Page 212 - Nursing: The Philosophy and Science of Caring

a dmi ni st ering sacr e d nu rs i ng a ct s
primary support system as well as significant others. Decreased feel-
ings of belonging can result from such withdrawal or disengagement,
even though it may be a necessary coping process.
This gradual but real disengagement as a result of illness was cap-
tured in the previous section on the need for activity and the existential
story of van den Berg. The excerpt is relevant to understand how the
affiliation need is affected by even a minor illness and being in a “sick-
bed.” The sickbed, or form of isolation resulting from illness, leads
to loss of contact with day-to-day activities and routines, deprivation
and disruption of patterned behaviors and experiences we take for
granted. Suddenly, when life patterns are interrupted, there is a sur-
real sense involving even intimate relationships and familiar activities
that previously were commonplace; they become estranged and dis-
tant, even foreign, to the sick person.
Regardless of the life situation that triggers isolation from affilia-
tion (e.g., worry, illness, diagnosis, loss, change, fear, trauma, and so
on), when a person’s capacity to focus on others is reduced, his or
her usual affiliation needs change, resulting in frustration. At the same
time, when one’s affiliation is compromised, there tends to be a need
for a quantitative decrease of relationships—a desire for fewer peo-
ple around the person; one’s social space and social sphere contract.
Correspondingly, there is a qualitative increase in the value of the peo-
ple who are around the individual. Having fewer people around who
are special, close, intimate, and meaningful may be more satisfying
than having many people who may have only a superficial connection
to the person.
A hospitalized person may be denied the few qualitative relation-
ships he or she needs and desires and instead may have more limited
superficial relationships with a variety of often impersonal visitors or,
worse still, impersonal, detached caregivers: “They have swabbed me
clean of my loving associations” (Sylvia Plath).
Nurses are often the ones who affect the quality of interactions with
persons during illness; therefore, nurses and Caritas Nursing are vital in
assisting with the affiliation need. Such awareness and understanding
of this need at many levels are necessary to guide caring practices.

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