Tronto (1993) offered this definition of care: On the most general level we suggest caring be viewed as a species activity that includes everything we do to maintain, continue and repair our “world” so that we can live in it as well as possible. That world includes our bodies, our selves and our environment, all of which we seek to interweave in a complex, lifesustaining web. (p. 103) Tronto suggested there is a pre-existing moral relationship between people; therefore, the question is, “How can I meet my caring responsibility?” Tronto’s model proposes four phases of caring and four elements of care. The phases are not necessarily in sequential order and often they overlap. The elements of care are considered the fundamentals necessary in order to demonstrate caring. Four phases of caring. Meeting Tronto’s (1993) four phases of caring for patients involves cognitive, emotional, and action strategies:
1. caring about
2. taking care of
3. care giving
4. care receiving (p. 165)
In Mr. Jones’s case, the nurse in phase one (caring about) recognized the need for increased pain medication in the assessment of the patient’s pain. In phase two (taking care of), the nurse saw a responsibility to respond to the level of pain the patient was experiencing. Therefore,
in phase three (care giving), the nurse took action to call the physician for a change in the analgesia order, and the morphine dose was increased. This is the work of reacting to a patient’s needs. Facing conflict with this physician is a necessary part of care (Kohlen, 2011; Lachman, 2009). Finally, in phase four (care receiving), the nurse assesses the success of the intervention with the patient (receiver of care). This last phase helps preserve the relationship between patient and nurse, and is a distinctive aspect of the ethics of care (Edwards, 2011).