relational care and attentiveness · 2015-03-01 · 1. in the tradition of the ethics of care and...
TRANSCRIPT
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Relational care and attentivenessA contribution from the perspective of the presence
approach
Prof. Andries BaartFeb. 26th, 2015
JohannesburgIntroduction
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Content of the lecture
In order to be able to elucidate the meaning
of attentiveness in (good) care, I have to start
with explaining what makes care good care.
I’ll do that from the perspective of the ethics
of care / theory of presence.
Introduction
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Program:
1. Good care cfr. presence theory: idea and
characteristics
2. The meaning, forms and groundings of
attentiveness in good care.
Pause
3. Discussion
Between the chapters of this lecture, photographs of the bronze
statues of the young Dutch artist Lotta Blokker (1980) will be
showed. Her statues embody and show the central message of my
lecture: the relational engagement to the needs and pain of others.
© A
.J.
Ba
art
The point of the lecture
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• All good care is relational
• Relational care has attentiveness as its key
concept
• Attentiveness is a complex concept on the
intersection of four discourses: together they
show what attentiveness may be and can
contribute to good care
• Attentiveness as contribution to good care is
paid in practices and by consequence
attentiveness is more political-ethical than a
personal virtue.
The point of the lecture
© A
.J.
Ba
art
I Presence
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Presence
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Presentie (presence) is an empirically grounded theory in the tradition of the ethics of care and a more practical care-ethical approach of good caring for the most vulnerable ones.
It is focused on professional care.
It is rather elaborated by now.8
Presence (approach and theory)
Characteristics of presence
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• Presence (approach and theory)
• Complete sketch of presence on 4 levels:
Primary process
Formational process
Managerial process
Epistemological process
Characteristics of presence
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Primary process, methodological characteristics:
1. Being there with…
2. Close connecting and attentive fine tuning
3. The change of perspective and bracketing
4. Relationally programming the offer of care
5. Care providing with honor and recognition
6. Staying present
Characteristics of presence
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Good care, as you can see:
• Is not simply identical with accountablecare
• Nor with optimal care
• Nor with evidence-based care
• Nor with ...
Good care is care, substantially defined and morally understood
Characteristics of presence More in detail
I will now specify how the solicitude* of the carer in the primary process may contribute to good care.
You will see that attentiveness is one of the
key characteristics of good care
*) Zorgzaamheid (NL)
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Solicitude of the carer
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Orientation
Illness-oriented
Human-oriented
Implementation-oriented
Attitude-oriented The contribution to good care has a fourfold orientation: four aspects of caring (in the primary process) should be addressed.
Solicitude of the carer
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Orienta-tion
Care should be
At stake.. All about..
Illness-oriented
Well caredfor
All the necessary things well done
Safe, evidence-based, effective, timely, transparant, unpartial care
Human-oriented
Considerate Attentive and relational programmed care
Attentiveness, open perception, apt, fine tuned, relational, dedicated,
Implemen-tation-oriented
Careful Completing care faithfully
Responsive caring: feedback sensitive, experienced profit, beneficence, integral, completing once started care, taking responsibility
Attitude-oriented
Solicitous Caring out of (sincere) involvement
Communicative carers, heartily, respectful (empowerment and vulnerability), the suffering one not leaving alone, allowing the work to be meaningful
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Orientation Two types of care
At stake.. All about..
Illness-oriented
All the necessary things well done
Safe, evidence-based, effective, timely, transparant, , unpartial care
Human-oriented
Attentive and relational programmed care
Attentiveness, open perception, apt, well (fine) tuned, relational, dedicated,
Implementation-oriented
Completing care faithfully
Responsive caring: feedback sensitive, experienced profit, beneficence, integral, completing once started care, taking responsibility
Attitude-oriented
Caring out of (sincere) involvement
Communicative carers, heartily, respectful (empowerment and vulnerability), the suffering one not leaving alone, allowing the work to be meaningful
Takingcare
that…
Caringfor…
Solicitude of the carer
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Orientation All about.. Opposite of
Illness-oriented Safe, evidence-based, effective, timely, transparant, , unpartial care
Incompetent, slopwork, discriminating
Human-oriented Attentiveness, open perception, apt, well (fine) tuned, relational, dedicated,
Mismatch, humiliation, disregarding the human, inappropriate and violent care
Implementation-oriented
Responsive caring: feedback sensitive, experienced profit, beneficence, integral, completing once started care, taking responsibility
Doing your own thing, cutting care into bits, patient on the assembly line, creaming, organized irresponsibility
Attitude-oriented Communicative carers, heartily, respectful (empowerment and vulnerability), the suffering one not leaving alone, allowing the work to be meaningful
Bleak of desolate care, care that hurts, repelling incurable and dead-end cases, management as 'intensive people farming'
Solicitude of the carer
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In the same way we could elaborate the other three dimensions of good care, but that would take too much time.
I’ll jump to a concluding overview.
Solicitude of the carer
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You got a glimpse of our model of ‘professional loving care’:
1. A care-receiver experiencing desired benefits
2. From a solicitous care-giver
3. Working in a accommodating organization
4. In a decent society.
Solicitude of the carer
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In this model ‘attentiveness’ is one of the key concepts.
I will now, in the 2nd part of this lecture, try to be more specific about that.
From Moving to Being Moved
Solicitude of the carer II Attentiveness
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Frames of interpretation
• The behavioral interpretation: being attentive = behaving ‘not discourteous’
• The romantic interpretation: being attentive = feeling compassion
• The care ethical interpretation: being attentive = accepting the duty of caring (Tronto)
Internal link care - attentiveness
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What is attentiveness in care, cfr. the scholarly literature? Depends in the discipline you choose:
• Philosophical consciousness, intentionality
• Psychological concentration, being focused
• Theological being open to the otherness of the other
• Sociological glue of social togetherness (solidarity)
Internal link care - attentiveness
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Conclusions:
• All these four disciplinary perspectives are relevant for and included in good care
• Nevertheless: be aware of transitions
• Judgmental elements included: it is about good care
• No sharp definition!
Internal link care - attentiveness
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Forms and discourses
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Forms and discourses
In our research we identify four discourses of
attentiveness in (good) care and each produces
its own ‘form’ (practice) of being attentive. Each
has its own focus.
A discourse is -- to put it simply -- a collective
coherent and complex way of talking and
thinking about, and of conceptualizing,
researching and valuing a phenomenon (here:
attentiveness).26
Forms and discourses
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Forms and discourses
1. None of these forms of
attentiveness can be missed
2. None of these discourses on
its own makes care good care
3. They are intertwined; you
should discern them but
separate them.
4. The huge effort: being
attentive in the full meaning
of the concept.
Conclusions
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Forms and discourses
1. Attentiveness does not exist without a
context it is part of practices of care
2. In those practices all kinds of ‘forces’ come
in
3. Those practices are ‘polluting’ this pure
forms and discourses of attentiveness
4. That’s is how it is, and why we have to
broaden the picture of attentiveness
Reframing
III Further elaboration
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Making the picture more complex:
1. Attention as struggle
2. The periphery and centre of attentiveness
3. The core business of care and
attentiveness
4. Attentiveness as a political-ethical
concept
Further elaboration
(c) A.J. Baart 2015 Quotation allowed only with full source reference.
--------------------------------------------------------------------------- To be distibuted only amongst participants of the lecture
(c) A.J. Baart 2015 Quotation allowed only with full source reference.
--------------------------------------------------------------------------- To be distibuted only amongst participants of the lecture
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1- Attention as struggle (Baart 2006)
Hear our common language!
Three strong associations
• Attention as a generous gift
• Attention as a economic exchange
• Attention as a hard job
Further elaboration
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1- Attention as struggle (Baart 2006)
Conclusion: attention is
1. A precious and wanted good
2. Very attractive but rare
3. And a difficult to maintain effort
Further elaboration
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2- The periphery and centre of attentiveness
In attentive care (as in many other activities and
practices) two contradictory efforts have to
be combined (Polanyi, Arvidson):
• Being focused
• Being not focused
Further elaboration
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2- The periphery and centre of attentiveness
In attentive care (as in many other activities and
practices) two contradictory efforts have to
be combined (Polanyi, Arvidson):
• Being focused
• Being not focused
The meaning of focal and distal consciousness
and the context as constitutive for the focus
Further elaboration
The core business of care
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3- The core business of care and the place of
attentiveness (Klaver)
The different appreciation of attentiveness in
(our) hospital research (2009-2014):
Examples
The idea of the core business and the not
essential attentiveness
Further elaboration
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3- The core business of care and the place of
attentiveness (Klaver)
What we found: paying attention is…
1. Indispensable to all good care
2. Is distractive when caring well
3. Is making good care (unnecessarily) heavy
and complex
4. Is a serious impediment to good care.
Further elaboration
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3- The core business of care and the place of
attentiveness (Klaver)
What we found: paying attention is…
1. Indispensable to all good care
2. Is distractive when caring well
3. Is making good care (unnecessarily) heavy
and complex
4. Is a serious impediment to good care.
Further elaboration
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4- Attentiveness as a political-ethical concept
(Baart & Klaver 2014/2015)
What turns out to be essential for these different
evaluations?
1. Personal factors
2. Professional factors
3. Political factors
Further elaboration
Being attentive as a care giver is a personal virtue but even more a political-ethical issue.
Summary
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1. In the tradition of the ethics of care and the presence theory good care is relational.
2. A key concept within that relational approach is attentiveness.
3. We better avoid common sense, behavioral and romantic interpretations of attentiveness: they reduce attentiveness to being well-mannered and feel good.
4. Attentiveness is more essential, more ethical, more complex, more tough.
Summary
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5. Four intertwined discourses and basic forms of attentiveness together give an impression what attentiveness in care might be and add to the beneficent nature of good care.
6. That ‘pure’ idea of attentiveness in care is unrealistic. Further research shows that good care is attentive care (in the extended meaning I have presented) and that this kind of attentiveness is not just a personal virtue but much more a political-ethical issue, that should be handled accordingly.
Summary
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Let’s discuss this idea and thank you for your attentiveness!
Summary
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The End
(c) A.J. Baart 2015 Quotation allowed only with full source reference.
--------------------------------------------------------------------------- To be distibuted only amongst participants of the lecture