1. Schoonover-Shoffner, Kathy

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Caring is a hot topic in nursing literature these days. There are stories and affirmations of caring, tales and accusations of lack of caring, theories of caring, research studies, two journals and an International Association of Human Caring. Caring seems to be taking center stage. Nursing has always been defined by four overarching concepts (i.e., our metaparadigm): nursing is what we do; person is the focus of what we do (i.e., who we do it to); health is the goal of nursing; and environment is the context in which we nurse. The core of all nursing theories is examining and elucidating these four concepts to explain and guide nursing. But nursing is now also being defined as caring. Caring has become the fifth metaparadigm concept.

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Why point this out? For starters, this is a good thing. Nurses have long known our "provision of a caring relationship that facilitates health and healing" is an essential feature of nursing.1 Identifying, delineating and understanding caring explains what we do, what is unique about nursing, and guides us as we seek to care.


But an interesting problem has arisen. While every nurse knows what caring is, it seems when you start looking at "it," caring is an elusive concept to nail down. Take a look at nursing literature, and you'll find different interpretations of caring. Some of this comes from pulling the concept apart to understand it. Analyzing any concept is like the story of the five blind men describing an elephant. Each one was feeling the same elephant but experienced it quite differently.


Like most everything else in life, worldview plays a huge part in determining what you think "caring" is. What I believe about "reality," right and wrong, our origins, what happens when we die, or what "truth" is, greatly impacts what I understand caring to be. If I believe all there is to life is the physical world, what we experience through the five senses, then my idea of caring may tend to be more hands-on, focusing on the here-and-now. This doesn't mean I'm not a caring nurse, but how I put caring into practice is going to come from what I think is important. If I believe a universal life force sustains and somehow connects all things, my ideas of caring will probably incorporate aspects of "life force" and take how I connect to others into consideration.


Despite the impact our worldview has on how we think, authors rarely state their underlying worldview in discussions of caring (at least in those I've read). Assumptions, tenets and principles are offered, but views of reality, truth and the nature of the universe are typically not discussed-at least not in a way that says "This is what I believe." It seems we assume ideas about caring are either worldview neutral (i.e., have no impact on what we think), or because world-views are all equally valid and correct, worldview doesn't matter. If asked, all of us would exclaim, "Of course everything comes from a worldview. Nothing is worldview neutral!!" But worldview typically isn't openly acknowledged, at least not in writing.


Not acknowledging worldview in our discussions of caring is problematic. Why? Stating one's worldview gives a broader understanding of information. Say an author wrote: "My theory of caring stems from my belief that the universe evolved through natural, evolutionary, scientific, processes. There is no 'intelligent design' or 'designer'; the world consists only of what we experience." How would you evaluate what you read? Say that you read, "My theory of caring is derived from my belief in a Higher Power (i.e. not the God of the Bible), which underlies all of life and is in all things. This Power unites us so that everything we do impacts all other living things. "What would your interpretation be of that author's ideas?


The worldview of Christian nurses originates and centers on God. We seek to discern worldviews and compare them to biblical truth. Colossians 2:8 explains why: "See to it that no one takes you captive through philosophy and empty deceit, according to human tradition, according to the elemental spirits of the universe, and not according to Christ." Ultimately, caring is modeled in the life of Jesus, and our understanding of caring is found in vigilant study of the Bible.




1 American Nurses Association, Nursing's Social Policy Statement, 2nd ed. (Washington, DC: ANA, 2003): 5. [Context Link]