NCM 100 TFN

1. Katie Eriksson
Caritative Caring Theory

2. Katie Eriksson
• Eriksson was born on November 18, 1943, in Jakobstad, Finland.
• She belongs to the Finland-Swedish minority in Finland, and her
native language is Swedish.
• She is a 1965 graduate of the Helsinki Swedish School of Nursing,
and in 1967, she completed her public health nursing specialty
education at the same institution.
• She graduated in 1970 from the nursing teacher education program
at Helsinki Finnish School of Nursing.
• She continued her academic studies at University of Helsinki, where
she received her MA degree in philosophy in 1974 and her licentiate
degree in 1976; she defended her doctoral dissertation in pedagogy
(The Patient Care Process—An Approach to Curriculum Construction
within Nursing Education: The Development of a Model for the
Patient Care Process and an Approach for Curriculum Development
Based on the Process of Patient Care) in 1982 (Eriksson, 1974, 1976,
1981).
Katie Eriksson
Caritative Caring Theory

3. Caritative Caring Theory
Caritative caring consists of love and
charity, which is also known as caritas,
and respect and reverence for human
holiness and dignity.
According to the theory, suffering that
occurs as a result of a lack of caritative
care is a violation of human dignity.

4. MAJOR CONCEPTS & DEFINITIONS
Caritas
• Caritas means love and charity. In caritas, eros (love) and agape (filial love) are united, and caritas is by nature
unconditional love. Caritas, which is the fundamental motive of caring science, also constitutes the motive for all
caring.
• It means that caring is an endeavor to mediate faith, hope, and love through tending, playing, and learning.
Caring communion
• It is a form of intimate connection that characterizes caring.
• Caring communion requires meeting in time and space, an absolute, lasting presence (Eriksson, 1992c).
• Caring communion is characterized by intensity and vitality, and by warmth, closeness, rest, respect, honesty, and
tolerance.
• It cannot be taken for granted but pre-supposes a conscious effort to be with the other.
• Caring communion is seen as the source of strength and meaning in caring.
• In this relationship, the individual perceives the other person’s possibilities as if they were his or her own.
• This requires the ability to move toward that which is no longer one’s own but which belongs to oneself.
• It is one of the deepest forms of communion (Eriksson, 1992b).
• Caring communion is what unites and ties together and gives caring its significance (Eriksson, 1992a).

5. The act of caring
• The act of caring contains the caring elements (faith, hope, love, tending, playing, and learning), involves the categories of
infinity and eternity, and invites to deep communion.
• The act of caring is the art of making something very special out of something less special.
Caritative caring ethics
• Caritative caring ethics comprises the ethics of caring, the core of which is determined by the caritas motive.
• Eriksson makes a distinction between caring ethics and nursing ethics.
• She also defines the foundations of ethics in care and its essential substance.
• Caring ethics deals with the basic relation between the patient and the nurse—the way in which the nurse meets the patient in
an ethical sense.
• It is about the approach we have toward the patient.
• Nursing ethics deals with the ethical principles and rules that guide my work or my decisions.
• Caring ethics is the core of nursing ethics.
• Ethical caring is what we actually make explicit through our approach and the things we do for the patient in practice.
• An approach that is based on ethics in care means that we, without prejudice, see the human being with respect, and that
we confirm his or her absolute dignity.
• It also means that we are willing to sacrifice something of ourselves.
• The ethical categories that emerge as basic in caritative caring ethics are human dignity, the caring communion, invitation,
responsibility, good and evil, and virtue and obligation.
• In an ethical act, the good is brought out through ethical actions (Eriksson, 1995, 2003).

6. The ethical categories that emerge as basic in caritative caring ethics are human dignity, the caring communion, invitation,
responsibility, good and evil, and virtue and obligation.
Dignity
• Dignity constitutes one of the basic concepts of caritative caring ethics.
• Human dignity is partly absolute dignity, partly relative dignity.
• Absolute dignity is granted the human being through creation, while relative dignity is influenced and formed
through culture and external contexts.
• A human being’s absolute dignity involves the right to be confirmed as a unique human being (Eriksson, 1988,
1995, 1997a).
Invitation
• Invitation refers to the act that occurs when the care provider welcomes the patient to the caring communion.
• The concept of invitation finds room for a place where the human being is allowed to rest, a place that breathes
genuine hospitality, and where the patient’s appeal for charity meets with a response (Eriksson, 1995; Eriksson &
Lindström, 2000).

7. Suffering
• Suffering is an ontological concept described as a human being’s struggle between good and evil in a state of
becoming. Suffering implies in some sense dying away from something, and through reconciliation, the wholeness
of body, soul, and spirit is re-created, when the human being’s holiness and dignity appear.
• Suffering is a unique, isolated total experience and is not synonymous with pain (Eriksson, 1984, 1993).
Suffering related to illness, to care, and to life
• These are three different forms of suffering.
• Suffering related to illness is experienced in connection with illness and treatment.
• When the patient is exposed to suffering caused by care or absence of caring, the patient experiences suffering
related to care, which is always a violation of the patient’s dignity.
• Not to be taken seriously, not to be welcome, being blamed, and being subjected to the exercise of power are
various forms of suffering related to care.

8. The suffering human being
• The suffering human being is the concept that Eriksson uses to describe the patient.
• The patient refers to the concept of patiens (Latin), which means “suffering.”
• The patient is a suffering human being, or a human being who suffers and patiently endures (Eriksson, 1994a;
Eriksson & Herberts, 1992).
Reconciliation
• Reconciliation refers to the drama of suffering.
• A human being who suffers wants to be confirmed in his or her suffering and be given time and space to suffer
and reach reconciliation.
• Reconciliation implies a change through which a new wholeness is formed of the life the human being has lost in
suffering.
• In reconciliation, the importance of sacrifice emerges (Eriksson, 1994a).
• Having achieved reconciliation implies living with an imperfection with regard to oneself and others but seeing a
way forward and a meaning in one’s suffering.
• Reconciliation is a prerequisite of caritas (Eriksson, 1990).

9. Caring culture
• Caring culture is the concept that Eriksson (1987a) uses instead of environment.
• It characterizes the total caring reality and is based on cultural elements such as traditions, rituals, and basic values.
• Caring culture transmits an inner order of value preferences or ethos, and the different constructions of culture
have their basis in the changes of value that ethos undergoes.
• If communion arises based on the ethos, the culture becomes inviting.
• Respect for the human being, his or her dignity and holiness, forms the goal of communion and participation in a
caring culture.
• The origin of the concept of culture is to be found in such dimensions as reverence, tending, cultivating, and caring;
these dimensions are central to the basic motive of preserving and developing a caring culture (Eriksson, 1987a;
Eriksson & Lindström, 2003).

11. Martha Elizabeth Rogers
Science of Unitary Human Being

12. Martha Elizabeth Rogers
• Martha Elizabeth Rogers, the eldest of four children of Bruce Taylor Rogers
and Lucy Mulholland Keener Rogers, was born May 12, 1914, in Dallas,
Texas.
• Soon after her birth, her family returned to Knoxville, Tennessee.
• She began her college education (1931 to 1933) studying science at the
University of Tennessee. Receiving her nursing diploma from Knoxville
General Hospital School of Nursing (1936), she quickly obtained a BS degree
from George Peabody College in Nashville, Tennessee (1937).
• Her other degrees included an MA degree in public health nursing
supervision from Teachers College, Columbia University, New York (1945),
and an MPH (1952) and an ScD (1954) from Johns Hopkins University in
Baltimore.
• Rogers’ early nursing practice was in rural public health nursing in Michigan
and in visiting nurse supervision, education, and practice in Connecticut.
Rogers subsequently established the Visiting Nurse Service of Phoenix,
Arizona. For 21 years (from 1954 to 1975), she was professor and head of
the Division of Nursing at New York University. After 1975, she continued her
duties as professor until she became Professor Emerita in 1979. She held
this title until her death on March 13, 1994, at 79 years of age.
Martha Elizabeth Rogers
Science of Unitary Human Being

13. • Martha Rogers’ theory is known as the Science of Unitary Human Beings (SUHB). The theory views
nursing as both a science and an art as it provides a way to view the unitary human being, who is
integral with the universe. The unitary human being and his or her environment are one. Nursing
focuses on people and the manifestations that emerge from the mutual human-environmental field
process.
SUHB contains two dimensions:
• the science of nursing, which is the knowledge specific to the field of nursing that comes from scientific
research; and
• the art of nursing, which involves using the science of nursing creatively to help better the lives of the patient.
• Rogers’ theory defined Nursing as “an art and science that is humanistic and humanitarian. It is directed
toward the unitary human and is concerned with the nature and direction of human development. The
goal of nurses is to participate in the process of change.”
• Her model addresses the importance of the environment as an integral part of the patient and uses that
knowledge to help nurses blend the science and art of nursing to ensure patients have a smooth recovery and
get back to the best health possible.
• There are eight concepts in Rogers’ nursing theory: energy field, openness, pattern, pan-dimensionality,
hemodynamic principles, resonance (The quality or act of resounding), helicy (esonating nonrepeating
rhythms of an acausal human-universe life process), and integrality.

14. MAJOR CONCEPTS & DEFINITIONS
Energy Field
• An energy field constitutes the fundamental unit of both the living and the nonliving.
• Field is a unifying concept, and energy signifies the dynamic nature of the field.
• Energy fields are infinite and pandimensional. (dimensions of all reality)
• Two fields are identified: the human field and the environmental field.
• “Specifically human beings and environment are energy fields” (Rogers, 1986b, p. 2).
The unitary human being (human field)
• Is defined as an irreducible, indivisible, pandimensional energy field identified by pattern and manifesting
characteristics that are specific to the whole and that cannot be predicted from knowledge of the parts.
The environmental field
• Is defined as an irreducible, pandimensional energy field identified by pattern and integral with the human
field.
• Each environmental field is specific to its given human field. While not necessarily quantifiable, an energy field
has the inherent ability to create change (Todaro-Franceschi, 2008).
• In this case, both human and environmental fields change continuously, creatively, and integrally (Rogers,
1994a).
•

15. Human-unitary human beings
• A person is defined as an indivisible, pan-dimensional energy field identified by a pattern and
manifesting characteristics specific to the whole. That can’t be predicted from knowledge of the parts. A
person is also a unified whole, having its own distinct characteristics that can’t be viewed by looking at,
describing, or summarizing the parts.
Health
• Rogers defines health as an expression of the life process. The characteristics and behavior coming from the
mutual, simultaneous interaction of the human and environmental fields and health and illness are part of the
same continuum. The multiple events occurring during the life process show how a person is achieving his or her
maximum health potential. The events vary in their expressions from greatest health to those incompatible with
the maintaining life process.

16. Nursing
• It is the study of unitary, irreducible, indivisible human and environmental fields: people and their world.
Rogers claims that nursing exists to serve people, and the safe practice of nursing depends on the nature
and amount of scientific nursing knowledge the nurse brings to his or her practice.
Scope of Nursing
• Nursing aims to assist people in achieving their maximum health potential. Maintenance and promotion of
health, prevention of disease, nursing diagnosis intervention, and rehabilitation encompass the scope of
nursing’s goals.
• Nursing is concerned with people-all people-well and sick, rich and poor, young and old. The arenas of
nursing’s services extend into all areas where there are people: at home, at school, at work, at play, in
hospital, nursing home, and clinic; on this planet and now moving into outer space.

17. Subconcepts
Openness
There are no boundaries that stop energy flow between the human and environmental fields, openness
in Rogers’ theory. It refers to qualities exhibited by open systems; human beings and their environment
are open systems.
Pandimensional (Dimensions of all reality)
Pan-dimensionality is defined as a “non-linear domain without spatial or temporal attributes.” Humans’
parameters to describe events are arbitrary, and the present is relative; there is no temporal ordering of
lives.
Synergy is defined as the unique behavior of whole systems, unpredicted by any behaviors of their
component functions taken separately.
Human behavior is synergistic. (interaction between the patient and the nurse and vice versa)
Pattern
Rogers defined the pattern as the distinguishing characteristic of an energy field seen as a single wave.
It is an abstraction and gives identity to the field.

18. Principles of Homeodynamics
Homeodynamics should be understood as a dynamic version of homeostasis (a relatively steady state of internal
operation in the living system).
Homeodynamic principles postulate a way of viewing unitary human beings.
The three principles of homeodynamics are resonance, helicy, and integrality.
Principle of Reciprocity
Postulates the inseparability of man and environment and predicts that sequential changes in the life process are
continuous, probabilistic revisions occurring out of the interactions between man and environment.
Principle of Synchrony
This principle predicts that change in human behavior will be determined by the simultaneous interaction of the
actual state of the human field and the environmental field’s actual state at any given point in space-time.

19. Principle of Resonancy
• It speaks to the nature of the change occurring between human and environmental fields. The life process in
human beings is a symphony of rhythmical vibrations oscillating at various frequencies.
• It identifies the human field and the environmental field by wave patterns manifesting continuous change
from longer waves of a lower frequency to shorter waves of higher frequency.
Principle of Helicy
• The human-environment field is a dynamic, open system in which change is continuous due to the constant
interchange between the human and environment.
• This change is also innovative. Because of constant interchange, an open system is never the same at any two
moments; rather, it is continually new or different.

20. Science of Unitary Human Beings and Nursing Process
The nursing process has three steps in Rogers’ Theory of Unitary Human Beings: assessment, voluntary mutual patterning, and
evaluation.
The assessment areas are the total pattern of events at any given point in space-time, simultaneous states of the patient and his or
her environment, rhythms of the life process, supplementary data, categorical disease entities, subsystem pathology, and pattern
appraisal. The assessment should be a comprehensive assessment of the human and environmental fields.
Mutual patterning of the human and environmental fields includes:
sharing knowledge
offering choices
empowering the patient
fostering patterning
evaluation
repeat pattern appraisal, which includes nutrition, work/leisure activities, wake/sleep cycles, relationships, pain , and fear/hopes
identify dissonance and harmony
validate appraisal with the patient
self-reflection for the patient

23. Assessment
Pattern
Mrs Geetha is a right sided hemiplegic.
She said, “I cannot do anything of my own.
I am dependent on others for everything.”
She tolerates only fluid and soft diet and her intake is reduced.
She has a deep bedsore over sacral region.
Her pattern is decided by others in the hospital.
She said, “I am not able to mix up with others due to my condition, I feel lonely.”
Mrs Geetha’s son stated, “She is very religious and bold enough to face the problems of life, but now she has
lost the confidence.
She feels lonely and isolated.”
Mrs Geetha strives hard to achieve the fullest health within her limits.

24. Assessment
Resonancy
Mrs Geetha is on treatment. She complies with it. She states, “If I do not take these medicines my condition may
deteriorate further.” She further states, “My illness has laid burden on my son.” But her son is very supportive. It is
observed that sometimes she is pleasant, sometimes dull and withdrawn. When she was dull she said, “I feel
depressed and guilty of my illness. I do not know what will happen in the future?”
Helicy
In Mrs Geetha’s present condition she is unidirectional in moving towards achieving health within her limits. She
said, “I accept my illness; I may be recovering by using all the resources available. I do not fear death.” Her son
stated, “We will support and care for our mother throughout her remaining life.”
Integrality
As Mrs Geetha is hemiplegic and ready for discharge, her family has to do some modifications at home. She has to
get treatment for her HTN and DM also. Her son stated, “I do not know how to take care of her at home and
prevent any forth coming problems.”

25. Application of Rogers’ system model to Mrs Geetha
The data in Figure 2 explains that the pattern of Mrs Geetha changed according to the changes in life.
Initially she was healthy, independent, and active in her life.
Once she was diagnosed with HTN, DM and later with hemiplegia, she had to change her life style and adjust with her
illness.
For the seven years she was moving towards maximum health, but she was not able to achieve it, her condition
deteriorated, and she was hospitalized.
Her pattern in the hospital had changed again, which was decided by others especially the health care professionals
and her family members.
During her hospitalization, the main concern of the nursing staff was to help her achieve maximum health.
At the time of discharge, family support and rehabilitation was provided so that she is hale and hearty in future.
She was using the resources from family, society, and the hospital for a better life in future.
Based on the above concepts, nursing care was provided to Mrs Geetha using the nursing process.

26. As per the Rogers’ theory, the nursing process has three steps i.e., assessment, voluntary mutual patterning, and
evaluation. The assessment areas include, the total pattern of events in the life of client at a given point of time,
simultaneous states of the client and his/her environment, rhythms of the life process, supplementary data,
categorical disease entities, subsystem pathology and pattern appraisal. It is essential to have a comprehensive
assessment of human being and his environment. Thus, the author has done a comprehensive assessment of Mrs
Geetha and her environment based on her pattern.
The mutual patterning of the Mrs Geetha and the environment included sharing of knowledge, offering choices to
her and family, empowering her and family members, repeated pattern appraisal like her dietary pattern,
work/leisure activity, awake/sleep cycles, relationships with family and others, pain, hopes, and self-reflection were
identified. Based on the principles of nursing process comprehensive nursing care was given to the client and family.

27. Mrs Geetha, a 70 years old female, was admitted to the Intensive Care Unit (ICU) in an unresponsive state and was
diagnosed to have septicaemia. She was a known case of hypertension and diabetes mellitus for seven years. She
had right sided hemiplegia due to a stroke a year ago. She was on regular treatment. On admission, she was
treated in the ICU for three days and then shifted to the general medical ward.
In the ICU she was drowsy, not able to verbalize her feelings. She stares blankly. Her face looked anxious.
She was fed through nasogastric tube, Foley’s catheter was draining urine, and bowel pattern was regular. A
decubitus ulcer was present on the sacral region. She had restricted movements of the right side. After regaining
her consciousness and when her condition was stable, she was shifted to medical ward.
In the ward, she looks more relaxed and able to tolerate fluids orally.
Mrs Geetha was a widow residing with her son. She said, “For seven years my son is spending a lot on my
treatment. My sickness has laid burden on him and his family.” Her son is very supportive and states, “Our mother
has brought us up with lot of difficulties, so we want to take care of her well.” He added, “My mother is very
religious and strong enough to face the problems of life.”
Mrs Geetha was treated in the hospital for three weeks and then discharged. On discharge, she was able to tolerate
soft diet. Foleys catheter was retained. Family members were taught about the care to be taken at home. They
were referred to social workers. Mrs Geetha was able to sit with support in the bed, move her left limbs, but was
dependent on others for all other activities of daily living.