2
What Is Caring?

2.1 Introduction

This section of the book considers how caring is defined and how the term 'care' can be better understood. It also outlines several theories of caring, explaining each in the hope of laying bare the concept of 'care' and 'caring'. It should be noted that most of the theories presented are now aging although most remain relevant and useful as a base to understand care.

Reflective Activity 2:

Before you read on - think about the word 'care'.

Where do you use it? In what context? With whom (strangers, pets, children, family, friends)? How does the word vary if used at home in your personal life or in a professional context? Do you use the word differently based on context?

Who or what do you care about?

2.2 Defining Care

Mayeroff (1990) suggested that caring in its most significant sense is about helping others grow. He offered the example of a father caring for their child, of an educator caring for their students, of a therapist caring for the emotional growth of their client. Caring, Mayeroff (1990, p. 1) said, 'is the antithesis of simply using the other person to satisfy our own needs,' adding that caring should not be confused with liking another, wishing well, comforting, or simply having a passing interest in another. Caring does not involve an isolated feeling or momentary relationship, nor is it simply a matter of wanting to care for someone.

Eslick et al. (2022) suggest that caring means different things to different people and, as such nurses and other health professionals will enact care in different ways as they interact with a client or patients. Caring involves helping another or others grow and 'actualize' themselves. Critically Mayeroff (1990, p. 2) defined care 'as a way of relating to someone that involves development, in the same way that friendship can only emerge in time through mutual trust and a deepening and qualitative transformation of the relationship.' However, Mayeroff never mentioned the other central role of caring: to heal. By healing I do not mean to 'cure' but healing in the sense that the wellbeing of the other, physically, emotionally, and/or spiritually is enhanced by the relationship and the other, the person being cared for, is supported in a position where they can be 'well'. This could even mean die well. I recall spending three hours on a quiet surgical ward doing little but holding the hand of a terminally ill man. It was near Christmas and the number of surgical cases was small. Enough for the other nurses to attend to. This gave me space to stay with this man in his final hours. We spoke little, and as the night wore on, I could see he was waning. He was comfortable but passing in and out of consciousness. I said a few kind words, words of reassurance, of comfort and although I wasn't sure he could hear them, I spoke kindly to him regardless. I also held his hand. I didn't stroke it, I just held his hand in mine, gently and with purpose. There were no relatives present, there were no others to call. But earlier in his admission he'd expressed a fear of dying alone and as a result I felt privileged to have been the one to be there with him at his end. In effect, all I did was 'be there', speak gently and kindly, and hold his hand. Crucially he wasn't alone, and I was sure he knew this, and this I hoped, gave him comfort. I believe the care I provided was a form of healing.

Virginia Henderson's (1966, p. 3) definition of nursing best fits the meaning of care that relates to both growth and healing. She wrote:

The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he (sic) would perform unaided if he (sic) had the necessary strength, will knowledge, and to do this in such a way as to help him (sic) gain independence as rapidly as possible.

Henderson's interpretation of nursing addresses both health and illness, each a feature of healing, and she acknowledges that nursing also involves engagement with people (not just patients or clients) when they are well or ill, and that this engagement may also involve a teaching and advocacy role (with greater focus on growth than healing). Henderson's theory is considered a, 'theory of nursing' and not a 'theory of care' Indicating that perhaps nursing is not just caring, and caring is not the core of nursing, as Leininger (1991) suggests (below). By placing the dual features of healing and growth at the centre of what it means to 'care' it is possible to reconcile the common themes evident in the many contemporary definitions of nursing, where nursing is considered to be:

• a science
• an art
• person centred
• holistic
• caring
• adaptive
• addressing health promotion
• addressing health maintenance
• addressing health restoration
• a helping profession

Healing (in its broadest sense), and growth are replete within these perspectives of what nursing is and how 'care' lies at the heart of what nursing may be. This view is supported by Leininger (1991) who said, 'caring is nursing, and nursing is caring' adding that care is the dominant, distinctive, and unifying feature of nursing, with both Leininger (1991) and Watson (1979) declaring that care is the essence of nursing, with each describing 'theories of care' to help outline nursing rather than specific 'theories of nursing'. Others support this perspective with Andersson et al. (2015) and Tang et al. (2019) also suggesting that care is at the heart of nursing practice.

Dictionary definitions of 'care':

Care: noun

1. the provision of what is necessary for the health, welfare, maintenance, and protection of someone or something.

   'The care of the elderly.'

2. serious attention or consideration applied to doing something correctly or to avoid damage or risk.

   'He planned his departure with great care.'

Care: verb

1. feel concern or interest; attach importance to something.

   'They don't care about human life.'

2. look after and provide for the needs of.

   'He has numerous animals to care for.'

Oxford Languages: (https://languages.oup.com/google-dictionary-en)

Care: noun (Protection)

• The process of protecting someone or something and providing what that person or thing needs. 'The standard of care at our local hospital is excellent.'
• 'Mir's going to be very weak for a long time after the operation, so she'll need
• a lot of care.'
• 'Nurseries are responsible for the children in their care.'

Cambridge Dictionary: (https://dictionary.cambridge.org/dictionary/english/care)

Caring is the way in which humans respond to the ill, distressed, and vulnerable in society and it is fundamental to human survival (Watson 1979; Leininger 1991). However, the definitions above only highlight some of what is understood about this most vital of human qualities. When Florence Nightingale died in 1910 her sister Parthenope said of Florence, she was 'a shocking nurse,' with 'little or none of what is called charity' (Brighton 2004, p. 308).

Charity is a term associated with religious concepts of care. Charity was something the poor and disaffected sought when they looked to the church for care - healthcare, social care, food, or shelter. The term is rarely used in the twenty-first century, but it describes what we would consider 'care' to mean today. It may be a surprise to realise that the most famous nurse was regarded as a 'shocking nurse' who showed little or no care. Perhaps we should look here at how others describe the concept of care. The following quote is from one of the nurses Patricia Benner interviewed about the meaning of caring in 1984. She describes care as:

a person to person kind of thing, just being with someone, really communicating with people . you talk about empathy or whatever, but somebody is frightened and just sitting down and listening to people, it's not that you even have to say anything.(Benner 1984)

The American Holistic Nurses Association (AHNA) suggested that holistic nursing includes all nursing practice (care) that has healing the whole person as its goal (Frisch et al. 2000). The AHNA descriptions of holistic nursing also includes the notion that the holistic nurse is an instrument of healing and a facilitator of the healing process (Frisch and Rabinowitsch 2019). Others suggest that to practice holistic nursing the nurse must integrate self-care, self-responsibility, and reflection in their lives (Mariano 2007; Dossey and Keegan 2009). Therefore, the practice of holistic care proceeds from a balance of physical, spiritual, psychological, and social needs with wholeness being dependent upon our relationship to each...