Current Issue

Critical Caring.

Paul Fulbrook, Professor of Nursing, School of Nursing and Midwifery, Australian Catholic University, Brisbane, Australia

The concept of caring, in the nursing context, has been a subject of discussion, debate, and theorisation for over thirty years. So, whilst the topic itself is not a new one, it is always interesting to revisit the subject.

One of the important considerations, especially for a journal such as Connect, is cultural differences. Too often we assume that concepts that have been developed within certain contexts and cultures - most notably North American settings - are transferable to other settings. Whilst, in some cases there is indeed a high degree of transferability, in many instances there is not.

I recently reviewed a Chinese article about a ‘professional caring’ protocol and this led me to reconsider what we mean when we talk about ‘professional’ caring: how is professional caring different to any other form of caring? Also, if we have professional caring, can we therefore have ‘unprofessional’ caring? I do not think so, since to be uncaring would - by definition - be unprofessional. This suggests then, that the word ‘professional’, in this context, is unnecessary: either we care or we do not.

For me, caring comprises of two essential elements: thoughts and actions. On the one hand, we may have feelings for another person that lead us to make a statement that ‘we care about’ him or her. We can hold these feelings without ever acting on them in any way. In some situations we might even demonstrate uncaring actions towards someone we care about. On the other hand, we can demonstrate caring actions in the things we do for someone. However, it could be argued that, rather like an actor on the stage, although we may perform caring actions this does not mean that we actually care about that person. I would argue that the best nurses are those who both care about, and care for, people. This becomes evident in what I often describe to nursing students as the ‘Mum principle’. Essentially, what this means is that as a nurse I challenge you to care for all patients in the same way that you would care for your own mother or someone very close to you. This provides a reference framework for caring that includes both caring about and caring for, which transcends culture.

A person who works as a nurse, but is uncaring, is abusing their title of ‘nurse’. I often hear about the work pressures that nurses face on a daily basis. Staff shortages, too many patients and not enough beds, colleagues who do not respect them, lack of resources, and not enough time are common complaints. Whilst I acknowledge that these issues are very real, all too often these complaints are used an excuse for inexcusable uncaring behaviour.

When we talk about critical care nursing, the word ‘critical’ is used to convey the serious nature of the patient’s illness. In the context of our nursing practice, I think we should also reflect on a different meaning of the word critical: essential. In other words, caring is critical (essential) to our practice and must form the heart of our being. And, to use the word critical in another sense, we should all be highly critical (judgmental) of colleagues who exhibit uncaring behaviours. There is a well known saying that states that we cannot control the actions of others but we can control our own. We are unlikely ever to be working in a prefect clinical environment, but if we are professionals then we must lead by example and always demonstrate how much we care, despite the difficult circumstances we sometimes face. This is what it means to be a professional nurse.

Contents

2008 - Volume 6 Issue 2

Improving patient safety in intensive care units

Birte Baktoft

Clinical Connections

Early tracheostomy: who decides?

May A Cairns

Clinical Connections

The needs of family members of critically ill patients: a literature review

Maria Mei Yuk Chan, Sek Ying Chair

Research Connections

An evaluation of patient diaries in intensive care

Wayne P Robson

Research Connections

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