Reciprocity for Care: Gift Giving in the Patient-Nurse Relationship

Authors

  • Janice M. Morse

Abstract

Caring for patients frequently requires intensely personal and intimate tasks to be performed by nurses. In their professional role, nurses are relative strangers to the patient, yet are responsible for providing support to patients in their most distressing moments, such as when they are in pain or facing the fear of death. Nurses also provide patients with such care or treatments as assisting with bedpans, bathing or catheterization, that would in other circumstances be considered "shameful" and private to the patients. Although these procedures are expected and routine nursing tasks, they rarely become expected and accepted by the patients themselves. Patients frequently apologize and express shame at the "work" created by the loss of bodily control. Nurses work for the hospital, yet they give care to the patient. In this article I will argue that this situation creates an imbalance in the nurse-patient relationship. It creates a loss of power, dependency and passivity within the patient, and a feeling of being obligated to reciprocate for the care given. Chapman (1976, 1980), Dowd (1975) and Kayser-Jones (1979, 1981) note that reciprocity is an essential part of the therapeutic process, although, ironically, the practice is discouraged in health care. As the nurse's employer considers that the nurse has already been reimbursed adequately in the form of salary, and recognizes the more powerful position of the nurse and the potential for exploitation, administrative policy frequently is developed to prohibit gift giving. I suggest that such a policy inhibits patient recovery and that the constant refusal results in a double-bind situation for nurses. The nurses are placed in a situation whereby they must choose between accepting or refusing the gift. The former involves breaking hospital rules with the subsequent feeling of guilt and the possibility of reprimand; the latter violates social norms (i.e., it is considered rude) and may be construed as

Downloads

Published

1989-04-13

Issue

Section

Articles