UNDERSTANDI NG THE DI MENSI ONS OF I NTENSI VE CARE: TRANSPERSONAL
CARI NG AND COMPLEXI TY THEORI ES
Key la Cr ist iane do Nascim ent o1 Alacoqu e Lor en zin i Er dm an n2
Nascim ent o KC, Erdm ann AL. Underst anding t he dim ensions of int ensive care: t ranspersonal caring and com plexit y t heor ies. Rev Lat ino- am Enfer m agem 2009 m ar ço- abr il; 17( 2) : 215- 21.
This is a descript ive, int erpret ive and qualit at ive st udy carried out at t he I CU of a Brazilian t eaching hospit al. I t aim ed t o u n der st an d t h e dim en sion s of h u m an car in g ex per ien ced by h ealt h car e pr ofession als, clien t s an d t heir fam ily m em bers at an I CU, based on hum an caring com plexit y. The Transpersonal Caring and Com plexit y t heories support t heory and dat a analysis. The following dim ensions of care em erged from t he t hem es analyzed accor ding t o Ricoeur : self- car e, car e as an indiv idual v alue, pr ofessional v s. infor m al car e, car e as suppor t iv e r elat ion sh ip , af f ect iv e car e, h u m an ized car e, car e as act / at t it u d e, car e p r act ice; ed u cat iv e car e, d ialog ical relat ionship, care coupled t o t echnology, loving care, int eract ive care, non- care, care am bience, t he essence of life an d pr ofession , an d m ean in g/ pu r pose of car e. We believ e in car e t h at en com passes sev er al dim en sion s pr esent ed her e, based on t he r elat ionship w it h t he ot her , on t he em pat het ic, sensit iv e, affect ionat e, cr eat iv e, dynam ic and under st anding being in t he t ot alit y of t he hum an being.
DESCRI PTORS: int ensiv e car e; int ensiv e car e unit s; nur sing car e
COMPRENDER LAS DI MENSI ONES DE LOS CUI DADOS I NTENSI VOS: LA TEORÍ A
DEL CUI DADO TRANSPERSONAL Y COMPLEJO
Est e ar t ícu lo es u n est u dio descr ipt iv o, in t er pr et at iv o y cu alit at iv o, desar r ollado en la UTI del HU/ UFSC. Su obj et iv o fue com pr ender las dim ensiones del cuidado ex per im ent ado en la UTI por pr ofesionales de la salud, client es y fam iliares, basándose para ello, en el cuidado hum ano com plej o. La Teoría del Cuidado Transpersonal y de la Com plej idad f u er on el m ar co t eór ico u t ilizado par a an alizar los dat os. De los discu r sos an alizados, según Ricoeur, surgieron las siguient es dim ensiones del cuidar: el cuidar de sí; el cuidado com o valor individual; la r elación de ay u da; la act it u d; la pr áct ica asist en cial; la r elación dialógica; la esen cia de la pr of esión ; el cuidado pr ofesional v er sus el com ún; lo afect iv o; lo am or oso; lo hum anizado; lo educat iv o; lo int er act iv o; la alian za con la t ecn ología en el cu idado; el am bien t e del cu idado y la fin alidad del cu idado. Cr eem os en u n cuidado capaz de englobar las diversas dim ensiones aquí present adas, que se basan en la relación con el ot ro, en ser em pát ico, sensible, afect uoso, cr eat iv o, dinám ico y com pr ensible en la t ot alidad del ser hum ano.
DESCRI PTORES: cuidados int ensiv os; unidades de t er apia int ensiv a; at ención de enfer m er ía
COMPREENDENDO AS DI MENSÕES DOS CUI DADOS I NTENSI VOS: A TEORI A DO
CUI DADO TRANSPESSOAL E COMPLEXO
Tr at a- se de est u do descr it iv o, in t er pr et at iv o e qu alit at iv o, desen v olv ido n a Un idade de Ter apia I n t en siv a do Hospit al Universit ário da Universidade Federal de Sant a Cat arina ( UTI do HU – UFSC) . Obj et ivou- se com preender as dim ensões de cuidado hum ano, ex per ienciado em UTI , pelos pr ofissionais de saúde, client es e fam iliar es, fundam ent ado no cuidado hum ano com plex o. A Teor ia do Cuidado Tr anspessoal e da Com plex idade for m ar am o supor t e t eór ico e de análise de dados. Dos discur sos analisados, segundo Ricoeur , em er gir am as seguint es dim ensões de cuidar: cuidar de si, cuidado com o valor individual, cuidado profissional x com um , cuidado com o relação de aj uda, cuidado afet ivo, cuidado hum anizado, cuidado com o at it ude, cuidado com o prát ica assist encial, cu idado edu cat iv o, cu idado com o r elação dialógica, cu idado aliado à t ecn ologia, cu idado am or oso, cu idado in t er at iv o, n ão- cu idado, am biên cia do cu idado, cu idado com o essên cia da pr ofissão e fin alidade do cu idado. Acr ed it a- se n u m cu id ad o cap az d e en g lob ar as d iv er sas d im en sões aq u i ap r esen t ad as, f u n d am en t ad o n a r elação com o out r o, no ser em pát ico, sensív el, afet uoso, cr iat iv o, dinâm ico e com pr eensív el na t ot alidade do ser h u m an o.
DESCRI TORES: cuidados int ensiv os; unidades de t er apia int ensiv a; cuidados de enfer m agem
Universidade Federal de Sant a Cat arina, Brazil: 1Doct oral St udent , Scholarship holder CAPES, e- m ail: keyla_nascim ent o@hot m ail.com ; 2 Ph.D. in Nursing
Philosophy, Full Professor, e- m ail: alacoque@new sit e.com .br.
I NTRODUCTI ON
N
ursing, as a scientific discipline and profession at t he service of hum anit y, is com m it t ed t o cont ribut e to the im provem ent of living conditions and health. Thiscom m it m ent can be facilit at ed by t he developm ent of aw ar eness on car ing pr esent ed in pr act ice, t eaching,
t heory and research.
Because care is a com plex concept, it has been
a con cer n n ot on ly of n u r sin g sch olar s, bu t also of researchers from other knowledge areas like philosophy,
t heology, educat ion, psychology and ant hropology( 1- 2).
Care has been highlight ed in nursing, however, as t he essence and m ain reason for it s exist ence as a field of
know ledge and pr ofession.
This ar t icle is t he r esult of t he r esear cher s’
ex p er i en ce i n t h e car e p r o cess an d r esear ch i n a intensive care unit ( I CU) . I CUs are designed to provide
specialized care t o client s in crit ical condit ions and at r i sk o f d e a t h a n d h a v e i n cr e a si n g l y i m p r o v e d
t echnologies av ailable in t he at t em pt t o sav e client s’ l i v e s, w h i ch r e q u i r e s h i g h l y q u a l i f i e d h e a l t h
p r of ession als( 3 ). Eq u ip m en t s f av or im m ed iat e car e,
provide securit y for t he ent ire I CU t eam , but are not conduciv e t o hum an r elat ions, per haps because one
knows m ore about equipm ent and less about the hum an being who is being taken care of.
I m p r o v ed t ech n o l o g y p er m i t s t h e g r ad u al m o d i f i ca t i o n o f t h e d y n a m i cs o p e r a t i n g i n I CUs.
Consequently, decisions need to be m ade in the face of deat h and t he dy ing pr ocess and also on t he longer
per m anence of cr it ical pat ient s in t hese unit s. These
f act s h av e l ed t o t h e co n cl u si o n t h at h ar m o n i o u s relat ionships should exist am ong professionals working
at I CUs, patients adm itted in these units and their fam ily m em bers( 4). Therefore, those who provide care to critical
pat ient s need t o at t em pt t o im prove t his care.
As the reality of nursing practice is concerning,
t he following quest ion arises: What is t he m eaning of car e ex per ienced at t he I CU for hospit alized client s,
t h eir fam ily m em ber s an d pr ofession als? Th is st u dy aim ed t o underst and t he dim ensions of hum an caring
experienced at an I CU by healt h professionals, client s
and t heir fam ily m em ber s t hr ough t he t r ansper sonal caring and com plexit y t heories.
REFERENCE FRAMEW ORK
Th e co m p l e x i t y p e r sp e ct i v e i s a w a y o f understanding the world, including in the real world the
relat ionships t hat support coexist ence bet ween beings
in t he univ er se, allow ing for t he ack now ledgm ent of order and disorder, the unique and the diverse, stability
and change( 5). Com plex it y at t em pt s t o dialogue w it h t he several dim ensions t hat const it ut e phenom ena and
obj ect s, t hat is, wit h realit y. I t com prises seven basic, com plem ent ary and int erdependent principles: syst em ic
or organizat ional, holographic, ret roact ivit y, recursion, aut onom y, dialogical and reint roduct ion( 6).
The or ganizat ional sy st em of nur sing car e is co m p o se d o f so ci a l a ct o r s: ca r e g i v e r s a n d ca r e
recipients, including people who are close to those who
r eceiv e car e, cr eat ing t ies of m ut ual help. They ar e p e o p l e w h o a ct , r e a ct , i n t e r a ct , sh a r e , a r e
interdependent, help each other, exchange experiences, different iat e and int egrat e, get close and get dist ant ,
connect, involve and negotiate with each other, living in a conflict ual har m ony. They occupy a physical, social
and polit ical- inst it ut ional space( 7). Care is present ed as an em ergency in this system , which by intuition, reason
and logic of it s act ors allows for int eract ive processes of inexhaustible and unpredictable m ultiple relationships.
Th e n ot ion of car e pr ior it y, st r on ger in t h e
subsy st em of int ensiv e car e, is link ed t o t he r isk of deat h, which oscillat es bet ween real- hidden, cert aint
y-uncertaint y, truth- deception, where possibilities, chances an d op p or t u n it ies ar e at st ak e in ack n ow led g ed or
rout inely elect ed priorit ies, where uncert aint y seem s t o arise as people becom e aware of t he risk( 8).
The perspect ive of t ranspersonal caring wit hin Jean Watson’s theory is based on her beliefs and values
of hum an life, and on health and healing, which are the
result of her experiences and observat ions( 9). Wat son em phasizes t he hum anist ic approach, that is, to at tend
the biopsychosocial, spiritual and sociocultural individual; and the goal of nursing, which is to help people to achieve
t he highest level of harm ony wit hin m ind- body- soul( 10). For Watson, the m ain goal of Nursing contains
t en car at iv e fact or s t hat or iginat e fr om a hum anist ic perspective com bined with scientific knowledge( 10). They
are: 1) practicing love, kindness and consistency within a cont ext of conscious caring; 2) being aut hent ic, be
present , be able t o pract ice and m aint ain a syst em of
deep beliefs, and a subj ective world of one’s life and of t he pat ient ’s life; 3) cult ivat ing one’s own spirit ual and
t ranspersonal pract ices of t he self; 4) developing and m ain t ain in g au t h en t ic, car in g , h elp in g an d t r u st in g
relat ionships; 5) being present and providing support t o ex pr ession s of posit iv e an d n egat iv e feelin gs; 6 )
to the care and protection practices; 7) being genuinely
co m m i t t ed t o t h e ex p er i en ce o f t each i n g - l ear n i n g pr act ice; 8) cr eat ing a pr ot ect iv e env ir onm ent at all
levels, where one is aware of the whole, beaut y, com fort, dignity and peace; 9) m eeting hum an needs, consciously
adm inistering essential hum an caring, which strengthens m ind- body- spirit; 10) be open and attentive to spirituality
and t he exist ent ial dim ension of life it self.
METHODOLOGI CAL TRAJECTORY
This is a qualit at iv e and int er pr et at iv e st udy w it h a p h en om en olog ical p er sp ect iv e t h at aim s t o
broaden and underst and t he phenom enon: dim ensions of care existent in critical units, m ore specifically at the
UCI of a t eaching hospit al in Florianopolis, Brazil. I t s t ar get populat ion w as t he I CU t eam ( t w o physicians,
on e ph y siot h er apist , t h r ee n u r ses an d f ou r n u r sin g t echnicians) w ho agr eed t o par t icipat e in t he st udy,
signed the inform ed consent term and accepted the use of a recorder. I n addition, clients who were hospitalized
at the I CU at the tim e of the study and respective fam ily m em bers ( six client s and nine fam ily m em bers) were
select ed accor d in g t o t h e f ollow in g cr it er ia: b ein g
hospit alized at t he unit ( or wit h a hospit alized relat ive at the unit) , older than 18 years of age, being aware of
t im e and space, able t o v er bally ex pr ess t hem selv es and agreem ent t o part icipat e in t he st udy. Dat a were
collect ed t hrough in- dept h int erviews and observat ions carried out by the first researcher, guided by the second
researcher. The st udy part icipant s com prised 25 people
wit h ages varying bet ween 22 and 80 years, num ber considered sufficient by data saturation in the prelim inary
analy sis.
Discou r se an aly sis w as b ased on Ricoeu r ’s
herm eneut ic analysis, which consist s of five m om ent s: initial reading of the text, distancing, structural analysis,
ident ificat ion of t he m et aphor and appropriat ion( 11). The m at erial w as organized during t he init ial
r eading, and sev er al t est im onies w er e r ead t o gr asp t h e m ean in gs t h at em er ged f r om t h e discou r se. I n
dist ancing ourselves, we sought t o suspend beliefs and
clar ificat ions on t he st udied phenom ena so as t o be able to look at it as presented by the participant. Through
st ruct ured analysis, t he veiled m eaning was discussed and underst ood, generat ing subt hem es and t hem es of
discourse produced from the reality experienced by the
p a r t i ci p a n t . Un d e r st a n d i n g o f t h e m e t a p h o r w a s
achiev ed as fr om t he under st anding of t he t ex t . The
t hem es t hat described part icipant s’ dim ensions of care
w er e m er ged int o cat egor ies, analy zed accor ding t o
t h e t h e o r y o f Je a n Wa t s o n a n d c o m p l e x i t y. Appropriat ion was t he last m om ent of t he herm eneut ic
int erpret at ion and m eans t o be apt t o underst and t he
m et aphor of t he t ex t w or ld. This m et hod of analy sis
perm it t ed t o int erpret and underst and experience wit h
ca r e sy st e m s i n I CUs, a n d co n n e ct i o n s b e t w e e n
r espondent s and t he w or ld t hey live in.
The code of professional et hics and resolut ion
196/ 96 were followed during t he developm ent of t his
st udy, w hich w as init iat ed only aft er agr eem ent fr om
t he inst it ut ion and appr ov al by t he Hum an Resear ch
Et hics Com m it t ee at t he Feder al Univ er sit y of Sant a
Cat ar ina w er e obt ained ( Pr ocess N. 311/ 04)
DI MENSI ONS OF CARE EMERGE
The set of discourse t ranscript ions com prised
t he body of t ext . This gradual const ruct ion ( discourse
a f t e r d i s c o u r s e ) m a d e a p a r t i a l a n d c r e s c e n t
codificat ion t o em erge. Recording of observat ions was
incor por at ed in t he const r uct ion of t he body of t ex t ,
f ollow ed by dat a an aly sis. Th e v eiled m ean in g w as
discussed and underst ood, generat ing subt hem es and
t h e m e s o f d i sco u r se p r o d u ce d i n t h e e x i st e n t i a l
m om ent , of t he realit y experienced by t he part icipant .
Thus, t he st r uct ur al analy sis led t o t he unv eiling of
s u b t h e m e s a n d t h e m e s o b t a i n e d t h r o u g h
con v er gen ces, t ot alin g 1 7 cat egor ies or dim en sion s
of car e accor ding t o t he follow ing pr esent at ion.
Sel f - car e
“ Com plex knowledge dem ands t hat we locat e
ou r selv es in t h e sit u at ion , u n d er st an d ou r selv es in
t he underst anding and know ourselves in t he st at e of
knowing”( 5) . Self- care passes t hrough a dialogue wit h
oneself and a dialogue wit h ot hers. Awakening t o
self-k n ow led g e an d self - car e is p ar t of t h e p r ocess of
lear ning how t o t ak e car e.
I believe t hat we can only t ransm it t ranquilit y, at t ent ion and hum an warm t h t o people under our care, if we have already resolved our own conflict s, t aking care of ourselves ( 4P)*.
W h en o n e ex p er i en ces sel f - ca r e, t h er e i s
o p p o r t u n i t y t o p e r f o r m s e l f - r e f l e c t i o n , e x p r e s s
em ot ions, absorb experiences t hat becom e knowledge
a n d d e v e l o p s e l f - p e r c e p t i o n a s s u b j e c t w h o s e
subj ect ivit y and sensit ivit y are put in act ion.
Car e as indiv idual v alue
Value is ever y t hing t hat in a giv en condit ion
cont r ibut es t o t he dev elopm ent and im pr ov em ent of
essent ial com ponent s of t he hum an condit ion in social
coex ist en ce( 8 ). Hu m an v alu es p r esen t p er son al an d
indiv idual ident ificat ions but also ex pr ession in social
coexist ence. I ndividual values are added t o professional
v a l u es l i k e l o v e, h o n est y, sp i r i t u a l i t y, l i k i n g , j o y,
pleasure in const ant im provem ent , which are im port ant
in t he est ablishm ent of t he current view of care.
Hum an care is included in values t hat em phasize peace, frat ernit y, religiosit y, individualit y, respect and love [ …] ( 22F).
I n t his perspect ive, care provides people t he
feeling of being in harm ony wit h t hem selves and wit h
t he environm ent , which t reat s not only physical healt h
b u t also sh ow s af f ect ion , sy m p at h y, at t en t ion an d
r esp ect f or ev er y t h in g t h at p er m eat es t h e ot h er ’s
s u b j e c t i v i t y. Fa i t h a n d b e l i e f a r e e v i d e n c e d i n
r elat ion sh ip s of car e. Pr act icin g an d m ain t ain in g a
sy st em of beliefs, fait h an d h ope is pr esen t ed as a
care fact or( 10).
Pr ofessional x infor m al car e
Many t im es, professional care is dist inguished
from inform al care in t he part icipant s’ discourse.
Professional care is m ore specialized ( 1C) . I nform al care is provided by fam ily m em bers wit h warm ness, com fort , at t ent ion, dedicat ion and affect ion ( 16F).
Pr o f essi o n al car e i s t h e car e d el i v er ed b y
pr ofessionals w it h scient ific k now ledge in t he healt h
a r e a a n d w h o h a v e t e c h n i c a l a b i l i t i e s t o h e l p
indiv iduals, fam ilies and com m unit ies t o im pr ov e or
r ecov er t h eir h ealt h . Pr of ession als h av e t ech n
ical-form al educat ion and acquire a professional perspect ive
of healt h, disease and care( 12).
I nform al care com prises at t it udes, t echniques
and processes based on cult ural values, helping people
t o t ake care of t hem selves in sit uat ions of healt h and
disease. Pr ofessional car e and infor m al car e happen
in t he beings, from t hem , t o t hem , t hrough t hem , and
coex ist in t h e n at u r e an d in t h e sam e st r u ct u r e of
organizat ion of t he life of hum an beings, in t heir several
biological, ant hr opological, psy chological, sociological
and ot her dom ains( 8).
Car e as a suppor t iv e r elat ionship
Car e as a w ay of being w it h t he ot her w as
ev idenced in t he discour se, est ablishing a suppor t iv e
and t r ust w or t hy r elat ionship:
Caring m eans helping t he ot her person t o get bet t er so t hat she can t ake care of herself ( 7P).
Being w it h t he ot her in care as a support ive
r e l a t i o n s h i p r e q u i r e s c l o s e n e s s . Th u s , f o r a
r elat ion sh ip of car e t o ex ist , p r of ession als n eed t o
develop abilit ies t o get close, observe t he client at all
dim ensions and per ceiv e sit uat ions in a r elat ionship
of r espect an d t r u st in ess. I n t h is r elat ion sh ip, t h ey
ex pr ess an d sh ar e t h eir k n ow ledge, sen sit iv it y an d
t echnical abilit y and help t he ot her t o grow. The ot her
shares his( er) self, rit uals and personal charact erist ics
t hat m obilize t he car e sy st em .
Af f ect iv e car e
A f f e c t i v e c a r e i s p r e s e n t i n h e a l t h
pr ofessionals’ at t it udes w it h sev er al k inds of feelings
in t heir r elat ionships of car e exper ienced at t he I CU.
I n lear n in g ab ou t p osit iv e an d n eg at iv e f eelin g s in
d a i l y r o u t i n e , o n e g a t h e r s i n f o r m a t i o n a b o u t t h e
p a t i e n t . D e - c o d i f y i n g t h e m e a n i n g s o f t h e s e
expr essions and feelings pr esent in t heir act ions is a
com p lex p r ocess n ecessar y t o ease ap p r ox im at ion
an d r el at i on sh i p w i t h p at i en t s. Bei n g p r esen t an d
ex p er i en ci n g an au t h en t i c af f ect i v e an d em p at h i c
relat ionship is not only a com ing- and- going t o perm it
for w ar d and back w ar d per cept ions and feelings, but
a l so m ea n s ca u si n g “ r u p t u r es”, “ l a n d i n g i n o t h er
ar eas”, ex p ect i n g i n si g h t s, n o t o n l y k n o w l ed g e o f
sit uat ions, but looking at what can be different , from
w h i ch am b i g u o u s, i n t u i t i v e an d cr eat i v e f o r m s o f
t hink ing/ act ing can em er ge( 8).
Hu m an ized car e
Healt h/ nur sing pr ofessionals ar e const it ut ing
a h u m a n i st i c ca r e , f o cu si n g o n h u m a n ca r e a n d
affect iv e t ou ch .
I n t he hum anizat ion of care, t he caregiver is a h u m an bein g w h o r espect s an d v alu es t h e bein g under car e in his( er ) ex ist ent ialit y, under st ands t his being as som eone w ho has his( er ) ow n ex per iences
t hat accom pany his( er) exist ence( 13).
Af f e c t i v e t o u c h i s e s s e n t i a l w h e n i t i s t r ansfor m ed in at t it ude by t he hand t hat est ablishes t he r elat ionship( 2). Touching r epr esent s t he car e per se, t he professional’s sensit ivit y and solidarit y. Touching is revealed as a hum anist ic at t it ude, st rengt hening t he b o n d a n d est a b l i sh i n g a n en co u n t er b et w een t h e car egiver and t he car e r ecipient .
Care as act , at t it ude
Care is seen as an act ion, idea of m ovem ent ,
car r ying out an act ivit y, act ing j oint ly w it h an agent , r ealizing som et hing for or j oint ly w it h anot her being, act ing in favor of t he ot her’s healt h.
Care is t he professional’s set of at t it udes t o at t end t he severe pat ient and fam ily m em bers so as t o m aint ain t he pat ient ’s living condit ion ( 14C).
Ca r e i s a n a c t i o n o f f a m i l i a r i z a t i o n , underst anding, t echnical abilit ies and feelings of each caregiver who experiences t he care process. This is a cyclical process, of relat ions and organizat ion of care by at t it udes lik e: be w it h, t ake car e of, help t o do, or ient and educat e.
Car e as car e pr act ice
This dim ension includes carrying out t echnical
p r o c e d u r e s a n d a l s o r e f e r s t o c o m m i t m e n t a n d responsibilit y am ong t hose involved in t he relat ionship of car e.
They are activities of care and support to a fam ily m em ber or a client wit h a view t o recovering healt h ( 25P).
Car e as assist ance pr act ice includes car r y ing out t echnical and support ive procedures for t he client in his( er) int egralit y as a com plex being, orient ed by Wat son’s t en car at iv e fact or s. I t is suppor t ed by t he syst em at izat ion of car e or nur sing pr ocess under t he nur se’s r esponsibilit y.
Edu cat iv e car e
Educat ive care refers t o inform at ion, t eaching
and form al and inform al t raining program s( 2). I t is t he
spr ingboar d for seek ing k now ledge for t he ev olut ion
of societ y; one cannot det ach care from educat ion( 9).
Educat ive care is t he exercise of crit ical t hinking, spirit
of cit izenship and cont inuous search for new horizons.
Care m eans t o have knowledge, m eans t o know t he developed healt h act ions ( 18C).
Ed u cat iv e p r act ice st r en g t h en s t h e n u r sin g
t eam so as t o p r ov id e a m or e au t h en t ic car e.
Re-educat ing oneself m eans t o st and out of a m inorit y; it
m ean s car egiv er s f eel t h e n eed an d h elp ot h er s t o
change( 6).
Care w it h a dialogical relat ionship
I n ca r e sy st em s, a h u m a n r el a t i o n sh i p i s
const r uct ed t hr ough t he encount er of t he client and
t h e car egiv er an d is ex pr essed t h r ou gh a dialogical
r elat ionship. This r elat ionship is ev idenced w hen t he
car eg i v er t u r n s t o t h e cl i en t w i t h r eci p r o ci t y an d
affect ion and is able t o conceive and be conceived as
a hum an being.
[ ...] I keep talking whenever I ’m perform ing a procedure, not only a m echanical t alk, I t hink t he pat ient feels safer when t here’s verbal com m unicat ion ( 11P) .
Discourse reveals t hat t he caregiver’s int ent ion
t o be aut hent ic, pr esent and able t o ex per ience t he
subj ect ive world of care wit h t he ot her concret ized t he
dialogical relat ionship. When t he caregiver aw akes t o
t he care full of sensit ivit y, ( s) he fully experiences t he
m o m e n t a n d v a l u e s n o t o n l y t e ch n i ca l - sci e n t i f i c
aspect s, bu t also essen t ially t h e h u m an bein g, an d
prom ot es t he care encount er. This dialogical encount er
is t he result of underst anding t he ot her’s expression in
a loving and respect ful m anner, perceiving t he ot her’s
feelings and em ot ions and r espect ing his( er ) w ay of
being and being in t he world.
Car e coupled t o t echnology
I t is evidenced as som et hing properly valued.
Technology is a way t o ease t he care delivered t o t he
client , oft ent im es vit al t o preserve life. However, it is
n ecessar y t o av oid gr eat er con cer n w it h equ ipm en t
t h an w i t h cl i en t s b ecau se car i n g i s n ot l i m i t ed t o
t ech n ology.
[ . . . ] t h e d ev elop m en t of t ech n ology is n ecessar y , b u t w e sh ou ld f ollow p r in cip les f or it s u se, it ’s im p ossib le t o e x p e ct a t t e n d i n g se v e r e p a t i e n t s w i t h o u t t e ch n o l o g i ca l su p p or t , it f acilit at es ou r act iv it y an d , in m an y cases, k eep s p at ien t s’ lif e ( 4 P) .
Te ch n o l o g y a s p a r t o f h u m a n ca r i n g w a s
cr eat ed b y an d in f av or of h u m an b ein g s, w it h ou t
t h e i n t en t i o n t o o v er co m e t h e d i m en si o n o f t h ei r
Lov ing car e
Care is underst ood as an act of love, exchange
bet w een car egiv er and car e r ecipient , in w hich bot h
shar e lov e t o achiev e successful r esult s.
You can tell there’re m any people here who work for love, because t here is at t ent ion, t heir sm ile ( 2F) .
Lo v e a s d i m e n s i o n o f c a r e w o r k s a s a
facilit at or, energet ic and t ender elem ent t hat nurt ures
and exalt s t he care. Through t he developm ent of one’s
ow n f eelin gs, on e can r eally in t er act in a sen sit iv e
m anner wit h anot her person( 10). I n relat ionships of care,
one can t ranscend t he physical and m at erial world and
get int o cont act wit h t he individual’s subj ect ive world.
Lov in g car e im p lies sh ar in g , sen sit iv it y, t r u st in ess,
com m unicat ion, underst anding, em pat hy, com m it m ent ,
view of t he ot her as unique, percept ion of t he ot her’s
e x i s t e n c e , a c c e p t a n c e , r e s p e c t , r e c e p t i v i t y,
com pet ence, t ouch, sm ile, inv olv em ent , m om ent s of
encount er, pr esence and ot her s.
I nt er act iv e car e
Healt h car e is a pr ocess of in t er act ion an d
associat ion bet ween beings, and is an organizing part
o f t h e h eal t h sy st em an d o r g an i zi n g p ar t o f car e
sy st em s, and co- or ganizes j oint ly w it h t he r em aining
soci al sy st em s( 8 ). Th ey ar e l i n k s, i n f o r m at i o n an d
co n n ect i o n s i n an i n t er act i v e an d r el at i o n al car e,
indicat ed in t he following discourse.
Care is an int eract ion process bet ween professionals, pat ient s and fam ily m em bers, where t hey experience an unst able sit uat ion, aim ing t o re- est ablish people’s healt h ( 11P).
I n t e r a ct i v e ca r e i s e st a b l i sh e d b a se d o n
int er nal for ces, t hat is, by t he subj ect iv e t r ansact ion
bet w een t he inner and out er w or lds of t he car egiv er
and t he client , in unique ways and m om ent s and wit h
different people, and t hat is why t hey are genuine.
Non - car e
I n t h e d i a l o g u e w i t h s o m e h e a l t h
professionals, t he way t hey would not want t o be cared
for appear s im plicit ly. Non- car e is t o use ar t ifact s so
as not t o get t oo close t o client s, perform ing care in a
h u r r y an d k eep i n g d i st an ce f r o m p eo p l e. I n su ch
ci r cu m st a n ce s, cl i e n t s a n d f a m i l y m e m b e r s f e e l
inhibit ed t o express or request support . Cert ain t erm s
m ay seem neglect ful or for m s of non- car e: I ’m in a
hurry, I do not have m uch t im e, be brief, am ong ot hers,
lim it ing t he space and closeness, dist ancing pat ient s
fr om pr ofessionals.
Non - car e is t o p er f or m act iv it ies in a h u r r y an d dist r act ed ( 23F) .
Br oadening t he under st anding of car e so as
t o im prove t he relat ionship wit h pat ient s should be an
im por t ant concer n for healt h pr ofessionals.
Car e, t he essence of life and pr ofession
Care is showed as a value essent ial t o people’s
life. Car e is t he essence, t he m or al ideal of nur sing,
w h ose aim is t o p r ot ect , ag g r an d ize an d p r eser v e
hum an dignit y( 10).
Professional care is t he essence of nursing and includes act ions developed in com m on agreem ent bet ween t wo people, t he one who t akes care of and t he one who’s under care ( 7P) .
Hum an caring, underst ood as t he m oral ideal
of nur sing, r epr esent s a set of t r ansper sonal effor t s
focused on pat ient s t o help t hem acquir e k now ledge
a n d se l f - co n t r o l , p r o m o t i n g a n d p r e se r v i n g t h e i r
exist ence. And car e as t he essence of t he pr ofession
is t he professional’s com m it m ent t o t ake care of so as
t o give sense t o life. This essence of care is t o be and
t o m ake a difference in t he relat ionship of care.
Car e am b ien ce
Cl i en t s a n d f a m i l y m em b er s co n si d er t h e
environm ent host ile, feel insecure and afraid because
of t h e dif f er en ce bet w een t h e h ospit al en v ir on m en t
and t hat of client s/ fam ilies. Client s consider t he I CU
h a r d l y c o z y a n d i m p e r s o n a l a n d p e r c e i v e t h e
st andardizat ion im posed by t he inst it ut ion, which does
not consider t heir individualit ies. I t is a well- equipped
p h y s i c a l s t r u c t u r e , w i t h m o d e r n t e c h n o l o g i c a l
resources, but which can som et im es pass t o t he client
a feeling of coldness and indifference in t he way care
is deliv er ed.
There is lit t le t o recall from t here. I know we get very t hirst y, t he lips get dry, we don’t t alk, st ay quiet , have no cont act wit h anyone, it ’s scaring ( 20C).
Th e y a l l u d e d t h a t t h e c a r e g i v e r i s a l s o
influenced by t he environm ent , which affect s t he care
p r o cess. Car eg i v er s n eed a co zy an d co m f o r t ab l e
environm ent because it is in t his place t hey int eract t o
Pr o m o t i n g a su p p o r t i v e e n v i r o n m e n t , o f
b i o p h y si ca l , p sy ch o p h y si ca l , p sy ch o so ci a l a n d / o r
int erpersonal prot ect ion is one of t he requirem ent s of
car e. The int er dependence bet w een people’s int er nal
a n d ex t er n a l en v i r o n m en t s i n f l u en ces h ea l t h a n d
disease condit ions( 10). There is an ongoing int eract ion
process bet ween t he environm ent and t he hum an being
t h a t c a n e i t h e r f a v o r a n d c r e a t e o r h i n d e r t h e
relat ionship of care bet w een hum an beings.
Meaning/ pur pose of car e
The client s’ clinical im provem ent and recovery
em erges as essent ial purpose of t he care process, t hat
is, car e is a w ay of r eest ablish in g clien t s’ h ealt h , a
way of helping t he ot her t o grow and self- fulfill, t o die
a peaceful deat h, cont ribut ing t o t he qualit y of hum an
beings’ process of being and living.
Th e big r esu lt is t h e pat ien t ’s im pr ov em en t or at least seein g h e is w ell, t h at y ou can do som et h in g t o im pr ov e h is h ealt h ( 1 6 F) .
Car e is focused on t he needs and desir es of
hum an beings involved in t he care relat ionship. Healt h/
disease is per m eat ed by m ov em ent s of liv ing at t he
lim it of sensat ions, com fort and discom fort , hoping for
new m om ent s in t he possibilit y of being in a sit uat ion
and get pr epar ed t o be in anot her. Healt h is in t he
organizat ional care syst em where being healt hy m eans
liv ing ups and dow ns, in a com e- and- go of j oy and
sor r ow , in a con f lict u al h ar m on y m ed iat ed b y t h e
t hreshold of int ersect ion bet ween deat h and life( 8).
CONCLUSI ONS
The cont ent t hat em erged from t he reflect ions,
based on com plexit y and t ranspersonal caring t heories,
on t h e discou r se r egar din g t h e r elat ion sh ip of car e
experienced in organizat ional care syst em s reveal t he
dim ensions of car e.
Th e q u a l i t a t i v e r e s e a r c h w i t h a
p h e n o m e n o l o g i c a l p e r s p e c t i v e a n d Ri c o e u r ’ s
in t er pr et at iv e an aly sis w as a dy n am ic pr ocess t h at
perm it t ed a broader underst anding of t he phenom enon:
dim ensions of car e exist ent in an I CU. The m om ent s
ex per ien ced an d sh ar ed w it h t h e st u dy par t icipan t s
w er e m om ent s of com plicit y, r ecipr ocit y, int er est and
solidarit y. They provided t he perspect ive of new pat hs
and differ ent at t it udes in t er m s of car e and people,
t hat is, hum an car ing w it h sensit iv it y, em pat hy and
sat isfact ion .
We e x p e c t t o p r o v i d e f e l l o w n u r s e s t h e
p l e a su r e o f e x e r ci si n g t r a n sp e r so n a l ca r i n g a n d
com plexit y in t he daily rout ine of nursing care, in it s
m u l t i p l e f a c e t s a n d a s p e c t s o f s t r u c t u r e s a n d
int eract ions. We also ex pect t hey r eflect on t he car e
p r o v i d e d a t I CUs . We b e l i e v e i n h u m a n c a r i n g
com posed of several dim ensions present ed here, based
on t he relat ionship wit h t he ot her, on em pathic, sensitive,
affect iv e, cr eat iv e, dy nam ic and under st anding being
in his( er) totality as hum an being. Behind all those wires,
tubes, slides, lights and alarm s, there are hum an beings
taking care of and hum an beings being cared for, hoping
to live a little longer and better.
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