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
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.
Available from: Alisoun Milne
- "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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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.
Available from: Asa Sandvide
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ABSTRACT: The purpose of the research was to understand the phenomenon of "discrimination" as a part of nursing students learning how to provide nursing care, that is, how students make decisions and prioritize nursing care. Using a qualitative research methodology data collection included the use of semi-structured interviews and field notes. The sample was made up of nursing students enrolled in a nursing program in a university in southern Chile. The students had acquired specific clinical skills and were in the third and fourth years of study. The extremecase method was used based on students' academic scores as mean criterion. Data were analyzed using the Atlas. ti tool followed by application of Grounded Theory techniques to identify four analytical categories. Results showed that nursing students were able to discriminate for themselves, based mainly on criteria about disease and personal factors, such as the attractiveness of a person's face, openness to dialog, level of communication and so on. Findings showed that students paid special attention to people with 'interesting' diseases, known diseases, or health problems which offered students the opportunity to implement nursing care plans and to assess outcomes. These elements emerged like determinant factors based on the emotions that they produce in the beginning students, triggering them to give better care to some individuals over others.
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