Caring and uncaring encounters in nursing and health care : Developing a theory

The general aim of the present thesis was to develop a theory on caring and uncaring encounters within nursing and health care from the patient's perspective. Results of an analysis of two phenomenological studies (paper I), as well as research findings from five other phenomenological studies (papers II-VI), were used to develop the theory. Caring and uncaring can be conceptualized on a continuum symbolizing five basic modes of being with another, which, for example, involves a neutral mode of being with another, where the individual is perceived as neither caring nor uncanng. There are two major metaphors in the theory, that of the bridge, symbolizing the openness in communication and the connectedness experienced by the recipient of care in an encounter perceived as caring. The other metaphor is the wall, which symbolizes negative or no communication, detachment and lack of a caring connection, experienced by the recipient in an encounter perceived as uncaring. In the theory the importance of professional caring within nursing and health care is proposed, essentially involving competence, caring, and connection. The above-mentioned 'bridge' is developed through mutual trust and the development of a connection between the professional and the recipient. This connection is a combination of professional intimacy and a comfortable distance of respect and compassion -- professional distance. On the other hand, uncaring involves perceived indifference and incompetence, creating distrust, disconnection and the above-mentioned 'wall' of negative or no communication. The recipient of professional caring is influenced positively. Theconsequences, which are an increased sense of well-being and health, can be summarized as empowerment. Uncaring, however, has the negative consequences of decreased sense of well-being and health, which can be summarized as discouragement. Empowerment and discouragement in this context are defined as subjective experiences of the recipients of care. The importance of seeing the recipient in his or her inner and outer contexts is emphasized in the theory. The inner context involves perceived needs, expectations, previous experiences and sense of self, which in the perspective of the recipient of nursing can be summarized as both a sense of vulnerability and the need for professional caring. The perceived hospital environment comprises the recipient's outer context. It is concluded that nurses and other health professionals can, by theirprofessional caring or lack of it, be powerful sources of empowerment ordiscouragement to those whom they are pledged to serve.Papers, included in the Ph.D. thesis, are not registered and included in the posts from 1999 and backwards.The following papers included in the Ph.D. Thesis are removed due to copyright restrictions.Paper I: Halldirsdottir, S. l 991. Five basic modes of being with another. In Gaut, D.A., & Leininger, M.M., (eds) Caring: The compassionate healer. NationalLeague for Nursing, New York, 37-49.Paper II: Halldirsdottir, S. & Hamrin, E. 1997. Caring and uncaring encounters'vvithin nursing and health care: From the cancer patient's perspective. Cancer Nursing April, 20(2):120-128.Paper III: Halldirsdottir, S. & Hamrin, E. 1996b. Experiencing existentialchanges: The lived experience ofhaving cancer. Cancer Nursing, 19(1), 29-36.Paper IV: Halldirsdottir, S. & Karlsd6ttir, S.I. 1996a. Empowerment ordiscouragement: Women's experience of caring and uncaring encounters during childbirth. Health Care for Women lnternational, 17( 4).Paper V: Halldirsdottir, S. & Karlsdottir, S.I. i 996b. Journeying through labourand delivery: Perceptions of women who have given birth. Midwifery 12(2).Paper VI: Halldirsdottir, S. 1996a. The lived experience of health: Aphenomenological case study. (on the day of the defence date the status of this article was Submitted. Published later: Halldorsdottir, S. 2000. Feeling empowered: A phenomenological case study of the lived experience of health. In B. Fridlund and C. Hildingh (eds), Qualitative methods in the service of health (pp. 82-96). Lund: Studentlitteratur.