Theory of Caritative Caring



Theory of Caritative Caring


Unni Å. Lindström, Lisbet Lindholm and Joan E. Zetterlund






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 have followed her work and progress in Finland have noticed her excellent ability from the very beginning to have designed caring science as a discipline, while at the same time with her excellent pedagogical skill 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, she 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 also held a professorship in caring science at University of Helsinki, Faculty of Medicine, where she has been a docent since 2001. Since January 1, 1996, she has 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.


At the end of the 1960s and beginning of the 1970s, Eriksson worked in various fields of nursing practice, but she continued her studies at the same time. Her main area of work, however, has been in teaching and research. Since the beginning of the 1970s, Eriksson has systematically deepened her thoughts about caring, partly through the development of an ideal model for caring that has formed the basis for the caritative caring theory, and partly through the development of an autonomous, humanistically oriented caring science. Eriksson is one of the few caring science researchers in the Nordic countries who has developed a caring theory, and she has been 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 was invited to found 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, she 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, with initial collaboration with University of Helsinki, was the beginning of caring science didactics. Under Eriksson’s leadership, Helsinki Swedish School of Nursing developed one of the leading educational programs in caring science and nursing in the Nordic countries. It became the forerunner of education based on caring science and also of integration of research in the education. Eriksson was in charge of the program for 2 years, until she became dean at Helsinki Swedish School of Nursing in January 1974. She remained the dean until September 1986, when she was nominated to plan and 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 the Finland-Swedish university, Åbo Akademi 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 areas or options and a research education program for caring science, was created. The result of her planning was the establishment of 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 new faculty, the Faculty of Social and Caring Sciences, was founded. A result of her work was that the education program for the MA in health and the caring science didactic education program were developed.


In 1987, a doctoral program was started under Eriksson’s direction, and 32 doctoral dissertations have been published at the department. At her own department, Eriksson, with her staff and researchers, has further developed the caritative theory of caring and caring science as an academic discipline. The department today has a leading position in the Nordic countries with students and researchers from those countries.


In addition to her work with teaching, research, and supervision, Eriksson is the dean of the Department of Caring Science. One of her central tasks has been to develop Nordic and other international contacts within caring science.


Eriksson has been a very popular guest and keynote speaker, not only in Finland, but in all the Nordic countries and at various international congresses. In 1977, she was a guest speaker at Symposium of Medical and Nursing Education in Istanbul, Turkey; in 1978, she participated in the foundation of medical care teacher education in Reykjavik, Iceland; in 1982, she presented her nursing care didactic model at the First Open Conference of the Workgroup of European Nurse-Researchers in Uppsala, Sweden; and for several years, she participated in education and advanced education of nurses at the Statens Utdanningscenter for Helsopersonell (Federal Education Center for Nursing Staff) in Oslo, Norway. In 1988, she taught a course titled “Basic Research in Nursing Care Science” at the University in Bergen, Norway, and a course called “Nursing Care Science’s Theory of Science and Research” at Umeå University in Sweden. She has worked as consultant at many educational institutions in Sweden; since 1975, she has been a regular lecturer at Nordiska Hälsovårdsskolan (The Nordic School of Public Health) in Gothenburg, Sweden. In 1991, she was a guest speaker at the 13th International Association for Human Caring (IAHC) Conference in Rochester, New York; in 1992, she presented her theory at the 14th IAHC Conference in Melbourne, Australia; and in 1993, she was the keynote speaker at the 15th IAHC Conference, Caring as Healing: Renewal Through Hope, in Portland, Oregon (Eriksson, 1994b).


Since 1985, she has been a yearly keynote speaker at the annual congresses for nurse managers and, since 1996, at the annual caring science symposia in Helsinki, Finland. In many public dialogues with Professor Kari Martinsen from Norway, Eriksson has discussed basic questions about caring and caring science. Some of the dialogues have been published (Martinsen, 1996).


Eriksson has worked as a leader of many symposia: in 1975, for The Nordic Symposium about the Nursing Care Process (the first Nordic Nursing Care Science Symposium in Finland); in 1982, for The Symposium in Basic Research in Nursing Care Science; in 1985, for The Nordic Symposium in Nursing Care Science; in 1989, for the Nordic symposium titled “Humanistic Caring”; in 1991, for the Nordic Caring Science Conference, “Caritas & Passio in Vaasa, Finland”; and in 1993, for the Nordic Caring Science Conference, “To Care or Not to Care—The Key Question” in Nursing in Vaasa, Finland.


Eriksson’s caritative theory of caring came into clearer focus internationally in 1997, when the IAHC for the first time arranged its research conference in a European country. The Department of Caring Science had the honor of serving as the host of this conference, which was arranged in Helsinki, Finland, in 1997, with the topic, “Human Caring: The Primacy of Love and Existential Suffering.”


Eriksson is a member of several editorial committees for international journals in nursing and caring science. She has been invited to many universities in Finland and other Nordic countries as a faculty opponent for doctoral students and an expert consultant in her field. She is not only an advisor for her own research students but also a supervisor for research students at Kuopio and Helsinki Universities, where she is an associate professor (docent). Eriksson served as chairperson of the Nordic Academy of Caring Science from 1999 to 2002.


Eriksson has produced an extensive list of textbooks, scientific reports, professional journal articles, and short papers. Her publications started at the beginning of the 1970s and include a total of about 400 titles. Some of her publications have been translated into other languages, mainly into Finnish. Vårdandets Idé [The Idea of Caring] has been published in Braille. Her first English translation, The Suffering Human Being [Den Lidande Människan], was published in 2006 by Nordic Studies Press in Chicago.


Eriksson has received many awards and honors for her professional and academic accomplishments, of which we want to mention several. In 1975, Eriksson was nominated by Finland to receive the 3M-ICN (International Council of Nurses) Nursing Fellowship award; in 1987, she was awarded the Sophie Mannerheim Medal of the Swedish Nursing Association in Finland; and in 1998, she received the Caring Science Gold Mark for academic nursing care at Helsinki University Central Hospital. Also in 1998, she received an Honorary Doctorate in Public Health from the Nordic School of Public Health, in Gothenburg, Sweden. Other awards include the 2001 Åland Islands medal for caring science activity in the province and the 2003 Topelius Medal, instituted by Åbo Akademi University in acknowledgment of good research. In 2003, she was honored nationally as a Knight, First Class, of the Order of the White Rose of Finland.



THEORETICAL SOURCES


Ever since the middle of the 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 great 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, her 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) have 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 a 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, in an objective way, to show the characteristics of caring (Eriksson, 1992c).


The basic motive in caring science and caring 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) become important sources. In further development of the discipline, Eriksson’s thinking has been influenced by sources of theory of science such as Thomas Kuhn (1971) and Karl Popper (1997), and later by the American philosopher Susan Langer (1942) and the 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 the development of 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 in education Peep Koort (1975) developed. Koort, who was Eriksson’s mentor, was unmistakably her 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 caritative 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 the 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 like Gustaf Wingren (1960/1996), António 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. In the field of caring science, historical sources like Plato, Aristotle, and Socrates have served as guides for Eriksson whenever she has been looking for a basis for the substance of caring in its original historical form.



MAJOR CONCEPTS & DEFINITIONS


CARITAS


Caritas means love and charity. In caritas, eros and agapé are united, and caritas is by nature unconditional love. Caritas, which is the fundamental motive of caring science, also constitutes the motive for all caring. It means that caring is an endeavor to mediate faith, hope, and love through tending, playing, and learning.



CARING COMMUNION


Caring communion constitutes the context of the meaning of caring and is the structure that determines caring reality. Caring gets its distinctive character through caring communion (Eriksson, 1990). It is a form of intimate connection that characterizes caring. Caring communion requires meeting in time and space, an absolute, lasting presence (Eriksson, 1992c). Caring communion is characterized by intensity and vitality, and by warmth, closeness, rest, respect, honesty, and tolerance. It cannot be taken for granted but pre-supposes a conscious effort to be with the other. Caring communion is seen as the source of strength and meaning in caring. Eriksson (1990) writes in Pro Caritate, referring to Lévinas:



Joining in a communion means creating possibilities for the other. Lévinas suggests that considering someone as one’s own son implies a relationship “beyond the possible” (1985, p. 71; 1988). In this relationship, the individual perceives the other person’s possibilities as if they were his or her own. This requires the ability to move toward that which is no longer one’s own but which belongs to oneself. It is one of the deepest forms of communion (Eriksson, 1992b). Caring communion is what unites and ties together and gives caring its significance (Eriksson, 1992a).




CARITATIVE CARING EFFECTS


Caritative caring ethics comprises the ethics of caring, the core of which is determined by the caritas motive. Eriksson makes a distinction between caring ethics and nursing ethics. She also defines the foundations of ethics in care and its essential substance. Caring ethics deals with the basic relation between the patient and the nurse—the way in which the nurse meets the patient in an ethical sense. It is about the approach we have toward the patient. Nursing ethics deals with the ethical principles and rules that guide my work or my decisions. Caring ethics is the core of nursing ethics. The foundations of caritative ethics can be found not only in history, but also in the dividing line between theological and human ethics in general. Eriksson has been influenced by Nygren’s (1966) human ethics and Lévinas’ (1988) “face ethics,” among others. Ethical caring is what we actually make explicit through our approach and the things we do for the patient in practice. An approach that is based on ethics in care means that we, without prejudice, see the human being with respect, and that we confirm his or her absolute dignity. It also means that we are willing to sacrifice something of ourselves. The ethical categories that emerge as basic in caritative caring ethics are human dignity, the caring communion, invitation, responsibility, good and evil, and virtue and obligation. In an ethical act, the good is brought out through ethical actions (Eriksson, 1995, 2003).









CARING CULTURE


Caring culture is the concept that Eriksson (1987a) uses instead of environment. It characterizes the total caring reality and is based on cultural elements such as traditions, rituals, and basic values. Caring culture transmits an inner order of value preferences or ethos, and the different constructions of culture have their basis in the changes of value that ethos undergoes. If communion arises based on the ethos, the culture becomes inviting. Respect for the human being, his or her dignity and holiness, forms the goal of communion and participation in a caring culture. The origin of the concept of culture is to be found in such dimensions as reverence, tending, cultivating, and caring; these dimensions are central to the basic motive of preserving and developing a caring culture (Eriksson, 1987a; Eriksson & Lindström, 2003).




USE OF EMPIRICAL EVIDENCE


From the beginning development of her theory, Eriksson has firmly established it in empiricism by systematically employing a hermeneutical and hypothetical deductive approach. Eriksson, in conformity with a human science and hermeneutical way of thinking, has developed a caring science concept of evidence (Eriksson, Nordman, & Myllymäki, 1999). As her main argument for this, she points out 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 where the idea was to develop evidence-based caring cultures in seven caring units in the Hospital District of Helsinki and Uusimaa (Eriksson & Nordman, 2004).


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. 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 (Kasén, 2002; Lindwall, 2004; Nåden, 1998; Rundqvist, 2004; Sivonen, 2000; 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 32 doctoral dissertations written at the Department of Caring Science between 1992 and 2008 are in different ways a test and validation of her ideas and theory.



MAJOR ASSUMPTIONS


Eriksson distinguishes between two kinds of major assumptions: axioms and theses. She regards axioms as fundamental truths in relation to the conception of the world; theses are fundamental statements concerning the general nature of caring science, and their validity is tested through basic research. Axioms and theses jointly constitute the ontology of caring science and therefore also are the foundation of its epistemology (Eriksson, 1988, 2001). The caritative theory of caring is based on the following axioms and theses, as modified and clarified from Eriksson’s basic assumptions with her approval (Eriksson, 2002). The axioms are as follows:



The theses are as follows:




The Human Being


The conception of the human being in Eriksson’s theory is based on the axiom that the human being is an entity of body, soul, and spirit (Eriksson, 1987a, 1988). She emphasizes that the human being is fundamentally a religious being, but all human beings have not recognized this dimension. The human being is fundamentally holy, and this axiom is related to the idea of human dignity, which means accepting the human obligation of serving with love and existing for the sake of others. Eriksson stresses the necessity of understanding the human being in his ontological context. The human being is seen as in constant becoming; he is constantly in change and therefore never in a state of full completion. He is understood in terms of the dual tendencies that exist within him, engaged in a continued struggle and living in a tension between being and nonbeing. Eriksson sees the human being’s conditional freedom as a dimension of becoming. She links her thinking with Kierkegaard’s (1843/1943) ideas of free choice and decision in the human being’s various stages—aesthetic, ethical, and religious stages—and she thinks that the human being’s power of transcendency is the foundation of real freedom. The dual tendency of the human being also emerges in his effort to be unique, while he simultaneously longs for belonging in a larger communion.


The human being is fundamentally dependent on communion; he is dependent on another, and it is in the relationship between a concrete other (human being) and an abstract other (some form of God) that the human being constitutes himself and his being (Eriksson, 1987a). The human being seeks a communion where he can give and receive love, experience faith and hope, and be aware that his existence here and now has meaning. According to Eriksson (1987b), the human being we meet in care is creative and imaginative, has desires and wishes, and is able to experience phenomena; therefore, a description of the human being only in terms of his needs is insufficient. When the human being is entering the caring context, he or she becomes a patient in the original sense of the concept—a suffering human being (Eriksson, 1994a).



Caritas


Love and charity, or caritas, as the basic motive of caring has been found in Eriksson (1987b, 1990, 2001) as a principal idea even in her early works. The caritas motive can be traced through semantics, anthropology, and the history of ideas (Eriksson, 1992c). According to Nygren (1966), caritas means human love and charity. Anthropologically, the essence of the human being is love. Giving love is a human characteristic (Lévinas, 1988). The history of ideas indicates that the foundation of the caring professions through the ages has been an inclination to help and minister to those suffering (Lanara, 1981).


Caritas constitutes the motive for caring, and it is through the caritas motive that caring gets its deepest formulation. This motive, according to Eriksson, is also the core of all teaching and fostering growth in all forms of human relations. In caritas, the two basic forms of love—eros and agapé (Nygren, 1966)—are combined. When the two forms of love combine, generosity becomes a human being’s attitude toward life, and joy its form of expression. The motive of caritas becomes visible in a special ethical attitude in caring, or what Eriksson calls a caritative outlook, which she formulates and specifies in caritative caring ethics (Eriksson, 1995). Caritas constitutes the inner force that is connected with the mission to care. A carer who works in love also beams forth what Eriksson calls claritas, or the strength and light of beauty.


Caritas comprises love for one’s neighbor and for God, a human being’s love for himself, a human being’s love for everything created, and God’s love for human beings. Eriksson sees expressions of love as a development of the original virtues of mercy and the theological virtues of faith, hope, and love (Eriksson, 1987a, 1990). From the idea of caritas, Eriksson has derived her whole caritative caring theory.



Caring


In accordance with the fundamental assumptions of caring science, Eriksson sees caring as ontological and an expression of caritas (Eriksson, 1988). Caring is something natural and original. Eriksson thinks that the substance of caring can be understood only by a search for its origin. This origin is in the origin of the concept and in the idea of natural caring. The fundamentals of natural care are constituted by the idea of motherliness, which implies cleansing and nourishing, and spontaneous and unconditional love.


Natural basic caring is expressed through tending, playing, and learning in a spirit of love, faith, and hope. The characteristics of tending are warmth, closeness, and touch; playing is an expression of exercise, testing, creativity, and imagination, and desires and wishes; learning is aimed at growth and change. To tend, play, and learn implies sharing, and sharing, Eriksson (1987a) says, is “presence with the human being, life and God” (p. 38). True care therefore is “not a form of behavior, not a feeling or state. It is to be there—it is the way, the spirit in which it is done, and this spirit is caritative” (Eriksson, 1998, p. 4). Eriksson brings out that caring through the ages can be seen as various expressions of love and charity, with a view toward alleviating suffering and serving life and health. In her later texts, she stresses that caring also can be seen as a search for truth, goodness, beauty, and the eternal, and for what is permanent in caring, and making it visible or evident (Eriksson, 2002). Her constant search has been centered on the question of what is care (the caring fundamentals) in caring. Eriksson emphasizes that caritative caring relates to the innermost core of nursing, and she has distinguished between traditions that she calls caring nursing and nursing care. She means that nursing care is based on the nursing care process, and that it represents good care only when it is based on the innermost core of caring. Caring nursing represents a kind of caring without prejudice that emphasizes the patient and his or her suffering and desires (Eriksson, 1994a).


Caritative caring arises in the encounter with the suffering human being in a caring relationship that involves caring communion (Eriksson, 1998). The core of the caring relationship, between nurse and patient as described by Eriksson (1993), is an open invitation that contains affirmation that the other is always welcome. The constant open invitation is involved in what Eriksson (2003) today calls the act of caring. The act of caring expresses the innermost spirit of caring and re-creates the basic motive of caritas. The caring act expresses the deepest holy element, the safeguarding of the individual patient’s dignity. In the caring act, the patient is invited to a genuine sharing, a communion, in order to make the caring fundamentals alive and active (Eriksson, 1987a) (i.e., appropriated to the patient). The appropriation has the consequence of somehow restoring the human being and making him or her more genuinely human. In an ontological sense, the ultimate goal of caring, according to Eriksson, cannot be only health; it reaches further and includes human life in its entirety. Because the mission of the human being is to serve, to exist for the sake of others, the ultimate purpose of caring is to bring the human being back to this mission (Eriksson, 1994a).



Ethos


Eriksson uses the concept of ethos in accordance with Aristotle’s (1935, 1997) idea that ethics is derived from ethos. In Eriksson’s sense, the ethos of caring science, as well as that of caring, consists of the idea of love and charity and respect and honor of the holiness and dignity of the human being. Ethos is the sounding board of all caring. Ethos is ontology in which there is an “inner ought to,” a target of caring “that has its own language and its own key” (Eriksson, 2003, p. 23). Good caring and true knowledge become visible through ethos. Ethos originally refers to home, or to the place where a human being feels at home. It symbolizes a human being’s innermost space, where he appears in his nakedness (Lévinas, 1989). Ethos and ethics belong together, and in the caring culture, they become one (Eriksson, 2003). Eriksson thinks that ethos means that we feel called to serve a particular task. This ethos she sees as the core of caring culture. Ethos, which forms the basic force in caring culture, reflects the prevailing priority of values through which the basic foundations of ethics and ethical actions appear.



Suffering


At the beginning of the 1990s, when Eriksson reintroduced the idea of suffering as a basic category of caring, she returned to the fundamental historical conditions of all caring, the idea of charity as the basis of alleviating suffering (Eriksson, 1984, 1993, 1994a, 1997a). This meant a change in the view of caring reality to a focus on the suffering human being. In an ontological sense, Eriksson sees all suffering as a fight between evil and good. Her starting point is that suffering is an inseparable part of human life, and that it has no distinct reason or definition. It has many faces and many characteristics, but it lacks an explicit language. Suffering as such has no meaning, but a human being can ascribe meaning to it by becoming reconciled to it. Eriksson makes a distinction between endurable and unendurable suffering and thinks that an unendurable suffering paralyzes the human being, preventing him or her from growing, while endurable suffering is compatible with health. In its deepest meaning, all suffering can be described in some sense as a form of dying, but it also can lead to renewal. Every human being’s suffering is enacted in a drama of suffering. Alleviating a human being’s suffering implies being a coactor in the drama and confirming his or her suffering. A human being who suffers wants to have the suffering confirmed and be given time and space to become reconciled to it. The ultimate purpose of caring is to alleviate suffering. Eriksson has described three different forms: suffering related to illness, suffering related to care, and suffering related to life (Eriksson, 1993, 1994a, 1997a).



Health


Eriksson considers health in many of her earlier writings in accordance with an analysis of the concept in which she defines health as soundness, freshness, and well-being. The subjective dimension, or well-being, is emphasized strongly (Eriksson, 1976). In the current axiom of health, she states that it is more than absence of illness; health implies being whole in body, soul, and spirit. Health means as a pure concept wholeness and holiness (Eriksson, 1984). In accordance with her view of the human being, Eriksson has developed various premises regarding the substance and laws of health, which have been summed up in an ontological health model. She sees health as both movement and integration. Health is a movement between actual and potential in a human being’s active becoming, and it is an integrated part of human life. The health premise is a movement comprising various partial premises: health as movement implies a change; a human being is being formed or destroyed, but never completely; health is movement between actual and potential; health is movement in time and space; health as movement is dependent on vital force on vitality of body, soul, and spirit; the direction of this movement is determined by the human being’s needs and desires; the will to find meaning, life, and love constitutes the source of energy of the movement; and health as movement strives toward a realization of one’s potential (Eriksson, 1984).


In the ontological conception, health is conceived as a becoming, a movement toward a deeper wholeness and holiness. As a human being’s inner health potential is touched, a movement occurs that becomes visible in the different dimensions of health as doing, being, and becoming with a wholeness unique to human beings (Eriksson, Bondas-Salonen, Fagerström, Herberts, & Lindholm, 1990). In doing, the person’s thoughts concerning health are focused on healthy life habits and avoiding illness; in being, the person strives for balance and harmony; in becoming, the human being becomes whole on a deeper level of integration.


Eriksson (1997a) sees that health and suffering belong together. Health becomes wholeness only through its combination with suffering. Health and suffering are two sides of the same movement, and they are integrated into each other and constantly present in a human being’s life. In the health dimension of doing, human beings are unfamiliar with their suffering and want to explain it away. In the health dimension of being, they seek harmony and want to get away from suffering. In becoming, human beings are not unfamiliar with suffering; instead, they strive to reconcile themselves to the circumstances of life. Eriksson (1994a) thinks that suffering can give health meaning by making the human being conscious of the contrasts of health and suffering.



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 common, clearly formulated ontology constitutes the foundation of both the caritative caring theory and caring science as a discipline. In accordance with Lévinas’ (1988) thinking, Eriksson is of the opinion that ethics precedes ontology. 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).


The outer structure of caring is constituted by the nursing care process, structured as a hermeneutic course of events in which understanding is a necessary prerequisite of action. It creates a caring culture in which caritative caring is made possible.



LOGICAL FORM


Meta-theory has always had a fundamental place in Eriksson’s thinking and thought patterns, and her epistemological work is anchored in Aristotle’s theory of knowledge (Aristotle, 1935). Searching for knowledge, which is intrinsically hermeneutic, and which has taken place within the scope of an articulated theoretical perspective, is to be 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.


The logical form is constituted both in Eriksson’s caritative theory of caring and in caring science as a discipline (Eriksson & Lindström, 1997). 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 has formed the guiding logic. The language, words, and concepts are the carriers of the content of meaning, and Eriksson stresses the necessity of choosing words, concepts, and language that correspond to the tradition of 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, in which reflection moves between patterns at different levels, and the repertory of interpretation is subject to the theoretical perspective. The movement takes place distinctly between dóxa (empirical-perceptive knowledge) and episteme (rationalconceptual knowledge), and “the infinite.” Movement thus takes place between the two basic epistemological categories of the theory of knowledge: perception and conception. The infinite reaches beyond rational concept-forming knowledge, in which epistemological categories mainly take the form of symbols and metaphors.


Eriksson has consistently applied three forms of inference—deduction, induction, and abduction or retroduction (Eriksson & Lindström, 1997)—that have given 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 have created a new chaos but have carried Eriksson’s thinking toward new discoveries. Through abduction, the ideal model for caritative caring has been shaped, proceeding from historical and self-evident suppositions (Nygren, 1972). Eriksson in this way has 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 continually.


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


Practice


A characteristic feature of Eriksson’s manner of working is her way of structuring abstract thinking as a natural and obvious precondition of clinical activity and an evidence-based form of caring that opens up a deeper insight. Eriksson uses the concept of caring as art as an expression of a caring practice in which the abstract generality appears in a unique individual caritative act of caring.


Several nursing units in the Nordic countries have based their practice and caring philosophy on Eriksson’s ideas and her caritative theory of caring. These include several clinics in the Hospital District of Helsinki and Uusimaa in Finland, Stiftelsen Hemmet in the Åland Islands of Finland, and Stora Sköndal in Sweden. Because Eriksson’s thinking and process model of caring are general, the nursing care process model has proved to be applicable in all contexts of caring, from acute clinical caring and psychiatric care to health-promoting and preventive care.


Since the 1970s, Eriksson’s nursing care process model has been systematically used, tested, and developed as a basis of nursing care and documentation at Helsinki University Central Hospital. From the beginning of the 1990s, Eriksson has served as director of the clinical research program, “In the World of the Patient.” This program comprises a number of empirical studies in various clinics within the whole district of university hospitals. In various studies, Eriksson’s theory has been tested, and the results have been presented in doctoral and master’s theses and published in professional and scientific journals. The study, “In the Patient’s World II: Alleviating the Patient’s Suffering—Ethics and Evidence” will lead to recommendations for the care of patients and is an ongoing research project that will become a handbook for clinical caring science.


Theoretical assumptions, assertions, and nursing care process model form the basis of the development of caring, planning and documentation. Eriksson’s model has been subjected to more comprehensive academic research (Fagerström, 1999; Kärkkäinen & Eriksson, 2003, 2004; Lukander, 1995; Turtiainen, 1999). Eriksson’s thinking has been influential in nursing leadership and nursing administration, where the caritative theory of nursing forms the core of the development of nursing leadership at various levels of the nursing organization. That Eriksson’s ideas about caring and her nursing care process model work in practice has been verified by everything from a multiplicity of essays and tests of learning in clinical practice to master’s theses, licentiates’ theses, and doctoral dissertations produced all over the Nordic countries.



Education


Since the 1970s, Eriksson’s theory has been integrated into the education of nurses at various levels, and her books have been included continuously in the examination requirements in various forms of nursing education in the Nordic countries. The education for master’s and doctoral degrees that started in 1986 at the Department of Caring Science, Åbo Akademi University, has been based entirely on Eriksson’s ideas, and her caritative caring theory forms the core of the development of substance in education and research.


Eriksson started the first Finnish-Swedish education of caring science teachers in 1970. She subsequently for 15 years had the advantage of working with a team of teachers who have integrated her ideas and her caritative caring theory, while at the same time developing caring didactics. Eriksson worked intensively to develop the caring science curriculum. In her book on didactics of caring (Eriksson, 1985), Eriksson further developed her curriculum theory and didactics. Her theory of caring didactics is based on a dialectic between a clearly articulated ontology, epistemology, and ethos, which results in didactics, an art of teaching that is hermeneutical by nature. The caring science concepts and the theory run like a main thread through whole education, independently of the level. Eriksson’s buildup of caring science as a humanistic autonomous discipline, with its subdisciplines such as caring ethics, caring theology, and the history of ideas of caring (Eriksson, 1988, 2001), forms the basic structure of the organization of the curriculum and teaching on numerous levels (Eriksson, 1986).


Development of the caring science–centered curriculum and caring didactics continued in the educational and research program in caring science didactics. Development of teachers within the education of nurses forms a part of the master’s degree program and has resulted in the first doctoral dissertation in the didactics of caring science (Ekebergh, 2001).


Eriksson realized at an early stage the importance of integrating academic courses in the education of nurses; nowadays, academic courses in caring science based on Eriksson’s theory are offered as part of the continuing education of those who work in clinical practice. Approximately 200 nurses take part annually in these academic courses.


Because Eriksson sees caring science not as profession oriented but as a “pure” academic discipline, it has aroused interest among students in other disciplines and other occupational groups, such as teachers, social workers, psychologists, and theologians. Eriksson stresses that it is necessary for doctors as well to study caring science, so that genuine interdisciplinary cooperation is achieved between caring science and medicine.

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Feb 9, 2017 | Posted by in NURSING | Comments Off on Theory of Caritative Caring

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