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.

The home as ethos of caring: A concept determination.

BACKGROUND:: Within nursing, the concepts of home and homelike have been used indiscriminately to describe characteristics of healthcare settings that resemble a home more than an institution. OBJECTIVES:: The aim of this study was to investigate the concept of home ( hem in Swedish). The main questions were as follows: What does the concept of home entail etymologically and semantically? Of what significance is the meaning of the concept to caring science and nursing? DESIGN AND METHODS:: This study had a qualitative design with a hermeneutical approach guided by Gadamer. Eriksson's model of concept determination was partly used to determine the etymology and semantics, the essence and epistemic category of the concept of home. In this study, etymological dictionaries and 17 Swedish language dictionaries published between 1850 and 2001 were investigated. ETHICAL CONSIDERATION:: In all parts of this study, ethical guidelines have been followed concerning both gathering data from dictionaries and other sources and during the interpretation of these sources. FINDINGS:: The home, framed as the ethos of caring, can be drawn as a three-dimensional picture where the three dimensions have a common core, enclosed and inviolable. Symbolically, the picture of home can be seen as the ethos of the human being's innermost room, the human being's manner of being and the tone expressed in the external or abstract room where the human being lives and interacts with others. CONCLUSION:: Based on the findings in this study, we conclude that home as ethos is an inner ethical dimension within the human being. Human beings who are in contact with their ethos, the self, feel at home and dare to follow the voice of their heart. Nurses who experience at-homeness have an ability to invite the patient into a caring relationship. The home and the feeling of being at home have significant meaning in terms of human beings' health and well-being.

Discovering the ethos of serving in nursing leadership from the first half of the 20th century in three Nordic countries - an idea-historical research approach.

The history of ideas may contribute to an awareness and an opening up of deep-seated currents of thought that have shaped the inner core of the caring culture and an ethical value base - the ethos of serving in nursing leadership. This article studies how serving as an ethos is represented, which becomes visible and evident in Sophie Mannerheim's, Bertha Wellin's and Bergljot Larsson's nursing leadership. This article also seeks to describe the main features of the idea-historical research approach the way in which it is represented within the caring science-tradition. An idea-historical methodological approach informed by Gadamer's philosophy was used for the hermeneutical interpretation within a caring science perspective. Primary and secondary historical sources were explored in the light of nursing praxis and serving. Three general idea patterns were discovered: the innermost room of the heart as the idea of serving, the action of the hand as acts of love and a cultivation of the head towards nursing leadership. These ideas open for a new vision that can bring out new patterns for action in the present and in the nursing leadership of the future.

Love and Responsibility: A New Understanding of Leadership.

The purpose of the study is to investigate the importance of substance for the disclosure of ontological evidence. The methodology is inspired by Gadamer's hermeneutic philosophy and involves clinical application research using a deductive approach. This means that leaders in a clinical context were taught and participated in a discussion about a theoretical model of leadership with caring science and ontological substance. The result shows that the leaders' attention and focus were primarily directed toward administration, finances, and outer structures. Caring science and ontological substance contributed toward disclosing ontological evidence, and leadership emerged as caring, love, inner responsibility, guilt, and vulnerability. In this study, substance has been combined with teaching and group discussion as a methodical approach. Substance is the guiding issue and has been shown to lead to truth. The method is in a true sense nothing without substance.

Nurse leaders as managers of ethically sustainable caring cultures.

AIMS: The aim of this study was to identify the distinctive foundations of the care culture and how nurse leaders (NL) can manage and strengthen these in a quest for ethically sustainable caring cultures. BACKGROUND: Sustainability presupposes an ethical leadership, a management of the good care and a well-educated staff, but research on NLs as managers of ethically sustainable caring cultures is not available. DESIGN: The study has a quantitative design with elements of a qualitative research approach. METHOD: Data were collected through a web-based questionnaire sent to staff at eight selected units at a hospital in western Finland during September 2013; the reply rate was 32%. The data material was comprised of opinion questions, the ranking of values and two open-ended questions on lodestars in care and ethical principles in care work. RESULTS: NLs manage a care culture that rests on a solid foundation, where staff are co-creators of an ethically sustainable caring culture that includes good traditions for the praxis of care. NLs as managers are therefore responsible for realizing and passing on ethically sustainable caring cultures and creating prerequisites for staff's growth and development. CONCLUSION: The basis of good care, patient safety and sustainability is comprised of ethics with a respectful and dignified care that is evidence-based and economically stable. Through their management NLs have a responsibility to nurture and protect the core of caring and create contextual, professional and cultural prerequisites to maintain the core and art of caring as well as care staff's ethical and professional competence.

Experience of Events of Truth in Hermeneutic Conversation With Text: Ethics and Ontology.

The purpose of this article is to explore what the experience of events of truth can entail in hermeneutic dialogue with text as well as the significance this can have for hermeneutic methodology in caring science. Experience of events of truth is discussed based on Hans-Georg Gadamer's ontological perspective and on Emmanuel Levinas's ethical perspective. A veritable experience of an event of truth is a testimony to the responsibility we take for the Other and to our humanity. Experience of events of truth requires that there is a connection of esteem between ethics and ontology in the reader's understanding of what Hans-Georg Gadamer calls the subject matter (Sache). The experience of events of truth has methodological significance for caring science in that it can contribute to the disclosure of ontological evidence and inform caregiving and caring science.

Ask me what is in my heart of hearts! The core question of care in relation to parents who are patients in a psychiatric care context.

The aim is to understand the experience of being cared for in psychiatric care as a patient and as a parent. Parenthood represents the natural form of human caring, a human directedness regardless of gender. The study has its starting point in this image, as it applies to mothers who receive care as provided in a psychiatric care context. The theoretical perspective is the theory of caritative caring, and the methodological approach is the philosophical hermeneutics outlined by Gadamer. The sample was purposeful: 10 mothers who experienced being a mother while suffering from mental illness and receiving care from professionals in psychiatric specialist health care contexts. The interpretation process is inductive, deductive, and abductive, and includes different levels of rational, contextual, existential, and ontological interpretation supported by the chosen theoretical perspective and the philosophy of ethics outlined by Emmanuel Levinas. The interpretation on the contextual level shows that the patients do not talk about their inner feelings concerning themselves as mothers in the care relationship. The interpretation on the existential level reveals the meaning of the mothers' experiences of inner struggle between their inner demands and assuming a mask of silence. The patients' experiences on the ontological level were interpreted as a struggle between the responsibility inherent in human being and the fear of condemnation. At the ontological level, a new hypothesis of the understanding of the meaning of the parents' experiences was formulated: Being in care as a patient and as a parent means struggling to restore one's responsibility as a human being. This new understanding paves the way for caring of the patient who is a parent.

Evidence of clinical competence by simulation, a hermeneutical observational study.

Making the transition from theory to practise easier in nursing education through simulation is widely implemented all over the world, and there is research evidence of the positive effects of simulation. The pre-understanding for this study is based on a definition of clinical competence as encountering, knowing, performing, maturing and developing, and the hypothesis is that these categories should appear in simulated situations. The aim of the study was to explore the forms and expressions of clinical competence in simulated situations and furthermore to explore if and how clinical competence could be developed by simulation. An observational hermeneutic study with a hypothetic-deductive approach was used in 18 simulated situations with 39 bachelor degree nursing students. In the situations, the scenarios, the actors and the plots were described. The story told was "the way from suffering to health" in which three main plots emerged. The first was, doing as performing and knowing, which took the shape of knowing what to do, acting responsibly, using evidence and equipment, appearing confident and feeling comfortable, and sharing work and information with others. The second was, being as encountering the patient, which took the shape of being there for him/her and confirming by listening and answering. The third plot was becoming as maturing and developing which took the shape of learning in co-operation with other students. All the deductive categories, shapes and expressions appeared as dialectic patterns having their negative counterparts. The study showed that clinical competence can be made evident and developed by simulation and that the challenge is in encountering the patient and his/her suffering.

Evaluating clinical competence during nursing education: A comprehensive integrative literature review.

This paper explored concepts, definitions and theoretical perspectives evaluating clinical competence during nursing education. The questions were: (i) How is clinical competence evaluated? and (ii) What is evaluated? An integrative review of 19 original research articles from 2009 to 2013 was performed. Results showed that evaluation tools were used in 14, observations in 2 and reflecting writing in 3 studies. The students participated in all but one evaluation alone or together with peers, faculty members or preceptors. Three themes were found: (i) professional practice with a caring perspective; (ii) clinical skills and reflective practice; and (iii) cognitive, affective and psychomotor skills both with a nursing perspective. This review shows an emphasis on structured methods with a risk reducing nursing to tasks and skills why combinations with qualitative evaluations are recommended. A holistic view of competence dominated and in designing evaluations, explicit perspectives and operationalized definitions of clinical competence became evident.

Technology and its ethics in nursing and caring journals: An integrative literature review.

BACKGROUND: Over the past 20 years, the impact of technology has increased significantly in health care. The diversity of technology is growing and its knowledge scattered. The concept of technology is ambiguous in caring and nursing sciences and its ethics remains unidentified. AIM: To find evidence on how the concept of technology and its ethics are defined in caring and nursing sciences and practice. The purpose of this study is to describe and summarize the concept of technology and its ethics in the past nursing and caring literature. METHOD: The integrative literature review of the past nursing and caring literature. The data were collected from caring and nursing journal articles from 2000 to 2013 focusing on technology and its ethics.The results were summarized and themed. RESULTS: Technology as a concept has three implications. First, technology is devices and products, including ICT and advanced, simple and assistive technology. Second, technology refers to a process consisting of methods for helping people. Third, technology as a service indicates the production of care by technology. The ethics of technology has not been established as a guiding principle. Some studies excluded ethical reflection completely. Many studies discussed the ethics of technology as benefits such as improved communication and symptoms management, and the simple use of e-health services whilst others remained critical presenting ethical problems such as unwillingness and the inability to use technology, or conflicts with human aspects or questions of inequality. CONCLUSION: In conclusion, this study indicates that technology as a concept is described diversely. The relation between technology and ethics is not a truism. Despite some evidence, more is needed to promote ethical care when using technology.

Understanding and becoming - the heart of the matter in nurse education.

The aim of this study was to deepen the understanding of student nurses' processes of understanding and becoming nurses. The study is phenomenological-hermeneutic in design, comprising data from three focus group interviews in two Scandinavian countries. The process of student nurses' understanding and becoming a nurse emerged as a hermeneutical movement. A caring student-preceptor relationship and a growth-promoting preception in a supportive and inclusive environment provide the frame within which the movement happens. The movement towards understanding and becoming is initiated as students, based on their level of knowledge, are given responsibility. In order to fulfil the responsibility imposed on them, students take their entire repertoire of knowledge into consideration. By tying these threads together, they found the basis for conscious action, and care is provided according to what the current situation requires. The experiences obtained are reflected on and integrated with earlier knowledge, which leads to enhanced understanding. Students form a new base to stand on. They show increased readiness for still more responsibility and action. This movement towards deeper understanding and becoming affects the students also ethically and deepens their ethical awareness. When one loop of understanding and becoming is closed the process continues by passing into a new loop. This movement could be described as a hermeneutical spiral consisting of interconnected loops taking the students further and deeper in their process of understanding and becoming a nurse. The student-preceptor relationship and the ethos permeating it are decisive for students' learning both epistemologically and ontologically. Responsibility is the catalyst in students' understanding and becoming both intellectually and ethically. Understanding and becoming are ongoing processes of appropriation, thus altering students both professionally and personally. Understanding and becoming can be perceived as the hearth of the matter in nurse education.

The core of love when caring for patients suffering from addiction.

Drug addiction is a serious health problem. The aim of this study was to gain an understanding of the core of love when caring for patients suffering from addiction. The study had a hermeneutical approach. Four nurses working at a detoxification unit were interviewed. Data were interpreted using a hermeneutical text interpretation based on Gadamer's hermeneutics. The results revealed the core of love in four dimensions: love as an inner driving force, searching for the human being behind the addiction, faith in the inner power of human beings and love as a movement of giving and receiving. The hermeneutical interpretation revealed the core of love as sacrifice, showing that sacrifice is an ethical dimension and that sacrifice involves searching for the patient's ontological suffering. Sacrifice is connected to faith, and faith in love is decisive for a life without drugs. Sacrifice involves being mutual gifts to one another, a self-reinforcing motion of sacrifice that energizes the nurses to go on with their work.

Through the depths and heights of darkness; mothers as patients in psychiatric care.

INTRODUCTION: This study attempts to contribute to the knowledge of caring science and mental health care by means of a profound understanding of the patients' existential world when being a mother in receipt of psychiatric care, with focus on inner processes such as health and suffering. Mothers struggle to cope with the demands of the illness and the responsibility for their children. They see themselves through their children and regard the child as an important part of themselves. Mothers experience guilt and shame related to motherhood, and when they have to relinquish their responsibility as a mother, they consider themselves a failure. Despite a range of practical and emotional difficulties, motherhood involved extremely positive experiences, which provide a purpose as well as fulfilment and meaning in life. METHODOLOGY: This study is rooted in philosophical hermeneutics inspired by Gadamer with an inductive-deductive-abductive approach. Interpretation of the data was made on different levels of abstraction described as rational, contextual, existential and ontological. The point of departure was the caring science theory about health and suffering and the hermeneutic philosophy of understanding. RESULT OF THE INTERPRETATION: The interpretation revealed the mothers' experiences of health and suffering as a struggle between the darkness of suffering and their inner source of strength. In the light of the theory of caring, the conscience became visible as the bearer of the human being's inner ethos of love and compassion. Experiences of health and suffering were interpreted as a struggle between guilt and responsibility, where conscience emerged as the road from ontological guilt to responsibility that leads the human being to what is true, beautiful and good in life.

Determination of concept technology - the ontology of the concept as a component of the knowledge development in caring science.

The purpose of this study is to determine the ontology of the concept of technology from the perspective of caring science. The aim is to increase knowledge of the concept in caring science and to answer the research question concerning what the concept of technology is in caring science. In literature, the concept of technology is used diversely referring it to caring technology, nursing technology, wellbeing technology, information technology, telenursing and technology in care named by a specific device or an area of nursing or medicine. The definition of the concept of technology and its ontology has not been determined from the viewpoint of caring science. Eriksson's model of concept determination provides a method to explore the ontology of the concept. This includes an etymological and semantic analysis as well as a determination of essence and basic category of the concept. The results showed that the concept of technology is multidimensional. It has evolved and altered over the centuries. The origin of the concept formulated from the Greek word 'techne', which has wider ontological dimensions. It is universal, it can be taught and it depends on the substance. Subsequently, the concept was introduced an ethical dimension, and it also developed more to the direction of engineering, mechanics and technical know-how. The semantic analysis revealed synonyms of the concept: art, equipment and knowledge. These introduced concepts such as craft, skill, treatment, engineering, science, study method and way. The nuances of the concept framed its nature. On the one hand, it stands out as practical and advanced, but on the other hand, it is difficult and conventional. The knowledge gained in this study will help to understand the phenomenon of technology in caring science.

The caregivers' possibilities of providing ethically good care for older people--a study on caregivers' ethical approach.

In the care of older people, unexpected and unpredictable situations often occur, which sometimes involve challenging ethical decision-making. This study starts off from an ethical perspective with caritative caring as the theoretical framework. The aim of this descriptive study is to describe what possibilities care givers regard themselves to have to provide good care based on ethical values in the daily care of older persons. A total of 105 (95%) care givers answered the questionnaire. The study was conducted in a municipality in the Western part of Finland during the spring of 2007. The result shows that good care based on ethical values cannot always be guaranteed in the care of older person. There are possibilities to provide the older person with individual, dignified and safe care, and to establish a caring communion and closeness in care, but without positioning these results in relation to an ethical discussion, we cannot state that the care is good enough.

Becoming a caring nurse--a Nordic study on students' learning and development in clinical education.

The aim of this study was to elucidate the meaning and deepen the understanding of student learning and development in becoming a nurse. Data were collected from focus group interviews with students from three different universities and analysed using a phenomenological-hermeneutical method. The comprehensive understanding of student learning and development in becoming a nurse resulted in two constituents: the prerequisites for learning and development, and itineraries for learning and development. The prerequisites consisted of a caring relationship as the foundation for learning and development, and will and motivation for learning and development. The itineraries for learning and development involved pushing boundaries through challenges and support, and of a synthesis of theory and praxis through reflection. Caring relationships can be seen as the foundation for student learning and development and as a prerequisite for becoming a nurse. Learning is not merely a skills-acquisition procedure but a transforming experience for students, who feel that their whole existence has been altered. It is time to move beyond examining student learning and development merely from an epistemological perspective and start focussing on the ontological aspect of learning, on the processes of transformation and becoming a nurse.

Assessment of ethical ideals and ethical manners in care of older people.

The aim of this study is to establish structured clusters and well-defined ontological entities (nodes) describing ethical values as both ideal and opportunity for ethical manner as perceived by thecaregiver.In this study, we use Bayesian Belief Networks (BBNs) to analyse ethical values (ethos) and ethical manners in daily work with older people. Material is based on questionnaire data collected by the instrument for the self-assessment of individual ethos in the care of older people(ISAEC) in spring 2007 in a municipality in Western Finland. This study is unique in its kind, both concerning the selected approach and methodological questions. BBNs have not been used significantly in nursing research, nor are there any studies that examine the ethical possibilities with focus on the probable effects upon changing conditions.

Nurse leaders' perceptions of an approaching organizational change.

The aim of the study was to achieve more profound understanding of nurse leaders' perceptions of an approaching organizational change. We used a three-dimensional hermeneutical method of interpretation to analyze text from 17 interviews. The results suggest that nurse leaders were positive toward and actively engaged in continual change to their units, even though they perceived themselves as mere spectators of the change process. The nurse leaders believed that change might benefit patients and patient care, yet their adaptation lacked deeper engagement. The approaching merger affected the nurse leaders' identities on a deeply personal level. They experienced uneasiness and anxiety with regard to being nurse leaders, the future of nursing care, and their mandate as patient advocates. Nurse leaders are in a critical position to influence the success of organizational change, but the organizations covered in this study were not incorporating their knowledge and experiences into the change.

Spirituality and caring in old age and the significance of religion - a hermeneutical study from Norway.

Spirituality is an important part of caring for the whole human being. However, there is lack of consensus about the concept parameter, and there is an ongoing discussion in nursing regarding the relation between religion and spirituality. Spirituality and religion is found to support health and well-being in old age, and this article portrays how older Norwegians understand religion and religious support as part of spirituality and caring. The theoretical framework in this study is Eriksson's caritative caring theory, and the research aim is to broaden the understanding of spirituality from a caring science perspective. The methodology is hermeneutical according to Gadamer. The study is based upon qualitative content analysis of 30 interviews with 17 participants above 74 years, six men and 11 women. The findings portray connectedness with a Higher power, including how Christianity has influenced upon the philosophy of life of the participants, wonders about the end of life/afterlife, and the meaning of religious symbols and rituals. The study also portrays how religious support may foster dignity, especially near the end of life, and experiences and opinions regarding support from nursing personnel. The study concludes that religiousness cannot be separated from spirituality, and that nurses should be able to provide spiritual care to a certain extent. Spiritual care including religious support according to patients' desires may foster health and preserve human dignity.

The substance of love when encountering suffering: an interpretative research synthesis with an abductive approach.

AIM: This study presents the results of an interpretative research synthesis undertaken to explore the essence of love when encountering suffering. The idea of caring as an expression of love and compassion belongs with ideas that have shaped caring for hundreds of years. Love and suffering are the core concepts in caring science and thus demand a basic research approach. METHODS: The synthesis was undertaken by the interpretation of 15 articles focusing on love in different aspects, but within a caring science perspective. The research process was guided by a hermeneutical perspective with an abductive approach. RESULTS: The substance of love, when encountering suffering, reveals itself in three themes: love as a holy power, love as fundamental for being and love as an ethical act, which are to be found, respectively, within three dimensions: love as holiness, love as a communion and love as an art. Love is a holy power and encompasses everything; it is the well of strength that heals. No human can exist without love: this points to the ethical responsibility one has as a neighbour. In the ethical act, love is evident in concrete caring actions. CONCLUSIONS: The core of the substance of love within the three dimensions can be understood as agape. Agape connects and mirrors the dimensions, while at the same time it is clear that agape stems from and moves towards holiness, enabling love to be the ethical foundation when encountering suffering. Through the dimensions of love as communion and love as an art agape intertwine with eros forming caritas enabling the human being to move towards the dimension of holiness, which signifies becoming through suffering.