IS IT IMPOSSIBLE TO NURSE SOMEONE
WHO IS IN AN UNCONSCIOUS OR
ALTERED STATE OF AWARENESS?
The key point here is the “caring between” that is
the nursing creation: When nursing a person who is
unconscious, the nurse lives the commitment to
know the other as caring person. How is that com-
mitment lived? It requires that all ways of knowing
be brought into action. The nurse must make self as
caring person available to the one nursed. The full-
ness of the nurse as caring person is called forth.
This requires use of Mayeroff ’s caring ingredients:
the alternating rhythm of knowing about the other
and knowing the other directly through authentic
presence and attunement; the hope and courage to
risk opening self to one who cannot communicate
verbally; patiently trusting in self to understand the
other’s mode of living caring in the moment; hon-
est humility as one brings all that one knows and
remains open to learning from the other. The nurse
attuned to the other as person might, for example,
experience the vulnerability of the person who lies
unconscious from surgical anesthetic or traumatic
injury. In that vulnerability, the nurse recognizes
that the one nursed is living caring in humility,
hope, and trust. Instead of responding to the vul-
nerability, merely “taking care of ” the other, the
nurse practicing nursing as caring might respond
by honoring the other’s humility, by participating
in the other’s hopefulness, and by steadfast trust-
worthiness. Creating caring in the moment in this
situation might come from the nurse resonating
with past and present experiences of vulnerability.
Connected to this form of personal knowing might
be an ethical knowing that power as a reciprocal of
vulnerability has the potential to develop undesir-
able status differential in the nurse-patient role re-
lationship. As the nurse sifts through a myriad of
empirical data, the most significant information
emerges—this is a personwith whom I am called to
care. Ethical knowing again merges with other
pathways as the nurse forms the decision to go be-
yond vulnerability and engage the other as caring
person, rather than as helpless object of another’s
concern. Aesthetic knowing comes in the praxis of
caring, in living chosen ways of honoring humility,
joining in hope, and demonstrating trustworthi-
ness in the moment (Schoenhofer & Boykin, 1993,
pp. 86–87).
HOW DOES THE NURSING
PROCESS FIT WITH THIS
THEORY?
Process, as it is understood in the term “nursing
process,” connotes a systematic and sequential se-
ries of steps resulting in a predetermined, specifi-
able product. Nursing process, as introduced into
nursing by Orlando (1961), is a linear stepwise
decision-making tool based on rational analysis of
empirical data (known in other disciplines as the
problem-solving process) and is a key structural
theme of many nursing theories developed in past
decades. Proponents of the theory of nursing as
caring view nursing not as a process with an
endpoint, but as an ongoing process; that is, as
dynamic and unfolding, guided by intentionality
although not directed by a preenvisioned outcome
or product. Nursing responses of care arise in
aesthetic knowing, in the creative and evolving
patterns of appreciation and understanding, and in
the context of a shared lived experience of caring.
Instead of preselected and quantifiable outcomes,
the value of nursing to the nursed and to others is
that which is experienced as valuable arising in and
evolving through the “caring between” of the nurs-
ing situation. Much of that value is neither measur-
able nor empirically verifiable. That which is
measurable and empirically verifiable is relevant in
the situation, however, and may be called upon at
any time to contribute to and through the nurse’s
empirical knowing. Information that the nurse has
available becomes knowledge within the nursing
situation. Knowing the person directly is what
guides the selection and patterning of relevant
points of factual information in a nursing situa-
tion. That is, any fact or set of facts from nursing
research or related bodies of information can be
considered for relevance and drawn into the sup-
porting knowledge base. This knowledge base re-
mains open and evolving as the nurse employs an
alternating rhythm of scanning and considering
facts for relevance while remaining grounded in the
nursing situation (Schoenhofer & Boykin, 1993,
pp. 89–90).
In addition to empirical knowing, knowing for
nursing purposes also requires personal knowing,
including intuition and ethical knowing, all con-
verging in aesthetic knowing within each unique
nursing situation.CHAPTER 21 Anne Boykin and Savina O. Schoenhofer’s Nursing as Caring Theory 343