Formal programs of education are an important means by which social groups transmit their culture to neophyte members. A central focus for students in a program of study is the examination and personalization of values fundamental to the culture. Nursing as a profession is a particular group in society, a culture characterized by a distinctive system of values. A program of education for nursing should address that value system.
When caring is fully understood, it is recognized as "the human mode of being" (Roach, 1984). Nursing, with its focus on the person living life, is necessarily characterized by caring. Caring is recognized as the spirit of nursing, its fundamental cultural value.
The primary spiritual values of love, truth, and beauty are illuminated in the caring nature of nursing and are appropriately acknowledged and nurtured in nursing curricula. Carper (1978) described the patterns of knowing essential for nursing positioning personal, ethical, and aesthetic knowing on a par with empirical knowing. Nursing education provides the cultural milieu within which the fundamental spiritual values of love, beauty, and truth can be experienced, appreciated, and creatively expressed.
In his critique of Kant, Healy (1986) suggested that feeling is the mediator between desire and cognition. Reinterpreted, beauty is the mediator between love and truth. The unifying character of aesthetic knowing, recognized by Phénix (1964) and Carper (1978), was the basis for an assignment given to students in a beginning nursing course. Students were invited to "creatively express the beauty of other as illuminated through nursing." The resulting projects represented many forms of expression: music, poetry, photography, puppetry, prose, painting, drama, and poster art. Some of the projects focused on the beauty of cultural variation, others on the beauty of shared experience, and many on the beauty of the unique individual. Images of love and truth were apparent in these expressions of beauty, thus reflecting the integrity of the caring spirit of nursing.
Laird (1929), in The Idea ofValue, noteda resurgence of interest in values as a topic of study and discourse, remarking "value may prove to be the key that will eventually release all the human sciences from their present position of pathetic, if dignified, futility" (p. xix). Many decades later, nursing is engaged in the continuing effort to humanize the practice and product of science as inquiry is directed toward caring as a value system for the discipline. Laird includes love, beauty, and truth among what he terms the "great values" (1929, p. xv). Watson (1985) proclaims caring the moral ideal of nursing. Laird calls ideals the "poetry of values" (1929, p. 375) and describes an ideal as a pattern or exemplar, an organization of values.
Value, the noun, has as its most common meaning "worth" or "the property of worth." The noun form is also used to denote the thing possessing characteristics of dignity, nobility, and good. Laird (1929) discussed three divisions of value: economic value (exchange or relative value); hedonistic value (desire, pleasure, satiety); and moral value (summum bonum, the greatest or ultimate good). The division of value addressed here is moral or ultimate value.
Parse (1981) described a value as a symbol that signifies meaning, a sign of meaning, and valuing as making meaning. Further, valuing is man's process of confirming cherished beliefs and is reflective of one's world view. Valuing as a process includes choosing, prizing, and acting; that is, choosing freely from alternatives, as well as choosing reflectively; cherishing and affirming that choice; and carrying out and repeating the chosen course.
Evaluating is often given as the opposite of valuing. Laird (1929) differentiated between evaluating and prizing: "we evaluate something when we think out its values and determine their place on a definite scale. Prizing, on the other hand, is defined as 'setting store by1 " (p. xv).
Paterson and Zderad (1988) have raised the question of how to transform a negatively judgmental attitude to one of prizing. The solution they propose requires the willingness and openness to choose to respond to the complement as valuable: to choose to respond to the unloving as loving, the unbeautiful as beautiful, and the untruth as truth. At first glance, that solution may seem to make absolute values relative. From a holistic perspective, however, the complements are seen as two of the many aspects of a single unity.
The correctness of this alternating rhythm was conveyed by a student in her narrative account of recognizing the utter dignity of an old woman named Dee. Dee was described as nicely confused with dyed rusty-colored hair sticking straight up, nasal oxygen prongs clenched in her hand, wrist restraints half off, and bare legs dangling from the bed through the side rails. Dee's concept of herself as a prim, proper, dignified lady was communicated in her reminding the student that she did not expose herself to the opposite sex, pointing to the man on the television screen. The ugliness of the situation was the backlight that permitted the student to see and recognize the loveliness of the person.
Scheler (in Deeken, 1974) described love as not merely a reaction nor a preference, but rather a dynamic, transforming presence that powers the human quest for selftranscendence. One student extemporaneously expressed her love for the class, that is, herself and her classmates as growing together in grace and beauty, knowing each other in unspoken ways. She accompanied these thoughts with her exquisitely framed sketch depicting Gibran's poem:
Bugbee (1966) wrote in Humanitas that love is venturing to render what is called for and feeling the appropriateness of this call as a claim on us to share "being in the world." A "Letter to Mrs. Smith" from her nursing student expresses this love.
Dear Mrs. Smith,
When we met, I was feeling like a bumbling idiot, yet the next moment I was silently thanking you for putting me at ease with your openness. We looked at each other and I knew that you were totally aware of what I was feeling. You were so kind.
You took me into your home and we exchanged small talk while quietly assessing each other. I had expected a small, frail, hunched-over old woman. Instead I saw a beautiful, strong, and confident elderly lady.
We talked of your days past, your words so real and so vivid that I could almost feel the emotions of each moment. Sometimes a passing thought would silence us, both lost in different times yet sharing this moment together.
You expressed no regrets over the mistakes you made in your life; but stressed that the successes and personal achievements were only made sweeter by them. After much reflection of your life passages you told me that you were at peace to die.
As we said goodbye we held hands for a moment. I was thinking of how much you have affected my life, and how special every encounter can be to my own personal growth. I thought how you have let me feel your pain, share in your joys and sorrows, and now I understand a little bit more about the meaning of reaching out to someone and just caring.
Thank you, Mrs. Smith...
Truth is another facet of caring. Truth is that wholeness that demands universal acknowledgement (Urban, 1977). An original composition, music and words by a beginning nursing student, reveals the beautiful simplicity of truth known "Through Children's Eyes."
Hegel (in Paolucci, 1979) describes truth as wholeness, relative and absolute, objective and subjective, personal and general. Phénix (1964) adds that truth as a value basic to human life is not merely the sum of all true propositions but is also an ideal, a unity that is the light that illuminates the path of excellence. One student expressed this with eloquence and simplicity:
You have asked me to relate to you something beautiful in my world, whether it be person, place, or thing is my choice, but that it must be in some way tied into nursing and its patterning of wellness is yours. ...To choose just one entity that depicts beauty to me would do so many others injustice. Can I choose how the wind, which brings the scent of morning flowers and brewing coffee, sways gently the trees? Can I choose light, which carries the forms of the orchid? My daughter, my wife? Can I choose one person on this earth whose presence has made me feel worthy?...! can't, for my explanation for choosing would be too one-sided, too selfish, too shallow. Instead, I choose life, not just breathing life by our lungs, not just pumping life through our veins, but knowing life... realizing life. To be human is to be so much more than alive. Life, real life, is caring. It says so much if you read it slowly, thoughtfully: life is caring.
Another student experienced truth in "Caring for the Moment:"
Once upon a time not long ago, there was a girl named Mary who truly believed that to really care about another and to understand the essence of that person's inner beauty, time was needed and that the uniqueness of the individual could not be communicated in silent, brief encounters. This story is about how one of these silent, momentary encounters during my first semester as a nursing student has changed, modified, and enriched my beliefs about caring for and knowing the inner beauty of others.
The incidence occurred at the hospital where I was assigned to bathe an elderly woman who was labeled as incontinent and "out of touch with reality." As I entered my patient's room the distinct odor of urine and feces nauseated me and I wanted to run for the nearest exit out of the hospital. As I recomposed myself, I began thinking that there must be more to nursing than this and started preparing for my patient's bath. Once I began touching this individual, an unfamiliar but comfortable understanding between the two of us occurred and I felt at home with this person as though we had known each other our entire lives. Through touching we had somehow established a silent, communicable understanding of each other's being that was expressed through energy. Suddenly this person was no longer a difficult patient, but a distinct, thriving, unique individual who was sharing her patterns of individuality, caring, valuing, and reality with me. After our experience had ended and we said our unspoken goodbyes, I knew that through the nursing procedure of bathing, I had truly experienced the essence of another in a short encounter and had answered my own question about nursing.
The philosopher Santayana (1925, 1936) spoke of beauty as a vital harmony, felt and recognized as an expression of the eternal. Intuition and passion, he wrote, are conditions necessary to the liberation of beauty. Intuition and passion are abundantly evident in these student creations, and beauty flows freely in each. The beauty of the nursing relationship was shown by one student in a poster that depicted a relationship emerging as a bud from the ground of caring, growing and developing into full flower.
Phénix (1964) discussed aesthetic meaning as being particular rather than general, gained through acquaintance, not description. In a lyrical phrase, Santayana (1925) says that beauty transports the subject into the realm of essence. A young mother, a junior nursing student, communicated aesthetic meaning in a video production titled "Beauty is in the Will to Live." Using poetry, music, and visual images she portrayed her premature son's efforts to assert his will to live, and related that experience to the importance of finding the will to live within each nursing client to accomplish the goals of caring and nursing.
Incorporating formal learning experiences involving personal and aesthetic knowing, as well as the more usual emphasis on empirical and ethical knowing is one important method of valuing caring as the spirit of nursing. The student creations that resulted from this project illustrate the richness of nursing knowledge that is illuminated when truth is graced with beauty and warmed with love.
- Bugbee, H.G. (1966). On starting with love. Humanitas, 2, 149-164.
- Carper, B.A. (1978). Fundamental patterns of knowing in nursing. ANS, l, 13-24.
- Decken, A. (1974). Process and permanence in ethics: Max Schelers moral philosophy. New York: Pauliet Press.
- Gibran, K. (1976 ed). On beauty. In The Prophet. New York: Alfred A. Knopf Inc., p. 83.
- Healy, M.J. (1986). The two-fold foundation of the 'Analytic of the Beautiful': Kant's architectonic and human experience. Journal Value Inquiry, 20, 95-107.
- Laird, J. (1929). The idea of value. Cambridge: University Press.
- Parse, R.R. (1981). Man-Living-Health: A theory of nursing. New York: John WUey & Sons.
- PatersoD, J.G., & Zderad, L. T. (1988). Humanistic nursing. New York: National League for Nursing. (Publication No. 4102218)
- Paolucci, H. (1979). Hegel: On the arts. New York: Frederick Ungar Publishing Co.
- Phénix, P.H. (1964). Realms of meaning. New York: MtGraw-Hill.
- Roach, M-, Sr. (1984). Caring: The human modeof being, implications for nursing. (Perspectives in Caring Monograph 1). Toronto: University of Toronto Faculty of Nursing.
- Santayana, G. (1936). The sense of beauty. In The works of George Santayana. Trition Edition, Vol. 1. New York: Charles Set-loner's Sons.
- Santayana, G. (1925). The mutability of aesthetic categories. Philosophical Review, 34, 281-291.
- Urban, WM. (1977). The intelligible world: Metaphysics and value. Westport, CT: Greenwood Press.
- Watson, J. (1985). Nursing: Human science and human care. Norwalk, CT: Appleton-Century-Crofts.