Covenantal Care: Nursing with God's Love and Justice.

ABSTRACT: With resources stretched thin and the growing risk of compassion fatigue, faith beliefs can offer enriching perspectives for nurses. Covenantal care is a nursing approach rooted in theological insights about humanity's inherent purpose to engage in relationship with God and actively participate in acts of love and justice. Based upon interpretations of Judeo-Christian teachings of imago Dei and God's covenant with humankind, this approach provides guidance for the nurse to care for self, patients, and the wider community. This exploration of theology-in-practice provides an orientating ethos for nurses that reflects the loving, restorative, and dignified care that is at the heart of the Christian faith.

Reframing covenant for nursing: From individual commitments to covenant with society.

Today's constrained healthcare environment can make it very difficult for nurses to provide compassionate, competent, and ethical care, and yet their continued commitment to care is viewed as requisite. Nurses' commitment to care of patients, enmeshed with professional identity, may be understood as heroic. A few nursing scholars have advanced the concept of a nurse-patient covenant to explain or inspire nurses' commitment to care. Covenant describes an enduring relationship characterised by mutual promises and generous responsiveness. However, recent critique has revealed a general misunderstanding and misuse of the term covenant in much of the nursing literature whereby individual nurses are improperly and impossibly idealised as holding sole responsibility in the commitment to care. Such an interpretation obscures society's responsibilities in caring for both patients and nurses and contributes to the idealisation of nurses' commitment to extend themselves to fill in healthcare system gaps. Yet, the concept of a covenant relationship, when reframed as occurring between society and the profession of nursing, may lead us toward solutions to the very problems the originally misused concept sustained. Evidence within healthcare systems globally suggests that nurses' commitments are fragile or fragmented under duress due to increasing pressure, demands, and even risks. A reframing of covenant has the common good for society and nursing at its core and, we argue, may lead to a more sustainable nursing identity. We present the results of an exploratory project, undertaken to examine the utility and suitability of covenant as a relational framework for nursing. We explore a reframing of a covenant of care as a relationship between nursing and society, which may provide a fruitful path toward a sustainable, shared commitment for healthcare. This covenant of care re-centres shared work-a joint responsibility between society and nursing-as necessary for the common good.

How Grounded Are Our Ideals? Rethinking Nursing's Covenant of Care.

ABSTRACT: Covenant has been used to describe the special relationship between nurses and patients yet has been misunderstood in nursing literature. Covenantal elements of keeping promises and nurturing relationship resonate with the work of nursing. However, unlimited devotion puts the nurse at risk for exploitation and burnout. One's conceptualization of covenant is important because it impacts beliefs about allegiance, identity, and responsibilities. This article offers a critical analysis of how the conceptualization of covenant in nursing literature compares to a theological understanding of covenant. The covenantal dimension of a nurse's practice is reframed from the nurse-patient relationship to a professional-societal relationship.

'The Elephant on the Table': Religious and Ethnic Diversity in Home Health Services.

Healthcare services are increasingly being provided in the home. At the same time, these home contexts are changing as global migration has brought unprecedented diversity both in the recipients of care, and home health workers. In this paper, we present findings of a Canadian study that examined the negotiation of religious and ethnic plurality in home health. Qualitative analysis of the data from interviews and observations with 46 participants-clients, administrators, home healthcare workers-revealed how religion is expressed and 'managed' in home health services.

Returning home: historical influences on home healthcare in Canada.

In this article, the historical context of home healthcare in early 20th century Canada is examined with an emphasis on key events and groups that shaped nursing in the home as the primary form of healthcare. Ways in which home healthcare evolved are also addressed, including the movement from an emphasis on the home as the point of care for both preventative and curative services, to the separation of healthcare functions into public health, treatment of illness and injury, and pregnancy care-each with its own practitioners and regulators as hospital-based systems became the desirable norm. We conclude that the nature and status of home-based nursing evolved in response to public expectations of what comprised "best care" and who was responsible for providing (and funding) it. At a certain level, the home offered independent-minded nurses a level of autonomy and inscrutability unparalleled in hospital-based settings. As hospitals took preeminence as preferred sites for healthcare, the same geographic, cultural, and economic barriers that complicated access to hospitals also provided nurses unique opportunities in the home as relatively autonomous caregivers.