Care concept in medical and nursing students’ descriptions – Philosophical approach and implications for medical education
More details
Hide details
Department of Development in Nursing, Medical University of Lublin, Poland
Department of Paediatric Nursing, Medical University of Lublin, Poland
Mental Health Research Education and Development (MHRED), University of Lincoln, UK
Department of Ethics and Human Philosophy, Medical University of Lublin, Poland
Beata Dobrowolska   

Department of Development in Nursing, Medical University of Lublin, Poland
Ann Agric Environ Med. 2014;21(4):854–860
Care is seen as something that is peculiar to the medical sciences but its meaning and status for physicians and nurses differs.

The aim of this research was to learn how nursing and medical students understand and define care, and how their definition and views on their practice of caring change as they advance through their studies.

Material and Methods:
The study was conducted among two groups of students: before and after their first practicum (n=102). Analysis of the students’ answers was carried out using Colaizzi’s phenomenological descriptive methodology, which means that a qualitative approach was used.

The qualitative analysis shows that the medical and nursing students define care in the same way, using 9 main categories: compassion, commitment, competence, confidence, conscience, communication, patience, courage and support. The nursing students viewed their caring to be within both practical and emotional dimensions and this was a core feature of their identity as nurses. Medical students, on the other hand, viewed the practical dimension of care as an additional activity. All the students in the study underlined the importance of having time to care and showed that, for them, ‘time’ in this context has a moral meaning. What was interesting to the research team centered on the initial attitudes to ‘caring’ from both medical and nursing students.

1. Watson J. Nursing. The philosophy and science of caring. CO: University Press of Colorado, Boulder, 1985.
2. Szewczyk K. Goodness, badness and medicine. The philosophical bases of cultural bioethics. Polish Scientific Publishers PWN, Warsaw, 2001 (in Polish).
3. Gilbert P. Human nature and suffering. Lawrence Earlbaum press. Hove 1989.
4. Jecker NS & Self DJ. Separating care and cure: an analysis of historical and contemporary images of nursing and medicine. In: Downie RS. ed. Medical ethics, MA: Darmouth Publishing, Sudbury 1996.p.89–109.
5. Rickard M, Kuhse H, Singer P. Caring and justice: a study of two approaches to health care ethics. Nurs Ethics. 1996; 3: 212–223.
6. Radsma J. Caring and nursing: a dilemma. J Adv Nurs. 1994; 20: 444–449.
7. Roach S. Caring: The human mode of being. University of Toronto, 1984.
8. Pellegrino E. The caring ethics. The relation of physician and patient . In: Bishop AH. Scudder JR. eds. Caring, curing, coping. Nurse, physician, patient relationship. University of Alabama Press, Birmingham, 1985.p.8–30.
9. Fry ST. A theory of caring: pitfalls and promises. In: Gaut DA, Leininger, MM. eds. Caring: The compassionate healer. NY, National League for Nursing Press, New York 1991.p.161–172.
10. Scott RA, Aiken LA, Mechanic D, Moravcsik J. Organizational aspects of caring. Millbank Q. 1995; 73: 77–95.
11. Gastmans C. Editorial comment. Nurs Ethics. 2003; 10: 352–353.
12. Lewis CT, Short CA. Latin dictionary. Clarendon Press, Oxford 1995.
13. Sławski F. Etymological dictionary of the Polish language. Vol. II. Nakładem Towarzystwa Miłośników Języka Polskiego, Kraków, 1961 (in Polish).
14. Lavoie M, de Koninck T, Blondeau D. The nature of care in light of Emmanuel Levinas. Nurs Philosophy. 2006; 7: 225–234.
15. James N. Care = organization + physical labour + emotional labour. Sociol Health Illn. 1992; 14: 488–509.
16. Allmark P. Can there be an ethics of care? J Med Ethics. 1995; 21: 19–24.
17. Bassett C. Nursing care. From theory to practice. Whurr, London 2004.
18. Nouwen HJM. Here and now: living in the spirit. Crossroad Publishing Company, New York, 2006.
19. Heidegger M. Being and Time. Polish Scientific Publishers, Warsaw 1994 (in Polish).
20. Edwards SD. Benner and Wrubel on caring in nursing. J Adv Nurs. 2001; 33: 167–171.
21. Dobrowolska B. Introduction to medical ethics of care. Bydgoszcz: Oficyna Wydawnicza Branta, 2010 (in Polish).
22. Szewczyk K. Ethics of medicine as the ethics of care. In: Walczak-Duraj D & Min Xu T (Eds.). Ethical Dilemmas of Medicine in Poland and China. Wydawnictwo ‘Omega-Praxis, Łódź 1998.p.47–57 (in Polish).
23. Szewczyk K. Cultural bioethics as extensive moral doctrine. In: Gałuszko M & Szewczyk K (Eds.). Birth and death. Cultural bioethics in border states of human life. Polish Scientific Publishers. Warsaw, 2002.p.16–59 (in Polish).
24. Lévinas E. Ethics and infinity. Conversation with Philippe Nemo. Papieska Akademia Teologiczna, Krakow, 1991 (in Polish).
25. Lévinas E. Otherwise than being, or beyond essence. Aletheia Publishing, Warsaw, 2000 (in Polish).
26. Ramsey P. Patient as person: exploration in medical ethics. PAX Publishing, Warsaw, 1977 (in Polish).
27. Roach S. The human act of caring. Canadian Hospital Association, Ottawa, 1987.
28. Mayeroff M. On Caring. Harper and Row, New York, 1972.
29. Bendapudi NM, Berry LL, Frey KA, Parish JT, Rayburn WL. Patient’s perspective on ideal physician behaviors. Mayo Clin Proc. 2006; 81(3): 338–344.
30. Marcinowicz L, Chlabicz S, Grebowski R, Patient satisfaction with healthcare provided by family doctors: primary dimensions and an attempt at typology. BMC Health Services Research. 2009; 9: 63. doi: 10.1186/1472-6963-9-63.
31. Weng HC, Steed JF, Yu SW, Liu YT, Hsu CC, Yu TJ, Chen W. The effects of surgeon empathy and emotional intelligence on patient satisfaction. Adv Health Sci Educ Theory Pract. 2011, 16: 591–600.
32. Larson EB & Yao X. Clinical empathy as emotional labor in the patient-physician relationship. JAMA. 2005; 293(9): 1100–1106.
33. Smith P & Gray B. Reassessing the concept of emotional labour in student nurse education: role of link lecturers and mentors in time of change. Nurse Educ Today. 2001; 21: 230–237.
34. Henderson A. Emotional labor and nursing: as under-appreciated aspect of caring work. Nurs Inq. 2001; 8(2): 130–138.
35. Sęk H. Cognitive and competence conditions of burnout in work with sick people. Postępy Psychiatrii i Neurologii. 2005; 14 (2): 98 (in Polish).
36. Wilkes LM & Wallis MC. The five C’s of caring: the lived experiences of student nurses. Aust J Adv Nurs. 1993; 11: 19–25.
37. Wilkes LM & Wallis MC. A model of professional nurse caring: students’ experiences. J Adv Nurs. 1998; 27: 582–589.
38. Colaizzi PF. Psychological research as the phenomenologist views it. In: Valle RS & King M. eds. Existential phenomenological alternatives for psychology. Oxford University Press, New York 1978.p.48–71.
39. Fredriksson L & Eriksson K. The ethics of the caring conversation. Nurs Ethics. 2003; 10: 138–148.
40. Lévy-Malmberg R, Eriksson K, Lindholm L. Caritas; caring as an ethical conduct. Scand J Caring Sci. 2008; 22: 662–667.
41. Gastmans C. Care as a moral attitude in nursing. Nurs Ethics. 1999; 6: 214–223.
42. Martinsen K. Care and vulnerability. Norway, Akribe 2006. In: Austgard K.I. What characterizes nursing care? A hermeneutical philosophical inquiry. Scand J Caring Sci. 2008; 22: 314–319.
43. Tschudin V. Ethics in nursing. The caring relationship. Butterworth-Heinemann, Edinburgh, 2003.
44. Finfgeld-Connett D. Concept comparison of caring and social support. Int J Nurs Terminol Classif. 2007; 18(2): 58–68.
45. Department of Health. High quality for all: NHS Next stage – final report (the Darzi review). Department of Health, London, 2008.
46. Monteverde S. The importance of time in ethical decision making. Nurs Ethics. 2009; 16: 613–625.
47. Legare F, Ratte S, Gravel K, Graham ID. Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals’ perceptions. Patient Educ Couns. 2008; 73: 526–535.
48. Fryderycka D & Chybicki M. Doctor-patient communication – does it take two to tango? In: Janowski K & Steuden S eds. Biopsychosocial aspects of health and disease. Volume 2. Wydawnictwo Gaudium, Lublin 2009.p.191–196.
49. Lundberg PC & Boonprasabhai K. Meaning of good nursing care among Thai female last-year undergraduate nursing students. J Adv Nurs. 2001; 34: 35–42.
50. Noddings N. Caring. A feminine approach to ethics and moral education. Second edition. University of California Press, Berkeley CA 2003.
51. De Valck C, Bensing J, Bruynooghe R, Batenburg V. Cure-oriented versus care-oriented attitudes in medicine. Patient Educ Couns. 2001; 45(2): 119–126.
52. Horowitz CR, Suchman AL, Branch WT, Frankel RM. What do doctors find meaningful about their work? Ann Intern Med . 2003; 138: 772–776.
53. Baumann A, Deber R, Silverman BE, Malette CM. Who cares? Who cures? The ongoing debate in the provision of health care. J Adv Nurs. 1998; 28: 1040–1045.
54. Hanson S. Teaching health care ethics: why we should teach nursing and medical students together. Nurs Ethics. 2005; 12: 167–176.