title: The contexts of caring: conscience and consciousness.
abstract: In this paper, I have maintained a distinction between person and self in order to describe and analyze contexts of caring in nursing encounters. As the nursed person's perspectives are examined in light of the nurse's capacity to engage his or her own experience, four contextual categories emerge: comprehension, consideration, concern, and communion. Such concepts can help us describe and analyze many situations in clinical nursing and in nursing education. The following paragraphs describe several of the possibilities for future research. It is important to study in which contexts in nursing personhood and selfhood are enhanced and when they are diminished. Diminishment of personhood leads to depersonalization which describes a condition of loss of agency and helplessness in a world where others are in control. This can happen to the nursed person and to the nursing person. When nurses are placed in contexts where they experience lack of agency and authority in their practice settings (even when they attempt to engage others with concern and compassion), they can start to feel and become depersonalized. Diminishment of self leads to dehumanization, which describes a loss of contact with one's own experience. Rules and relationships are oppressive or inflexible and the participants experience meaninglessness. For example, how long can nurses be in daily situations of administering painful procedures to patients without experiencing dehumanization? The same question can be asked of nurses at all levels in hierarchies, and in all relationships, for example, nursing instructors with students, nurse administrators with staff nurses, faculty in academic institutions, and staff nurses with each other. Depersonalization and dehumanization eventually lead to one another. Another significant question to explore could be this: In which of the four contexts defined above does the nurse experience most satisfaction, most dissatisfaction, and the condition we call burnout? We live in a world, a society, and a profession where depersonalization and dehumanization are the plight of many. How can personhood and selfhood be enhanced or even restored in our hospitals, clinics, classrooms, and academic institutions? I propose that investigations of the contexts of caring can help us explore, discover, describe, and analyze these questions.
authors.forename: M T
authors.initials: MT
authors.lastname: Dombeck
mesh_terms: D003242:Conscience; D004645:Empathy; D006808:Humanism; D006801:Humans; D009723:Nurse-Patient Relations; D009732:Nursing Care / Q000592:standards*; D012649:Self Concept