RESPONSE TO CRITIQUE OF "CARING AS EMANCIPATORY NURSING PRAXIS: THE THEORY OF RELATIONAL CARING COMPLEXITY"

RESPONSE

We wish to thank the doctoral students of the University of Massachusetts, Amherst, for their thoughtful evaluative critique of and suggestions to enhance our article, "Caring as Emancipatory Nursing Praxis: The Theory of Relational Caring Complexity."1

Drs Marilyn Ray and Marian Turkel have provided a response to this critique.

This article examined the importance of nursing praxis by asserting that a social caring ethic, a practice of how we think about nursing's responsibility of human caring in complex health care organizations, needs be woven into the cultural context of day-to-day nursing practice. A social caring ethic illuminates through critical reflection and reasonable communication the core values of nursing as caring-love and compassion, and ethics-respect for human dignity, human rights, and justice (fairness) within the nurse-patient relationship. The reflective practice science articulated in this article on caring as emancipatory nursing praxis focuses on highlights of Ray and Turkel's extensive 30-year research trajectory on caring science, technology, politics, economics, and organizational complexity and applications in practice gleaned from the advancement of the Theory of Relational Caring Complexity, a theory that integrates human capital and social justice-the meaning of caring as the essence of nursing and ethical principles of fairness, respectively. Praxis of this kind is "thoughtful action, ... knowing of, in, and through doing,"2^(p69) as Sandelowski stated. Human capital recognizes that both the nurse and the patient are autonomous beings worthy of respect and dignity. The nurse who is invested in the patient cares who the patient (and family or family of choice) is, what the patient's needs and limitations are, what is conducive to the patient's needs, what the social context may be, and also what the limitations may be for the one caring (from Mayeroff).3 Coevolving the integral nature of this knowing facilitates a deeper understanding of relationship as it is unfolding. The examples of emancipatory nursing praxis highlighted in this article may seem "simple" to some readers; however, they were initiated by nurses themselves in relation to patients' and significant others' needs and the context (the hospital, the school, the street, the home) wherein the practice of nursing took place. The decision to initiate these practices and to identify which practices to initiate was accomplished by the nurses practicing at the bedside; they were not selected by the hospital administrators or nursing leaders as a top-down process. That action in itself is reflective of emancipatory nursing praxis, and as acknowledged in this article, nurses self-identified that "this is freeing." The nurses choose what they wanted to do and then did it. Although the reality of the practice environment is busy, chaotic, and complex, nurses are making the choice to integrate caring into practice.

The ideas suggested by the doctoral students in this critique-that practice is too busy to allow for this to occur-are not reflective of the nursing cultures within the hospitals cited as exemplars for this article. Yes, practice is busy but nurses are making an ethical choice and making the time to integrate caring-healing modalities into practice. Their actions were different from those of a leader identifying practices for nurses or bringing in a consultant who tells nurses what to do. The nurses in these exemplars illuminated the art of praxis-human rights and social caring justice, "...nurses' obligation to understand social contexts, promote moral mindfulness, seek ethical knowledge, exercise ethical evaluation and judgment, and promote caring as emancipatory praxis within the moral community."1^(p144)

Caring-healing modalities such as self-care, aromatherapy, and hand massages initiated with intentionality and authentic presence are not simple but reflective of Caritas Process #8: Creating Healing Environments at All Levels4 and are tangible and meaningful expressions of the integration of Watson's Theory of Human Caring into Practice. Buying a bus pass for a family member to be with a loved one is a genuine expression of Caritas Process #1: Practice of Loving Kindness to Others4 and knowing what is most important to the family member at that time. The exemplars cited in this article serve as "forms of evidence" reflective of aesthetic knowing in practice and especially for Dr Watson when she does site visits to designate hospitals as Watson Caring Science Institute (WCSI) affiliates.5

Many of the exemplars referenced in this article are reflective of the Caritas Coach projects of registered nurses prepared at the baccalaureate and graduate levels (http://www.WCSI.org). It was beyond the scope of this article to identify the research guided by appreciative inquiry and caring science that took place in the hospitals cited. Within the past 2 years, an increased number of Caritas Coaches have been PhD prepared and are using qualitative and quantitative methods grounded in concepts relative to emancipatory nursing and caring science. Coaches, WCSI faculty, academics, and PhD researchers from the practice setting study the practice/"work" environment of registered nurses in Magnet hospitals, many of which are WCSI5 affiliates and compare and contrast data in hospitals where a caring science theoretical foundation for nursing practice is not part of the practice environment.

-Marilyn A. Ray, PhD, RN, CTN-A, FSfAA, FAAN

Marian C. Turkel, PhD, RN, NEA-BC, FAAN

Christine E. Lynn College of Nursing

Florida Atlantic University

Boca Raton Florida

[email protected]

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