A critical analysis of the concept 'care' in the practice and discourse of nursing

Doctoral Thesis


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University of Cape Town

This research sought to answer the question: " What meanings has the nursing profession given to the concept 'caring'"? This was achieved by means of a three-fold approach: interpretive phenomenology combined with linguistic analysis [Wittgenstein's as interpreted by Bowden], and, a conceptual philosophical framework. Narratives, from registered nurses working in hospices and oncology/haematology units, were obtained and analyzed through juxtaposing them with selected theorists, and each other, to construct 'family resemblances' and 'layers of understanding'. Their meanings, obtained by requesting them to draw on memories of being cared-for or caring, resulted in descriptive understandings of their use of the concept 'care'; and, to a relational ethic enabling the construal of a normative ethic: one allegedly embedded in the practice and experience of these practitioners. The findings show it is not possible to give a simple definition to explain the concept 'caring'. The meanings, contained in the collected narratives, reveal strong 'family resemblances' in their usage of the term, verifying the Wittgensteinian observation: that no single meaning, no singular essence captures every cultural, individualized use of the term. The findings pointed to these 'meanings' being 'private' but not in the sense of being 'false'. Within the research one becomes aware that the term 'care' is not an ethical notion. To be ethical care is dependent upon context and responsible attitudes and actions. The discourses comprise the personal 'passion', an ethical ideal, held by most respondents; but, their ideal was not always the caring they were enabled to give. Institutionalized care whether hospice or not fell below the ideal because of socio-economic constraints and concerns. The original thesis question was from O'Malley: "[W]hether in encounter man himself makes his own meaning or is made by the meaning made of and for him ...". This research led to the assertion that the reality of the practice setting shapes the 'public' meaning of caring these practitioners act upon, but, they shape their own 'private' meanings and implement it on a micro level. It is at the macro-level of care/caring that there should also be concern. Although not true of all respondents, a possible reason for this less-than-ideal-type caring is the possibility that in institutions there are nurses who for some reason(s) fail to 'grow' - to develop in a fully integrated way that includes the freedom to exercise one's spirituality and to become morally caring not merely on a micro [one-to-one] basis but on a macro level [whole unit basis].