Page 96 - Nursing: The Philosophy and Science of Caring

F r o m ca ra t i v e F a c t o r 4 t o C a r i t a s P r o C e s s 4
the field.” It is about being reflective, mindful, and skillful mid-step,
mid-sentence, mid-action when connecting with another person. Such
competencies and skill in connecting with another generate trust and
safety. It is a life-giving, life-receiving, human-to-human, spirit-to-spirit
connection that goes beyond the physical-ego level. These skills and
this consciousness for relationship involve ontological competencies,
as presented earlier. Such relationship building is about first under-
standing self as a critical variable in any care situation. How to trans-
late one’s own self-awareness, sensitivity, and loving-consciousness
into informed moral practice in relation to self and other is a major
task of professional practice.
This process, this consciousness, this skill of being-in-relation
is fundamental and essential to any caring-healing relationship, as
it is often the relationship itself that is healing rather than the exter-
nal interventions alone. A body of empirical evidence supports what
many have ethically, intuitively, and experientially known for centu-
ries—that the quality of the relationship with another person is one of
the most significant elements in determining helping effectiveness. At
the least, the research indicates that relationship is a strong predictor
of outcome, beyond the actual therapy; thus, at the very least, inter-
ventions interact with the relationship for the most therapeutic, heal-
ing outcomes (Herman 1993; Horvath and Symonds 1991; Luborsky
et al. 1986; Martin, Garske, and Davis 2000; Orlinsky and Howard
1985; Strupp and Hadley 1979).
In this sense, the caring relationship can be considered an interven-
tion in and of itself, or at least a core ingredient. For example, some
research in the medical literature has indicated that “better health,”
functional behavior, and subjective evaluations are related to physician-
patient communication (Kaplan, Greenfield, and Ware 1989, cited in
Quinn et al. 2003). The nursing literature has a great deal of informa-
tion and publications related to relationship and caring, even though
few are controlled studies. In general, the Caring Science literature in
the field is closely aligned and consistent with renewed scientific and
educational interest in caring relationships and healing outcomes (Pew
Fetzer Report 1994; Samueli Conference on Definitions and Standards
in Healing Research 2002).

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