NursingScience

Caring Science Quarterly, 15:1, January 2002

Caring Science in a New Key

Katie Eriksson, RN; PhD
Professor, Department of Caring Science, Åbo Akademi University, Vasa, Finland,
Director of Nursing, Helsinki University Central Hospital, Helsinki, Finland

A reorientation is going on in caring science. It could be called a new key characterized by more humanistically ori-
ented thinking, which gives new significance to caring science. The sounding board of the new key is to be found in
its ontological core. Its progress depends on whether we will succeed in laying bare the core of caring and develop-
ing its fundamental concepts and main theory. We need to regain the hermeneutical approach to penetrate into the
core. Caring today needs this knowledge to help the patient in an increasingly complex world.

It is obvious that there has been a reori-
entation in caring science in the 1990s
toward a more distinctly humanistic
way of thinking. In Bernstein’s (1983)
words, it could be said that the herme-
neutic dimension, with its implied em-
phasis on understanding and interpre-
tation, has been regained. The necessity
of a humanistically oriented caring sci-
ence was pointed out much earlier in the
United States as well as in the Nordic
countries (see, for example, Eriksson,
1981, 1988; Parse, 1981; Parse, Coyne,
& Smith, 1985; Qvarnström, 1978;
Watson, 1988), but the time was not yet
ripe for its open admission. Those who
do research in caring science acknowl-
edge a common core of caring and sup-
port the striving for holistic care of the
patient but are, on the other hand, not
ready to work in a scientific tradition
that creates the prerequisites for a
deeper understanding of caring in all its
complexity. Regaining the hermeneutic
dimension and bringing out a humanis-
tic way of thinking means going beyond
the immediate experiences and pene-
trating into the core of caring. It means
having the courage to release ourselves
from the traditional way of thinking
(Parse et al., 1985) and to strike a new
note. The aim of this article is to discuss
some of the preconditions for this reori-
entation and to present a model
(Eriksson, 1988, 1990, 1994, 1997b) for
development of humanistic thinking in
caring science.
Nursing Science Quarterly, Vol. 15 No. 1,
January 2002, 61-65
© 2002 Sage Publications
A New Key
Regaining the humanistic dimension
can be compared to a new key (Langer,
1942) that is appearing in caring sci-
ence. As this key is becoming more
prominent, the basic premises of caring
science thinking tend to be brought into
harmony with the new keynote. We get a
new ethos, which is capable of bringing
out the value of caring in the spirit of the
present time. Langer says that every
change of key gives a new meaning to
the preceding bars and opens up new
perspectives on past ideas and argu-
ments. Starting in a new key means
bringing to life what has already been
said, animating dead words (Lévinas,
1988). It is a reorientation in time with
the prevailing context, without leaving
the core of caring out of sight. The key-
note is found in the ontological core, the
inmost being of caring, and every reori-
entation deepens and brings to the fore
this core.
New Questions and a New
Conception of Reality
The new key and reorientation imply
the formulation of new questions on the
basis of the fundamental premises. Re-
formulating the questions may bring
deeper motives to light. Every age has
its questions that most profoundly re-
flect the ripeness of the science that
poses the questions and the underlying
conception of reality. The depth of the
questions is determined by the basic
concepts we have at our command
(Langer, 1942). Our questions are al-
ways restricted in relation to their
direction, whereas the direction of the
question at the same time constitutes the
precondition for arriving at meaningful
answers (Gadamer, 1960/1988b). An
honestly formulated question, one that
seeks the truth, is open and prevents us
from being swayed by conventional pat-
terns of thought. Our present language
and our concepts are insufficient to de-
scribe reality, and the task of science is
to refine our concepts.
A science loses its vitality when no
more questions can be asked, when we
run out of new ideas. Asking questions
is an art. The development of a human-
istic research program could be started
by formulating fundamental questions
from the standpoint of basic scientific
assumptions (Eriksson, 1988, 1990).
The task of basic research is to devise
new questions. The limit to our thinking
is not determined from outside, but
from our own inner ability to widen our
intellectual horizon and create new
ideas. A new note, an original idea, a vi-
sion always first appears as a metaphor
before subsequently assuming a more
concrete linguistic form.
The Hermeneutic Dimension
The hermeneutic dimension is more
than a methodology. It involves a new
scientific conception, and sooner or
later we are all obliged to discover it or,
Keywords: caring science, core of
caring, Eriksson, hermeneutic

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62 Nursing Science Quarterly, 15:1, January 2002
as Kuhn (1977) says, “In my case the
discovery of hermeneutics nevertheless
implied something more than that his-
tory came to stand out as meaningful.
The most immediate and decisive effect
concerned my view of science” (p. xiii).
Humanism represents a concept of
knowledge which comprises culture
and an open concept of theory. Accord-
ing to the original Greek concept of the-
ory, theory is an open view of reality and
participation in it (Gadamer, 1988a).
Hermeneutics forces us to make up our
minds about different basic questions in
science, such as: What do we mean by
science, truth, text, reading, method?
Through hermeneutics we gain access
to new knowledge in the form of histori-
cal, philosophical, and other sources
dealing with human life.
Introducing the hermeneutic dimen-
sion in caring science implies that lan-
guage, metaphors, words, concepts, and
texts are given a central place in the for-
mation of knowledge. In the basic con-
cepts of symbolism we have the key to
all humanistic problems (Langer,
1942). To Gadamer (1960/1988b), un-
derstanding is always language-based
interpretation, the finding of one’s own
words. Interpretation implies above all
the description and naming of events in
the world. Understanding, interpreta-
tion, and application should not, ac-
cording to Gadamer, be seen as method,
but as substance. In distinction from
other hermeneutic theorists, Gadamer
does not think that specific methods
will bring us closer to truth in the hu-
manistic sciences. Instead, he stresses
that humanistic culture derives its origin
from rhetoric, which aims at conferring
culture and not merely knowledge in a
theoretical sense on a person. Under-
standing is ontology, Gadamer argues,
and thus hermeneutics takes us deeper
into reality and into the world of the
patient.
A New Caring Science Develops
Below is a brief description of the
leading ideas in Eriksson’s theory
(1987, 1988, 1997a, 1998) and in the
discipline of caring science, which have
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Table 1
Basic Assumptions of Eriksson’s Theory
1. The human being is fundamentally an entity of body, soul, and spirit.
2. The human being is fundamentally a religious being, but all human beings have not recognized
this dimension.
3. The human being is fundamentally holy. Human dignity means accepting the human obligation of
serving with love, of existing for the sake of others.
4. Health means a movement in becoming, being and doing, and striving for integrity and holiness
which is compatible with bearable suffering.
5. The basic category of caring is suffering.
6. The basic motive of caring is the caritas motive.
7. Caring implies alleviating suffering in charity, love, faith, and hope. Natural basic caring is ex-
pressed through tending, playing, and teaching in a sustained caring relationship.
8. Caring relationship forms the meaningful context of caring and derives its origin from the ethos of
love, responsibility, and sacrifice, that is, a caritative ethic.
developed since the 1970s and which nature. The ontological questions, that
are being further developed today at the is, the questions about what the inmost
Department of Caring Science at Åbo being of caring reality is actually like,
Akademi University in Finland (see Ta- came to the fore in our search for knowl-
ble 1). edge. It is the questions of “what” rather
Viewing the world, we have chosen than “how” that lead to the scientific
the term caring to emphasize that the formation of concepts and theories. In
focus is on the phenomenon of caring, search for the fundamental category of
not on the profession. We call this field caring, that is, the basic concept or the
of science caring science, not nursing idea behind all forms of caring, we have
science (Eriksson, 1997b). The con- used different approaches, such as his-
cepts caring and nursing are notori- torical research and motive research
ously ambiguous. Our idea of caring (Nygren, 1972).
science is closely related to Parse’s From the standpoint of concepts and
(1981, 1995) approach in developing the history of ideas, two leading con-
nursing science. ceptions of caring come to the fore, that
Our vision has been to revive the of compassion and that of human love,
leading idea of caring, the idea of love that is, the caritas motive, which we see
and compassion, and to incorporate it as the basic motive of caring. The
once more into the core of caring sci- caritas motive at the same time ex-
ence. The aim has been to create a hu- presses the basic value of caring science
manistically oriented caring science. and the ethical inducement to all forms
Our attachment to the challenge can be of caring. The leading idea of caring is
best captured in the words of Langer to alleviate human suffering and to pre-
(1942): serve and safeguard life and health
(Eriksson, 1992a, 1992b, 1992c, 1994,
Most new discoveries are suddenly- 1997a, 1997b; Lindholm & Eriksson,
seen things that were always there. A 1993, 1998).
new idea is a light that illuminates
presences which simply had no form
for us before the light fell on them. Basic Assumptions
We turn the light here, there and ev- of Eriksson’s Theory
erywhere, and the limits of thought
recede before it. A new science . . . is Ontology is reflected in various ba-
generated by such a basic innovation. sic assumptions, which are made con-
(p. 30)
crete in a multifaceted view and pro-
found understanding of the human
The Ontological Core being, of health, suffering, caring, and
the world, as well as in our attitude to-
We started from the assumption that
ward these entities. The basic assump-
caring science is basically humanistic in
tions have been developed since the

1980s and tested theoretically and em-
pirically (Eriksson, 1988, 1997b;
Fagerström, Eriksson, & Engberg,
1999; Fredriksson & Eriksson, 2001;
Lindholm & Eriksson, 1998; von Post &
Eriksson, 1999).
Our ontology (see Table 1) is an-
chored in a conception of the human be-
ing as an entity of body, soul, and spirit
and as basically religious and in suffer-
ing as the fundamental category of car-
ing, which can be seen as radically dif-
ferent from a generally accepted
perspective primarily based on the natu-
ral sciences. This confronted us with the
task of creating an epistemology and
some general methodological points of
departure as a basis for the further de-
velopment of caring science.
In accordance with the fundamental
assumptions of caring science, caring is
basically seen as something natural and
primordial. Caring has a specific mean-
ing context of its own—a caring rela-
tionship that arises in an unselfish rela-
tion with another and from a genuine
desire to alleviate suffering. The basic
motive of caring, the caritas motive, in-
vites us to caring. The deepest ethical
motive in all caring involves respect for
the absolute dignity of the human being.
Holiness is part of human life. Human
dignity implies inner freedom and re-
sponsibility for one’s own and others’
lives. The mission of the human being is
to serve, to exist for the sake of others.
The profoundest significance of caring
has been reached when a human being
has been restored to his or her mission.
Starting from the caritas motive, com-
passion for a fellow human being arises
in meeting a suffering human being.
Suffering can be alleviated in a relation-
ship characterized by responsibility and
a desire to do good. All caring is formed
in the relationship between patient and
caregiver. In this relationship, the pa-
tient is seen as a unique human being, an
entity of body, soul, and spirit. This
spiritual dimension is stressed as spiri-
tually existential, spiritually religious,
and spiritually Christian. Ontologically,
every human being, every patient, is
fundamentally seen as someone who
longs for something beyond their own
selves, a god or abstract other (Eriks-
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son, 1992a, 1992b, 1993, 1994; Lind-
holm & Eriksson, 1998).
Epistemological Standpoints
The most characteristic feature of a
young caring science is its endeavor to
form itself in terms of its own historical
and ontological conditions, which im-
plies that questions of method stay in
the background in the initial phase. By
expressly formulating the theoretical
terms on which knowledge is enhanced,
the preconditions for the generation of
theory based on the ontological core can
be created. It is necessary for the theo-
retical core to be made explicit enough
before clinical research is launched,
which always diffuses the core. Basic
knowledge of a field can be achieved
without knowing the concrete charac-
teristics, the absolute qualities
(Lindström & Eriksson, 1999).
The aim of science is to attempt to
create some form of order and intelligi-
bility in our world. It involves a search
for some form of a basic pattern, a the-
ory. The supreme purpose of science is
its search for truth and for the evident.
The humanistic conception of truth in-
cludes the true, the beautiful, and the
good (Gadamer, 1960/1988b). The
unity of caring, evident caring, is mani-
fested as true, good, and beautiful caring.
Our ontology and basis of value pre-
suppose an open view of knowledge,
which implies humility before the limi-
tations of knowledge—the realization
that absolute truths cannot be attained
even if there is the greatest possible pre-
cision and exactness. The understand-
ing attained is only a step forward and a
challenge for a continued search for
knowledge. Interest in knowledge can
be characterized as hermeneutic—
emancipatory with an emphasis on the
inner understanding of meaning and the
formation of ideas, which is seen as
constituting the basic precondition for
change with fresh ideas. In such a dis-
tinctive image of knowledge, both tradi-
tions and visions are allowed free scope
and can be seen to enrich our under-
standing of the world of caring
(Eriksson, 1998). The open view of
knowledge is also an endeavor to under-
stand what is unknown and difficult to
Caring Science 63
capture and is based on confidence in
the human capacity for innovative and
creative thinking and new ways of doing
research. Such search for knowledge
also implies something like an archaeo-
logical approach. This can be seen as
the most important tool of discursive
thinking. Awareness of language and
handling of concepts are of decisive im-
portance for our development of
knowledge.
Ethics Precedes Ontology
A caring science theory of human
relevance is by its nature ethical, and it
will be necessary to formulate an
epistemological postulate: Ethics pre-
cedes ontology. Lévinas (1988) thinks
that ethics precedes ontology. In his
opinion, an ontology that is not subordi-
nated to ethics is next to impossible, be-
cause the understanding of being in
general cannot indicate and control the
genuine relation to another person, but
it is this relation that must determine the
understanding of being. “The objectiv-
ity of sciences which presupposes their
inter-subjectivity, i.e. their validity for
everyone who tests their results, is
based on ethics, not the other way
round. Ethics is not an addition to our
knowledge, but the basis of knowledge”
(Kemp, 1992, p. 48).
Because ethics precedes ontology,
the situation is subordinated to ethics. In
a concrete sense, this implies that the
thought of human holiness and dignity
is always kept alive in all phases of the
search for knowledge. Ethics precedes
ontology in theory as well as in practice.
The fact that ethics precedes ontology
implies that we assume an attitude to the
reality we want to study and influence
through caring. It is through under-
standing and adopting an ethos, that is,
the values we embrace or, in the words
of Lévinas (1988), “passionate meta-
physics,” (p. 182) that we indicate the
mood and key which accompany our
development of knowledge.
Discussion
Caring science and caring as a whole
today require humanistic knowledge
64 Nursing Science Quarterly, 15:1, January 2002
and the hermeneutical dimension to
achieve real progress in caring. Caring
is becoming more and more complex,
and the patient is standing at the inter-
section between an increasing number
of sciences that attempt to describe and
explain him or her and influence the sit-
uation. It will be interesting to see in
what way the knowledge of care based
on human science will be integrated in
the formation of knowledge and in nurs-
ing care. I see three possible ways for
development of humanistic caring sci-
ence: an autonomous caring science, a
medical science more and more influ-
enced by caring, and an interdisciplin-
ary influenced science.
The greatest challenge of all is to de-
velop an autonomous caring science,
and it presupposes the development of a
caring science body of knowledge from
the core of caring not primarily tied to a
specific profession. Whether a caring
science will be successful in the aca-
demic world as well as in clinical prac-
tice is to a great extent a question of
power and authority. It is a question as
to whether the practitioners of caring
science are daring enough to assert their
own knowledge and its intrinsic value,
but it is above all a question of believing
in it ourselves and acquiring a caring
science identity.
Every theory and new scientific idea
has its own career or, to quote James
(1975), “At first, as we know, a new the-
ory is attacked as absurd; then it is
recognized as true but self- evident
and unimportant, and eventually it is
considered so important that its oppo-
nents themselves claim to have discov-
ered it” (p. 18). Many caring scientists
who have launched some bold novelty
probably recognize this. The strength of
an idea, a theory, or a whole scientific
structure lies in its theoretical core and
in how well it has been expressed. An
epoch comes to an end when the con-
cepts it produced are exhausted. Do we
today have enough originality, courage,
and creative zest to develop a humanis-
tic caring science? A decisive precondi-
tion is our own bid for basic research.
Another possible line of develop-
ment is that medical science and re-
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search will be more and more concen-
trated on caring and a human science
perspective, because this knowledge is
needed and there are questions to be an-
swered. Caring scientists are still en-
gaged in developing this knowledge,
but they have not the official authority
to support their own discipline. Caring
science knowledge is more and more in-
tegrated into medical science, but dif-
ferent concepts are used. From an ethi-
cal standpoint, this development can be
defended, because the knowledge will
benefit the patient. As far as caring sci-
ence is concerned, it implies a disinte-
gration of the discipline. Medical sci-
ence shows an ever-growing interest in
humanistic medical research, and pro-
fessorial chairs of medicine based on
human science are established in the
Nordic countries. It will be interesting
to see what such knowledge will be
called.
A third possible line of development
is that caring science ideas will have a
stronger impact in interdisciplinary
contexts, in which researchers repre-
senting different sciences will meet to
discuss some concrete problems of car-
ing. The risk is that the caring science
thinking will be blurred, mainly be-
cause the concepts will be used with dif-
ferent meanings. The knowledge will be
more pragmatically oriented and the
need for an independent caring science
will be questioned. This will be the case
especially if caring science will not
manage to establish a clear enough
identity of its own.
The starting point of this contribu-
tion was that there is a new key in caring
science, a key that carries the sound of a
long tradition and a historical develop-
ment characterized by the ethos of com-
passion and love. This is an ethos and a
key that is so fundamental to human life
that it will always endure and survive in
some form. It is my hope that this key
will continue to exist in caring and that
researchers in caring science all over the
world will meet the challenge, making
caring science and its intrinsic value
recognized. For a science to be taken se-
riously and to be able to make an impact
on society and culture, it must manifest
itself as truthful, heuristic, and innova-
tive.
Caring science as an academic disci-
pline has its intrinsic value, which
means that scientific progress and de-
velopment are assessed in terms of their
own internal criteria and their genera-
tion of substance. A caring science that
lacks its own intrinsic value and serves
more in the capacity of a techne has its
role assigned and is molded by other au-
thorities. It will then find it difficult to
operate for the benefit of caring. In car-
ing science, the pursuit of knowledge is
compatible with the task of exploring
the idea of good care and with indicat-
ing possibilities of implementing it, in-
dependently of professional consider-
ations. The transferring of caring
science knowledge and the application
of it to professional ends will be a task
for academic education. A caring sci-
ence theory that is successful sheds
light on both the successes and the fail-
ures of caring or, to finish with a quota-
tion from Langer (1942), “Freedom of
thought cannot be reborn without
throes; language, art, morality, and sci-
ence have all given us pain as well as
power” (p. 318).
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