Fred Richards, PhD

Do you care for, or care about?

If the humanistic revolution is alive anywhere, it is alive and stirring in the field of nursing. The concept of “caring for and caring about” is now a present focus of concern in hospital care and possibly part of the rallying cry of a humanistic revolution already under way.

I want to share with you some brief quotations from a book I am writing on two different ways of caring- caring for and caring about.

I speak here of two ways of caring in the world. One is caring for. The other, caring about.

Caring for is a matter of provid- ing for or looking after. If I care for you, you are the object of my con- cern. I express my concern for you by taking charge of your life.

When I care for, I feel most needed when you are an invalid in need of my care. I feel most needed when you are in need.

Fred Richards, PhD, is assistant pro- fessor, department of psychology, West Georgia College, Carrollton, Ga. He re- ceived BA and MA degrees from Stet- son University, DeLand, Flu, an MEd from the University of Florida, and his PhD fiom Union Graduate School, Yel- low Springs, Ohio. He was a speaker at the 1975 AORN Congress.

If I care for you, I see you as an object. Reducing you to an object, I invalidate you as a person. When I experience you as an object, I feel more secure and comfortable. You do not touch my life. You seem more predictable. You are much easier to control.

Caring about is a matter of going out of one’s self to meet fully the other. If I care about you, I meet you as a person. You matter in my world. In a sense, I stand naked before you. I wear no mask. I hide behind no role. We meet. And in the moment of meeting, we are free to discover our humanity.

When I care about, I see you as a person. I see you as a person in process, growing, becoming. You are never quite the same. You are always new.

Experiencing the newness of you, I am free also to unfold and be who I am. We see one another as persons. We are not displaced. We are not invisible. We are free to be present and real.

Every situation is an opportunity to care for and care about. Every dialogue, every meeting, every mo- ment is an invitation, a calling out to ourselves to go beyond caring for. If I care about you, the appearance

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of caring for is lifted into love. If I fail to care about you, my caring for diminishes both of us.’ Many persons perceive the hospital

as a place where they are nonpersons. They perceive the hospital as a place where they are cared for, where they become objects to be poked, prodded, and pushed about. In On Death and Dying, Kubler-Ross relates the experi- ence of the patient who, hospitalized and rushed into surgery, feels himself made over into an object or a thing: “He slowly but surely is beginning to be treated like a thing. He is no longer a person.”2

In a n article, “The hospital,” Knowles concludes tha t the efficiency-centered rather than person-centered approach to hospital care “dehumanizes what should be an intensely personal and humane en- c o ~ n t e r . ” ~ He continues, “As in so much of modern institutional and technology-based life, the threat of dehumanization of personal relationship-here between the physi- cian and the patient-has in many in- stances become a real it^."^ While Knowles insists “that the benefits of modern medicine far outweigh the drawback^,"^ his balanced criticism of the hospital environment suggests that patient care is often one of caring for rather than caring about.

The climate of caring for, which some believe prevails in the hospital environment, is illustrated by what Jourard describes as the bedside man- ner.6 The bedside manner is something some nurses “put on” when they put on their uniform. It becomes a form of character armor behind which nurses hide to protect themselves from get- ting too involved with their patients. Jourard writes:

Doubtless the bedside manner war- rants being regarded as an instance

of character armor. . . . It is ac- quired as a means of coping with the anxieties engendered by re- peated encounters with suffering, demanding patients. If the “armor” is effective, it permits the nurse to go about her duties unaffected by any disturbing feelings of pity, anger, inadequacy, or insecurity. . . . Hence, one nurse might habitually crack jokes, another might look and act hurried, and still another might mother all her pa- tients on the premise that all pa- tients are babies.7 The bedside manner is a learned

way of caring for patients that “seeks to obliterate or to deny individuality in patients; it unconsciously attempts to enforce a certain uniformity in pa- tients’ personalities, the kind of uni- formity with which the nurse feels most competent to cope.”8

A poem by Ruth Johnston voices the concerns of the patient experiencing herself or himself as a victim of the bedside manner. The poem, “Listen, Nurse,” (quoted in part) presents the patient’s plea that the nurse see and hear, view and treat her or him as a person.

I was lonely and afraid, but you left me alone because I was so cooperative and never asked for anything.

I was a nursing problem and you discussed the theoretical basis of my illness, and you do not even see me. . . .

You seem so well educated, well spoken and so very neat in your spotless, unwrinkled uniform.

But when I speak you seem to listen but do not hear me.

Help me, care about what happens to me, I am so tired, so lonely and so very afraid.

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uring your tour D of duty, you cease to be human.

Talk to me-reach out to me-take my hand. Let what happens to me matter to you. Please, nurse, 1isten.O Persons perceive and behave toward

other persons in a particular way be- cause they have learned to experience themselves and others in a particular way. Nurses are not out to brutalize their patients. The degree to which they function as whole persons re- flects, in part, the extent to which the hospital setting and fellow staff mem- bers invite them to be persons in their own right. The term nurse, according to Travelbee, “is as much a label as is the term patient and nurses are de- humanized in the same way that pa- tients are. . . . The human being who is nurse reacts to dehumanization as does any human being.”1°

Travelbee suggests that educational programs for nurses and the hospital environment in general may convey to the nurse the message: You are a pro- fessional nurse and it is your job to meet the needs of others but not your own. During your eight-hour tour of duty, you must cease to be human or simply a person. The good nurse is one who concentrates on meeting the needs of others while denying her or his own.

As a result of this invitation to func- tion as less than whole persons, nurses may acquire a facade of professional

aloofness. They may hide their per- sonhood and learn to perform as eff% cient machines. They may become alienated from themselves and jeopar- dize their own health and well-being.”

Like others in the helping pro- fessions, nurses may have received their education in programs emphasiz- ing subject matter but indifferent to preparing nurses for the human re- alities they will personally confront day after day on the hospital ward. Those receiving their education in such programs feel ill-prepared and inadequate when confronted by the re- ality of the whole-person-as-patient.

The humanistic revolution will fail if the humanization process does not begin with an honest concern for the personhood of both the nurse and the patient. Failing to be equally con- cerned with caring about the growth and well-being of nurses will com- pound the illness rather than provide the cure.

Numerous hospitals around the country are increasingly using groups in which nurses and other staff mem- bers gather to explore, in an accepting atmosphere, their deepest meanings and concerns. In these groups, staff members are free to step out of their stereotype roles. They are free to care about one another, to discover and explore their personal meanings, to be open, to disclose, to meet simply as persons.

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Education programs need to keep in focus understanding the nurse as a whole person. In addition to develop- ing the competencies and skills of the learners, the program should convey concern for the fullest development and growth of the nurse as a person. The qualities of caring seen as an ex- pression of humanistic patient care must become the qualities of the cli- mate in which nurses receive their education. Any program claiming to be concerned with humanizing nursing practice and failing to provide a humanistic climate within the pro- gram itself is dishonest.

Nurses and persons in all the help- ing professions must demand that both educational programs and the envi- ronments in which they practice their profession seek to maximize the health and well-being of all involved. Nurses need to be evaluated in terms of both their competencies and skills and their perceptual capacities to relate to others in healthy ways, to perceive others as persons, to care about rather than care for. Such evaluations, how- ever, would be a dehumanizing viola- tion of nurses’ rights if substantial efforts were not made to provide the kind of education and hospital settings that reward and evoke such qualities.

An effort to create a climate of car- ing about in our hospitals will encour- age another important aspect of the humanistic revolution-an increased opportunity for genuine dialogue be- tween patient and nurse.

Nurses who seek to create human- to-human relationships do not retreat before the patient who desires to explore with another person the possi- ble meaning of his or her suffering. The nurse who cares about accepts such a dialogue as a learning experi- ence and as an enrichment and exten- sion of her own understanding of life and the human experience.

Finally, nursing education and pa-

t ient care should emphasize tha t which makes us human-our beliefs, values, meanings, perceptions. The principles of perceptual psychology can be used to design and implement edu- cational programs seeking to conform the personhood of students and to maximize their ability to provide person-centered patient care. Humanizing the education and func- tioning of nurses calls for a radical review of nursing education-one that concerns itself with the internal and external aspects of human experi- ences, with behavior and perception, with competence and the discovery of personal meaning.

Students who learn in such pro- grams prove to be professionally com- petent because they have discovered the personal meaning of the knowl- edge they acquired; they have learned to understand themselves and others as whole persons, coming to see them- selves as more rather than less adequate; they have felt the liberating experience of growing toward being the best they can possibly become; they have become the kinds of helpers and healers most capable of under- standing and furthering what I believe we all desire-a humanistic revolu-

0 tion.

Notes 1. Fred Richards, “Introduction to Caring For/

Caring About,” unpublished manuscript, 1975. 2. EWsabeth Kubier-Ross, On Death and Dying

Macmillan Paperbacks ed. (New York: Macmillan Publishing Co, Inc, 1970) 9.

3. John L Knowles, “The hospital,” Scientific American 229 (September 1973) 132.

4. Ibid, 128. 5. Ibid, 132. 6. Sidney M Jourard, The Transparent Self, rev

ed. (New York: Van Nostrand Reinhoid, 1971). 7. /bid, 180-181. 8. Ibid, 182. 9. Ruth Johnston, “Listen nurse,” American

Journel of Nursing (February 1971) 303. 1 0. Joyce Travelbee, Interpersonal Aspects of

Nursing, 2nd ed. (Philadelphia: F A Davis Co, 1971) 43.

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Research on brain, nervous system Research on the role of the brain and nervous system in learning and memory is likely to lead to improvements in education, according to a report from the National Institute of Education (NIE) of the US Department of Health, Education, and Welfare.

The report predicts such results as improved methods of teaching to foster more rapid learning and more effective memory, more efficient retrieval of information from memory, improved treatment of learning disabilities and impaired memory due either to retardation or resulting from injuries or diseases, prevention of learning disabilities and memory impairment through better understanding of their causes, and decreasing the effects of aging on memory.

The report “Neural mechanisms of learning and memory” summarizes views of scientists who met to discuss current knowledge about how the brain functions.

Discussions revealed that the brain is a much more changeable organ than was previously thought. Its basic unit, the neuron, rather than being fixed, is a dynamic structure that can undergo anatomical, biochemical, and biophysical changes in response to various experiences throughout life. Animals raised in cages that provide for varied activities, rather than in impoverished environments, are better learners, show increased weight and thickness of brain structures, and have larger amounts of enzymes that are involved in brain activity.

One hypothesis advanced was that memory may be greatly influenced by hormones released during emotional states such as anxiety, fear, hunger, and pleasure.

The scientists reported no evidence that man can learn in his sleep, but the stage of sleep characterized by rapid eye movements may help him retain what was learned during waking hours.

published by the MIT Press early next year. A complete conference report will be

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