In a nutshell . . . .
This page introduces you to the fourth of the six ideas that give life to the Therapeutic Milieu, Caritas. Caritas is a Latin word that's meaning in English is charity. But the word charity has lost its original meaning as expression of the spiritual quality of love. Because charity is now understood mainly as financial or material generosity to people in need, Careful Nursing keeps caritas so we can keep to its original meaning.
You will see that Caritas is a complex idea – and as a type of love, it is easily misunderstood. You will find a summary of the many meanings of love. Caritas can be described as generosity of spirit, as the expression of unconditional benevolent affection of one human person for another, or as willing what is good for another, for the other's own sake and well-being.
You will find an overview of the origin of caritas and the history of caritas as a nursing idea. You will also find a summary of the use of the idea of caritas in contemporary nursing literature; some consistent with Careful Nursing and one essentially different from the meaning of caritas in Careful Nursing.
You will learn that a number of very important value habits, for example, patience and kindness, enable and support expression of Caritas in Careful Nursing. You will also find an example of a post-operative patient's experience of Caritas as it was expressed by a nurse taking care of him following his surgery.
Caritas is the fourth concept of the Therapeutic Milieu because nurses require for its expression the ability to be calm, to be intellectually engaged and to respect the inherent human dignity of themselves and others.
Caritas is nurses' experience and expression of love for patients and others as the benevolent affection of one human person for another that flows through nurses' inner awareness of their sharing in the infused love of Infinite Transcendent Reality in life processes. Caritas is a love which arises in the spirituality of human persons; as such it is unconditional and expressed irrespective of the characteristics of the person who is loved. Importantly, nurses' expression of Caritas is enabled and supported by habits of patience, attentiveness, empathy, gentleness, kindness and compassion.
Caritas is a complex concept and as a type of love it is easily misunderstood. Caritas has also been subject to re-definition in ways that are inconsistent with its original philosophical meaning. Thus, it is important to explore the origin and nature of the concept of Caritas.
Caritas is the Latin name for the spiritual aspect of love. The English translation of caritas is charity but the word charity has largely lost its original meaning; it is now understood mainly as financial or material generosity to people in need. For this reason caritas is used to retain the original meaning of charity as the spiritual generosity of love for others.
The many meanings of love
Love is a word to which we attach many different meanings, for example, love of country, love of our profession, love of sport, love between family members, love between friends, love for others generally, and love for God. We are aware of the sensual yearning of eros and its meaning of a special attraction for another person or for exceptional beauty which draws us to seek its fulfilment and joy. Because we often think of love only in terms of personal relationships and sensuality, as nurses we can find the idea of loving our patients alarming.
But caritas is a spiritual aspect of love that has its source in Infinite Transcendent Reality and is expressed through the intellect and spiritual essence of human persons. As such, it is an impartial, deeply benevolent affection of one human person for another; it is transmitted though the will rather than through transient emotions (De Young et al. 2009)
Because we are unitary beings the many meanings of love are interrelated within us. At different times we are motivated primarily by one or other of the different meanings of love. In professional nursing practice we are motivated by the love of caritas and other meanings of love fade into the background.
Origin of caritas
The word caritas has its origin in the Hebrew word ahabà as it was used in the Torah to mean, broadly, a mature loving, self-giving concern and care for other people, closely associated with the love of Yahweh for His people (Jackson 1999). When the Torah was translated from Hebrew into Greek during the 3rd to 1st century BC, ahabà was translated as agapē. Prior to this time agapē had been an obscure and little-used word which meant affection, usually within a family.
Among the aspects of love recognised in ancient Greece, three types were prominent; agapē, spiritual love; philia, love of friendship; and érōs, a relational, creative love of desire. As Christianity emerged and Latin became the dominant language these words were translated into Latin; agapē as caritas, érōs as eros, and philia became amacitia (Jackson 1999). In its origin, agapē or caritas is a Judeo-Christian concept. At the same time, Jackson observes that agapē resonates with some non-Christian virtues, although only in Christianity is agapē, and thus caritas, given prominence.
History of caritas in nursing
In the 1st century AD with the development of Christianity nursing as a public service began to gain prominence in the Western world. Caritas was a guiding principle in the work of early nurse prototypes, for example, the 1st century Phoebe of Cenchreae who was a deaconess companion of Paul of Tarsus, and the 4th century deaconess Fabiola who established the first free hospital in Rome (Egenes 2018). Nursing as "compassionate accompaniment" (Donley 1991, p. 179), especially of the poor and dispossessed, became the driving force of nursing as it developed and flourished across Europe, despite natural disasters and political and theological upheavels.
Caritas was the guiding principle of the Daughters of Charity, founded in the 17th century by Louise de Marillac, who became famous for their nursing service (Carr 2001). It was from Sisters of Charity that Florence Nightingale first sought to learn about hospital nursing and management (Sattin 1987, Scanlon 1991, Vicinus & Nergarrd 1989). Today with unassuming commitment, Sisters of Charity continue to hold caritas as their guiding motto; Caritas Christi urget nos; in their many hospitals and health systems around the world. In keeping with their heritage they have "said little" while they "[did] much" nursing (Nelson 2001), meaning they focused on their practice but didn't publish about it; this probably accounts for the virtual absence of their practice principles in contemporary nursing literature.
Caritas in contemporary nursing literature
Caritas as an aspect of nursing practice was introduced to recent nursing literature in 1989 by Katie Eriksson as the caritas motive, a motive proposed to guide all human caring in society at-large and particularly in nursing. Eriksson (1990) argues that caritas is caring in its original form; "caring which is based on human love", having "a real interest in doing something for another person, by attending, in a deep sense feeling responsible for another person. It is human love and mercy, it is willingness to serve another person" (p.4).
Eriksson (1997) also describes caritas as "a vaccine for the weary" (p. 45.), implying that nurses draw on caritas for their own health from a spiritual source within themselves. Drawing on philosophical sources and practice experience, Eriksson developed her work on caritas into the theory of caratative caring (Lindstrom et al. (2018). This theory has caritas as a principle concept, an understanding of caritas that is similar to that of Careful Nursing.
The word caritas became more widely known in nursing in 2006 when it was adopted by Jean Watson into her theory of human caring. In 1990 Watson sought to transform nursing knowledge into a caring science encompassing transpersonal caring relationships, drawing on an expansive cosmic love. At first, caring relationships were guided by ten carative factors. Then in 2006 Watson replaced carative factors with caritas processes to be implemented according to 'clinical caritas' and 'caritas consciousness'.
Watson (2005) describes her understanding of caritas as magnetic and a supreme life force that is synonymous with love. Watson (2006) proposes that caritas is derived from the Greek word, carus, meaning to cherish. In fact, carus is a Late Latin word meaning one person being dear to or cherished by another (Partridge 2008). While carus is somewhat similar to caritas, its origin and specific meaning are different. Watson constructed her own definition of caritas. Although Watson's understanding of caritas may appear similar to caritas in Careful Nursing, it is essentially different from the understanding of caritas in Careful Nursing.
Caritas in Careful Nursing
Caritas in its original meaning is of central importance in the Therapeutic Milieu dimension of the professional practice model because it enables the highest possible helping and healing quality of our relationships with the people we care for. Likewise, it shapes the quality of our relationships with nursing colleagues and assistants, other health professionals, and all who we encounter in our practice.
Caritas is complex and includes several interrelated dimensions. Drawing on its spiritual foundation caritas enables us to have patience and to be attentive, empathic, gentle, tender, kind, compassionate, joyful and peaceful in our practice. These dimensions are "signature" qualities of nursing practice, qualities which have special value for us. In fact, we think of these qualities as values and we know that values are what motivate us (Stein 1922/2000). We can call these dimensions caritas values. Let us consider each caritas value, described mainly according to the philosophy of Aquinas (1265-1274/2007, I, II, Q26-28; II, II, Q23-26, 30).
Value habits which support Caritas
Habits are ways of living our values and giving them meaning in our practice. The following value habits in particular enable and support expression of Caritas:
Having patience is a value similar to fortitude, which is a strength that helps us resist being overcome by difficulties we face. For example, in our practice having patience can help us overcome feelings of being irritated or annoyed when we can't do something quickly. This can happen when we are under pressure and in a situation such as administering a medication to a patient who is slow to take it because of physical or cognitive disabilities. Having patience under pressure can become a habit over time. Each time patience is achieved, it makes it easier to achieve it the next time patience is called for.
Being attentive is a value that happens in our intellect and enables us to focus on a person without being distracted. It reflects a keen interest in the person. This value comes into play especially when we approach a patient, whether to greet them briefly or engage in a longer interaction. Patients know intuitively when we are attentive to them, when we actually "see" them with our mind. They are assured by knowing they have been individually recognised. Even when we are attentive to patients for only a few seconds in passing, they can feel it as a life-line. In a longer interaction attentiveness fosters a healing nurse-patient relationship.
Having empathy is a value whereby we open ourselves to our ability to be conscious of the conscious experience of other persons in a secondary way; empathy is purely conscious experience. In an attentive relationship with a person we experience what the person feels without having the actual experience ourselves (Stein 1917/1989). For example, if a patient is afraid or suffering we can become fully conscious of their fear or suffering without being afraid or suffering ourselves. Patients' can feel supported by our empathic sharing of their experiences. And, our empathic awareness can enhance the accuracy of our patient watching-assessment-recognition, and clinical reasoning and decision-making.
Being gentle is a value which moderates any excessive attitudes or actions we may find ourselves drawn to engage in, especially if we are feeling stressed or under pressure. Gentleness is always free from impatience or irritation. A gentle manner in the face of patients' often understandable impatience and irritation with their illness can help them defuse such feelings. In addition, often enough we find ourselves or others not practicing as well as expected. In correcting ourselves and in offering correction to others gentleness is of foremost importance.
Being tender is a value which enables us to reach (stretch) in our intellect toward people who we perceive as vulnerable with the intention to help them (Frijda (1986). Tenderness also enables us to give special expression to being "soft" or very delicate in our attitudes and activities with patients who are very ill and are experiencing anguish and suffering. For example, a patient who is dying may yearn for a few mouthfuls of toast soaked in warm milk and need this to be fed to him slowly and with the greatest patience and attentiveness (Galland 2008). Tenderness encompasses a special sensitivity to a patient's need for softness of approach, movement, touch and voice.
Being kind is a value which concerns our kinship with all human beings. The origin of the word kind means that all human beings are kin or naturally part of one human family (Partridge 2008). Kindness describes our inborn disposition to "have feelings befitting our common nature"; to be naturally "disposed to do good and confer happiness" (Porter 1891, p. 813). We can think of kindness as "kin-ed-ness"; having a manner of recognising and helping one another as kin, whether or not we personally like one another. Common use of the term loving-kindness in Eastern and Western cultures indicates the close relationship between kindness and the love of caritas.
Being compassionate is a value which reflects its Latin origin, misericordia, meaning the heartfelt (cordia) experience of the other's misery (miseri) which impels us to provide succour if possible. Succour means "to run to the help of" someone in need (Partridge 2008, p. 125). Thus, compassion is an immediate response to misery and suffering experienced by people we care for. Their experience may be acute, such as physiological pain and distress or situational, such as having to plan care for themselves alone with minimal resources and diminished personal capacity.
Being joyful is a value which harmonises closely with our spiritual being and encompasses the expectation to achieve in the present or future what is good and beautiful. Joy is also described as an aspect of staying lovingly with something for its own sake (Porter 1891). Joy is more than pleasure, which mainly concerns the body and senses, and more than happiness, which mainly concerns satisfaction with life (Sloan 2011). In nursing practice we can think of our commitment to nursing as staying lovingly with something for its own sake, despite the stresses and difficulties we sometimes encounter. Joy is evident in a ready smile in nurse-patient relationships and in all professional relationships.
Being peaceful is a value which is also harmonises closely with our spiritual being and follows closely on joy. Peacefulness can be thought of as arising from joy and bringing with it the ability not to be disturbed by outward things; it allows our intention to rest on the helping, healing purpose of our practice. Peacefulness is closely associated with our ability to have patience in our practice and allow for delay when it is needed for a healing outcome. Peacefulness has a unifying influence and especially communicates itself to others so that in being peaceful in our practice we foster peacefulness in patients, colleagues and others.
Notice that these supporting value habits; these "signature" qualities of nursing practice; are closely interrelated and that they build on one another.
Our value habits begin with patience because we need to have patience in order to be attentive.
When we are attentive we open ourselves to being empathic. Having empathy opens up for us conscious but seperated experience of patients' lived experiences of their world.
Our empathic insight and understanding of a patient's lived experience gives meaning to the importance of our need to be gentle, tender, kind and compassionate in our practice.
Joy comes from our insight into the goodness and beauty possible in our professional nursing practice and leads to our sense of peacefulness, despite the many stressors that may surround us.
In turn, as if completing a circle, peacefulness supports our ability to be calm and have patience.
At first caritas may seem very complicated. You might wonder, "how can I keep all these value habits in mind and implement them with every patient"? You might think, "I'm too busy; I don't have time to do all that".
But caritas has its own mysterious solution to these concerns. Once you become aware of its underlying value habits and think about them as you practice, over time they embed themselves in your being and express themselves in your practice naturally while you are thinking of other things. In a way you just become caritas.
How might a patient experience your "caritas being"?
"The night nurse . . . moved without sound, seemed a constant presence in the room, and yet I know she must have had other charges. She came and went, explaining in a whisper the things she needed to do: injections, drips, catheter, something about the drain from my side. . . . As I watched the nurse going about her tasks, a strange mixture of shame and gratitude came upon me: shame that she was required to deal with my bodily detritus; gratitude that she was there and did not seem to regard this as an imposition".
"It struck me that here I was in [a place] where a perfect stranger was prepared to treat me with something indistinguishable from love" (Waters 2018)".
The patient experienced one human person (a nurse) in relationship with another human person (sick, injured and vulnerable); spirit centred being to spirit-centred being; in the mind and heart of caritas.
Caritas 'I will' statements
Sit quietly in a chair, close your eyes and take a moment to relax. Recall the caritas values and take a few moments to reflect on each value.
Bring to mind your practice experiences over the past three months.
On a scale of 1 to 10, how do you rate your level of patience with patients?
On a scale of 1 to 10, how do you rate your degree of attentiveness to patients?
On a scale of 1 to 10, how do you rate your ability to empathise with patients?
On a scale of 1 to 10, how do you rate your level of gentleness toward patients?
On a scale of 1 to 10, how do you rate your level of tenderness toward patients?
On a scale of 1 to 10, how do you rate your level of kindness toward patients?
On a scale of 1 to 10, how do you rate your level of compassion toward patients?
On a scale of 1 to 10, how do you rate your level of joy in your practice patients?
On a scale of 1 to 10, how do you rate your level of peacefulness in your practice?
Based on your assessment of your current level of implementation of caritas values in your practice, decide what you will do to further develop your ability to implement caritas values in your practice?
Examples of caritas 'I will' statements:
. . . treat patients as real persons and not just bed numbers
. . . work on always having patience when caring for patients
. . . continue to be kind to patients/family members if their behaviour is challenging
. . . . . . . . . . . . . . . . . . . . . . . . be more aware of my love of helping and healing
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Therese C. Meehan © July 2020