Scand J Caring Sci; 2012; 26; 427-435 Care as a matter of courage: vulnerability, suffering and ethical formation in nursing careThe aim of the study was to explore nurses' experience of how their own vulnerability and suffering influence their ethical formation and their capacity to provide professional care when they are confronted with the patient's vulnerability and suffering. Care is shaped in the meeting between human beings. Professional care is informed by the patient's appeal for help as it is expressed in the meeting. Ethical formation is understood as a personal ethical and existential process, resulting in the capacity to provide professional care. A nurse must have the sense of being a complete human being with own personal attributes and sensitivity in order to be able to relate to other people. The study is based on qualitative interviews with 23 experienced nurses from Sweden, Finland and Denmark. The analyses and interpretation were carried out in line with Steinar Kvale's three levels of interpretation. The study clarifies that ethical formation is a union of the nurse's personal attributes and professional qualifications and that ethical formation is developed over time. Moreover, it also demonstrates that the nurse's personal and professional life experiences of vulnerability and suffering influence ethical formation. Vulnerability and suffering have proven to be sensitive issues for nurses, like a sore point that either serve as an eye-opener or cause the development of blind spots. Furthermore, vulnerability, suffering and the sore points are seen to shape the nurse's courage in relation to care. Courage appears to be a significant unifying phenomenon that manifests itself as the courage to help patients face their own vulnerability and suffering, to bear witness to patients' vulnerability and suffering and to have faith in oneself in arguing for and providing professional care. Courage thus seems to play a significant role in nurses' ability to engage in care. Nurses' own vulnerability, suffering and sore points seem to shape their courage.

The aim of the study reported in this paper was to describe and analyse care-givers' caring relationships with patients suffering from dementia. The theoretical perspective was caring science. Data were collected through interviews with six care-givers in a ward for patients with severe dementia. From the qualitative analysis of the narratives, the following factors emerged as important for the caring relationships: 'touching', mutual 'confirmation', and the care-givers' 'values in the caring culture' in the ward. We conclude that communication skills are very important in a ward where patients with severe dementia reside, and that there is always a need for formulating the basic values. Theoretical education and clinical supervision are examples of means to improve competence and skills.

The findings show how different conceptions of power occur within nursing science, differences that can be interpreted as different views of human beings and ethics. Among the advocates of empowerment in caring, there is a desire to eliminate the difference in power between nurse and patient. The relationship between nurse and patient becomes mutual through the patient’s participation in and responsibility for his/her own care. But from a caring science perspective, a caring relationship is not mutual since nurse and patient cannot change places due to being on different levels nor can responsibility be delegated from nurse to patient.

The ultimate aim of caring is to preserve a person’s dignity, his/her absolute value as a human being, and the right of self-determination. Caregivers experience a sense of impotence when, for various reasons, they are unable to provide care that preserves the patient’s dignity. This may lead to burnout and drop-out from the profession. This paper discusses shared humanity, moral behavior, and responsive relationships as sources of caring as described in the literature.

The ultimate aim of caring is to preserve a person’s dignity, his/her absolute value as a human being, and the right of self-determination. Caregivers experience a sense of impotence when, for various reasons, they are unable to give care that preserves the patient’s dignity. This may lead to burnout and dropout from the profession. This paper discusses shared humanity, moral behavior, and responsive relationships as sources of caring as described in the literature.