Katie Erikson's caring theories. Part 2. The theory of caritative caring ethics and the theory of evidence.

In this article, Katie Eriksson's theory of caritative caring ethics and the theory of evidence, are described. Both theories are anchored in caritas, that is love, mercy and compassion. The theory of caritative caring ethics was first described by Eriksson in 1995, where seven assumptions or basic categories were elaborated. These were: the human being's dignity, the care relationship, invitation, responsibility, virtue, obligation or duty, and good and evil. Eriksson's theoretical contribution is that she makes a distinction between caring and nursing ethics, between inner and external ethics, and between natural and clinical ethics. Concerning the theory of evidence, Eriksson claims that a multidimensional scientific view of evidence in caring that focuses on the patient's world is necessary and vital. To see, realise, know, attest and revise constitute the ontological definitions of the concepts of evidence and evident. The theories are united by the core concepts of testimony and witnessing the human being's suffering. Eriksson points out that it is in the ethical acts that deeds are formed, based on ethos. The anchorage in an ethos means to have firm value-loaded judgements of an inner motive. Moreover, the anchorage in ethos presupposes a personal and natural ethic. The good deeds are realised in the relationship between the patient and the carer, but the caring ethics is not a professional or external ethics. Caring ethics is an ontological inner ethics meaning fellowship and the right to exist, but it is the patient's world and reality that decides the foundation and starting point for caritative caring ethics in clinical practice. The ultimate purpose and goal of caring are to guarantee the patient's dignity and absolute value as a human being.

Katie Eriksson's caring theories. Part 1. The caritative caring theory, the multidimensional health theory and the theory of human suffering.

In this article, Katie Eriksson's caring theories including the caritative caring theory, the multidimensional health theory and the theory of human suffering are described. The assumptions and concepts, both etymologically and semantically investigated, are founded in ontology. Caring is a human natural phenomenon and patient means the suffering human being. In the caritative caring theory, the substance and core of caring is described as 'to care is to tend, play and learn in faith, hope and love'. The starting point is love, mercy, human kindness, compassion and a caring relationship. Caring is healing and sharing-a will to care, which is founded in faith and life energy. Caring promotes humanity and people's health, and thus a feeling of wholeness, integration, growth and inner freedom. The goal is to promote and protect health and life and alleviate suffering. Health means wholeness and holiness. Eriksson emphasises an ontological aspect of health, where the human being is seen as an inseparable being comprising a body, soul and spirit. To be healthy is to be whole and to feel whole, where wholeness means life itself. In the multidimensional perspective, the essence of health is vitality. Vitality is the innermost dimension of health; it is a force to energy in life, to joy and desire. Health is a dynamic movement between dimensions of becoming, being and doing. Eriksson seeks answers to the 'what' of suffering through concept analysis, but she also discusses the 'why' question. Each suffering is unique. There is a connection between suffering and desire, where suffering gives birth to an unsuspected life power that is not seen as having any other source than suffering itself. Desire and suffering make up the driving power for a person's being and formation into the person she is intended to become.

The caring encounter in nursing.

BACKGROUND:: The concept 'encounter' occurs in caring literature as a synonym for dialogue and relation describing deeper levels of interaction between patient and nurse. In nursing and caring research, the concept 'caring encounter' is often used without further reflection on the meaning of the concept. Encounters are, however, continuously taking place in the world of caring, which calls for a clarification of the concept. OBJECTIVES:: This study is an analysis of the concept of caring encounter in nursing from the patients' and nurses' point of view. METHOD:: Rodgers' evolutionary view guided the concept analysis within the theoretical perspective of caritative caring. DATA SOURCES:: Peer-reviewed articles in English published between 1990 and 2014 were retrieved from the databases: CINAHL, PubMed, Web of Science, ScienceDirect (Elsevier), Springer Link, Primo Central (Ex Libris) and Academic Search Premier (EBSCO) using different combinations of encounter, caring and nursing as keywords. In all, 28 articles related to caring encounters were included in the analysis after applying inclusion and exclusion criteria. ETHICAL CONSIDERATIONS:: This study was conducted according to good scientific practice. RESULTS:: Four antecedents to the caring encounter are found in the nurse's way of being: a reflective way of being; openness, sensitivity, empathy and ability to communicate; confidence, courage and professionalism; and showing respect and supporting dignity. The attributes are as follows: being there, uniqueness and mutuality. As a consequence, the caring encounter influences both patient and nurse. DISCUSSION AND CONCLUSION:: The caring encounter is an encounter between two equal persons where one is nurse and the other is patient. They encounter in mutuality, in true presence, and both have allowed themselves to be the person they are. The results clarify the conceptual differences between relationship and caring communion as the mutuality in the caring encounter differs from the dependence on the other pronounced in the relationship.

Ethos: The heart of ethics and health.

BACKGROUND:: Ethics in nursing care are traditionally discussed in terms of moral norms or principles. When taking an ontological approach to ethics, ethics is about ethos. Ethos involves both an internal and an external side of ethics. Considering ethics and health from an ontological perspective can provide a different understanding of ethics and health in caring and nursing. AIM AND RESEARCH QUESTION:: The aim of this study is to deepen the ontological understanding of ethics and health in caring and nursing. The research question is as follows: What is the ontology of health and ethics in caring and nursing? RESEARCH DESIGN:: The study follows a hermeneutical design inspired by Gadamer. Participants and research context: essays about ethics and health were gathered from PhD students in nursing and caring sciences. ETHICAL CONSIDERATIONS:: The research follows Responsible conduct of research guidelines provided by the Finnish Advisory Board on Research Integrity. FINDINGS:: An ethos with the values of freedom and responsibility seem to ontologically be important for ethics and health. These values allow a movement between the internal and the external sides of ethics that is important for health. DISCUSSION:: The ethos of freedom and responsibility that is essential for ethics and health can provide the current ethical debate a new starting point that previous research asks for. CONCLUSION:: Ontologically, an ethos of freedom and responsibility is essential for ethics and health in nursing and caring.

Application in the World of Understanding: Researchers' Experiences of Participation in Reflective Dialogues.

The aim of this study was to describe researchers' experiences of participation in reflective dialogues through a hermeneutic application research approach. The aim was also to describe their perspectives on application, that is, the inner appropriation and application of theory into practice and vice versa. Twenty-one clinical coresearchers and four scientific researchers participated in reflective dialogues in a project on ethical sustainable caring cultures, in which an application research approach was used. The study included questionnaires, a focus group interview, and conversations. The findings show that participation in the reflective dialogues required that the participants are present, open for dialogue, share a common interest in the thematics of the dialogue, and are given space to express themselves. The participants described their experiences of the dual meaning underlying application. Application research strengthened the relationship between research and clinical practice and it contributed to the development of theory.

Toward Understanding Through Hermeneutic Letterwriting.

The authors present letterwriting as a hermeneutic research method in that it contributes to the methodological development within the hermeneutical research tradition in caring science. The hermeneutic methodology is inspired by Hans-Georg Gadamer. Hermeneutic letterwriting in accordance with Gadamer's thought is a form of dialogue in writing, where what is truthful about the thing itself is unveiled with the help of the language. Hermeneutic letterwriting is presented in five steps. As a method, hermeneutic letterwriting is appropriate for complex caring science issues, and it offers new opportunities for attaining a deeper understanding of the world of caring.

Sustainability in care through an ethical practice model.

BACKGROUND: While sustainability is a key concept in many different domains today, it has not yet been sufficiently emphasized in the healthcare sector. Earlier research shows that ethical values and evidence-based care models create sustainability in care practice. OBJECTIVE: The aim of this study was to gain further understanding of the ethical values central to the realization of sustainability in care and to create an ethical practice model whereby these basic values can be made perceptible and active in care practice. RESEARCH DESIGN: Part of the ongoing "Ethical Sustainable Caring Cultures" research project, a hermeneutical application research design was employed in this study. PARTICIPANTS: Dialogues were used, where scientific researchers and co-researchers were given the opportunity to reflect on ethical values in relation to sustainability in care. FINDINGS: An ethical practice model with ethos as its core was created from the results of the dialogues. In the model, ethos is encircled by the ethical values central to sustainability: dignity, responsibility, respect, invitation, and vows. DISCUSSION: The model can be used as a starting point for ethical conversations that support carers' reflections on the ethical issues seen in day-to-day care work and the work community, allowing ethical values to become visible throughout the entire care culture. CONCLUSION: It is intended as a tool whereby carers can more deeply understand an organization's common basic values and what they entail in regard to sustainability in care.

Young Finnish Unemployed Men's Experiences of Having Participated in a Specific Active Labor Market Program.

The purpose of the present study was to describe young Finnish unemployed men's experiences of having participated in a specific active labor market program, intended to fight unemployment and offered at a resource center. Fifteen young unemployed Finnish men in the age range 18 to 27 years were interviewed face-to-face. Purposive sampling was used to increase the variation among informants. The interview texts were analyzed using both manifest and latent qualitative content analysis. The present results reported that the young men felt that they, thanks to the program at the resource center, had acquired daily routines and could ultimately believe in the future. The young men described how they now had a structure, economic support, and that they could return to their daily life. The informants also described how they could see new possibilities and believe in oneself. There is a lack of empirical studies assessing the possible impact of active labor market programs on the unemployed based on participants' own experiences. Further research is needed to describe and elucidate in more detail the effects of targeted support measures and the needs of unemployed men of different ages and living in different contexts.

Older persons' experiences of what influences their vitality - a study of 65- and 75-year-olds in Finland and Sweden.

Throughout the world, life expectancy has noticeably increased during the past decade, and health promotive initiatives for older persons will therefore become ever more important. During the past few years, interest in what constitutes the source of health for human beings has markedly increased in health science research. An interesting and relatively unresearched domain is what provides older persons the strength and energy to look forward and what positively or negatively influences older persons' vitality. The aim of the study was to explore and describe older persons' vitality and their subjective experiences of what influences their vitality, despite disease and suffering. The study has an explorative and descriptive design. A comprehensive questionnaire including two open-ended questions about vitality was sent to 4927 older persons aged 65 and 75, and a total of 2579 responded to the open-ended questions. Qualitative content analyses were used. A safe and confirming communion, meaningful activities, an optimal state of health and an inner strength were important sources of vitality. Ageing that includes illness or a restricted life, happenings in the world and in one's close environment that threaten inner meaningfulness, and mental burdens that give rise to a feeling of hopelessness or depression decrease vitality. Vitality is an important health resource for 65- and 75-year-olds in that it influences a person's longing for life, love and meaning. Accordingly, it is of fundamental importance that Registered Nurses and other healthcare personnel strengthen older persons' vitality during the ageing process. By taking into consideration that which positively vs. negatively affects the vitality of each unique person, healthcare personnel can strengthen each older person's health resources and attempt to minimise and limit what negatively influences said person's vitality.

Hermeneutic application research - finding a common understanding and consensus on care and caring.

To clinically and contextually implement the theoretical and factual knowledge of care and caring that has been developed in the last 30 years is seen as a great challenge in caring science research. Emphasis has been put on problem-solving research methodologies and action research in hopes of narrowing the divide between caring theory and clinical practice. Thus, the intention is now to further action research towards a hermeneutic approach and to put emphasis on hermeneutic application where theory and praxis become one through human dialogue. This article highlights hermeneutic application research as an alternative methodology within participatory-oriented research which presents a new opportunity to unite clinical practice and caring theory. The aim is to contribute to the development of the hermeneutical application research design in its epistemological, ontological and ethical perspective, by articulating and clarifying the central foundations in the application. On the basis of Gadamer's hermeneutical thinking and Levinas ethical thinking, the central foundations in the application research are ethics, creation of a hermeneutical room, dialogue and common understanding and appropriation and action. When theoretical understanding turns into praxis, knowledge also becomes activity and theory and practice become one. Application thus realises the basic idea that praxis and theory are one, and thus, theory of caring can only become evident and implemented in a clinical practice through moments when the participants find a common understanding and consensus on the knowledge of care and caring.

Unemployment and health: experiences narrated by young Finnish men.

Studies have shown that the experiences and consequences of unemployment can affect people differently depending on, for example, age and gender. The purpose of the present study was to describe young Finnish men's experiences of being unemployed as well as how their experiences of health emerged. Fifteen young unemployed Finnish men in the age range 18 to 27 years were interviewed face to face. Purposive sampling was used to increase the variation among informants. The interview texts were analyzed using both manifest and latent qualitative content analysis. The present results showed that the young men were strongly negatively affected by being unemployed. They described how they had slowly lost their foothold. They also described feelings of shame and guilt as well as a flight from reality. The present results show that even young men who have only experienced shorter periods of unemployment, in this study periods between 2 and 6 months, are negatively affected, for example, with regard to their identity and emotional life. Further research is needed to describe and elucidate in more detail the effects of unemployment on men of different ages and living in different contexts.

The space of togetherness--a caring encounter.

Encounters in relation to the nurse-patient relationship are often discussed within nursing and caring literature without a reflection on the actual meaning of the concept. Assuming that an encounter is essential for nursing care, this article seeks to create a deeper understanding of the concept through a hermeneutic approach to texts by the philosophers Buber and Marcel. Presence, recognition, availability and mutuality seem to be essential prerequisites for an encounter. As these prerequisites are fulfilled within and between human beings who encounter each other, it is possible to speak of a space of togetherness, a mutual existence, where life's mystery shines forth and caring is realized. The challenge lies in creating these encounters within nursing care.