need to define "care" in Pharmaceutical care: An examination across research, practice and education, The

American Journal of Pharmaceutical Education, Fall 2000 by Galt, Kimberly A

The purpose of this paper is to examine the concept of "care" and how it relates to pharmacy. A cross-discipline review of the literature is presented. Five areas are examined: the definition of care, care as behave ior, the relationship of caring behaviors to health, the relationship of caring behaviors to outcomes, and the teaching of caring behaviors. How the prior work of other disciplines relates to the pharmacy profession is discussed. Case scenarios are included which are intended to illustrate the patients experience when caring behaviors of professionals are either absent or present. A suggested list of specific caring behaviors of pharmacists is identified which fulfill or advocate for a patient's needs. The profession is urged to adopt specific caring behaviors within the professional standards of practice and perform these routinely in patient care. Education, practice and research agendas to further the pharmacy profession with the adoption of care values and behaviors are presented.

INTRODUCTION

Have you ever overheard a patient say, "no one seems to care"? The adoption of the concept and definition of pharmaceutical care in the last two decades reemphasized the profession's recognition that the pharmacist's primary responsibility is to the patient who has needs related to drug therapy(l). This revitalized the centrality of the relationship between the pharmacist and patient in the delivery of care. But what does this mean about what the patient should expect from the pharmacist and what the individual pharmacist should do? What behaviors are now expected from the pharmacist that may differ from traditional expectations? I believe the answers are in the further examination and development of the concept of care itself. We must identify and articulate the caring behaviors or acts which pharmacists perform in order to fulfill or advocate for fulfillment of individual patient needs. These behaviors must become expected in the professional standards of practice, resulting in routine performance in patient care. Such continued transformation, growth and maturation of the pharmacist professional is challenged by several competing pressures. The continued integration of technology and machines into daily life, the continued pursuit of efficiency in all areas of life, and the explosion of information in quantity, form and accessibility compete with our sensibilities toward the needs of others and our ability to meet their needs. The underlying belief is that the continual improvement of technological advances will greatly enhance the quality of our lives. Yet, while this almost mystical revolution progresses, "humanness" seems distant. The values, attitudes and emotions which provide context and relevance for what we do are not evident at the forefront of this change. Apathy about the "who" this perceived quality improvement applies to is the ironic result. This phenomenon permeates throughout the health care industry, including the systems of patient health care delivery. When reduced to the level of the individual, the absence of care as a value and caring behaviors is hallmark to this change. The greatest challenge posed is to infuse human context, meaning and richness to our professional choices, keeping the individual patients needs as a primary concern, and acting on their behalf(2).

Overt attention must be paid to the value of caring itself. An examination across research, practice and education of this area suggests substantial benefits to all. This review is intended to bring forward the highlights of prior work in other disciplines, and integrate the cumulative learning of others into the pharmacy movement. The intention is to stimulate thought and action by leaders in the profession of pharmacy to further develop and operationalize care as a value and caring behaviors into our professional culture, education and work. Scholarly work of the various health disciplines and humanities has been drawn upon and incorporated into each area of examination. The areas include:

a cross-discipline review of the literature about the concept and definition of care;

care - operationalized as behavior;

the relationship of caring behaviors to health;

the relationship of caring behaviors to outcomes; and

teaching caring behaviors.

Education, practice and research agendas suggesting further areas of advancement and study for the profession of pharmacy are presented near the conclusion of this paper.

A CROSS DISCIPLINE REVIEW OF THE CONCEPT AND DEFINITION OF CARE

A purposeful examination of care is most evident in the literature of nursing, pharmacy and medicine over the last 20 years. The longest history and greatest prevalence of scholarship on this subject resides in the nursing profession. In a comprehensive review of the health professions literature, nursing is the only discipline that recognizes care as a complete and wholly developed concept. An explicit definition of what care or caring is as it relates to the profession of nursing, is articulated within the nursing literature. This has been attempted in the pharmacy literature by offering the profession an initial reference to care when dissecting the term pharmaceutical care(3). Most professions have articulated the need for care(3-6). Our examination begins with a set of key definitions for which a common understanding is needed if we are to understand care as a concept that can be operationalized. All but the pharmaceutical care definitions are selected from the nursing literature. The nursing profession has a large momentum built on the notion that caring is the essence of nursing (see definitions for detail), and they further distinguish professional care from care as a general idea by the concept of health.