The case presented is a philosophy of practice, by Ulf Donner, leader of the Foundation Home at the psychiatric nursing home in Finland that for 15 years has based its practice on Erikssonàcaritative theory of caring.

Even at an early stage in our serving in caring science, we caregivers recognized ourselves in the caring science theory, which stresses the healing force of love and compassion in the form of tending, playing, and learning in faith, hope, and charity. The caritative culture is made visible with the help of rituals, symbols, and traditions, for instance, with the stone that burns with the light of the Trinity and the daily common time for spiritual reflection. In every meeting with the suffering human being, the attributes of love and charity are striven for, and the day involves discussions of reconciliation, forgiveness, and how we as caregivers can tend by nourishing and cleansing on the level of becoming, being, and doing. In the struggle in love and compassion to reach a fellow human being who, because of suffering, has withdrawn from the communion to find common horizons, the sacrifice of the caregiver is constantly available.

We work with people who often have the feeling that they do not deserve the love they encounter and who, in various ways, try to convince us caregivers of this. We experience patients$isappointment in their destructive acts, and we constantly have to remember that it may be broken promises that produce such dynamics. Sometimes, it may be difficult to recognize that suffering expressed in this way in an abstract sense seeks an embrace that does not give way but is strong enough to give shelter to this suffering, in a way that makes a becoming movement possible. In recognizing what is bad and what is difficult, horizons in the field of force are expanded, and the possibility of bringing in a ray of light and hope is opened.

As caregivers, we constantly ask ourselves whether the words, the language we use, bring promise, and how we can create linguistic footholds in the void by means of images and symbols. In our effort to nourish and cleanse, that which constitutes the basic movement of tending, we often recognize the importance of teaching the patient to be able to mourn disappointments and affirm the possibilities of forgiveness in the movement of reconciliation.

We also try to bring about the open invitation to the suffering human being to join a communion with the help of myths, legends, and tales concerned with human questions about evil versus good and about eternity and infinity. Reading aloud with common reflective periods often provides us caregivers a possibility of getting closer to patients without getting too close, and opens the door for the suffering the patient bears.

In the act of caring, we strive for openness with regard to the patientàface and a confirmative attitude that responds to the appeal that we can recognize that the patient directs to us. When we as caregivers respond to the patientàappeal for charity, we are faced with the task of confirming the holiness of the other as a human being. Our constant effort is to make it possible for the patient to reestablish his or her dignity, accomplish his or her human mission, and enter true communion.

1. Reflect on the meaning of caritas as the ethos of caring.

a. How is Caritas culture formed in a care setting?

b. How do caritative elements appear in caring?

c. What is the nature of nursing ethics based on Caritas?

2. Health and suffering are each otheràpreconditions. Think of what this meant in the life of a patient you cared for recently.

3. How have you recognized the elements of caring¡ith, hope, love and tending, playing, and learningn a concrete caring situation? Give examples.

4. Suffering as a consequence of lack of caritative caring is a violation of a human beingàdignity. Think about a situation in which you saw this occur, and consider what can be done to prevent suffering related to care.