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Keywords:

  • caring science;
  • love;
  • agape;
  • caritas;
  • eros;
  • suffering;
  • hermeneutics;
  • abduction

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Aim
  5. Methodology
  6. The scientific opening
  7. The scientific creation
  8. The scientific synthesis
  9. Methodological considerations
  10. Limitations
  11. Conclusion
  12. Author contribution
  13. Ethical approval
  14. Funding
  15. References

Scand J Caring Sci; 2013; 27; 449–459

The substance of love when encountering suffering: an interpretative research synthesis with an abductive approach

Aim:  This study presents the results of an interpretative research synthesis undertaken to explore the essence of love when encountering suffering. The idea of caring as an expression of love and compassion belongs with ideas that have shaped caring for hundreds of years. Love and suffering are the core concepts in caring science and thus demand a basic research approach.

Methods:  The synthesis was undertaken by the interpretation of 15 articles focusing on love in different aspects, but within a caring science perspective. The research process was guided by a hermeneutical perspective with an abductive approach.

Results:  The substance of love, when encountering suffering, reveals itself in three themes: love as a holy power, love as fundamental for being and love as an ethical act, which are to be found, respectively, within three dimensions: love as holiness, love as a communion and love as an art. Love is a holy power and encompasses everything; it is the well of strength that heals. No human can exist without love: this points to the ethical responsibility one has as a neighbour. In the ethical act, love is evident in concrete caring actions.

Conclusions:  The core of the substance of love within the three dimensions can be understood as agape. Agape connects and mirrors the dimensions, while at the same time it is clear that agape stems from and moves towards holiness, enabling love to be the ethical foundation when encountering suffering. Through the dimensions of love as communion and love as an art agape intertwine with eros forming caritas enabling the human being to move towards the dimension of holiness, which signifies becoming through suffering.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Aim
  5. Methodology
  6. The scientific opening
  7. The scientific creation
  8. The scientific synthesis
  9. Methodological considerations
  10. Limitations
  11. Conclusion
  12. Author contribution
  13. Ethical approval
  14. Funding
  15. References

In this paper, we will present the findings of an interpretative research synthesis undertaken to explore the substance of love when encountering suffering within the theoretical framework of caring science. Love in the form of compassion for the suffering human being is an idea that has shaped caring for hundreds of years. At the same time, there is hardly any other major idea that has been so invisible in the explicit form of caring. Owing to this, there is a need for increased understanding of the substance of love when encountering suffering.

Interpretative research synthesis synthesizes separate studies focusing on the same phenomenon, leading to encompassing a process of theory development. The research process in this study follows the hermeneutical circle where abduction is used as reasoning.

Background

Eriksson (1, 2) and Watson (3) argue that love is the key to further development of caring science, and these theorists are among those who see love, in the form of caritas, as the basis for the development of their theories. The development of knowledge in caring science has been, to a great extent, characterized by vocational reasoning without any anchoring in a theoretical framework with clearly articulated ontological contention. In addition, there has been little discussion related to the theory of science addressing ontological and epistemological questions. Consensus has emerged in the field of caring that the knowledge basis for caring practice is incomplete and that the development of a scientific basis for caring practice has a high priority within the discipline (4).

Love

Caritas is the Latin word for love, in parallel to the Greek agape (5, 6). Caritas has roots in the idea of Christian charity illustrated, for example, by the Biblical story of the Good Samaritan (7), a well-known parable for what is at the core in caring.

Beginning with the caritas motive, compassion for a fellow human being arises in meeting a suffering human being (1). Nygren (8) rejected any attempt to build unity of agape and eros, arguing that agape-love involves self-spending and self-offering, while eros-love is ultimately egocentric. Augustine’ (9) synthesized agape and eros within the concept of caritas, as reaching out for God, which is all that is good and beautiful, with humility. Eriksson (6, 10) has developed the concept and idea of caritas as a synthesis between eros and agape united with faith and hope. She argues that both eros and agape must be integrated in caring (6). In a caring science perspective, eros does not involve sexual love; instead, it is the desire to unite with the object of one’s affection behind the material world, and eros also implies passion, creativeness and intuition (6). Agape is unconditional, unselfish love toward the neighbour, identifying with his/her needs and recognizing his/her value in a communion (6). Eriksson (11, 12) emphasizes that love stands as the core of ethics and ethos, and as the basic caring motive for caring science, both scientifically and substantially. Much of the research on love is implicit in other topics. Fredriksson (13) found that through caritas, it is possible to create a space for the human being to restore his/her self-esteem, autonomy and responsibility and thereby create the prerequisites for a good life. Rundquist (14) maintained that the purpose of human life can be understood as the use of one’s own inner power, strength and love.

Suffering

Suffering is understood, ontologically, as a drama with three acts: confirmation of suffering, being in suffering and becoming in suffering (15). In the drama of suffering, the patient is given the possibility of creating an expression of suffering in meaning-creating accompaniment of the caregiver (16). Suffering is a struggle with life, between shame and dignity, threatening a human being’s view of himself/herself as authentic and whole (17). The human being’s struggle for existence and absolute dignity deprives their healing process of strength, and their suffering becomes unbearable (14). Suffering can also contain a possibility of individual growth and development (15) in the fact that health and suffering are integrated in a dialectical movement (18). The ultimate purpose of caring is to alleviate suffering (12). Suffering as such has no meaning, but a human being can ascribe meaning to it by reconciling with the experience of suffering (15). This means safeguarding the human being’s dignity by restoring his/her capacity and purpose through caritative caring (15).

The prevalence of encounters with suffering in caring is emphasized by recognizing that the Latin roots of the words ‘suffer’ and ‘patient’ are strikingly similar, both meaning ‘to bear’ (15). Luehrman (19) suggested that through suffering many human beings find some of the most important insights of their lives in relationship to God and their fellow beings. ‘The work of suffering’ is the work performed to move through a situation of pain to a moment of healing, and this work involves finding a voice for suffering (19).

If caring science is to be developed as a discipline on the basis of its own core, research needs to be performed in a more explicit form on the substance of love when encountering suffering. This may emphasize the foundation of caring science and strengthen caring science as an autonomous scientific discipline.

Aim

  1. Top of page
  2. Abstract
  3. Introduction
  4. Aim
  5. Methodology
  6. The scientific opening
  7. The scientific creation
  8. The scientific synthesis
  9. Methodological considerations
  10. Limitations
  11. Conclusion
  12. Author contribution
  13. Ethical approval
  14. Funding
  15. References

The aim of this interpretative research synthesis was threefold:

1. To increase the understanding of the substance of love when encountering suffering by relating separate studies focusing on different aspects of love through the aid of interpretative research synthesis.

2. To contribute to theory development within the caring science paradigm.

3. To apply the methodology of interpretative research synthesis within a hermeneutical perspective with an abductive approach.

Methodology

  1. Top of page
  2. Abstract
  3. Introduction
  4. Aim
  5. Methodology
  6. The scientific opening
  7. The scientific creation
  8. The scientific synthesis
  9. Methodological considerations
  10. Limitations
  11. Conclusion
  12. Author contribution
  13. Ethical approval
  14. Funding
  15. References

Design

Interpretative research synthesis integrates and interprets individual studies focusing on different aspects of the same phenomenon into each other, contributing to more substantive findings (20) and, as a result, encompassing a process of theory development (21). Achieving this within a hermeneutical perspective with an abductive approach, the integration of separate studies makes a whole that is more than the sum of its parts and offers novel interpretations of findings. This requires a sophisticated understanding of the nature of comparison and interpretation, a meticulous yet creative rendering of the texts to be synthesized and reciprocal translations of the meanings of one case into the meanings of another (22). According to Jensen and Allen (23), synthesis of representations is essential to advance knowledge and influence practice.

Inductive theory development is traditionally the objective in qualitative research synthesis, but this is only a first step towards new scientific insight. The abductive process enables the discovery of new meaningful patterns; thus, abduction is particularly suitable for research on ontological phenomena and contributes to the development of caring science (24, 25). Alvesson and Skjøldberg (26) describe the abductive process as a hermeneutical spiral. The central issue in hermeneutics is understanding through interpretation of text (27). This understanding takes place on an ontological and a methodological level (28). The structure of understanding is a circular process between the whole text and its parts. Through this dialogue, the researcher’s preunderstanding evolves into new understanding (27).

In this study, empirical studies, theoretical studies, concept analysis and philosophical texts have been used and interpreted, which have allowed for abductive reasoning (29). Undertaking a hermeneutical study with abductive reasoning in an interpretative research synthesis implies creating a synthesizing abstraction of an interpreted text. Induction and deduction are phases of the abductive process (25). Neither induction nor deduction can in themselves enable any scientific progress; they function as a springboard for the abductive leap, which makes it possible to reach one step further (24, 29). Some might question the ethical aspects of abductive reasoning and see it as far too speculative (30). However, Råholm (24) emphasizes that abductive reasoning is analogous to the ethics within caring, which is concerned with what we ought to do, not what we in fact do.

The process of abductive reasoning

This hermeneutical study incorporated three phases of reasoning within the hermeneutical circle: induction, deduction and abduction. See Fig. 1 for a visual presentation of these different phases.

image

Figure 1.  Abductive reasoning, a presentation of the different stages (25. Råholm, 2010 with permission).

Download figure to PowerPoint

The starting point of the abduction was an emerging idea that love and suffering should be examined more deeply and in a more nuanced manner when analyzing the central position these concepts have in caring science. On these grounds, the existing theoretical knowledge about love and suffering was elucidated, and the aims for the study were constructed.

The first phase consisted of a scientific opening, an induction to obtain an overall impression and involving the collection of relevant articles and a reflective reading of each article with the research questions in mind. Important expressions about the substance of love when encountering suffering were isolated and formed into a coherent text. Reflective reading of the text in the light of research questions was an important step of the scientific building process, as this reading provided us with plausible and descriptive knowledge. Research questions were posed to the text, and the text posed questions to us.

The second phase consisted of a scientific creation, a deduction. In this phase, the texts from all the articles were merged into each other and written into one coherent theory-filled text, wherein the text emerged by mirroring the text against the ontological assumptions of caring science. This phase played an important role in setting forth creative hypotheses that allowed us to generate new ideas. As a result, the researcher moved to the next stage or mode of reasoning – deduction and theory-filled empirics. Openness was important in this phase of scientific creation; the hermeneutical movement was a reflective movement between already known scientific grounds and openness to new horizons, hence, making the invisible perceptible. Through the process of the scientific creation, three themes emerged.

The third phase consisted of a scientific synthesis, that is, abduction, meaning a boundary-transgressing theory formation where the synthetical abstraction of the text resulted in three dimensions. These dimensions created a pattern of the substance of love when encountering suffering. In this phase, caring science theory determined the direction of the scientific process. Simultaneously, it meant creating a new scientific pattern that had a stronger capacity to explain matters regarding the concept of love when encountering suffering. Abduction portrayed the potential and assisted in linking the ontological questions (30). Abduction is not just about one move from surprising fact to an explanation, but rather the deliberate way nurse researchers ‘press on’ for new explanations on the basis of background theories and data requiring explanation, often in very long-term processes (24), however, starting from surprising, curious or somehow anomalous phenomena. In this way, abduction as a logical step of discovery paved the way for deeper knowledge and understanding, and through its aid, the interpreted knowledge (empirics-filled theory) could be further processed.

Table 1, columns 3, 4 and 5 provide a short description of how the substance of love presents itself through the phases of induction, deduction, abduction.

Table 1. Overview of studies included in the research synthesis and description of central themes created through induction, deduction and abduction. The numbers correspond to the reference list
Included studiesAim of the studyInduction The scientific openingDeduction The scientific creationAbduction The scientific synthesis
31. Hoffman (2007)Great Britain Theoretical studyIs neighbourly aspirations sensitive to the worth of close personal relationships and to material wellbeing of fellow citizens?Compassion is self-denial. By the duty of loving ones neighbour love is tied to infinity, freedom and independenceLove as a holy power, love as fundamental for being, love as an ethical actLove as holiness, love as a communion, love as an art
32. Watson (2003)USATheoretical studyA new view of the essential ethic of loveLove is the underlying, the original in caring, and call attention to the metaphysical dimension. The substance of love can be understood and communicated through metaphors like face and hands. Love call for ethical responsibility for the vulnerable otherLove as a holy power, love as fundamental for being, love as an ethical actLove as holiness, love as a communion, love as an art
33. Pembroke (2006)AustraliaTheoretical studyTo show that charm is a quality of loving careLove is the spiritual and metaphysical dimension of human beings. Love is eros and agape. Love is the core in the inter-human communionLove as a holy power, love as fundamental for being, love as an ethical actLove as holiness, love as a communion, love as an art
34. Young-Mason (2001)USATheoretical studyUnderstanding suffering and compassionCompassion become visible when one act in relation to a desire in a meaningful relationshipLove as a holy power, love as fundamental for being, love as an ethical actLove as holiness, love as a communion, love as an art
35. Arman & Rehnsfeldt (2006) Sweeden Theoretical studyExploring how love can be visible in caringLove is the core of the human beings substance. Love is hidden and implicit in all human relations. Love is a creative power. Love relieves sufferingLove as a holy power, love as fundamental for being, love as an ethical actLove as holiness, love as a communion, love as an art
36. Alvsvåg (2010)NorwayTheoretical studyDescribing love’s different aspectsLove is out of the human beings power. Love is of vital necessity for the human communion. Love is expressed spontaneously. Compassion implies to pass on something we are given. Cultivation in virtue is necessary for love to unfoldLove as a holy power, love as fundamental for being, love as an ethical actLove as holiness, love as a communion, love as an art
37. Råholm & Lindholm (1999) Finland Empirical study n = 8To discover, describe and understand how patients experience their life situation three years after undergoing surgeryLove is a holy art. Love is a holy power which is in all relations and become visual through responsibility. Love means duty, guilt and sacrificeLove as a holy power, love as fundamental for being, love as an ethical actLove as holiness, love as a communion, love as an art
38. Edelgass (2006) USA Theoretical studyAn analysis of suffering and compassionCompassion is the nexus of subjectivity, it is a vulnerable, painful sensibility for the suffering other, it is the superior principle, to be a witness for the other by saying: here I am, and by givingLove as a holy power, love as fundamental for being, love as an ethical actLove as holiness, love as a communion, love as an art
39. Von Dietze & Orb (2000)AustraliaTheoretical studyFocus on the concept of compassionCompassion is a healing power. Compassion is participation on an ontological and ethical level to alleviate suffering and enabling the person to retain independence and dignity. Compassion is expressed through caring acts and sharing of experienceLove as fundamental for being, love as an ethical actLove as a communion, love as an art
40. Fitzgerald & van Hooft (2007)Australia Empirical study N = 9What is love in nursing?Love brings human beings behind the demands of caring to a dimension characterized by involvement and devotionLove as a holy power, love as fundamental for being, love as an ethical actLove as holiness, love as a communion, love as an art
41. Young-Mason (1988)USATheoretical studyUnderstanding compassionCompassion is reconciling with the truth and suffering. This lead to freedom by forgiving the other thus spiritual hope grows in oneselfLove as fundamental for beingLove as a communion
42. Kendrick & Robinson (2002)Great BritainTheoretical studyTo offer an alternative means of viewing relational ethicAgape is to be found in the relationship. Agape means to share responsibility and power, to recognize otherness and freedom, it means actionLove as a holy power, love as fundamental for being, love as an ethical actLove as holiness, love as a communion, love as an art
43. Baumann (2000) USA Empirical study N = 13Understanding the meaning of the lived experience of feeling lovedFeeling loved lead to a movement of development, renewal and confirmation. Feeling loved is tied to freedom, confidence and hopeLove as a holy power, love as fundamental for beingLove as holiness, love as a communion
44. Stickley & Freshwater (2002)Great BritainTheoretical studyFocusing on the importance of love and its healing potentialWhen the caring person has genuine care for the whole human being love is true and the possibility for healing enhancesLove as fundamental for being, love as an ethical actLove as a communion, love as an art
45. Levy-Malmberg, Eriksson & Lindholm (2008)FinlandTheoretical studyTo describe and analyze caritasCaritas exist in the dialogue between human beings. Caritas is an ethical act filled with curiosity, wonder and responsibilityLove as fundamental for being, love as an ethical actLove as a communion, love as an art

The following work of the abductive process was carried out by one of the researchers based on consensus within the research group before each methodological step and procedure (Fig. 1).

The scientific opening

  1. Top of page
  2. Abstract
  3. Introduction
  4. Aim
  5. Methodology
  6. The scientific opening
  7. The scientific creation
  8. The scientific synthesis
  9. Methodological considerations
  10. Limitations
  11. Conclusion
  12. Author contribution
  13. Ethical approval
  14. Funding
  15. References

In this first phase of the abductive process, we present the data collection and the sample. See Table 1, columns 1–3 for an illustration of this phase.

Data collection

Data collection, that is, scientific articles, was completed using the following databases: Academic Search Premier, Cinahl, Health & Safety Science Abstracts, Ovid, MEDLINE, PubMed, Sage Journals Online, and using the following keywords; love, agape, eros, caritas, charity, compassion and altruism, all in combination with suffering. There were also searches through the reference lists of the retrieved articles.

The inclusion criteria were (1) one or more of the keywords were found in the title, keyword or abstract, (2) the philosophical and theoretical perspective of the article was in compliance with the caring science perspective, (3) the texts were written in English or a Scandinavian language, (4) the articles were peer-reviewed – this to secure a certain academic standard. As a result, 104 articles were reviewed in full and, upon further reading, some of the articles were determined as not having a clear theoretical foundation or were using theories from different paradigms, which made the basis for their arguments unclear. Some articles were not consistent with the ontological foundations of caring science, and some were not explicit and clear enough regarding the substance of love. Others were rather superficial in their description. On this basis, 15 articles were selected for a deeper analysis.

Sample

Fifteen selected articles were included in the sample for deeper analysis; see Table 1, column 1. Of these articles, 13 had an explicit purpose to explore the substance of love, while two of the articles did not; see Table 1, column 2. These articles were, however, consistent with the ontological foundations, and their contents were considered important regarding theoretical development and the research questions. These articles were published between 1988 and 2010. Love is a timeless issue, and these articles were included as having important contributions to the understanding of the substance of love. See Table 1, column 3 for examples of the empirics-filled text.

The scientific creation

  1. Top of page
  2. Abstract
  3. Introduction
  4. Aim
  5. Methodology
  6. The scientific opening
  7. The scientific creation
  8. The scientific synthesis
  9. Methodological considerations
  10. Limitations
  11. Conclusion
  12. Author contribution
  13. Ethical approval
  14. Funding
  15. References

The scientific creation (second phase) of the abductive process in this interpretative synthesis, which is based on the preunderstanding of caring science, represents the findings of this study. The substance of love emerges as three themes: love as a holy power, love as fundamental for being and love as an ethical act.

Love as a holy power

Love is a holy power that may be found everywhere and encompasses everything (31, 32). Love bears eternity and infinity (31, 32), and it is consolidated in the spirit of the human being (32–35), still independent of the power and will of human beings (31, 36). Duty is tied to infinity and it is experienced as freedom (31, 37).

The connections between caring, loving and infinity become the process of facing our humanity as mystery, …uniting us and the cosmic energy of love, as one

(32: 200).

There are…phenomena which are essential and beyond our reach and power… like love

(36: 246).

In the spirit of human beings, love and suffering are reflected to each other (32); these two essentials can only be understood in relation to each other (34, 38). Becoming through suffering concerns a spiritual longing for what is behind here and now (37). Following the suffering human being to the well of strength is to help him understand what love is (37). Love is a healing power (39) that alleviates suffering because it is above and beyond suffering (32, 38, 40). When a human being suffers the most, love can turn life from destruction and coldness to strength and hope, in a way one did not believe to even exist (41). To be healed, human beings need help to rediscover the love deeply rooted in themselves (31). This requires belief in love as a healing power from the caregivers’ perspective (33, 40). Consequently, both the sufferer and caregiver can move together towards health (42).

Suffering develops a human being’s ontological awareness. Through suffering one sees the relationship that brings people closer to each other (37: 536). An ontology of caring as the sacred art of love is, first, the awareness of love and givenness because there is love, a force that is the basis of all intersubjective or co-present experience

(37: 537).

Love as fundamental for being

Love as fundamental for being means that no human being can exist without love (34, 35) and without love humans suffer (32, 41). Humans need to acknowledge this vulnerable form of being (32, 35, 37, 41, 43, 44). Love as fundamental for being brings human beings in touch with themselves and enables binding to other people (34, 39, 42). This provides human existence meaning and cohesion (33). Human beings need to love and to be loved (31, 32); and love emerges in the communion (32–37, 42, 43, 45). In this communion, love as fundamental for being can be acknowledged, accepted and made real by sharing suffering (34, 36, 45). To reconcile oneself to love means that one can forgive and be forgiven (41) and that one experiences hope, forgiveness and freedom (31, 34, 43).

In attending to our deepest desires, we reach … our essential self

(33: 271).

We are authentically free and independent when we fully embrace our need to love and be loved…

(31: 270).

… love is fundamental to human experience…

(44: 170).

A communion embedded in love can hold the other’s otherness (42) with respect and dignity and without prejudice (32, 37, 39). The caregiver steps out of her own world and into the suffering human being’s world (39) and offers herself, respecting the will and choices of the suffering human (40). Neighbourly love for a fellow human being makes one sensitive, curious and wondering, and from these experiences, a wish arises to know the other and try to understand what his/her suffering means (33, 45). Humans who feel and show love radiate joy (33). Love brings a movement of development, renewal and confirmation, but also of pain and frightening challenges (43). Being loved is a process of learning about oneself and the world (43), and the movement towards development and renewal is a mutual experience (35, 42).

Agape refers to an impartial self-giving for the sake of the other. One spends oneself for the other because of her inherent dignity and worth as a human being.

…a particular expression of agape, namely, the suppressing of one’s own needs and desires in order to attend fully to the other (33: 268–269). Eros is the source of vitality, liveliness and passion. It is a physical and spiritual energy that animates a person in every dimension of her life, including her caring activity

(33: 272).

Steps of development and changes in a person’s life are to a large extent the fruit of love…(35: 4). This means that in the source of love lays a challenge to overcome limitations and in some way identify with the other person. … When a person has come to know love and also disclosed its significance to every other person, he or she has reached an understanding and an attempt at compassion and suffering with others. Love may in light of this be viewed as the basic core of alleviation of suffering

(35: 8).

Through love as fundamental for being, what is expected from one as a fellow human being is revealed; an unlimited ethical responsibility (36, 37, 45) of giving oneself (32, 40, 45) and suffering for the vulnerable neighbour (37, 38). One cannot avoid this responsibility, as this is the ethical expression of love (38, 45). Human existence is possible because one can subject oneself to another’s suffering (38). One is always given to the other, and through this neighbourly love one is connected to fellow human beings (37, 38). This manner of giving diminishes guilt (37).

With the saying ‘here I am’, the exposure and generosity to the Other… my own here is made possible by exposure to suffering. This subject is not ethical accidentally… Rather, the subject is essentially and primarily ethical, a singular someone elected to moral responsibility… It is as a moral subject that I am elected, unique and responsible…

(38: 54).

Love as an ethical act

Love as an ethical act is expressed by the form of words, tone, face, eye and hands (32, 33, 35–39, 45). Love as a holy power and love as fundamental for being are mirrored in this creative act (32, 34), which conveys a wisdom which only the understanding of love and suffering can give (34, 36, 38). The cultivation of virtue is essential in order for the substance of love to unfold (35, 36, 44). By the substance of love as an ethical act, one encounters and tends to the sufferer’s needs and desires in a practical way (34, 40, 45). The expression of love in the form of actions is necessary to experience love as truth (42). Love is shown in engagement and spontaneity (33, 36, 39, 40), but is also a duty of acting in a caring manner (33, 36, 39). Love cannot be grasped or forced (33), it appears quietly and invisibly (35), but in the ethical act, it appears in behaviour and attitude (31, 34, 45). Through the acts of caring one is a witness by passing on the love one has been given and carries with oneself (36, 38, 39), and puts others’ best interests before one’s own needs without expecting anything in return (37–40).

Compassion, like freedom, is a word whose meaning becomes clearer and finally clarified in practice when known through desire and need, in hands on exchange. Like freedom, compassion is a mutual experience given two or more people who act together for its realization (34: 347). It is only through the wisdom derived of compassion that we as nurses can be of true assistance to our patients, their families and, ultimately, to ourselves

(34: 353).

The development of the art of loving cannot be refined without genuine concern for love and genuine concern for those in our care. …love is an essential ingredient for human existence, to demonstrate love in practice is of critical concern. …Where nurses are genuinely concerned for the whole person, love is evident and the prospect for healing increases

(44: 254).

The scientific synthesis

  1. Top of page
  2. Abstract
  3. Introduction
  4. Aim
  5. Methodology
  6. The scientific opening
  7. The scientific creation
  8. The scientific synthesis
  9. Methodological considerations
  10. Limitations
  11. Conclusion
  12. Author contribution
  13. Ethical approval
  14. Funding
  15. References

This scientific synthesis (the third phase) of the abductive process represents that in an article with a traditional structure would be the discussion. In this phase, we will advance the process of abductive reasoning starting from the existing interpreted knowledge. Based on the three themes that emerged in the scientific creation, we see something new in the substance of love that has changed our previous understanding and directed our attention to yet new deep structures where the substance of love as a pattern of three dimensions has emerged: love as holiness, love as a communion and love as an art.

Love as holiness

Love as an underlying, original, healing power behind the duty of care appears in several of the articles (32, 38–40), expressing love’s eternity and infinity; the universal love that stays when everything else has passed on (8, 46). Love reveals the human beings’ connection with the whole existence (46, 47) as love is consolidated in the innermost of human beings (32–35, 46). In the perspective of Kierkegaard (46), love as a holy power can be understood as agape, love that is laid down in the heart of human beings (33–35, 46) and is in everlasting movement (46). According to Kierkegaard (46), this is the fundamental form of love which is present in all other forms of love, as a given, spontaneous, devoted and undemanding love (31, 36, 40, 46). Love as a holy power within a universal, omnipresent and cosmic-metaphysical dimension can be described as a dimension of holiness that refers to something sacred and human beings’ quality of being holy (8, 32, 47). This gives human beings a preunderstanding of what love is (8) and an experience of freedom and duty (31, 37). Within caring science, agape refers to ethical matters and not a Christian content (6, 38). Spiritual phenomena can be existential and religious (48); however, Eriksson (12) emphasizes that human beings are fundamentally religious, but not all human beings have recognized this. Human beings continually return to and reassess the dimension of holiness because it is seen as a meaningful factor in a human being’s life, as it involves questions about life, suffering and death (49). Suffering as a core structure entails being unable to give and receive love; in other words, not being in touch with holiness (15, 38, 47). To respond to the suffering with agape signifies becoming, through self-transcendence for both the sufferer and the caregiver (37, 46, 50), moving towards the deepest core where the holy power of love is to be found (46). The movement towards holiness signifies finding a meaning that provides a human being with power and connectedness, which can be described as a homecoming (51). This requires hope and faith in love (40, 46, 47). Love heals (39) and can turn suffering into hope and strength (41). Human beings’ desire for agape directs them towards the substance of themselves (6, 8, 33), towards that which is holy (46). Eriksson (15) claims that love and suffering are the deepest movements of life and health and are reflected on each other in the innermost of the human spirit (15, 32). Moving towards the dimension of holiness of oneself means becoming whole, becoming health (31, 47, 52), which signifies becoming through suffering, as suffering and health and are two sides of the same aspect (15, 37, 47). This implies an internal unity through reconciliation in association with something more powerful than oneself (15, 47). On this deepest level of integration, reverence for one’s own life and for oneself and as someone unique can be experienced (12, 15).

Love as a communion

All included articles highlight love as the core in the caring communion and refer to human beings’ inability to exist without love. Humans need to realize this vulnerable form of being (32, 35, 37, 41, 43, 44) as the human is fundamentally dependent on communion to give and receive love (12). This requires a communion with an awareness of human beings’ holiness as the basis as well as the objective. In the light of Halldorsdottir (53), it can be described as a spiritual connection which is experienced as a bond of energy. Humans bear within themselves an everlasting desire for love and communion (46).Through a spiritual connection, eros on an ethical basis can energize and revitalize the fellow human being (6, 33). Agape reveals itself in the communion as an ethical responsibility for the vulnerable suffering other (6, 38), and through agape one is in an eternal debt of giving (6, 38, 47). This characterizes the caritas communion where suffering can be shared (34, 36, 45), and the human being can express his/her suffering in accompaniment with the caregiver (16). Caring for the other’s otherness (38) implies an asymmetrical communion giving the suffering human being a chance to step forward and disclose their inner being with their desire to be completely loved (15, 38, 50). Human beings’ desire for love, eros, is a desire for confirmation and to become who one is (33, 39, 43). Being invited into the caritas communion implies receiving agape love, a spontaneous devotion that provides an experience of freedom, confidence and hope (8, 41, 43); it is the experience of being understood and forgiven, and being part of a larger whole (42), that makes it possible to move into the dimension of holiness.

Love as an art

Love as an art is a creative form of love that originates from what is beautiful (8). Eriksson (6) emphasises that performing the art of caring and striving for what is beautiful requires intuition and an understanding of what is beyond the material world. In the caring science context of this study, this means tending, playing and learning and implies alleviated suffering and healing through faith, hope and love (12). As a result, the dignity of human beings is created in the concrete art performance by referring to holiness (8, 15, 54). Compassionate acts of love beget healing of self and others (32). Caring for the human being’s body, soul and spirit enables love to be experienced as truth (12, 34, 42, 44), and the substance of the true human being, the ability to love, is made concrete (50). Practising spontaneous and creative love and compassion (33, 36, 39, 40) is to have the character of agape (6). A human being who works in love has the charisma of love’s power and light, also named claritas (33, 50). Claritas can be seen as a flame of love that the caregiver is given through eros and agape, which sheds light on the human being and enlightens the caregiver in exploring what is true, good and beautiful (50).

The substance of love, when encountering suffering in this scientific synthesis, emerges within three dimensions: love as holiness, love as a communion and love as an art. The core of the substance of love within these dimensions can be understood as agape. Agape connects and mirrors the dimensions, while at the same time it is clear that agape stems from and moves towards holiness, enabling love to be the ethical foundation when encountering suffering. Through the dimensions of love as communion and love as an art agape intertwines with eros forming caritas enabling the human being to move towards the dimension of holiness which signifies becoming through suffering.

Methodological considerations

  1. Top of page
  2. Abstract
  3. Introduction
  4. Aim
  5. Methodology
  6. The scientific opening
  7. The scientific creation
  8. The scientific synthesis
  9. Methodological considerations
  10. Limitations
  11. Conclusion
  12. Author contribution
  13. Ethical approval
  14. Funding
  15. References

Abductive reasoning is a form of basic research that is necessary for a scientific discipline to develop and to retain its identity and autonomy (25, 30). Barrett (55) argues that a discipline needs unique research methods to facilitate creation of knowledge and thus develop the discipline. To further develop a theory on an ontological level, one has to pose questions of an abductive character; such questions give room for a creative logic that lifts the level of abstraction in theory development. Doing an interpretative research synthesis within a hermeneutical perspective with an abductive approach can also be seen as an epistemological issue (30). This paper is the first to undertake an interpretative research synthesis to further develop the understanding of the substance of love when encountering suffering. Basic research is the basis for practice and development in complex contexts. By uniting caring science and practice in ethos, thesis (the historical grounds; love and charity) and antithesis (the rational practice of today) might merge into a synthesis (6). The ability of a discipline to be innovative and creative is dependent on how clear is the core of its theory (56). A dialogue between nurses about recent knowledge development can facilitate and strengthen the consensus of the theory basis of caring science and how to practise caring using this as the starting point. A future challenge is to develop the substance and theoretical perspective within caring science, which requires basic research.

Limitations

  1. Top of page
  2. Abstract
  3. Introduction
  4. Aim
  5. Methodology
  6. The scientific opening
  7. The scientific creation
  8. The scientific synthesis
  9. Methodological considerations
  10. Limitations
  11. Conclusion
  12. Author contribution
  13. Ethical approval
  14. Funding
  15. References

One limitation of this study might be that the substance of love is seen in the perspective and concept of caring science only. However, a clearly delineated theoretical perspective opens for new dimensions to emerge. Fifteen articles in this study might have limited the depth of the findings. We may have reached a deeper level of understanding with a smaller sample. According to Jensen and Allen (23), there is no limit for how many articles or texts to include, the point is to achieve an understanding of the phenomenon. All 15 articles contributed in their unique way to the understanding of the substance of love. The content of the articles is based on several philosophers and theorists, in accordance with the caring science perspective; however, there is a possibility that the substance of love might have been even more deeply elucidated on the basis of fewer or only one philosopher or theorist.

Conclusion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Aim
  5. Methodology
  6. The scientific opening
  7. The scientific creation
  8. The scientific synthesis
  9. Methodological considerations
  10. Limitations
  11. Conclusion
  12. Author contribution
  13. Ethical approval
  14. Funding
  15. References

Starting with love as the basic motive, this study has displayed some aspects of the substance of love when encountering suffering that might contribute to the theory of caring science.

The substance of love when encountering suffering in this abductive reasoning love emerges within three dimensions: love as holiness, love as a communion and love as an art, respectively, holding the three themes of love as a holy power, love as fundamental for being and love as an ethical act. The core of the substance of love can be understood as agape. Agape connects and mirrors the three dimensions; at the same time, it is clear that agape stems from and moves towards holiness, thus, enables love to be the ethical foundation when encountering suffering. Practising the art of love through compassionate ethical acts, the dignity of the human being is created by referring to holiness. In the dimension of love as communion, agape is expressed through the ethical responsibility inviting the suffering human in to a communion where suffering can be shared. Through the dimensions of love as communion and love as an art agape intertwines with eros forming caritas enabling the human being to move towards the dimension of holiness. Reaching the dimension of holiness and the holy power of love, the deepest level of integration can be attained, which signifies becoming through suffering.

Given the substance of love, the healthcare system has an ethical demand to make love visible. Love as a profound reason for healing and alleviation of suffering should be seen as the central feature in evidence-based practice. There is a challenge concerning organizational structures and allocation of resources for love to unfold. Love has to be the foundation on which knowledge is based and therefore the perspective for forming the curricula.

We have found interpretative research synthesis with an abductive approach to be a useful approach, but there is a great demand for more research on the concept of love as a value in caring ethics and as a core concept in theory development within caring science.

Author contribution

  1. Top of page
  2. Abstract
  3. Introduction
  4. Aim
  5. Methodology
  6. The scientific opening
  7. The scientific creation
  8. The scientific synthesis
  9. Methodological considerations
  10. Limitations
  11. Conclusion
  12. Author contribution
  13. Ethical approval
  14. Funding
  15. References

Kari Marie Thorkildsen was responsible for the data collection, analysis of data and writing of the manuscript. Maj-Britt Råholm was responsible for the design and participated in the writing and in critical reviewing of the manuscript. Maj-Britt Råholm and Katie Eriksson supervised the study.

Ethical approval

  1. Top of page
  2. Abstract
  3. Introduction
  4. Aim
  5. Methodology
  6. The scientific opening
  7. The scientific creation
  8. The scientific synthesis
  9. Methodological considerations
  10. Limitations
  11. Conclusion
  12. Author contribution
  13. Ethical approval
  14. Funding
  15. References

This study is based on previously conducted studies, and thus has not applied to the ethics committee for permission to conduct the study.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Aim
  5. Methodology
  6. The scientific opening
  7. The scientific creation
  8. The scientific synthesis
  9. Methodological considerations
  10. Limitations
  11. Conclusion
  12. Author contribution
  13. Ethical approval
  14. Funding
  15. References
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