What Caring Is and Is Not to a Patient

What does your caring feel like to a patient, at different times and with different nurses?

What work conditions impact your caring?

There is much discussion in the literature and among ourselves about the difficulty in consistently achieving meaningful connections with patients and families in your fast-paced care settings.

There are variations in levels of care. We know this. All caring is not equal.



Halldorsdottir’s work on the Development of the Nurse-Patient Relationship (1991) is the most recognized source for defining levels of care.

This clinical research is from a patient’s experiential view of the nurse-patient relationship and reveals a continuum from uncaring to caring (Watson, 2012).

The AAACN bases their CCTM (Care Coordination and Transition Management) Core Curriculum on the Halldorsdottir’s model. The model:

Uncaring modes of being with another:

  • Biocidic: nurse causes distress, despair
  • Biostatic: nurse is insensitive & indifferent
  • Biopassive: nurse is detached (just doing the job)

Caring modes of being with another:

  • Bioactive: nurse is kind, concerned, responsive ; a classic description of a good nurse-patient relationship
  • Biogenic: patient feels accepted, safe, understood; a sense of wellbeing and healing is extended from the nurse

Seeing these levels of caring defined in concrete detail is helpful in gaining an understanding of what human caring is and is not to a patient.


The question is how does a nurse get to the biogenic level of caring?

What does it involve?

When does a patient know a nurse is open to this level of connection?

Certainly a nurse has to be competent and have a professional wisdom about him or herself before reaching these deeper levels. Or not? Can’t a novice nurse connect deeply?

Does a nurse happen into these connections? Or do they occur purposeful?

How much personal knowing does the biogenic level require of a nurse?  Does this require more energy or same?

And for your situation, Do you feel it’s realistic to consistently create these events in your practice setting?



Halldorsdottir, S. (1991). Five basic modes of being with another. In D.A. Gaut & M Leininger (Eds.), Caring: The compassionate healer. New York: National League for Nursing Press.

Watson, J. (2013). Human caring science; A Theory of nursing (2nd ed). USA: Jones & Bartlett Learning.

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