Mark Lazenby's Caring Matters Most: The Ethical Significance of Nursing
Philosopher and Nurse-scholar Dr. Mark Lazenby has written a new book, Caring Matters Most: The Ethical Significance of Nursing, Oxford University Press (2017). When I read this book, I realized how invaluable a resource it will be for our palliative nursing community in describing how we care for our patients, ourselves, and each other.
Dr. Lazenby states that "nursing is a profession with a moral character at the heart of its identity[horizontal ellipsis]centered on caring for others and for the world." In developing the theme of care, Dr. Lazenby expands on the five habits that embody "nursing's moral character": trustworthiness, imagination, beauty, space, and presence. These habits are so very important in how we, as palliative care nurses, care for our very ill patients.
Dr. Lazenby speaks about the "moral imagination" needed to better a patient's life and direct his or her care. He says that nurses must listen to their patients to learn what they desire most, whether it is better health or a peaceful death. By listening and acting in accord with a patient's desires, we are able to render care consistent with the patient's wants and needs. Dr. Lazenby explains that the patient's vision becomes the nurse's "present imagination" in the care he or she renders. As palliative care nurses, we know how important listening is in our work, for it is in listening to our patients at the most vulnerable point in their lives that we learn how to render the care they so desperately want and need, especially at the end of life.
By seeing beauty, by seeing patients' "aliveness as beautiful", Dr. Lazenby explains that nurses are motivated to perpetuate that beauty in performing the work of nursing. By embracing the concept of "space", nurses see beyond their patients' vulnerabilities and allow the patients and their families the space to feel and be apart from their vulnerabilities. Dr. Lazenby describes this space, for example, as "beyond the machines of the intensive care unit." When explaining "presence" as the fifth habit of nursing's moral character, Dr. Lazenby says that by being present, nurses share a "common humanity" with their patients. In palliative care, being present is so critical for our very ill patients and their families when our presence is the constant by their bedside as their lives draw to a close.
Dr. Lazenby expands upon the 5 important habits, by showing us how important they are in nurses' own lives and in the nursing community. As nurses, we care for our patients and it is equally important that we care for each other and for our palliative care community, where the stress and demands of our work take a toll on each of us. The trustworthiness we show with and for each individual patient is just as important to show to each other. With nursing imagination, nurses "preserve our patients' humanity in the world of automation and technology. We preserve our own as well."
Caring Matters Most also reminds us how important civility is among nurses and how we must avoid sexism, racism, and other forms of discrimination and intolerance. We must always look "toward a better world" and contribute to that better world by cultivating good nursing habits. He states: [W]e imagine a world in which there is equal access to quality health care, then we work to that end[horizontal ellipsis]By practicing the habits of a good nurse, we are the presence of a better world for our patients and their communities[horizontal ellipsis]we produce in the here and now a better world that is better than disease and disorder, a world in which vulnerability and uncertainty are lessened."
Our presence as palliative care nurses, taking care of the most vulnerable and ill as their lives draw to a close, ensures a better world not only for our patients and their families, but also for our fellow nurses, our nursing community, and ourselves as well.
There is a great deal of discussion about the need for those of us in palliative care, Specialty Palliative Care, to extend our knowledge to Generalists-those in Oncology, Geriatrics, ICUs, primary care, and all of the areas caring for the seriously ill. HPNA has an important role to play in mentoring our nursing colleagues across specialties to extend the palliative care workforce. I suggest that the first step is to share what we know about caring.
Betty Ferrell, PhD, MA, FAAN, FPCN, CHPN
Editor-in-Chief
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