infirmière TLC

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infirmière TLC
June 2002 Nursing Ethics 9(3):291-300
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In the West, the term ‘tender, loving care’ (TLC) has traditionally been used as a defining term that characterizes nursing. When this expression informs practice, it can comfort the human spirit at times of fear and vulnerability. Such notions offer meaning and resonance to the ‘lived experience’ of giving and receiving care. This suggests that, in a nursing context, TLC is rooted firmly in relationship, that is, the dynamic that exists between carer and cared for.
Despite this emphasis on relationship, there is a scarcity of literature that draws a connection between TLC and the moral challenge that is so much a part of human interaction. In this article we will address this deficit and present a narrative that places TLC at the centre of moral engagement between nurse and patient; in essence, we offer an alternative means of viewing relational ethics.
... 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) . ...
... 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). ...
... … 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). ...
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.
... Cette chercheuse distingue alors différentes variations de l'engagement qui découlent de l'analyse de propos tenus par les infirmières (Ramos, 1992 d'ajuster ses soins, mais surtout d'aller au rythme du soigné au sein des échanges qu'elle aura avec lui (Halldorsdottir, 2008; Kendrick & Robinson, 2002; Peplau, 1952). ...
... Il s'agit de l'accueil et de la découverte de l'autre ( Peplau, 1952). Cette phase permet de définir les problèmes du soigné en vue de déterminer le service requis de l'infirmière (Peplau, 1952 Cette écoute doit surtout permettre de s'attarder à la façon dont la personne décrit la situation et comment elle tente d'en faire émerger une signification personnelle (Kendrick & Robinson, 2002 Bien que la littérature infirmière regorge de plusieurs réflexions et constats observés chez les infirmières concernant l'importance et le rôle que devrait tenir la relation infirmière/soigné, celle-ci se définit aussi à l'intérieur d'attentes spécifiques décrites par l'entremise de différentes directives professionnelles. On remarquera que ces cadres ne tiennent pas toujours compte de l'ensemble des réflexions proposées par les travaux des théoriciennes ou des chercheurs. ...
... En fait, les notions de responsabilité et de relation ont souvent été associées à des objectifs qui, ultimement, décrivent le rôle professionnel de l'infirmière. Des auteures misent en ce sens sur le développement d'habiletés chez l'infirmière en vue de formuler des objectifs structurés avec le soigné au sein de la relation (Collière, 1982;Hartrick, 1997; Kendrick & Robinson, 2002; Smith, 1980), ce qui est différent de la conception de Marcel. ...
La relation infirmière/soigné est une dimension essentielle de la pratique et de la
discipline infirmières. Elle s’illustre par l’entremise de modèles et de phases incluant une
terminologie multiple et variée. Une recension plus exhaustive expose une certaine
confusion dans la littérature infirmière, surtout là où les termes s’entremêlent et deviennent
interchangeables. Cet état de fait est susceptible, pour les infirmières, d’influencer la façon
dont elles mettent en place et développent leurs relations avec le soigné. Aussi, pour tenter
de clarifier le tout, la notion d’intersubjectivité a été suggérée comme concept phare. Celuici
permet en effet d’offrir un regard novateur sur ce qui unit deux personnes entre elles. Le
choix de s’appuyer particulièrement sur les écrits de Gabriel Marcel, un philosophe du
courant existentiel, s’explique par le fait que sa pensée ouvre à la conscience de soi et à
l’importance de considérer d’abord qui l’on est pour ensuite aller vers les autres. La pensée
de Gabriel Marcel et particulièrement sa description de l’intersubjectivité conduisent à trois
thèmes: le lien entre deux personnes, le passage de soi vers l’autre et la « communion ». Par
une approche dialectique qui permet de comparer les écrits infirmiers à ceux de Gabriel
Marcel, plusieurs propositions sont émises en vue de préciser la nature, les conditions et les
limites de la relation à l’autre. Ces propositions ont mené à l’élaboration d’un Modèle
Intersubjectif d’une Rencontre Infirmière/Soigné (MIRIS). Selon ce dernier, la rencontre
avec l’autre offre deux trajectoires possibles : une relation créée grâce à l’intersubjectivité,
ou une communication fonctionnelle générée par son contraire, la non-intersubjectivité.
Alors que la nature de la relation se définit par la symétrie et l’ouverture sur soi, ses limites
correspondent au seuil à ne pas franchir, soit la communication unidirectionnelle. En
somme, le MIRIS clarifie la terminologie sur la relation infirmière/soigné, les niveaux et les
rôles que jouent les multiples termes qui l’entourent. Ce modèle offre une logique et une
structure pouvant faciliter la compréhension du phénomène de la relation et guider les
infirmières concernant le développement d’un véritable lien avec le soigné, constituant
essentiel au soin.
... Health care. Love has been recognized as an important component of practice for health care professionals, including paramedics (Wahlin, Wieslander & Fridlund, 1995), nurses (Arman & Rehnsfeldt, 2006; Kendrick & Robinson, 2002; Stickley & Freshwater, 2002), and physicians (Willer, 2014), throughout the field. One might assume a duality between medical science and the relational foundation of loving, however the literature regarding the practice of love in health care professions does not support such division. ...
... The practice of compassionate love in health care goes beyond the provision of social support; instead of focusing on caring words and behaviours, compassionate love also attends to the other's thoughts and emotions (Willer, 2014). Though similar to compassion, empathy and bonding, compassionate love is different in that its focus is more comprehensive; compassionate love is offered to everyone at all times, rather than being specifically focused on those who are experiencing suffering (Underwood, 2009; Kendrick & Robinson, 2002) . Where the word compassion alone "can imply detachment", compassionate love implies "emotional engagement" and "emphasizes the enhancement of human flourishing" (Underwood, 2009, p. 4). ...
... Research regarding compassion fatigue and the stresses sometimes involved in caring and relational work, is in fact more prevalent than research related to the positive impacts of compassionate care (Willer, 2014). Campbell (as cited in Kendrick & Robinson, 2002) proposed the term "moderate love" to describe "how love is shaped and refined to meet the conflicting demands of practice" (p. 293). ...
Since children and youth are often cared for by many professionals who are trained and educated in different disciplinary traditions, it is important that child and youth care (CYC) practitioners who work alongside other professionals have knowledge of how love is understood across different disciplines. Through a review of current literature in the fields of health care, education and CYC, this article explores the perceptions of love across different fields where CYC is practised. It begins by defining love in a manner that reflects the engagement and interactions between individuals in professional and public relationships, and differentiates this from the kind of love present in private relationships. It then focuses on the ways that love is currently being talked about and practised in different professional contexts. While there is increasing openness to talk about love across the human service fields, and some similarities in the questions and assertions that are being raised, there are also differences of opinion regarding love’s place in professional practice both within and across practice domains. In contemplating the varying perceptions of love, I hope to offer the reader an opportunity to be more mindful about the role of love in their own professional practice.
... A number of scholars have identified agape as central in an ethic of care for nursing (Campbell, 1984;Bradshaw, 1996;Fitzgerald & van Hooft, 2000; Kendrick & Robinson, 2002; Pembroke, 2004). What these authors contend, each in their own way, is that the moral presence of a nurse is founded on a commitment to give of her-or himself in promoting the good of the other, without reciprocity. ...
... A number of personal qualities and capacities are identified as central in loving care. Nurses who love their patients possess humility (De Vries, 2004), attentiveness (McCrea et al ., 2003;Jonsdottir et al ., 2004), a sense of responsibility and duty (Bradshaw, 1996;Watson, 2003), and compassion and tenderness (Bradshaw, 1996; Kendrick & Robinson, 2002) . In this essay, I invite reflection on a personal quality that I believe is foundational in loving care, but which is more elusive, more difficult to define than these. ...
... This discussion on the moral ground of charm, I argue, extends our understanding of the ethics of nursing care. It has been commonly observed that agape is central in an ethic of care (Campbell, 1984;Bradshaw, 1996;Fitzgerald & van Hooft, 2000; Kendrick & Robinson, 2002) . What these authors posit, in essence, is that the moral presence of the nurse is founded on an impartial and spontaneous commitment to give of her-or himself in advancing the good of the other. ...
In the nursing literature, a number of qualities are associated with loving care. Reference is made to, among other things, humility, atten-tiveness, responsibility and duty, compassion, and tenderness. The author attempts to show that charm, in the Marcelian sense, also plays a central role. It is argued that the moral foundation of charm is a unity of agape and eros. An impartial giving of the self for others is clearly of fundamental importance in an ethic of care. Including charm in the discussion points to the fact that eros also plays a crucial role. Eros produces a passion for people and for life. It is a physical and spiritual energy that animates a person in all facets of her life, including her caring work.
... We used the VAS and VRS to measure pain intensity. These are standardized tools, and their reliability has been (24) .14 Compound presentation, n (%) 0 (0) 2 (3) Transverse lie, n (%) 2 (2) 3 (5) Values expressed with a plus/minus sign are the meanstandard deviation. ...
... The effects of this type of accompaniment, similar to the concept of ''tender, loving care,'' may in itself be considered an intervention. 24 Although practitioners have identified a good relationship with the obstetrician and a particular state of relaxation, notably abdominal wall relaxation, in most ECV attempts under hypnosis, the success rate of ECV did not improve in our study. Despite the pain and anxiety reported, most participants would undergo an ECV attempt again for breech presentation and would recommend this procedure to friends. ...
Objective:
To assess the effectiveness of hypnosis to reduce pain and facilitate external cephalic version (ECV).

Design:
Cohort study.

Setting:
Geneva University Hospitals, Switzerland.

Participants:
63 women attempting ECV under hypnosis from 2010 to 2011 were compared with 122 women who received standard care from 2005 through 2008.

Intervention:
Immediately after the ECV attempt, both groups completed the same questionnaire evaluating the participants' pain (visual analogue and verbal rating scales) and experience with the procedure. Physicians also completed a questionnaire that elicited their views on the effect of hypnosis on the intervention. A chi-squared test was used to compare differences in proportions, and the Mann-Whitney U test was used for differences in continuous variables. A thematic content analysis of the obstetricians' responses to the open question regarding their experience of hypnotist accompaniment was also performed.

Outcome measures:
Pain evaluated by women (visual analogue and verbal rating scales) and success rate of ECV.

Results:
Pain intensity reported by women did not significantly differ between the hypnosis group and the standard care group (visual analogue scale score, 6.0 versus 6.3, respectively; p=.25; difference for verbal rating scale, p=0.31. In 72% of cases, physicians reported that hypnosis facilitated the procedure. The success rates in both groups were not significantly different (30% with hypnosis compared with 38% without; p=.31). Most women in both groups found the ECV attempt painful and a source of anxiety but would undergo it again if necessary.

Conclusion:
Hypnosis accompaniment during ECV does not reduce pain intensity associated with the procedure or improve the probability of a successful version.
... Contudo esta relação, nomeadamente o conceito de amor é alvo de mal-entendidos (Kendrick & Robinson 2002; Lavoie et al, 2006), sendo mesmo criticado, enquanto designação. O receio da utilização do termo amor em enfermagem tem também a ver com a confusão que pode ser gerada pois facilmente poderá ser conotado como um sentimento de caráter romântico/amoroso/sexual (Kendrick & Robinson 2002;Stickley & Freshwater, 2002;Castledine, 2011). ...
... Contudo esta relação, nomeadamente o conceito de amor é alvo de mal-entendidos (Kendrick & Robinson 2002;Lavoie et al, 2006), sendo mesmo criticado, enquanto designação. O receio da utilização do termo amor em enfermagem tem também a ver com a confusão que pode ser gerada pois facilmente poderá ser conotado como um sentimento de caráter romântico/amoroso/sexual (Kendrick & Robinson 2002; Stickley & Freshwater, 2002;Castledine, 2011). Mas, mais uma vez estes mal-entendidos decorrem de uma interpretação O AMOR NA RELAÇÃO TERAPÊUTICA EM ENFERMAGEM deturpada e de um provável desconhecimento da natureza do amor e dos seus diferentes tipos. ...
O amor é uma pequena palavra que encerra muitos e grandes sentidos. No dia-a-dia usamo-la sem estarmos preocupados com o sentido atribuído, pois ele é intuído dependendo do objeto a que nos referimos. O amor em enfermagem é considerado um dos pilares da ciência do cuidar. Contudo esta assunção não está isenta de mal-entendidos. Importa clarificar o âmbito do amor numa relação terapêutica e perceber como se manifesta.
Esta pesquisa tem como finalidade a compreensão da experiência vivida do amor pelos enfermeiros de saúde mental na relação terapêutica em enfermagem. A pesquisa situa-se numa metodologia qualitativa, fenomenologia da prática que está radicada na filosofia, usando métodos filosóficos, filológicos e das ciências humanas.
Foram colhidos relatos experiencias junto de dez enfermeiros de saúde mental. Resulta desta reflexão que o amor se manifesta por ver o invisível; pela impossibilidade da não ação; por gestos securizantes; por fazer “1km extra”; por estar em sintonia; por estar ligado; por deixar que o outro apareça; por hospedar o outro em mim; como uma experiência pática; por um custo pessoal. A compreensão destes sentidos e significados do fenómeno teve por base uma reflexão radical, por meio da epoché e redução. O amor é um ingrediente transformador da experiência relacional terapêutica. Esta pesquisa é uma possível compreensão do fenómeno do amor na relação terapêutica em enfermagem. É um contributo para clarificar e desmistificar alguns estereótipos e despoletar reflexões acerca do quotidiano relacional em enfermagem que poderá estimular compreensões que tornem a prática de cuidados mais sensível e próxima do mundo de cada pessoa cuidada.
Palavras-chave: amor; relação terapêutica; enfermagem; enfermagem de saúde mental; fenomenologia da prática
... Virtue is often viewed as an inner attitude, a characteristic of The Presence of Love in Ethical Caring good traits like courage, goodness, or honesty manifest in actions (Allmark, 1998;Randers & Mattiasson, 1999;van Hooft, 1999). Kendrick and Robinson (2002) use the concept of "tender loving care" as an ethical expression of caring including a relationship. To achieve this, they place emphasis on the steps of responsibility, dialogue and transformation, all in an attitude of unselfish love related to agape. ...
... It is vital that the concept of tender loving care is viewed in actions as talk of loving in the absence of action is vacuous. Even with love, it is not always easy to find the proper caring acts, but tender loving care has a prerequisite of flexibility and a constant seeking together with disclosure and testing of substance and meaning (Kendrick & Robinson, 2002) . ...
Caring as a virtue and an act of ethics is from both a natural and a professional point of view inseparably related to love as a universal/ontological value. Love is shown, like suffering and death, to be a concept of universal or metacharacter. From current nursing/caring science as well as from ethical and philosophical perspectives, this paper explores how love can be visible in caring through virtue and that the art of caring creates its evidence. The ethical and existential practicing of love, particularly unselfish love, allows a caregiver to come distinctly closer to the essence of his or her own personality and to live in a more authentic manner. Obstacles and alienation in caregivers that induce a holding back of one's own natural impulses to give the suffering patient tender, dignified care are examined. Economy, p
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