Editor’s Choice


Caring in nursing has been a controversial and disputed territory for decades with a body of literature relatively enthusiastic about the concept (Lea & Watson 1996), and exploring it from qualitative and quantitative perspectives, with at least one prominent philosopher and commentator on nursing (Paley 2001) dismantling a substantial body of that research. There is no agreed definition of caring and only some agreement about its uniqueness in nursing. However it is defined in its broadest sense, caring is essentially a collective noun or adjective – depending on its use – for a constellation of actions, attitudes and attributes whereby the humanistic aspects of nursing and other caring professions are expressed, received and experienced. In the absence of a precise definition or shared understanding, some of the most useful work in the field has been into the comparative understandings of caring, especially between nurses and patients.

There are few truly comparative studies of the fundamental nature of nursing and I count one of my own (Watson et al. 2003a) – cited by Papastravou et al. (2012)– among the few. However, whereas my study compared two EU countries, the study by Papastravou et al. compares six and these include: Cyprus, Czech Republic, Finland, Greece, Hungary and Italy and include some of the finest nursing scientists in these countries. With sample sizes of both patients and nurses exceeding 1000, the study is adequately powered overall, and in each country, for the analysis applied. Frankly, it represents a major achievement in terms of organization and data collection with questionnaires translated into the languages of each country and across such disparate locations in Europe.

The study by Papastravou et al. (2012) compares nurses and patients and also compares them in different countries; they used the Caring Behaviours Inventory-24 which measures different dimensions of caring including technical aspects (skills and knowledge) and psychosocial aspects. Although there were some differences between countries between patients and nurses, the study largely confirmed previous work which shows that nurses and patients perceive caring differently. Although both rate the technical aspects of nursing higher than the psychosocial aspects, the nurses rate the psychosocial aspects higher than patients. There seems to be shared understanding that the technical aspects of nursing outweigh the psychosocial: you can be connected to, and respectful of, the patient but this is not as valuable as knowing how to, and being able to, do things for the patient. On the other hand, nurses who spend a great deal of time acquiring knowledge and practicing skills, rate the psychosocial aspects of nursing higher than patients; this is a consistent finding across previous studies (Larson 1987, Watson et al. 2003b). Seemingly, patients are less concerned about the affective and interpersonal aspects of nursing than are nurses.

The study by Papastravou et al. (2012) is set against a background of harmonization of educational curricula – including nursing – across Europe. In this study there were some significant differences in scores on dimensions of the Caring Behaviours Inventory-24 between countries and also differences within countries between nurses and patients. The paper draws out some of the reasons such as the social and cultural influences in the countries and the organization of the health services and the disparity between patient expectations and involvement in shaping their health services. It should be noted that the differing scores between countries do not, necessarily, indicate differences in how much nurses there are actually caring or care about their patients; the interpretation of the scores is more complicated than that and tends to indicate what nurses emphasize or have been taught about caring and what it means to care.

Studies such as Papastravou et al.’s (2012) remain useful and interesting in the comparative sense and serve to indicate the difficulties in harmonizing curricula; indeed, they may serve to indicate how curricula may be harmonized. Within Europe, pending the ability to speak the language of the country and meeting local registration requirements, nurses may work freely across those countries in the European Community. The cultural mix of nurses is increased by nursing immigrants from across the world, largely caused by nursing shortages in Europe and ‘over-production’ of nurses in other parts of the world. This is another controversial area but the present study is relevant in the sense that we cannot expect all nurses to be the same, regardless of qualification and experience. There are subtle differences in perceptions of what constitutes caring and this does, as exemplified in the UK press, lead to misunderstanding between local patients and nurses from other countries...and vice versa. It is hard to know if there is a problem waiting here to be ‘fixed’ or if this is just an observation that is made periodically and ignored. However, without work like that of Papastavrou et al. we will never know. Anything that can help nurses from different cultures to work comfortably in other cultures and for the recipients of care to feel safe and cared for, must be advantageous.

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