The final element is patient/family responsiveness to care (Tronto, 1993). The patient is vulnerable to the nurse’s actions or lack of actions. In some situations, the patient’s lack of responsiveness to analgesia is not reassessed to determine if a different plan of care is warranted. The nurse needs to verify that the caring needs of the patient are met. Care is a reciprocal practice, occurring within a framework of a relationship between the nurse (caregiver) and patient (care receiver) (Gastmans, 2006). The reciprocity consists of verifying that the care given actually met the needs of the patient. This interchange always must be focused on meeting the care needs of the patient or family, so no abuse of power occurs (e.g., paternalism). Watson (2001) also focused on this reciprocity of the relationship, which she indicated addresses the importance of the nurse’s own caretaking. The patient is never to be used as a means to an end of self-gratification. Summarizing Gilligan’s (1982) ideas, the nurse needs to take care of self in order to be able to care for others. The nurse must engage in self-care strategies so he or she will have the energy and motivation to implement the four elements of care: attentiveness, responsibility, competence, and responsiveness (Tronto, 1993).