How Grounded Are Our Ideals? Rethinking Nursing's Covenant of Care.

ABSTRACT: Covenant has been used to describe the special relationship between nurses and patients yet has been misunderstood in nursing literature. Covenantal elements of keeping promises and nurturing relationship resonate with the work of nursing. However, unlimited devotion puts the nurse at risk for exploitation and burnout. One's conceptualization of covenant is important because it impacts beliefs about allegiance, identity, and responsibilities. This article offers a critical analysis of how the conceptualization of covenant in nursing literature compares to a theological understanding of covenant. The covenantal dimension of a nurse's practice is reframed from the nurse-patient relationship to a professional-societal relationship.

'The Elephant on the Table': Religious and Ethnic Diversity in Home Health Services.

Healthcare services are increasingly being provided in the home. At the same time, these home contexts are changing as global migration has brought unprecedented diversity both in the recipients of care, and home health workers. In this paper, we present findings of a Canadian study that examined the negotiation of religious and ethnic plurality in home health. Qualitative analysis of the data from interviews and observations with 46 participants-clients, administrators, home healthcare workers-revealed how religion is expressed and 'managed' in home health services.

Returning home: historical influences on home healthcare in Canada.

In this article, the historical context of home healthcare in early 20th century Canada is examined with an emphasis on key events and groups that shaped nursing in the home as the primary form of healthcare. Ways in which home healthcare evolved are also addressed, including the movement from an emphasis on the home as the point of care for both preventative and curative services, to the separation of healthcare functions into public health, treatment of illness and injury, and pregnancy care-each with its own practitioners and regulators as hospital-based systems became the desirable norm. We conclude that the nature and status of home-based nursing evolved in response to public expectations of what comprised "best care" and who was responsible for providing (and funding) it. At a certain level, the home offered independent-minded nurses a level of autonomy and inscrutability unparalleled in hospital-based settings. As hospitals took preeminence as preferred sites for healthcare, the same geographic, cultural, and economic barriers that complicated access to hospitals also provided nurses unique opportunities in the home as relatively autonomous caregivers.