Journal of Nursing Education

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The Relevance of Modelings' Ethics of Care to the Moral Education of Nurses

Margaret A Crowley, MS, RNC

Abstract

ABSTRACT

Noddings' ethics of care is proposed as a model for moral education in nursing. A discussion of Noddings1 moral theory is followed by a review of significant criticisms of her theory and her response to these criticisms. Finally, the usefulness of her moral theory as a guide to moral education in nursing is explored.

Abstract

ABSTRACT

Noddings' ethics of care is proposed as a model for moral education in nursing. A discussion of Noddings1 moral theory is followed by a review of significant criticisms of her theory and her response to these criticisms. Finally, the usefulness of her moral theory as a guide to moral education in nursing is explored.

Introduction

Nurse educators have expressed profound dissatisfaction in recent years regarding what they are doing and how they are doing it (National League for Nursing [NLN], 1988, 1989, 1990). What has emerged as the central theme of this discourse and debate within nursing education is the belief that a philosophy of caring is foundational to nursing education (Donley, 1989).

If nurse educators believe that they can contribute to the creation of practitioners who are committed to caring as an essential element of healing, then a discussion of Nel Noddings' (1984, 1992) ethics of care and its relevance to the moral education of nurses is in order. This discussion of Noddings1 ethics begins with an overview of the major tenets of her theory. Criticisms of Noddings" work are presented as well as responses to these. Finally, the usefulness of Noddings* work as a theory of moral education for nurses is explored.

Noddings* Ethics of Care

Noddings5 (1984) ethics of care departs from more traditional ethics in that she views the ethical self existing only in relationship. We are enhanced or diminished ethically within the context of our relationships with others. The choice to enter a relationship as one caring, Noddings argues, is grounded in a vision that we hold of our best selves, which she refers to as our "ethical ideal." This ideal self is rooted in two things: our history of having been cared for in past relationships (beginning with the original caring relationship of mother/child) and a remembrance of ourselves in our best caring moments as we cared for others. Our desire to preserve the fundamental goodness at the heart of these experiences inspires us to enter caring relationships now and in the future.

Within an ethics of care, we may play either of two roles (or both roles alternately) in our relationships with others, that of the one caring or the one cared for. Noddings (1984) stresses that each role carries with it unique responsibilities and challenges if we are to operate from an ethics of care. The one caring enters relationships with an attitude of receptivity that Noddings refers to as "engrossment." It is this attitude that allows the one caring to now view the world through the eyes of the other, to see things from the perspective of the one cared for. What accompanies engrossment is what Noddings refers to as "motivational displacement." The one caring clears her agenda of everything save the hopes, plans, dreams, and projects of the one cared for. She is at the disposal of the one cared for and shares of herself

Noddings (1984) repeatedly stresses that caring is a relationship, not something that can happen unilaterally. This is clear in her discussion of a second form of receptivity, the receptivity required of the one cared for. In a caring relationship, the one cared for must indicate in some way that the caring has been received. Noddings1 (1984) suggests that the one caring measure her caring efforts as follows:

[T] he test of my caring is not wholly in how things turn out; the primary test lies in an examination of what I considered, how fully I received the other, and whether the free pursuit of his projects is partly a result of the completion of my caring in him. (p. 81)

Noddings (1984) does not entirely discount ethical rules and principles as guides to ethical conduct, but she is careful to point out how they frequently function in a manner destructive of the very relationships that an ethics of care seeks to preserve. Given the complexity and lack of similarity between most situations that confront one, abstract rules and principles are often not appropriate guides to ethical conduct.

Criticisms of Noddings* Work

Challenges to Noddings* work have come largely from the community of feminist scholars (Card, 1990; Hoagland, 1990; Houston, 1990). None of these criticisms is leveled at the most fundamental aspect of Noddings' ethics: the ethical self existing in relation. There is agreement that her ethics speaks to the lived experience of women and that it embraces aspects of the human condition important to both women and men (e.g., child care) that principled and rule-based ethics have largely ignored (Houston, 1990). The potential transformative capacity of an ethics based on care, an ethics that addresses individuals in their particularity versus a reliance on universal principles, is acknowledged. Houston (1990) notes further that *[s]he so persuasively demonstrates the flaws in much principled moral thinking that one can never again hear the expression 'It's a matter of principle' without shrinking from the inhumanity of it" (p. 115).

Concerns have been raised by these scholars, however, based on their attempts to use Noddings1 ethics within the current context (social, political, and economic) of both women's and men's lives, a context that they insist continues to be oppressive for women, and a context that they believe Noddings has not adequately addressed. It would seem, then, that criticisms of Noddings* work center primarily on the belief that a moral theory useful to women should serve to eliminate, to some degree at least, the oppressive conditions of their lives.

Missing Rules and Principles

Both Card (1990) and Houston (1990) raise questions about the absence within Noddings' theory of rules and principles common to most ethical theory. Does Noddings intend her ethics to stand in competition with other moral theories, theories that are based on justice and rights, for example? Card (1990) argues that Noddings does just that: "She presents her ethic of care as an alternative to an ethic of principle, rejecting universalizability except in the universal accessibility of the caring attitude" (p. 101).

For Card (1990), the absence of justice in Noddings' ethic needs to be addressed and she suggests that Gilligan (1982) also pointed out the need for a link between care and justice. Card points to two sets of relationships in which the ethic of care alone will not transform our current relationships, thus will not be an improvement.

The first set of relationships to which Card (1990) alludes are those that exist between the self and all of the unknown others throughout the world. Card argues persuasively that we are in relationship with all of the earth's inhabitants, known and unknown, because we have the capacity to act, often without conscious awareness, in ways that will effect the lives of others. It is precisely our capacity to commit acts of evil, acts that have the potential to affect countless unknowns, that compels Card to claim the need for an ethic that addresses our moral responsibility here. She contends that Noddings1 ethic ignores our moral responsibility to most of the earth's inhabitants by focusing solely on those who come into direct relationship with us.

Noddings (1984) also describes a fear of the proximate stranger: anyone previously not known who may enter our circle of intimates obliging us to be as ones-caring. This fear of entering into a caring relationship with one previously unknown to us is based on our concern that enlarging our circle of cared-fors will both burden us and deplete the caring available to those intimates to whom we have already committed ourselves. Card (1990) believes it is precisely this fear of strangers and the focus on caring for those who are like us that does nothing to alter the current moral landscape. There is no incentive with this ethic to move beyond the familiar and to create opportunities for caring between peoples who have not had a history of caring for one another.

Potential for the Continued Exploitation of Women

Card (1990) joins both Hoagland (1990) and Houston (1990) as she expresses concern about another type of relationship that may not be transformed with Noddings" ethics of care: the nature of the relationship between the one caring and the one cared for. Hoagland (1990) expresses concern about Noddingsf use of the mother/child relationship as the model of caring. She argues that the ". . . unidirectional nature of the analysis of one-caring reinforces oppressive institutions" (p. 109).

The seeming imbalance in the expectations of the one caring and the one cared for suggests to Hoagland a relationship that is not fully mature and thus not the type of relationship to which one should aspire in the construction of an ethical ideal. She is particularly concerned with the lack of reciprocity expected of the one cared for and she points again to what Noddings (1984) expects of the cared for: ". . . [I] t is not a mutual engrossment and motivational displacement, not even a receiving of the other's world to the extent of understanding it. Reciprocity amounts to acknowledgement of the other's caring" (p. 109).

This concern is taken a step further by all three critics (Card, 1990; Hoagland, 1990; Houston, 1990). Given the dangerous relationships that women may find themselves in, for example, as the victims of family violence, Noddings* ethics of care may not help women to discover when their continued caring may prolong exploitative relationships. Because the ethic commands the turning outward of the one caring toward the needs and projects of the other, there may be a loss of recognition of the needs of the seht Hoagland reminds us of how motivational displacement, a shift from self-interest to the interests of the other, parallels the shin in the attention of oppressed people who must focus on "psyching out" the other for mere survival. Card (1990) also contends that ". . . elevating caring into an ethical ideal threatens to valorize the maintenance by carers of relationships that ought to be dissolved or those from which a carer should be able to withdraw without being in anyway 'ethically diminished* " (pp. 105-106X

Houston (1990) explains further that with regard to abusive or exploitative relationships, ". , . [I]t is possible that being cared for may increase the exploiters' capacity for response, but in Noddings* terms that can mean simply sharing their subjective experience and engaging in Tiappy and vigorous pursuit of [their] own projects' " (p. 117). Both Houston (1990) and Hoagland (1990) argue that there is no reason to conclude that the one cared for will ever be inspired to become one caring.

Houston (1990), Card (1990), and Hoagland (1990) all point to women's historical position in society as both paid and unpaid ones-caring. In the long Une of paired relationships that Noddings speaks of, will the ethics provide any correction, any relief, for the woman who finds herself perpetually in the role of one caring? Houston (1990) graphically describes this scenario when she notes, "Any given woman may be always the one in service to others. Her projects may be valued only to the extent that they serve others. In such a set of relationships she is diminished* (p. 117).

Response to Critique

Noddings (1990), in response to Card's criticism, states an important moral fact. We cannot care for everyone. It is simply not possible to do this. But if caring cannot be the only moral relationship, what alternative moral relationships are there? What moral obligations exist to address our treatment of those with whom we cannot be engaged in a caring relationship? This criticism is perhaps best left to the moral philosophers whose work it is to debate the criteria for a complete theory. Noddings acknowledges that her moral theory may not be adequate to cover all moral situations.

The relevant but related question for those in a practice discipline is instead this: Does Noddings" ethics of care offer adequate prescriptive assistance to those whose business it is to design and carry out the nursing curriculum? Does the ethics of care help nurse educators formulate answers to critical questions about what and how we should teach nursing? The answer to both of these questions is "yes." Details of how the theory might guide those engaged in nursing education follow in the discussion section.

In response to Card's (1990) and Houston's (1990) criticism that little is expected of the one cared for, Noddings (1990) returns to her discussion of the caring relationship in which an unequal relation exists of necessity (parent/child or teacher/student) and argues that she has rejected *. . . the usua] contractual definition of reciprocity as too limited" (Noddings, 1990, p. 122). Noddings (1984) suggests that the one cared for should show "... a response that contributes to another's capacity to relate, to work, to sustain caring" (p. 23). In this way, she is able to define the increasing responsiveness of a healthy infant as sustenance to the caretaker. And, conversely, she is able to show how caring for the progressively nonresponsive patient (e.g., a patient with Alzheimer*s disease) becomes increasingly burdensome in direct proportion to the declining responsiveness of the one cared for. This recognition of the needs of the one caring and the struggle at times to continue caring has considerable intuitive appeal to those in helping professions such as nursing.

Noddings (1990) acknowledges that there are indeed those who would exploit ones-caring just as there are those who would exploit those operating from any other ethic. She views the test question more importantly as: Would an ethics of care in some way contribute to or increase exploitation? Noddings1 (1990) primary argument to support the contention that an ethics of care is not inherently exploitative of the one caring centers on the ethics as a pedagogy of caring or a model for moral education. In this way, Noddings (1990) writes:

Everyone must learn to care, and an ethics of caring reminds us that we are responsible for each other's moral development. It matters whether I induce caring or not-caring or exploitative responses from you. But my responsibility does not reduce yours. Properly, caring applies to a relation, and parties in both roles contribute to its maintenance, (p. 123)

The question that would be posed based on this criticism as it relates to nursing education is: Would there be increased possibility for exploitation of either the one caring (nurse educator) or the one cared for (the student and the patient) when acting from the ethics of care?

If one views exploitation as a sociological phenomenon that is most likely to occur in relationships between people in situations of unequal status, then two relevant relationships should be addressed. First is the relationship between the teacher (the one caring) and the student (the one cared for). In this case, the student may potentially be exploited by the teacher. Examples abound of teachers using their power over students - from instances of blatant sexual harassment to manipulative control of rewards such as grades.

Contrary to the notion that Noddings' ethics would somehow increase the potential for exploitation, a teacher operating from Noddings' ethics of care would be challenged to ask key questions of themselves about their practice that would diminish the possibility of exploitation. Am I meeting this person as one caring? What can I do to maintain and enhance caring in this relationship? Am I putting this person above all other ends? Further, because Noddings discounts the usual notion of reciprocity in caring relationships, a final question would be: Is it clear to this student that my reward for caring is simply in seeing her happily pursuing her projects and increasing her capacity to go on to successfully care for others, and that I have no expectation that my caring be returned in kind?

The second potentially exploitative relationship that must be addressed as part of nursing education is that between the patient and the nurse. There is evidence to suggest that the potential exists for exploitation in either direction here (Lanza, 1985; Pillemer & Moore, 1989). This paper addresses the exploitative relationship that is expressed in the earlier criticisms of Noddings, that of the one cared for (the patient) exploiting the one caring (the nurse). In fact, a number of parallels have been drawn between these nurse-patient relationships and relationships in which domestic abuse exists (Lanza, 1985). The test question now becomes: Would the student who is taught to operate from Noddings1 ethics of care be more at risk for victimization from her patients?

This criticism assumes an individualistic framework that the ethics of care eschews. If the ethics of care were implemented in nursing, it would be necessary to establish an environment in which nurses were cared for as well as patients. In this instance, many people would be alert to conditions that may be harmful to the individual nurse caring for patients. Thus, no single nurse would be expected to diagnose the situation correctly and recognize when her continued attempts at caring might be misguided and possibly dangerous. Instead, a caring community of nurses and other health workers might relieve her of the burden of continually attempting to care when no response is received. Or, the caring community might surround the exploitative patient with the message, "We shall acknowledge your sickness and pain, your sense of helplessness, and your frustration. But this response is not acceptable; we cannot allow you to be diminished ethically by continuing this abusive behavior." The nurse educator would help students to focus on caring for one another as well as the patient.

Finally, the criticism that Noddings does not address our moral responsibility toward those "unknown* others who inhabit the earth along with us and upon whom our actions have impact, is not without merit. We must all decide what our moral responsibility is here and how we will choose to focus our moral attention. However, once the decision is made to become engaged in a practice discipline such as nursing and nursing education, Noddings* ethics of care serves to define the practical boundaries of the moral community.

Nursing practice and nursing education both focus on the here and now - the "proximate" student and patient, not the patient and student in the abstract who are yet to be encountered. What appears at first glance to be a flaw in Noddings' ethics of care is in fact a virtue in this particular instance. Noddings* ethics is grounded quite literally in these flesh-and-blood relationships, not relationships in the abstract. Her theory thus focuses on the moral relationships of concern to nurse educators. A further advantage of this particular perspective may be that it will help nurse educators sharpen their focus more clearly on what their educational endeavors should be about: teaching students how to care for specific patients in specific environments.

Discussion

It is useful to ask the question that Baier (1985) poses regarding Noddings1 moral theory and moral education in nursing. Specifically, when and why does Noddings' theory of caring ". . . merit our acceptance and support?" (p. 54).

Noddings* ethics of care has considerable appeal because her theory is, at its heart, a pedagogy of caring. In Noddings* (1984, 1992) view, caring is learned. It follows that caring must be taught, and Noddings views this instruction as an important task within the caring relationship. Whatever the relationship, mother and child, teacher and student, or friend and friend, if we are to be as ones caring, part of our task is to enhance the ethical ideal of the other.

Because Noddings (1984, 1992) is so concerned about people learning to care, she focuses much of her discussion on relationships between unequals - parent and child, teacher and student. In this way, she is able to explore relationships in which she contends that much of the work of the one caring (parent, teacher) is to provide an apprenticeship in caring so that those who are cared-fors (student, child) may go on to successfully care for others. She persuasively argues that instruction in caring is a goal of education that stands above all other goals:

The one-caring has one great aim: to preserve and enhance caring in herself and in those with whom she comes in contact . . . Everything that is proposed as part of education is examined in its light. That which diminishes it is rejected, that which casts doubt on its maintenance is postponed, and that which enhances it is embraced. Noddings, 1984, p. 172)

If we accept the "maintenance and enhancement of caring* (Noddinga, 1984, p. 172) as the primary aim of education, Noddings" theory has potential prescriptive power with regard to the content and process of the nursing curriculum, and the organization of the educational unit. In this discussion, curriculum is defined in broadest terms as suggested by Bevis (1990): *. . . Interactions between and among teachers and students with the intent that learning take place . . . curriculum is not some plan but what actually occurs interactively among students and among students and teachers" (p. 64).

The Content of Ethics Education

Because Noddings (1984) contends that the primary aim of education is the "maintenance and enhancement of the ethical ideal," she would argue that all of the programs, courses, and individual assignments within the curriculum must be acknowledged as endeavors of moral significance. To that end, all educational tasks must be assessed. Noddings (1984) writes, ''When we deliberately pose tasks or suggest means that may promote the intellect but put the ethical ideal at risk, we have confused our priorities dangerously" (p. 173).

Noddings is reluctant to turn over the ethical aspects of the student's learning to the experts in theology, philosophy, and ethics. Although she does not suggest that special courses in ethics have no place, she would caution against assuming that the job of ethics education is thus completed.

Noddings returns again to the notion of the ethical self existing only in relationship as she reinforces the need for practice in caring, which can occur only when concrete experiences in caring are provided for the student. She is wary of abstract and hypothetical classroom discussions of ethics for several reasons. The first is that discussions of ethics, far removed from the scenes of true commitment and caring, may ultimately become indistinguishable within the student's mind from actual caring. "Tb be always apart in human affairs, a critical and sensitive observer, to remain troubled but uncommitted, to be just so much affected or affected in just such a way, is to lose the ethical in the aesthetic" (Noddings, 1984, p. 22).

The second argument, posed against the use of hypothetical moral dilemmas for instructional purposes, relates to what Belenky, Clinchy, Goldberger, and larule (1986) and Gilligan (1982) and colleagues (Gilligan, Ward, & Taylor, 1988) have discovered about how women make moral decisions. In their empirical research, they discovered that as a rule, women are reluctant to make moral decisions in situations that are stripped of context, the manner in which hypothetical moral dilemmas are generally presented. Noddings (1984) writes:

They want more information . . . want to know more ... in order to form a picture more nearly resembling real moral situations. Ideally, we need to talk to the participants, to see their eyes and facial expressions, to receive what they are feeling, (pp. 2-3)

While Kohlberg and Kramer (1969) would argue that this seeming inability to reason morally based on abstract rules and principles is an indication of moral immaturity, Gilligan and Noddings would contend that this is simply a matter of attending to moral life in a different way. And, they argue, this view of morality should be nurtured rather than devalued or ignored.

Noddings' (1984) insistence on the necessity of practice in caring cannot be overstated. She would require that students at every level be involved in some sort of service activity that will acquaint them with the various forms and expressions of caring as well as provide them with an opportunity to commit themselves to caring relationships. One example she gives is the expectation that more advanced students tutor younger students.

Practice in caring occurs for nursing students most significantly in the clinical area where patients are cared for. An important point should be raised here with regard to the issue of competence and caring. Although Noddings (1984) has defined the initial impulse to care based on feeling, the "I must" of caring, she does not ignore the "cognitive work* (p. 171) that must accompany this feeling in order to be a skilled professional caregiver. This notion of "thinking objectively and well" (p. 26) in caring situations is viewed as not inconsistent with the model of caring that begins with a subjective, nonrational feeling state. Noddings (1984) writes, "If I am ill informed or if I make a mistake, or if I act impetuously, I may hurt rather than help the cared-for* (p. 26).

Learning the techniques and skills of the profession, then, is an important part of caring in nursing. Interestingly, in empirical studies of caring in nursing practice (Brown, 1986; Mayer, 1986), patients listed competent practice (the feeling that the nurse knows what she or he is doing) as the most important element in feeling cared for.

Noddings (1984) cautions, however, that overreliance on this rational objective mode can lead the caregiver into practicing from a place that is abstracted and distant from the patient's reality. Application of the "tools of the trade" of a particular profession must always be tempered via frequent return to the subjective state of feeling with the patient. This is not unlike Pellegrino's (1983) description of what he calls the healing relationship between physician and patient. Pellegrino argues that the scientific paradigm that has for so long guided medical practice is no longer adequate if one views the practice of medicine as essentially a moral enterprise. He describes the necessary blending of what Zaner (1990) refers to as "meticulous attention ... to the clinical arts" (p. 313) (history taking, physical exams, etc.) with attention to the patient's experience. Doing this,

... a technically right decision . . . [becomes] a good one. A good decision not only cures the illness but does so in harmony with the patient's conception of the conditions of an acceptable life. The choices must be responsive to the way the patient wishes to spend his ufe. This is a moral imperative particularly when the illness is untreatable or fatal. (Pellegrino, 1983, p. 165)

In teaching the ethics of caring, Noddings would also incorporate opportunities for students to explore ways in which the ethical ideal may be diminished via customs, institutional affiliations, the choice of evil, and external pressures. Students would learn to question, for example, the rules and principles established by institutions and organizations. Noddings (1984) writes: "The duty to enhance the ethical ideal, the commitment to caring, invokes a duty to promote skepticism and noninstitutional affiliation. In a deep sense, no institution or nation can be ethical* (p. 103).

Noddings (1989), in her study of the phenomenology of evil, demonstrates how individuals, operating from a set of principles associated with institutions deemed "moral," are capable of contributing to what she has defined as the three great evils: pain, helplessness, and separation.

The teacher would also show students how they might enhance the capacity of others to continue caring when their caring is threatened with becoming "cares and burdens." An example that has relevance for nursing practice is offered: "... If you become weary of caring for cantankerous old X, I may be able to help simply by caring more about you. The eternal question is: 1WiIl I?' " (Noddings, 1984, p. 120).

There is another wellspring of sustenance available to the one who would be caring, sustenance that comes not from other people but from an attitude, an approach to the rhythms, patterns, and repetitions of everyday life. Noddings ( 1984) writes:

The body becomes repeatedly hungry; it requires satisfaction. The sexual appetite persists and recurs; it requires satisfaction. Hair and fingernails grow; they must be trimmed. Dust accumulates; it must be displaced. The seasons change predictably; to each special functions are assigned . . . Daily we have meals and dishes; cleaning and soiling; growing and cutting; making and using and making again; sallying forth and returning home. Each of these may be decried or celebrated . . . The one caring chooses to celebrate, (pp. 124-125)

On this approach, the teacher would be a model to students. For the nursing teacher, this might take the form of showing students how the frequently repetitive tasks of caregiving in a long-term care facility, a place where students are likely to complain that "nothing interesting or exciting ever happens" can be transformed. In one sense, this approach is not unlike that advanced by Johnson (1987) when she talks about living for the moment. The joys and pleasures of day-to-day life are often lost to us as we wait and focus on the future when something important might happen. Johnson (1987) writes: "I must learn to live from second to second, not merely to anticipate living ... So the question 'What shall we do?' is the wrong question . . . The question, then, is 'how shall we be?' " (p. 300).

How would the nurse be? She would delight with patients in watching the sun go down on a winter afternoon; she would celebrate with the patient who has one less "accident* on the way to the bathroom, the patient who takes two more bites at breakfast, the patient who takes three more steps with a walker; she would listen to a patient recite the same poem for the hundredth time and hear something new to admire in the presentation or the message conveyed.

In this way, the receptivity necessary for caring would be always in a state of readiness, especially during the ordinary, mundane moments of life when opportunities to care most often present themselves. Tisdale (1987), writing about her experiences as a nurse in a nursing home, conveys this receptivity:

... in Harrest Moon, I found myself caught up not only in big concerns, in questions of considerable size, but in many small concerns too - in a single step and how to take it, a single bite of food, a glass of water, a snowfall, a memo, a glance, (p. xiv)

Brief conversations that never conclude, small moments suspended - these are the only rewards to be found. And they are great, precious, gleaming jewels of satisfaction that take me out of myself and into a blurred world where age and youth are the same. (p. 29)

The Process of Ethics Education

On the process of moral education, Noddings (1984) writes, "We cannot separate means and ends in education, because the desired result is part of the process, and the process carries with it the notion of persons undergoing it becoming somehow !setter1 " (p. 174).

Within Noddings* (1984) model for moral education, the relationship between teacher and student is characterized by three processes that serve to enhance the ethical ideal - dialogue, practice, and confirmation.

Dialogue, Practice, and Confirmation. Dialogue between student and teacher can only occur within the context of a trusting relationship. For the student, part of this trust is rooted in the knowledge that she or he will always be regarded as "... infinitely more important than the subject matter" (Noddings, 1984, p. 176). This does not deny the importance of the skills that must be honed or the cognitive development that must occur if the student is to be recognized as a competent caregiver. The teacher is still responsible for determining the minimum body of knowledge that must be acquired. But the teacher, as one caring, sees the world through two sets of lenses - her own and those of her student. Her engrossment and motivational displacement with the student permit her to view the subject matter from her/his perspective. In this way, for example, she does not struggle with winning the student over, getting the student to !ove the subject as she does. Rather, the teacher explores with the student how they might work together to learn what is necessary to get through, from the student's point of view, "this work which I sometimes find so tedious."

Trust is also nurtured through cooperative learning with the student. The teacher does not merely impart knowledge but rather she engages in a cooperative effort with the student that involves ". . . sharing and reflecting aloud* (Noddings, 1984, p. 122). Solving a problem with a student begins first with "sharing a feeling* so that the receptivity necessary to respond as one caring is nurtured before the cognitive work commences. It is in this sharing, this exploration into what the student thinks as well as "why he thinks what he thinks" (Noddings, 1984, p. 178) that the student is given the opportunity to achieve a greater degree of self-understanding (Crowley, 1989). And the teacher, by also sharing how she thinks, becomes a model of caring practice. Both student and teacher are given the opportunity to evaluate their practice. Are actions taken that are motivated by a reliance on rules and principle or an ethics of care?

On the process of confirmation, Noddings (1984) writes, "she [the one caring] always approaches the other as though the other has a respectable motive* (p. 123). In a sense, Noddings asks that as ones-caring, we attribute the same noble motives to the acts of others that we attribute to our own acts. This does not mean that the teacher fails to address what would traditionally be caued "unethical* behavior on the part of students (e.g., plagiarism), but she would still approach the student ". . . with the assurance that this - this-which-was-a-mistake - might still have occurred with a decent motive" (p. 123). Andi she would explore with the student not the standard objections to plagiarism based on traditional rules of ethical conduct but rather how their actions might be hurtful within an ethics of care.

Organization of the Educational Unit

All of the recommendations for restructuring the educational unit advanced by Noddings (1984, 1992) are focused on the creation of a caring community. She centers her discussion on the early years of education, elementary and secondary, but her discussion has relevance to education at the collegiate level as well.

One recommendation (Noddings, 1984) would be for faculty members and administrators to become involved in new cycles of work. As an example, a faculty member might teach for three years and then spend the fourth year in an administrative role. The administrator would similarly return to the classroom for a period of time. In this way, each would come to appreciate and respect the work of the other and opportunities to enter into a working relationship would be advanced based upon a heightened understanding of one another.

A second recommendation for restructuring relates to the amount of time a student spends with a particular teacher. Noddings (1984) suggests that in order to build a close and trusting relationship with students, the period of contact with a group of students should be extended. In nursing education, this might mean having a group of students work with one or two faculty members for an entire year. Noddings (1984) alludes to the merits of this proposal: "If I know how my student typically reacts to certain topics and tasks, I am in a better position to guide him both sensitively and economically* (p. 180).

Conclusion

In recent years, nurse educators have expressed deep and growing concern about preparing nurses who are more than "applied scientists." Noddings' moral theory, the ethics of care, is offered as a guide to transforming the nursing curriculum. With this approach to moral education in nursing, the pursuit of the caring relationship - between student and teacher, and nurse and patient - is valued above all else.

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