and decision-making, adaptation to context, empathy and recognition of the couple’s expertise. The women confirmed that they establish a relationship of trust with the professionals when the latter show empathy and that they adapt the follow-up to their knowledge and life context. Key factors in establishing this kind of care relationship are the time given, a de-medicalized environment, the comprehensive care received, and professionals who are well-informed about the partnership. In addition, the birthing centre has a users’ committee that can put forward ideas but has no decision-making powers.ConclusionsBoth the women and the professionals at the birthing centre appear to be working in partnership. However, at the organizational level, the women are not involved in decision-making. A study of all birthing centres in Quebec would provide a more comprehensive picture of the situation.

An ecosystem approach to mentoring research faculty in schools of nursing: The pacific northwest interdependence mentoring model

BackgroundMentoring can facilitate faculty career development and retention. Given ongoing challenges in academic nursing (e.g., shrinking number of experienced mentors), it is necessary to revisit and improve upon existing mentoring models and practices to support current and future nurse researchers. PurposeTo describe the development of a new faculty-to-faculty research mentoring model. MethodsConstruction of a model describing mentoring needed by research-focused nurse faculty based on analysis of the literature alongside the authors’ personal experiences. FindingsThe Pacific Northwest Interdependence Mentoring Model (PIMM) describes academic nursing as an ecosystem that fosters caring, trust, solidarity, equity, openness, and interdependent relationships among research faculty, administration, institutions, and funding sources. DiscussionAlthough mentoring environments differ in unique strengths, weaknesses, mission, culture, and values, the PIMM’s approach could be applicable for many schools of nursing and beyond to support the growth of the nursing discipline.

The role of the specialist nurse in comprehensive care for bleeding disorders in Europe: An integrative review.

Managing bleeding disorders (BDs) is complex, requiring a comprehensive approach coordinated by a multidisciplinary team (MDT). Haemophilia nurses (HNs) play a central role in the MDT, frequently coordinating care. As novel treatments bring change to the treatment landscape, ongoing education and development is key. However, understanding of the roles and tasks of HNs is lacking. The EAHAD Nurses Committee sought to identify and describe the roles and tasks of the European HN. A five-step integrative review was undertaken, including problem identification, literature search, data evaluation, data synthesis and presentation. Relevant literature published from 2000 to 2022 was identified through database, hand and ancestry searching. Data were captured using extraction forms and thematically analysed. Seven hundred and seventy-seven articles were identified; 43 were included. Five main roles were identified, with varied and overlapping associated tasks: Educator, Coordinator, Supporter, Treater and Researcher. Tasks related to education, coordination and support were most frequently described. Patient education was often 'nurse-led', though education and coordination roles concerned both patients and health care practitioners (HCPs), within and beyond the MDT. The HN coordinates care and facilitates communication. Long-term patient care relationships place HNs in a unique position to provide support. Guidelines for HN core competencies have been developed in some countries, but autonomy and practice vary. As the treatment landscape changes, all five main HN roles will be impacted. Despite national variations, this review provides a baseline to anticipate educational needs to enable HNs to continue to fulfil their role.

Franco Basaglia's mind is still needed.

Talking about Franco Basaglia traces the history of Italian psychiatry since the end of the Second World War, highlighting the radical changes attributable to his thought and practice. Basaglia profoundly influenced the history of psychiatry, both in Italy and throughout the world, with the closure of asylums and the taking into care of people with mental disorders, even severe ones, in the contexts of life, in the community, restoring citizenship rights to the patients. It has shone a spotlight on the issue of knowledge/power in the care relationship, on the historically determined transformation of diversity into social inequality, on the centrality of social indicators of health, and all the more on the fact that psychiatry is an instrument of social control rather than of cure and the asylum a container of misery rather than of madness.

Why Look at Toy Animals?

Abstract This article addresses the toy as a neglected cultural and technical object. The toy is neither tool nor ritual object, and its animation in children's imaginative play suggests alternative perspectives on the history and lived experience of material and technological artifacts. The concept of protopolitics is advanced to explore the implications for the cultural politics of the ambiguous articulation of power relationships in play. The article takes the long history of the toy animal as a case study, drawing attention to its creaturely, artificial facets that go beyond, or more accurately precede, familiar cultural-political binaries of authentic and inauthentic, depth and surface, knowledge and illusion, truth and lies, belief and fetishism, human and nonhuman, natural and synthetic. These other facets include dynamics of the technics of imagination, and their ambivalent articulation of relationships of control, training, care, violence, and love—a protopolitics evident in imaginative play. And, in postnatural media culture, the toy animal has migrated to digital habitats, offering an alternative animal perspective on questions of artificial intelligence. The child's toy and media environment is playfully zoomorphic, populated with artificial animals, from toys and stories to virtual pets and video-game characters, a new simulacral and postnatural trajectory in the descendance of the artificial animal and its playful and play-like behaviors.

Skills Training for Family Medicine Residents to Attenuate the Impact of Childhood Trauma: A Pilot Study.

Toxic stress and trauma are prevalent in the pediatric population. The sequela can be significant, leading to disruptive behaviors in early childhood to chronic medical conditions in adulthood. Two factors that can mitigate negative outcomes of developmental traumatic stress include relational health care and healthy parental relationships. Family physicians are poised to play a significant role in both attenuating factors. Therefore, focused pediatric trauma-informed knowledge and skills training for family medicine residents is important. One family medicine residency program added a training module for residents, with two objectives: increase in-exam room trauma-informed interaction skills, and increase knowledge and skills for physicians to coach parents on strengthening the parent-child relationship. The training included didactics and skills training. Knowledge and skills were measured pre- and posttraining. A total of 39 residents participated in the study over 3 years. The knowledge score increased by 4.49 points from pre- to posttraining. The number of trauma-informed interactional skills the residents demonstrated at posttraining had increased significantly. During the pilot, all participants moved from below mastery of skills to full mastery. After being instructed in best practices in trauma-informed pediatric interactions, residents demonstrated an increased number of behaviors that cultivate pediatric relational health care. Residents demonstrated knowledge and skills gains that denoted their ability to interact with patients and coach parents in evidence-based ways that can mitigate the impact of childhood trauma exposure.

Where Are All the Specialists? Current Challenges of Integrating Specialty Care Into Population-Based Total Cost of Care Payment Models.

The Centers for Medicare & Medicaid Services Innovation Center (CMMI) has set the goal for 100% of traditional Medicare beneficiaries to be part of an accountable care relationship by 2030. Lack of meaningful financial incentives, intolerable or unpredictable risk, infrastructure costs, patient engagement, voluntary participation, and operational complexity have been noted by the provider and health care delivery community as barriers to participation or reasons for exiting programs. In addition, most piloted and implemented population-based total cost of care (PB-TCOC) payment models have focused on the role of the primary care physician being the accountability (that is, attributable) leader of a patient's multifaceted care team as well as acting as the mayor of the "medical neighborhood," leaving the role of specialty care physicians undefined. Successful provider specialist integration into PB-TCOC models includes meaningful participation of specialists in achieving whole-person, high-value care where all providers are financially motivated to participate; there is unambiguous prospective attribution and clearly defined accountability for each participating party throughout the care journey or episode; there is a known care attribution transition accountability plan; there is actionable, transparent, and timely data available with appropriate data development and basic analytic costs covered; and there is advanced payment to the accountable person or entity for management of the care episode that is part of a longitudinal care plan. Payment models should be created to address the 7 challenges raised here if specialists are to be incented to join TCOC models that achieve CMMI's goal.

Chat windows and zoom bombers: virtual boundaries in mental health peer support

Mental health peer support is a form of care in which people with mental health conditions provide emotional support and education to fellow individuals in recovery, and it is often offered online. Yet little research has considered the social and ethical consequences of providing peer support virtually. Drawing on qualitative data on peer support at mental health agencies across Ohio, this paper argues that the move to online platforms like Zoom led to concerns around boundaries: the rules within personal relationships between people giving and receiving support. In particular, the shift to virtual delivery of peer support posed new questions around privacy and communication. I assert that understanding boundaries in virtual settings is critically important to the field of disability studies, as scholars, activists, and practitioners document and analyze the nature of interdependent care relationships that unfold across a variety of social contexts.

Home Care Worker Continuity in Home-Based Long-Term Care: Associated Factors and Relationships With Client Health and Well-Being.

Despite the importance of provider continuity across healthcare settings, continuity among home care workers who provide hands-on long-term care is understudied. This project describes home care worker continuity, identifies factors associated with increased continuity, and examines associations between continuity and client outcomes. We conducted a retrospective cohort study of clients receiving Medicaid-funded home-based long-term care (n = 3,864) using insurance plan and home care agency data from a large nonprofit organization. We estimated home care worker continuity for clients between 6-month clinical assessments using Bice-Boxerman scores. We then used generalized estimating equations to model associations between home care worker continuity and (1) client characteristics (e.g., cognitive impairment), and (2) client functional, health, and psychosocial outcomes. While home care worker continuity was lowest for clients receiving the most weekly care hours, a range of continuity existed across all levels of care need. Those who were male, older, Asian/Pacific Islander/Native American, cognitively impaired, and functionally impaired had lower continuity. Higher home care worker continuity was significantly associated (p < .05) with fewer falls, a higher likelihood of functional improvement/stabilization, and fewer depressive symptoms. The finding that home care worker continuity is associated with the health and well-being of home-based long-term care clients underscores the importance of building high-quality relationships in long-term care. Continued efforts are necessary to understand and advance home care worker continuity and to identify other aspects of the home care experience that benefit those receiving long-term care at home.

Emergence of the “e-patient” and “e-caregiver” around a serious game in ETP

The advent of e-health has an impact on many areas of health care practice, including TPE. The impact of the introduction of information and communication technologies (ICTs) in health care, such as serious games, remains largely unexplored in the field of e-TPE. To ask patients and health care professionals about the use of a serious game, in order to clarify the impact of these technologies on health care practices and on the relationship between caregiver and patient, as well as their advantages and limitations. A qualitative study based on the grounded theory approach, using semi-structured interviews with six health care professionals and six patients using the DRAGO© serious game, a smartphone application designed to improve compliance with allergy treatment. A lexicometric analysis was carried out, with classification by theme and sub-theme, followed by a statistical breakdown of verbatims according to whether they expressed a favorable or unfavorable opinion. 64% of professionals surveyed are in favor of digital innovations in health care, and 67% of patients. Health care professionals have reservations about their patients’ eligibility for these new technologies. In both categories, the ethical issues surrounding the emergence of e-health are positively echoed, with 69% of health care professionals and up to 83% of patients in favor. Both categories are more reserved about the impact of ICTs on the health care relationship. Health care professionals and patients alike consider the presence of ICTs in TPE to be “acceptable,” although they remain vigilant about the impact they can have on the health care relationship. These developments imply a necessary change in the practices of health care professionals, leading them to think about and encourage the emergence of the profile of tomorrow’s e-caregiver working with e-patients.

Nurses' experiences of caring for nursing care-dependent ICU patients: A qualitative study.

Nursing care dependency is a key, yet under-studied, nursing phenomenon. Patients in intensive care units are highly dependent on nursing care. Patients find dependency challenging, experiencing feelings of powerlessness and shame. The nurse-patient care relationship can influence patients' perception of dependency. Understanding how nurses experience their care for dependent patients is crucial, as nurses might not always grasp the impact of their actions on patients' dependency experiences. To explore and interpret ICU nurses' perceptions of patients' nursing care dependency and their experiences in caring for nursing care-dependent patients. A qualitative interpretative phenomenological study inspired by Merleau-Ponty's philosophical stance was conducted using focus groups with nurses who had been caring for adult patients for at least 6 months in ICUs of two hospitals. Data analysis followed Smith et al.'s guidance. Researchers immersed themselves in the transcripts, noted individual's experiences before transitioning to shared insights, coded significant phrases and generated themes and superordinate themes. Four focus groups were conducted with 18 nurses with widely ranging ages and work experience. Four superordinate themes emerged: 'Time and context define dependency', 'Empathetic relationships help nurses understand patients' experience of dependency', 'Trusting nurse-patient relationships change the dependency experience' and 'Nurses' skills help patients to recover independence'. This study increases critical care nurses' awareness of the overlooked phenomenon of caring for nursing care dependent patients and offers them an opportunity to reflect on their care for dependent patients and adapt it to patients' experiences. Further studies are needed with nurses and patients in different ICUs, cultures and countries, to gain a broader picture of experiences of nursing care dependency. ICU nurses need strong relational skills to offer high-quality care for dependent patients, facilitating meaningful nurse-patient relationships based on empathy and trust. These relationships can significantly impact the patient's experience of dependence.

Care giving and receiving for people with complex emotional needs within a crisis resolution/home treatment setting: A qualitative evidence synthesis.

WHAT IS KNOWN ON THE SUBJECT?: The term 'complex emotional needs' (CEN) is used here to describe people with difficulties and needs that are often associated with the diagnostic label of 'personality disorder'. People with CEN might use out of hours services such as emergency departments and Crisis Resolution/Home Treatment (CRHT) teams more often when experiencing a mental health crisis. Very little is understood about the experiences of both those receiving, and those delivering care, for people with CEN within CRHT settings. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: There are differences between priorities for those delivering and those receiving care within CRHT settings. CRHT staff members are likely to focus more upon those aspects of their role relating to risk issues. managing resources, anxieties and the expectations of others. Service users, meanwhile, focus upon the caring relationship, wanting staff to listen to them, and to feel supported and reassured. In the papers reviewed, service users experiencing CEN did not always feel 'listened to' or 'taken seriously' especially in relation to risk issues and decision-making. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Relating the findings to mental health nursing and CEN within the context of CRHT, to better understand the person experiencing a mental health crisis, mental health nurses need to focus more upon the person and when making decisions around their care and must be aware of the potential for power imbalances. Collaborative 'sense-making' in relation to a person's risk behaviours may help. ABSTRACT: Background A growing body of qualitative evidence focusing upon the experiences of care within Crisis Resolution/Home Treatment (CRHT) is emerging; however, a firm evidence base regarding both the giving and receiving of care for those with complex emotional needs (CEN) in this context is yet to be established. Objective A qualitative evidence synthesis was used to develop a comprehensive understanding of how crisis care for people with CEN is experienced by both those giving and receiving care, within the context of CRHT. Method Findings from 19 research papers considering both clinician and service users' experiential accounts of CRHT were synthesised using meta-ethnography. Findings Both the giving and receiving of care within a CRHT context was experienced across four related meta-themes: 'contextual', 'functional', 'relational' and 'decisional'. Discussion Service user accounts focused upon relational aspects, highlighting a significance to their experience of care. Meanwhile, clinicians focused more upon contextual issues linked to the management of organisational anxieties and resources. For those with CEN, a clinician's focus upon risk alone highlighted power differentials in the caring relationship. Conclusions There is a need for nurses to connect with the experience of the person in crisis, ensuring a better balance between contextual issues and relational working.

Whanaungatanga: tutors’ experiences of caring for students in an Aotearoa New Zealand university

ABSTRACT Who is caring for and supporting our students at university and how is the care and support demonstrated? Students come to university with diverse backgrounds, experiences, and needs and many will require pastoral care at some time during their study. Tutors often find themselves caring for students and this paper focuses on the experiences of care-giving of eight tutors, aged 22 to 34 years. We use a reflexive thematic analytic approach to describe how tutors conceptualised caring as whanaungatanga, a Māori concept that encompasses kinship and caring relationships, community, rights and responsibilities, and inclusion. Tutors describe whanaungatanga in terms of five themes: care for students as people and learners, creating a safe and respectful space for all students, barriers, feelings of obligation, and tutors’ self-care and needs. Our research highlights the complexities of tutors’ care for students. They felt undervalued by the university but nevertheless strove to build and embed whanaungatanga, often at their own cost. Implications for practice include properly acknowledging, remunerating, and training tutors. Future research should focus on who is caring-about and caring-for students at university, and how that caring occurs.

Lying as a moral choice: an examination of moral reasons for lying in dementia relationships

A total of 60 young adults responded to vignettes presenting moral dilemmas experienced in caregiving interactions with a family member with dementia. Four types of reasons for deceiving (or not deceiving) a family member with dementia emerged: care reasons (improving the welfare of the person with dementia), justice reasons (universal principles), care-for-others reasons (protecting the welfare of others), and relationship reasons (maintaining the relationship). Care reasons and care-for-others reasons positively predicted moral decisions to lie, whereas justice reasons and relationship reasons negatively predicted these decisions. These findings underscore the importance of understanding the motives underlying deception in dementia relationships.

Child Health Needs and the Pediatric Nephrology Subspecialty Workforce: 2020-2040.

Pediatric nephrology is dedicated to caring for children with kidney disease, a unique blend of acute care and chronic longitudinal patient relationships. Though historically a small field, trainee interest has declined over the past 2 decades. This has led to growing alarm about the health of the pediatric nephrology workforce, although concerns have been hampered by a lack of available data to enable feasible projections. This article is part of a supplement that anticipates the future pediatric subspecialty workforce supply. It draws on existing literature, data from the American Board of Pediatrics, and findings from a model that estimates the future supply of pediatric subspecialists developed by the Carolina Health Workforce Research Center at the University of North Carolina Chapel Hill's Cecil G. Sheps Center for Health Services Research and Strategic Modeling Analytics & Planning Ltd. The workforce projections from 2020 to 2040 incorporate population growth, clinical effort, and geographic trends and model alternate scenarios adjusting for changes in trainee interest, clinical efforts, and workforce attrition. The baseline model predicts growth of clinical work equivalents by 26% by 2040, but further widening geographic disparities worsen the existing mismatch between supply, clinical need, and market demand. The worst-case scenario projects 13% growth by 2040 which, at best, maintains the status quo of an already strained workforce. The models do not account for many factors expected to heighten demand over the coming decades. Urgent reforms are necessary now. Proposed solutions require multipronged changes in education and training pathways, remuneration, clinical practice models, and government policy.

PROPEDEUTICS OF CHILDREN'S DISEASES AND POLYCLINIC PEDIATRICS

This article explores the crucial realms of propedeutics in children's diseases and polyclinic pediatrics, emphasizing their integral roles in the holistic care and well-being of the pediatric population. Propedeutics, as the preliminary study and diagnosis of diseases based on observed signs and symptoms, serves as a vital tool for pediatricians to identify subtle indicators of underlying health issues in children. In parallel, polyclinic pediatrics offers a comprehensive and community-oriented approach to child health, operating in outpatient settings to provide continuity of care. The article delves into the proactive role of propedeutics in early intervention and disease prevention, highlighting how polyclinic pediatrics fosters preventive care, routine check-ups, and collaborative relationships with parents. Together, propedeutics and polyclinic pediatrics emerge as indispensable components in nurturing the health and well-beingof the younger generation, contributing to a healthier and brighter future.

Insights Into Informal Caregivers' Well-being: A Longitudinal Analysis of Care Intensity, Care Location, and Care Relationship.

This study investigates the psychological well-being of informal caregivers over time. It identifies the thresholds (or "tipping points") of caring intensity at which caregiving is associated with lower psychological well-being, and how this varies by care location and caregiver-care recipient relationships. It also examines how caring location and relationship are linked to informal caregivers' psychological well-being while controlling for caring intensity. Waves 1-18 (1991-2009) of the harmonized British Household Panel Survey and Waves 1-8 (2009-2017) of the U.K. Household Longitudinal Study were analyzed. Psychological well-being was measured using the General Health Questionnaire (GHQ)-12 score. Care intensity was measured by the weekly hours of care provided. Fixed-effects estimators were applied to the GHQ-12 score of caregivers across different care intensities, caring locations, and caring relationships. All levels of informal care intensity are associated with lower psychological well-being among spousal caregivers. The thresholds to well-being are 5 hours per week when caring for a parent, and 50 hours per week when caring for a child (with a disability or long-term illness). Caring for "other relatives" or nonrelatives is not negatively associated with psychological well-being. The thresholds are 5 hours per week for both coresident and extraresident caregivers. Extraresident caregivers experience better psychological well-being compared to coresident caregivers, given relatively lower weekly care hours. Caring for primary kin (especially spouses) is linked to lower psychological well-being compared to other caregiving relationships, regardless of care intensity. Policy and practice responses should pay particular attention to spousal caregivers' well-being. Caregiving relationship has a stronger association with the caregiver's well-being than care location.

Latinx Geographies

With increased interest in Latinx geographies there is a need for more in-depth exploration of how Latinx geographers are approaching this work in their own words. In this article, we open a discussion on Latinx geographies that is grounded in our multiple, different, embodied experiences as Latinx geographers who have gathered over the last several years to have conversations, create spaces and build relationships of care and accountability with each other. We reflect on how we each arrived to Latinx geographies, what it means to us, how we do Latinx geographies and what is on the horizon. We refuse singular or imposed definitions, and collectively imagine an expansive, nuanced, and relational Latinx geographies that critically engages with difference, conquest, power, and liberation across Turtle Island and Abya Yala.

Understanding the caring network of podoconiosis patients in Rwanda: a qualitative study

IntroductionGlobally, a total of almost 4 million people live with podoconiosis in 32 potentially endemic countries including Rwanda. Podoconiosis is a non-infectious geochemical disease that causes massive swelling of the lower leg and is caused by long-term exposure to red clay soil found in tropical highland areas. The disease is a disabling neglected tropical disease (NTD) and is associated with profound stigma, discrimination and comorbid mental health conditions. Treatment interventions are commonly known as morbidity management and disability prevention. Both biomedical and traditional treatments are used by affected people. However, understandings informed by the social sciences of care in the context of NTDs are largely unexplored. This study explored the perspectives and experiences of care among care receivers (podoconiosis patients) and caregivers (family members, traditional healers) in the district of Huye, Rwanda.MethodThe study used qualitative methods including seventeen InDepth Interviews (eleven patients, two traditional healers, two care professionals, and two family members) and participant observation in a health centre and patients’ houses.ResultA caring network was found amongst the podoconiosis patients, their family members, care professionals and traditional healers. Caring network is not only about the medical treatments, but also about the caring relationship amongst them.DiscussionUsing notions of ‘Network’ and ‘Collectives’, from the care ethics literature the study shows that in addition to care work requiring professional know-how, it is also about the relationships between patients, their families, traditional healers, and biomedical care professionals.