Transforming Care: A Christian Vision of Nursing Practice by Mary Molewyk Doornbos;Ruth Groenhout;Kendra G. Hotz Page B
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expertise and experience. It would
be a mistake to think that in giving care nothing is traveling in the reverse
direction. In fact, without the reciprocal gifts of respect, gratitude,
warmth, and humanity that clients can offer, nursing would be an unattractive profession. And as scheduling pressures and lack of funds have
made this reciprocity harder and harder to maintain in acute care settings,
nursing has become more stressful and less rewarding. The problem of
mid-career burnout has clear connections to the structures that prevent
reciprocity in the nurse/client relationship.
Persons as Co-authors
We have described embodiment as enjoyment and vulnerability, freedom
and responsibility, all drawn together in the image of God; but this still
leaves something unsaid because it treats persons as if they were complete
at any given instant. Such a description omits the ways in which identity
involves being a character in a narrative with a past, present, and future
plot (Maclntyre 1984, 206). Ann and Janet are not abstract embodied
agents. Each of them also has a history that has determined the shape of
her character and makes sense of her choices and actions. Part of this story
is composed of the social roles into which we are born. None of us enters
society as a generic human being. We begin our lives as someone's son or
daughter, as a citizen of a nation and a member of a particular society and
civilization. Each of these roles involves expectations and responsibilities.
We enter the world as members of ethnic groups with particular languages, concepts, assumptions, rules for the proper use of humor, and so
forth, all of which constrain the shape that the story of our lives can take, while providing the necessary context within which those stories can be
told. Without membership in those larger social groupings I would have
no particular identity - which is to say, no identity at all, for identity is always particular.
To be a person is to be historically and socially situated. Each person
has a character informed by social expectations about gender, social class,
nation, race, and ethnicity as well as by assumptions about duties, rights,
goods, dangers, temptations, evils, and obligations. Both Janet and Ann
enter their interactions with each other from the midst of such social presuppositions about identity and roles. Their identities as characters, including their social roles as nurse and client, only make sense against the
backdrop of the narratives of the communities - family, society, nation,
civilization - in which they are embedded. Most of the time we simply assume that these identities exist, without paying them much attention, but
when we find ourselves working in a context where groups with critical
cultural differences must interact, we suddenly become aware of how
deeply our assumptions of identity structure our lives.
Culturally congruent nursing
care can only occur when
culture care values, expressions, or patterns are known
and used appropriately and
meaningfully by the nurse
with individuals or groups.
MADELEINE M. LEININGER
However, the social situation in which one is a character is not the
only feature that marks personal identity. One is always a character in a
narrative in two ways: first, passively, to the extent that one's life is scripted
by historical and social conditions; and second, actively, to the extent that
one affirms or rejects those conditions.
Just as independence is always relative to
vulnerability and dependence, so active
determination of the direction and meaning of one's life always takes place against
the background of social and historical
possibilities. Both Janet and Ann exhibit
this mixture of activity and passivity, albeit in different ways. Janet, we might
think at first glance, is largely the agent in
this narrative fragment, the one who has
the freedom to come into the room, actively checking diagnostic information,
be a mistake to think that in giving care nothing is traveling in the reverse
direction. In fact, without the reciprocal gifts of respect, gratitude,
warmth, and humanity that clients can offer, nursing would be an unattractive profession. And as scheduling pressures and lack of funds have
made this reciprocity harder and harder to maintain in acute care settings,
nursing has become more stressful and less rewarding. The problem of
mid-career burnout has clear connections to the structures that prevent
reciprocity in the nurse/client relationship.
Persons as Co-authors
We have described embodiment as enjoyment and vulnerability, freedom
and responsibility, all drawn together in the image of God; but this still
leaves something unsaid because it treats persons as if they were complete
at any given instant. Such a description omits the ways in which identity
involves being a character in a narrative with a past, present, and future
plot (Maclntyre 1984, 206). Ann and Janet are not abstract embodied
agents. Each of them also has a history that has determined the shape of
her character and makes sense of her choices and actions. Part of this story
is composed of the social roles into which we are born. None of us enters
society as a generic human being. We begin our lives as someone's son or
daughter, as a citizen of a nation and a member of a particular society and
civilization. Each of these roles involves expectations and responsibilities.
We enter the world as members of ethnic groups with particular languages, concepts, assumptions, rules for the proper use of humor, and so
forth, all of which constrain the shape that the story of our lives can take, while providing the necessary context within which those stories can be
told. Without membership in those larger social groupings I would have
no particular identity - which is to say, no identity at all, for identity is always particular.
To be a person is to be historically and socially situated. Each person
has a character informed by social expectations about gender, social class,
nation, race, and ethnicity as well as by assumptions about duties, rights,
goods, dangers, temptations, evils, and obligations. Both Janet and Ann
enter their interactions with each other from the midst of such social presuppositions about identity and roles. Their identities as characters, including their social roles as nurse and client, only make sense against the
backdrop of the narratives of the communities - family, society, nation,
civilization - in which they are embedded. Most of the time we simply assume that these identities exist, without paying them much attention, but
when we find ourselves working in a context where groups with critical
cultural differences must interact, we suddenly become aware of how
deeply our assumptions of identity structure our lives.
Culturally congruent nursing
care can only occur when
culture care values, expressions, or patterns are known
and used appropriately and
meaningfully by the nurse
with individuals or groups.
MADELEINE M. LEININGER
However, the social situation in which one is a character is not the
only feature that marks personal identity. One is always a character in a
narrative in two ways: first, passively, to the extent that one's life is scripted
by historical and social conditions; and second, actively, to the extent that
one affirms or rejects those conditions.
Just as independence is always relative to
vulnerability and dependence, so active
determination of the direction and meaning of one's life always takes place against
the background of social and historical
possibilities. Both Janet and Ann exhibit
this mixture of activity and passivity, albeit in different ways. Janet, we might
think at first glance, is largely the agent in
this narrative fragment, the one who has
the freedom to come into the room, actively checking diagnostic information,
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