Credentials of the theorist

Katie Eriksson is one of the pioneers of caring science in the Nordic countries. When she started her career 30 years ago, she had to open the way for a new science. We who followed her work and progress in Finland have noticed her ability from the beginning to design caring science as a discipline, while bringing to life the abstract substance of caring.

Eriksson was born on November 18, 1943, in Jakobstad, Finland. She belongs to the Finland-Swedish minority in Finland, and her native language is Swedish. She is a 1965 graduate of the Helsinki Swedish School of Nursing, and in 1967, she completed her public health nursing specialty education at the same institution. She graduated in 1970 from the nursing teacher education program at Helsinki Finnish School of Nursing. She continued her academic studies at University of Helsinki, where she received her MA degree in philosophy in 1974 and her licentiate degree in 1976; she defended her doctoral dissertation in pedagogy (The Patient Care Process—An Approach to Curriculum Construction within Nursing Education: The Development of a Model for the Patient Care Process and an Approach for Curriculum Development Based on the Process of Patient Care) in 1982 (Eriksson, 1974, 1976, 1981). In 1984, Eriksson was appointed Docent of Caring Science (part time) at University of Kuopio, the first docentship in caring science in the Nordic countries. She was appointed Professor of Caring Science at Åbo Akademi University in 1992. Between 1993 and 1999, she held a professorship in caring science at University of Helsinki, Faculty of Medicine, where she has been a docent since 2001. Since 1996, she has also served as Director of Nursing at Helsinki University Central Hospital, with responsibilities for research and development of caring science in connection with her professorship at Åbo Akademi University.

In the late 1960s and early 1970s, Eriksson worked in various fields of nursing practice and continued her studies at the same time. Her main area of work has been in teaching and research. Since the 1970s, Eriksson has systematically deepened her thoughts about caring, partly through development of an ideal model for caring that formed the basis for the caritative caring theory, and partly through the development of an autonomous, humanistically oriented caring science. Eriksson, one of the few caring science researchers in the Nordic countries, developed a caring theory and is a forerunner of basic research in caring science.

Eriksson’s scientific career and professional experience comprise two periods: the years 1970 to 1986 at Helsinki Swedish School of Nursing, and the period from 1986, when she founded the Department of Caring Science at Åbo Akademi University, which she has directed since 1987.

In 1972, after teaching for 2 years at the nursing education unit at Helsinki Swedish School of Nursing, Eriksson was assigned to start and develop an educational program to prepare nurse educators at that institution. Such a program taught in the Swedish language had not existed in Finland. This education program, in collaboration with University of Helsinki, was the beginning of caring science didactics. Under Eriksson’s leadership, Helsinki Swedish School of Nursing developed a leading educational program in caring science and nursing in the Nordic countries. It was the forerunner of education based on caring science and integration of research in education. Eriksson was in charge of the program for 2 years, until she became dean at Helsinki Swedish School of Nursing in 1974. She remained the dean until 1986, when she was nominated to start academic education and research at Åbo Akademi University.

Toward the end of the 1980s, nursing science became a university subject in Finland, and professorial chairs were established at four Finnish universities and at Åbo Akademi University, the Finland-Swedish university. In 1986, Eriksson was called to plan an education and research program within the subject of caring science at Åbo Akademi University’s Faculty of Education in Vaasa, Finland. A fully developed education program for health care, with three focus options and a research program for caring science, was created. The result of her planning was the Department of Caring Science in 1987. It became an autonomous department within the Faculty of Education of Åbo Akademi University until 1992, when a Faculty of Social and Caring Sciences was founded. Eriksson developed an academic education for Masters and Doctoral degrees in Caring Science. The doctoral program started in 1987 under Eriksson’s direction, and 44 doctoral dissertations have been published.

Theoretical sources

Ever since the mid 1970s, Eriksson’s leading thoughts have been not only to develop the substance of caring, but also to develop caring science as an independent discipline (Eriksson, 1988). From the beginning, Eriksson wanted to go back to the Greek classics by Plato, Socrates, and Aristotle, from whom she found her inspiration for the development of both the substance and the discipline of caring science (Eriksson, 1987a). From her basic idea of caring science as a humanistic science, she developed a meta-theory that she refers to as “the theory of science for caring science” (Eriksson, 1988, 2001).

When developing caring science as an academic discipline, Eriksson’s most important sources of inspiration besides Plato and Aristotle were Swedish theologian Anders Nygren (1972) and Hans-Georg Gadamer (1960/1994). Nygren and later Tage Kurtén (1987) provided her with support for her division of caring science into systematic and clinical caring science. Eriksson introduces Nygren’s concepts of motive research, context of meaning, and basic motive, which give the discipline structure. The aim of motive research is to find the essential context, the leading idea of caring. The idea of motive research applied to caring science is to show the characteristics of caring (Eriksson, 1992c).

The basic motive in caring science and caring for Eriksson is caritas, which constitutes the leading idea and keeps the various elements together. It gives both the substance and the discipline of caring science a distinctive character. In development of the basic motive, St. Augustine (1957) and Søren Kierkegaard (1843/1943) became important sources. In further development of the discipline, Eriksson’s thinking was influenced by sources such as Thomas Kuhn (1971) and Karl Popper (1997), and later by American philosopher Susan Langer (1942) and Finnish philosophers Eino Kaila (1939) and Georg von Wright (1986), all of whom support the human science idea that science cannot exist without values.

For many years, Eriksson collaborated with Håkan Törnebohm (1978), holder of the first Nordic professorial chair in the theory of science at the University of Gothenburg, Sweden. It is especially Törnebohm’s research in and development of paradigms related to various scientific cultures that inspired Eriksson (Eriksson, 1989; Lindström, 1992).

The thought that concepts have both meaning and substance has been prominent in Eriksson’s scientific work. This appears through a systematic analysis of fundamental concepts with the help of a semantic method of analysis rooted in the idea of hermeneutics, which professor Peep Koort (1975) developed. Koort was Eriksson’s mentor and unmistakably the most important source of inspiration in her scientific work. Building on the foundation of his methodology, Eriksson subsequently developed a model for concept development that has been of great importance to many researchers in their scientific work.

In her formulation of the caritas-based caring ethic, which Eriksson conceives as an ontological ethic, Emmanuel Lévinas’ (1988) idea that ethics precedes ontology has been a guiding principle. Eriksson agrees especially with Lévinas’ thought that the call to serve precedes dialogue, that ethics is always more important in relations with other human beings. The fundamental substance of ethics—caritas, love, and charity—is supported further by Aristotle’s (1993), Nygren’s (1972), Kierkegaard’s (1843/1943), and St. Augustine’s (1957) ideas. In the formulation of caritative ethics, Eriksson has been inspired by Kierkegaard’s ideas of the innermost spirit of a human being as a synthesis of the eternal and temporal, and that acting ethically is to will absolutely or to will the eternal (Kierkegaard, 1843/1943). She stresses the importance of knowledge of history of ideas for the preservation of the whole of spiritual culture and finds support for this in Nikolaj Berdâev (1990), the Russian philosopher and historian. In intensifying the basic conception of the human being as body, soul, and spirit, Eriksson carries on an interesting dialogue with several theologians such as Gustaf Wingren (1960/1996), Antnio Barbosa da Silva (1993), and Tage Kurtén (1987), while developing the subdiscipline she refers to as caring theology.Perhaps the most prominent feature of Eriksson’s thinking has been her clear formulation of the ontological, epistemological, and ethical basic assumptions with regard to the discipline of caring science.

Use of empirical evidence

From the beginning development of her theory, Eriksson established it in empiricism by systematically employing a hermeneutical and hypothetical deductive approach. In conformity with a human science and hermeneutical way of thinking, Eriksson developed a caring science concept of evidence (Eriksson, Nordman, & Myllymäki, 1999). Her main argument for this is that the concept of evidence in natural science is too narrow to capture and reach the depth of the complex caring reality. Her concept of evidence is derived from Gadamer’s concept of truth (Gadamer, 1960/1994), which encompasses the true, the beautiful, and the good. She points out, in accordance with Gadamer, that evidence cannot be connected solely with a method and empirical data. Evidence in a human science perspective contains two aspects: a conceptual, logical one, which she calls ontological, and an empirical one, each pre-supposing the other. The evidence concept developed by Eriksson has been shown to be empirically evident when tested in two comprehensive empirical studies in which the idea was to develop evidence-based caring cultures in seven caring units in the Hospital District of Helsinki and Uusimaa (Eriksson & Nordman, 2004). A further development of evidence resulted in caring scientific evidence concept and theory (Martinsen & Eriksson, 2009).

During the 1970s, Eriksson initially developed a nursing care process model (Eriksson, 1974), which later, in her doctoral dissertation (1981), was formulated as a theory. Since then, Eriksson, step by step, has deepened her conceptual and logical understanding of the basic concepts and phenomena that have emerged from the theory. She has tested their validity in empirical contexts, where the concepts have assumed contextual and pragmatic attributes (Kärkkäinen & Eriksson, 2004b). This logical way of working, a constant movement between logical and empirical evidence, has been summarized by Eriksson in her model of concept development (Eriksson, 1997b). The validity of this model has been tested in several doctoral dissertations since 1995 (Gustafsson, 2008; Hilli, 2007; Kasén, 2002; Lassenius, 2005; Lindwall, 2004; Nåden, 1998; Näsman, 2010; Rundqvist, 2004; Sivonen, 2000; Wallinvirta, 2011; von Post, 1999). She started more comprehensive systematic as well as clinical research programs on caring when she was appointed director of the Department of Caring Science at Åbo Akademi University. All 44 doctoral dissertations written at the Department of Caring Science between 1992 and 2012 are in different ways a test and validation of her ideas and theory.

Major assumptions

Theoretical assertions

Eriksson’s fundamental idea when formulating theoretical assertions is that they connect four levels of knowledge: the meta-theoretical, the theoretical, the technological, and caring as art. The generation of theory takes place through dialectical movement between these levels, but here deduction constitutes the basic epistemological idea (Eriksson, 1981). The theory of science for caring science, which contains the fundamental epistemological, logical, and ethical standpoints, is formed on the meta-theoretical level. Eriksson (1988), in accordance with Nygren (1972), sees the basic motive as the element that permeates the formation of knowledge at all levels and gives scientific knowledge its unique characteristics. A clearly formulated ontology constitutes the foundation of both the caritative caring theory and caring science as a discipline. The caritas motive, the ethos of love and charity, and the respect and reverence for human holiness and dignity, which determine the nature of caring, give the caritative caring theory its feature. This ethos, which encircles caring as science and as art, permeates caring culture and creates the preconditions for caring. The ethos is reflected in the process of nursing care, in the documentation, and in various care planning models.

Caring communion constitutes the context of meaning from which the concepts in the theory are to be understood. Human suffering forms the basic category of caring and summons the carer to true caring (i.e., serving in love and charity). In the act of caring, the suffering human being, or patient, is invited and welcomed to the caring communion, where the patient’s suffering can be alleviated through the act of caring in the drama of suffering that is unique to every human being. Alleviation of suffering implies that the carer is a co-actor in the drama, confirms the patient’s suffering, and gives time and space to suffer until reconciliation is reached. Reconciliation is the ultimate aim of health or being and signifies a reestablishment of wholeness and holiness (Eriksson, 1997a).

Logical form

Meta-theory has always had a fundamental place in Eriksson’s thinking, and her epistemological work is anchored in Aristotle’s theory of knowledge (Aristotle, 1935). Searching for knowledge, which is intrinsically hermeneutic, and which takes place within the scope of an articulated theoretical perspective, is understood as a search for the original text in a historical-hermeneutic tradition, that which in the old hermeneutic sense represents truth (Gadamer, 1960/1994). To achieve the depth in the development of knowledge and theory she has consistently striven for, Eriksson has used various logical models for the hypothetical deductive method and hermeneutics guiding principles.

Eriksson stresses the importance of the logical form being created on the basis of the substance of caring (i.e., caritas), not on the basis of method. It is thus deduction combined with abduction that formed the guiding logic. The language, words, and concepts carry the content of meaning, and Eriksson stresses the necessity of choosing words, concepts, and language that correspond to human science.

In the dynamic change between the natural world and the world of science, there has constantly occurred a striving toward the source of the true, the beautiful, and the good—that which is evident. Eriksson (1999) shapes her theory of scientific thought, as reflection moves between patterns at different levels and interpretation is subject to the theoretical perspective. The movement takes place distinctly between dxa (empirical-perceptive knowledge) and episteme (rational-conceptual knowledge), and “the infinite.” Movement thus takes place between the two basic epistemological categories of the theory of knowledge: perception and conception.

Eriksson applied three forms of inference—deduction, induction, and abduction or retroduction (Eriksson & Lindström, 1997)—that give the theory a logical external structure. The substance of her caring theory has moved simultaneously by abductive leaps (Peirce, 1990; Eriksson & Lindström, 1997), which sometimes created a new chaos but also carried Eriksson’s thinking toward new discoveries. Through abduction, the ideal model for caritative caring was shaped, proceeding from historical and self-evident suppositions (Nygren, 1972). Eriksson in this way made use of old original texts that testify to caritative caring as her research material. Through induction and deduction, the validity of the theory has been tested.

Theory as conceived by Eriksson is in accordance with the Greek concept of theory, theoria, in the sense of seeing the beautiful and the good, participating in the common, and dedicating it to others (Gadamer, 2000, p. 49). Theory and practice are different aspects of the same core. The convincing force and potential of the whole theory are found in its innermost core, caritas, around which the generation of theory takes place. The caring substance is formed in a dialectical movement between the potential and the actual, the abstract general and the concrete individual. With the help of logical abstract thinking combined with the logic of the heart (Pascal, 1971), the Theory of Caritative Caring becomes perceptible through the art of caring.

Acceptance by the nursing community

Further development

Eriksson continues developing her thinking and the caritative caring theory with unabated energy and constantly finds new ways, recreating and deepening what has been stated before. Systematic research and the development of caritative caring theory, as well as the discipline of caring science, take place chiefly within the scope of the research programs in her own department with her own staff and the postdoctoral group. The dissertation topics of doctoral candidates are connected with the research programs and form an important contribution of knowledge to the ongoing development of Eriksson’s thinking.

During the last few years, Eriksson has emphasized the necessity of basic research in clinical caring science, where she has especially stressed the understanding of the research object, caring reality. She describes the object of research from three points of view: the experienced world, praxis as activity, and the real reality. In the real reality, which carries the attributes of mystery, one finds something of the deepest potential of caring, and it is a reality that can be understood in Gadamer’s sense, in the old Greek meaning of praxis, as a way of living, a mode of being, that is, an ontology (Gadamer, 2000). The development of knowledge in caring science becomes fundamentally different depending on what object of knowledge constitutes the focus of research (Eriksson & Lindström, 2003). Another central area of interest for Eriksson (2003) is formed by the development of caritative caring ethics. Continued development of the caritative theory of caring also occurs, as has emerged before, through continued implementation and testing in various clinical contexts.

Critique

Summary

Eriksson has been a guide and visionary who has gone before and “ploughed new furrows” in theory development for many years. Eriksson’s caritas-based theory and her whole caring science thinking have developed over the course of 30 years. Characteristic of her thinking is that while she is working at an abstract level developing concepts and theory, the theory is rooted in clinical reality and teaching. The whole caritative theory and the caring that are built up around the theoretical core get their distinctive character and deeper meaning. The ultimate goal of caring is to alleviate suffering and serve life and health.