This paper considers the implications for nursing practice of what the continental philosopher Emmanuel Levinas described as the 'non-intentional'. The place of the non-intentional emerges from a critique of Buber's conception of the 'I-Thou' and the 'I-It' relations, and is revealed to a person in the moments prior to the grasping of conscious understanding. A specific incident that took place between a nurse and a person diagnosed with dementia is described and then used to illustrate an exploration of the 'I-Thou' relation and then the non-intentional. The nurse practitioner's pre-understandings of the term dementia are shown to have hindered the emergence of an 'I-Thou' relation and the possibility of a non-intentional glimpse of the otherness of the other. It is suggested here that the plausible associations that become synonymous with a diagnosis like dementia detract from attentiveness to another 'person'. The more tangible an understanding of another person becomes, the less likely it is that a person can really experience the other as separate to their perception of them. The implications for practitioner education and learning in relation to the non-intentional are considered, in particular the need to reflect on the immediacy of the feelings experienced in a relationship. The non-intentional highlights how 'I', as a nurse practitioner, can exclude the other by imposing an understanding on what is seen and experienced in relation to another person. The 'I' prioritizes intentional understanding and so obscures the importance of the spontaneous response to the tear in the eye of the other, which is the basis for Levinas's conception of the non-intentional. The spontaneity of the non-intentional is what Levinas believed confirmed the separateness and autonomy of the other and consequently should be the basis for a therapeutic nursing relationship with a patient.
"One of the key concerns about the quality of care in care homes is the nature of practice interactions, particularly with residents with dementia; these have long been criticised as lacking in respect and dignity for the person and as task focused (Dening & Milne, 2011). Despite recent investment in developing person-centred and relational models of care, daily practice 'on the ground' remains of mixed quality (Brooker, 2003; Care Quality Commission, 2012; Greenwood, 2007). The role of effective communication with residents with dementia, including appreciation of the person's individual biography, is emerging as a key issue not only in enhancing well being but also in reducing levels of challenging behaviour (Milne, 2010). "
[Show abstract][Hide abstract] ABSTRACT: As part of a Practice Learning Centre, representing a partnership between an English University social work department and a non-governmental organisation, 12 students were placed in care homes for older people for their first period of assessed practice. The aims of this initiative were to facilitate: development of critical reflection; deployment of social work skills in a care home setting; and opportunities for social work students to work with care home residents. The learning was captured via four Experiential Groups facilitated by the Practice Educator with responsibility for assessing the students' practice. On-site supervisors also participated. Key learning included understanding of: the importance of critical reflection as a key social work skill; the influence of organisational norms and care home culture on the quality of care practice; the complexity and emotion-rich nature of person-centred care; and the pivotal role of relationships in work with people with dementia. Links made in the Groups—between the experiential and theoretical, the emotional and cognitive, and the structural and personal—demonstrate their value as learning platforms. Placements in care homes have considerable potential to enrich practice education; this is especially important in the context of an ageing population.
Social Work Education 01/2015; 34(1). DOI:10.1080/02615479.2014.949229
[Show abstract][Hide abstract] ABSTRACT: Otherness is an important concept in understanding the health provider-patient relationship and in creating insights into how to be more present with patients and families. This is an analysis of the concept of Otherness that leads to a definition of the construct.
Holistic nursing practice 03/2012; 26(2):87-91. DOI:10.1097/HNP.0b013e31824621d9 · 0.62 Impact Factor
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