Relational care: learning to look beyond intentionality to the ?non-intentional? in a caring relationship

School of Human and Life Sciences, Research Centre for Therapeutic Education, Roehampton University, Whitelands College, London SW15 4JD, UK.
Nursing Philosophy (Impact Factor: 0.83). 11/2007; 8(4):223-32. DOI: 10.1111/j.1466-769X.2007.00316.x
Source: PubMed


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.

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    • "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). "
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