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neighborly activities, and generosity. It is an aspect of personal and social life that is almost
ubiquitously important. When the phrase is attached to the profession of caring, it becomes even
more significant. Since the foundation of nursing as a professional practice, caring has been an
integral part of the work. In fact, the two words are almost synonymous. “Nursing” calls up
images of individuals like Florence Nightingale, and individuals like Florence Nightingale call
up thoughts of a generous and caring spirit. All of this is to say that caring is, ostensibly, the very
foundation of nursing as a profession and a practice. Some even call caring an art form,
contending that it is “the distinguishing quality” that works to set “nursing apart from other
professionals” (Watters, 2009). Thus, healthcare professionals must engage in this art form
actively, and seek to engage both its difficulties and its benefits. This is precisely what this paper
seeks to fulfill.
Watters goes on to quote Marie Marthey, who deems the art of caring the ‘invisible
power of nursing’ (2009). This is, it seems, because of the fundamental yet immeasurable
positive effect that a nurse’s caring has on the patient. It is invisible, however, because this
specific aspect of nursing is rarely discussed or considered in the discussions that surround the
integral to the very profession. Watters contends that the reality of nursing care “is an
interpersonal process between a patient and the nurse in which knowledge must be applied to
create a safe, caring environment” (2009). Seeing as the benefits of nursing care are clear, the
subsequent question is two fold: first, what challenges must be addressed in nursing care and,
second, what can nurses and other healthcare professionals do to address these difficulties?
This paper examines three areas in which difficulties to nursing care may arise: the
personal, the educational, and the systematic levels. Each of these is looked at in turn, and an
attempt to answer each part of the above question is made. Through this examination, it is clear
that nursing care has hit a crossroads both in personal practice and in professional standards.
Where caring in nursing goes from here will, largely, determine a similar path for the nursing
profession as a whole.
Given that caring is inherently a personal attitude, choice, and action, it is clear that
caring within the nursing profession begins, and must begin, here. The personal aspect of care is
the most important part of the practice – as stated above, nursing is in essence a personal
relationship between nurse and patience. Therefore, if there is a lack of care on the part of the
nurse, there is consequently a lack of professional fulfillment. However, this is not always a
choice, per se. Instead, there are often external factors that affect a nurse’s behaviors and actions.
Two in particular are discussed here: the level of self-care in a nurse’s environment, and the level
of experience a nurse has with the culture of a patient. While these two may not seem directly
related, they both bear a great impact on the level of personal care a nurse is able to give a
patient.
First, it is almost a foregone conclusion to say that nurses experience a great deal of
pressure and stress in their work environment. Cronqvist, Theorell, Burns, & Lutzen (2004)
discuss this aspect of care from a unique perspective. In their paper, the authors discuss the
findings of a study made of 36 nurses from various intensive care units. The environment for
these units are quite similar – “high working pace, advanced technology, budget restrictions,
recent reorganization, and shortage of experienced nurses” (2004). This environment therefore
served as an ideal situation for examining the importance and effect of nursing care – it was,
The authors’ findings are relevant to applying personal changes in order to ensure proper
care – in essence, the research found that there was a lack of balance between personal care and
professional obligations. More specifically, “Moral obligations and work responsibilities are
assumed to be complementary dimensions in nursing, yet they were found not to be in balance
for intensive care nurses” (Cronqvist et al., 2004). In other words, the researchers found a tension
in nurses between the desire to care personally for patients and the reality of having to fulfill
working expectations and conditions. This is described in terms of Caring For vs. Caring About.
Caring About describes a moral action, based on a “personal ability to know what is morally
good to do”; in contrast, Caring For is “task-oriented nursing care that is assigned and controlled
by others” (Cronqvist et al., 2004). In essence, Caring About is the true ideal of caring within
nursing, while Caring For is a necessary byproduct of nursing as a profession. The resulting
effect of the tension between these two aspects of nursing is that neither is able to be fully met by
nurses.
In answer to this tension, the authors suggest, “there is a need to support nurses in
difficult intensive care situations” (Cronqvist et al., 2004). This may seem an obvious
conclusion, but it is of paramount importance for individual employers – such as hospitals and
intensive care units – to utilize. The first and foremost form that this ought to take is mentoring
for nurses. An active attempt to address the tensions between Caring For and Caring About head
on will, in the long run, help nurses gain insight into how this tension arises and how it can be
answered. The end result, it is hoped, is both better professional practice and personal care.
A second aspect of the personal answer to nursing care has to do with the experience of
the nurse. This is best examined in a study made of the cultural self-efficacy of Canadian nursing
students (Quine, Hadjistavropoulos, & Alberts, 2012). While this study focused on the “cultural
self-efficacy of Canadian nursing students caring for aboriginal patients with diabetes”, the
The authors define cultural self-efficacy as having to do with “how capable one feels
functioning in culturally diverse situations” (Quine et al., 2012). The research found the ability
for nurses to care for their patients was largely dependant on their experience with them. If a
nurse held low intercultural anxiety, high intercultural communication, and high experience with
the persons s/he was dealing with, the nurse possessed higher knowledge and skills for how to
care for the patient (Quine et al., 2012). Therefore, an important aspect of addressing the
personal aspect of nursing care is to ensure that nurses (both professionals and students) have a
high level of interaction and comfort with their patient base. While this may, in part, be met by
educational standards, it will ultimately depend on the individual. Each of these aspects help to
The second level that is paramount for the preservation of patient care in nursing practice
is found in nursing education. This is based on one fundamental position that is important to
note, “Nursing education plays a central role in the ability to practice effectively” (Sawatzky,
Enns, Ashcroft, Davis, & Harder, 2009). This perspective, if not universally held, is at least
widespread among healthcare practitioners. The authors quoted above state that “A teaching
philosophy is intimately intertwined with one’s philosophy of nursing and the ethic of caring and
therefore is fundamental to a caring framework” (Sawatzky et al., 2009). In other words, the goal
of nursing education is not only to instill knowledge and skills, but the philosophy and ethic that
are so important for the art of caring in the nursing profession. The ethic of caring may not be
able to be taught completely, but can at least be supplemented in a nursing education that
includes it. As Sawatzky et al. (2009) argue, this means excellence in teaching scholarship (such
as quality research on pedagogy), teaching practice (that is, excellence in teachers themselves)
and teaching leadership (for example, providing personal mentoring). An emphasis on this type
of excellence in nursing education will, in turn, instill the ethic of care in the nursing profession.
A more specific approach to the educational aspect of nursing care is that of values. As
Paldanius & Määttä state, “learning about caring and caring in nursing could be improved during
nursing education” seeing as “the most essential element in nursing is the sensibility to feel love
for one’s neighbor” (2011). Paldanius & Määttä cite the focus of nursing education as being on
both discipline and the spirit of nursing – this will prove a fundamental element of nursing
education. The authors state that there are primary values that ought to be instilled in nursing
The primary values, on which caring is based, are the so-called platonic basic
values: truth, beauty, and goodness. The value related to reasoning is truth
concern only a specific area because it is possible to refer to the goodness and
beauty of thoughts as well as to the truth of actions. Values structure the action in
their own special way, as our special relationships with other people. (Paldanius
From this conception of values, the authors derive three essential factors of care: internal
feeling, professional caring, and the ethics of nursing. Internal feelings, such as empathy, ought
to be encouraged in nursing students. In the same way, the professional standards of caring, such
as equality and individuality, ought to be taught outright (Paldanius & Määttä). Finally, the
ethical standards of nursing (such as the expectations of nursing activities and interaction with
patients) ought to be stressed throughout nursing education. An emphasis on these three essential
factors of nursing care in education will, in the long run, lead to better nursing practices outside
The final level of healthcare important to the art of care in nursing practice is that of the
overarching system, or structure. Nearly every social or professional endeavor relies on the
no exception. Even if nurses have a personal commitment to care and healthcare professionals
have an educational mandate to encourage this care, the practice cannot be sustained if it is not
supported by the healthcare system. Laurie Gottlieb, the Editor-in-Chief of the Canadian Journal
of Nursing Research, released an insightful and challenging editorial in 2004 related directly to
the structural changes needed to maintain care in nursing practice. In the letter, Gottlieb
highlights the many personal and professional challenges faced by nurses in relation to a failing
The system under which nurses work has not been as generous, supportive,
committed, and loyal to them as nurses have been to it. It is well documented that
financial cuts, downsizing, and mergers. Nurses have been marginalized, de-
dearly with their own health, frozen and lost wages, elimination of jobs, a
loss of status, workplace violence and abuse, shortages, recruitment and retention
This laundry list of challenges can only be solved at the structural level. A nurse’s
personal commitment to the ethic of caring is simply not enough. Individuals will burn out. The
profession’s attempt to instill care into nursing students will not be enough in the long run, if
there is no support. In addition to these efforts, steps must be taken by the healthcare system at
the institutional and structural level in order to affect a lasting support of nursing’s devotion to
care. This may not necessarily mean drastic changes, but it does necessitate an examination of
the core of the structure, to ensure that aligns with the nursing ethos of caring.
Conclusion
It is clear that care is an integral part of nursing as a profession and a practice – it is “the
glue that brings the patient to us” (Watters, 2009). Care, when properly implemented by a nurse,
is exactly what makes nursing such a unique and necessary part of the healthcare system.
Therefore, the above levels of care have been briefly examined in order to give a picture of what
is needed to continue, or enhance, the practice of caring nursing in the field of healthcare.
Personal commitment is not enough. Education is not enough. Structural changes are not enough.
Instead, individual nurses, healthcare professionals, and policymakers must work together in
order to affect the needed changes and continue the successes. Care in nursing is at a crossroads,
and the careful consideration and application of the above research will prove beneficial for both
Cronqvist, A., Theorell, T., Burns, T., & Kim Lützén. (2004). Caring about - caring for: Moral
obligations and work responsibilities in intensive care nursing. Nursing Ethics, 11(1), 63-
76. doi:http://dx.doi.org/10.1191/0969733004ne667oa
Gottlieb, L. N. (2004). Nursing's ethos of caring and its support for a single-tiered health-care
http://search.proquest.com/docview/218806172?accountid=12347
Paldanius, A, PhD., & Määttä, K., PhD. (2011). What are students' views of (loving) caring in
Quine, A., PhD., Hadjistavropoulos, H. D., PhD., & Alberts, N. M., M.A. (2012). Cultural self-
efficacy of Canadian nursing students caring for aboriginal patients with diabetes. Journal
http://search.proquest.com/docview/1024699486?accountid=12347
Sawatzky, J. V., Enns, C. L., Ashcroft, T. J., Davis, P. L., & Harder, B. N. (2009). Teaching
Watters, C. (2009). Caring - is it even more invisible today? Orthopaedic Nursing, 28(3), 146-