NURSING CONCEPTS

Nursing Concepts

Nursing Concepts

There are many concepts discussed in the book titled, “Reaching Past the Wire: A Nurse at Abu Ghraib”, which are related to nursing ethics. This paper discusses the topic of caring with a nursing perspective. Patient expectations reflect the hopes, wishes, or desires of patients concerning health care needs and services. They include expectations about the structure, process, and outcomes of health care. Structural expectations focus on both the physical facilities (location, ambience, amenities, and equipment) and personnel (numbers, types, and appearance). Expectations centering on processes of care include technical (information gathering, physical examination, testing, prescriptions and referrals) and interpersonal (physician-patient communication including information exchange and active listening) aspects of care. Outcome expectations include aspects of somatic and psychosocial results of care, both in the short and the long term (Freeman, 2008).

The particularity of relations is fundamental to the ethics of care. Each relation consists of at least two people, the one-caring and the cared-for. Such a relation can certainly be more than merely dyadic as the one-caring and the cared-for come to exhibit reciprocal commitment to each other's well-being. However, what is distinctive in all such relations is that the one-caring acts in response to a perceived need on the part of the cared-for. The act is motivated by an apprehension of the cared-for's reality, a receiving of the cared-for into the one-caring such that the one-caring feels and senses what the cared-for is experiencing. The one-caring responds to the well-being of the cared-for by initiating a commitment to help the cared-for. Authentic care provides the motivation for such assistance. This does not mean that the one-caring does exactly what the cared-for desires in all situations. Rather, the onecaring considers the cared-for's point of view, assessment of need, and expectations of the one-caring in formulating a response that provides the best opportunity for helping the cared-for (Dobson, 2005). This response might be irrational, since caring involves the commitment to do something, however remote the possibilities of success, to improve the cared-for's condition. In the ideal situation, however, the reason(s) the one-caring gives for his or her actions would be sufficient to convince a disinterested observer that he or she indeed acted in a way to promote the cared-for's well-being. Caring thus involves sentiment but is not necessarily emotional in nature (Dobson, 2006).

Within the ethics of care the one-caring receives the cared-for without evaluation. However, in deciding how to respond, the one-caring works in what Nel Noddings calls a “problem-solving” mode—keeping in mind the particular relationship and context to avoid slipping into the abstract, impartial, impersonal reasoning of the deontologist, the utilitarian, or the justice theorist. Ultimately, there is a defining imperative to act that is a critical function of what it means to care (Derry, 2006).

These ideals apply to both natural caring, or caring born of inclination and love for those close to the onecaring, and ethical caring, which is the feeling response of “I must” to a person's ...