attentiveness and care hand-out

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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

(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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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


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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


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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.


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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,


Completing care faithfully


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…


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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



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'


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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.


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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.




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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)


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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!


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Forms and discourses



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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


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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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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



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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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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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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



attentiveness and care hand-out

Healthcare

care good care

good care attentiveness

good care cfr

optimal care

accountable care

professional care

offer of care

relational relational