Becoming a caring nurse : the heart of the matter in nurse education

This thesis in caring science didactics is based on a thinking, where the fundamental basis for the didactic is science-based, i.e. it does not emanate from the nursing profession but brings forward a didactic that grows out of caring science and its core substance and ethos. This view on didactics arises from the caritative theory developed by Eriksson. The overall aim of the study is to clarify the meaning and essence of understanding, as well as to explore and deepen the understanding of student nurses' processes of understanding and becoming with the intention of developing a theory model for caring didactics. The overarching research questions are: What is the essence of understanding (of caring science knowledge)? What are the possibilities and importance of understanding in the appropriation of caring science? What characterizes and impels the process of becoming? The thesis consists of four sub studies and a summary section. The overall methodological approach is hermeneutic involving quantitative as well as qualitative methods. The data for the study has been collected through a longitudinal research project that followed student nurses at three universities during their entire education. The empirical sub studies form the basis for the interpreted knowledge that is formulated in the new understanding. This new understanding have, through additional theory-charging with the theory fragments from Gadamer, generated the heuristic synthesis which is illustrated in the theory model. The findings shows that understanding can be described as something unlimited, as an endless movement, which can be illustrated as a lying eighth, a lemniscate. The lemiscate of understanding is characterized by seeing, knowing and becoming and consists of seven differently named phases; the acquired horizon of understanding, the encounter of horizons, the dialogue of horizons, the fusion of horizons, application, reflection and shaping a new horizon of understanding. Bildung (formation), is the ultimate imprint of the endless spiral movement of understanding. Ethos and arête constitute the hubs around which the lemniscate of understanding circles. These include the spirit and driving force that the student carries within. The caring culture encloses the lemniscate of understanding. The caring culture provides the life space of understanding and the prevailing basic values are evinced in the culture.

Livets källa kärleken : hälsans urkraft

This basic research focuses on the ethos of health and the human being's becoming in health. The theoretical perspective consists of the caring tradition within caring science developed at Åbo Akademy University. The aim of the present doctoral thesis is to uncover a new understanding as well as to deepen and attain a more nuanced understanding of the ethos of health, the essence of health, by penetrating to the core of what gives the human being the strength for experiencing a becoming in health. The research questions are as follows: l) What is the human being's source of strength? and 2) What reveals the source of strength so that the human being can perceive it and dedicate its strength in order to experience a becoming in health? The primary methodology used in the dissertation is hermeneutical. The material consists of the work Kärlekens gerningar by Kierkegaard, texts from focused interviews with respondents who have lived through severe personal suffering, as well as the book Det bländande mörkret by Wikström. These texts are interpreted through hermeneutical reading. The new horizon of understanding that emerges is reflected towards Eriksson's caritative theory, towards prior research within the tradition of caring science at Åbo Akademy University and towards previous national and international studies within this field. The new understanding shows that the human being's source of strength is love, the essence and origin of life. The substance of health is love, which, through the trinity of faith, hope and love, also makes possible the existence of the source of strength. Love has a deeper dignity than faith and hope, is connected with eternity and is the uniting link between temporality and eternity. The human being's inner longing entails an ontological attraction towards the source of strength. This source of strength is hidden, which provides and maintains its force, like a mystery connected with the darkness of suffering that hides the secret representing the source of strength, life's mystery, bu t w hi ch is revealed in both the darkness of suffering and in the light of joy. The dedication of strength requires freedom, willingness and courage to see the light, despite awareness of shame and guilt. Creative acts liberate the human being for the dedication of strength, which is preceded by a holy presence where, in solitude, the human being makes sacrifices for the sake of his or her human smallness and weakness, and allows himself or herself to be enclosed by the darkness of suffering to discover the light from the source. This entails being enraptured in a quiet "doing" in order to experience the beauty that bears witness to the holy which creates unity. The source of strength is revealed through beauty. The ethos of the human being and the ethos of health have the same fundamental substance, whilst the ethos of life possesses the deepest dimension and concerns the mysterious and infinite eternity. The ethos of life, eternity, which is a wellspring of strength, is not in itself strength-giving unless it is allied with love. Health can be understood in the light of life, of which death is an inevitable part. Life itself constitutes and creates the source which, through its alliance with eternity' s primordial wellspring of strength, generates strength from which the human being's source of strength, love, receives its eternal fervour. The human being is fundamentally interconnected with an abstract other, the first love, a universal wellspring of strength. Through Communion with this abstract other a dedication of the strength to experience a becoming in health becomes possible. Love for one's neighbour is the fundamental substance in the movement of becoming in health. Becoming in health presupposes a simultaneous movement in which the human being practices the human calling through ethos. As one loves one's neighbour through actions the still forces of eternity are in motion. When life emerges in the foreground and becomes the home of the human being, a dedication of the power of love is possible. Life itself determines the human being's becoming in health. A humble fundamental attitude towards life constitutes the basis for a continuous dedication of vitality from this source.

Identification of characteristics for successful university-company partnership development

The importance of university-company collaboration has increased during the last decades. The drivers for that are, on the one hand, changes in business logic of companies and on the other hand the decreased state funding of universities. Many companies emphasize joint research with universities as an enabling input to their development processes, which aim at creating new innovations, products and wealth. These factors have changed universities’ operations and they have adopted several practices of dynamic business organizations, such as strategic planning, monitoring and controlling methods of internal processes etc. The objective of this thesis is to combine different characteristics of successful university-company partnership and its development. The development process starts with identifying potential partners in the university’s interest group, which requires understanding the role of different partners in the innovation system. Next, in order to find a common development basis, matching the policy and strategy between partners is needed. The third phase is to combine the academic and industrial objectives of a joint project, which is a typical form of university-company collaboration. The optimum is a win-win situation where both partners, universities and companies, can get addedvalue. For the companies added value typically means access to new research results before their competitors. For the universities added value offers a possibility to carry on high level scientific work. The research output in the form of published scientific articles is evaluated by the international science community. Because the university-company partnership is often executed by joint projects, the different forms of this kind of projects is discussed in this study. The most challenging form of collaboration is a semi-open project model, which is not based on bilateral activities between universities and companies but on a consortium of several universities, research institutes and companies. The universities and companies are core actors in the innovation system. Thus the discussion of their roles and relations to public operators like publicly funded financiers is important. In the Finnish innovation system there are at least the following doers executing strategies and policies: EU, Academy of Finland and TEKES. In addition to these, Strategic Centres for Science, Technology and Innovation which are owned jointly by companies, universities and research organizations have a very important role in their fields of business. They transfer research results into commercial actions to generate wealth. The thesis comprises two parts. The first part consists of an overview of the study including introduction, literature review, research design, synthesis of findings and conclusions. The second part introduces four original research publications.

NEW BUSINESS MODELS – Sustainability as a main focus

A business model is a structure frame of an organization that can bring significant benefits and competitive advantage when structured properly. The aim of this paper was to observe and describe development of business models’ and identify factors and elements of a business model that are in a key role from the perspective of an organizational sustainability. One is striving to bring out in this thesis how should truly sustainable business model look like and what are main characteristics of it. Additionally, some recommendations that could be helpful in order to build sustainable and balanced business model in a company are presented in this work. The meaning was to make theoretical and in some extent practical acquaintance with such new business models as open business model and sustainable business model. Long-term sustainability achievement in a company was in a centric role and used as a main criteria when constructing sustainable business model structure. The main research question in this study aims to answer: What a firm should consider in order to develop profitable and sustainable business model? This study is qualitative in nature and it was conducted using content analyze as a main method of this research. The perspective of the target data in this study is an outlook of its producers of how sustainability is reached in an organization throw business model and which practices are important and has to be taken into account. The material was gathered mainly from secondary sources and the theoretical framework was outright built based on secondary data. The secondary data that have been mostly dissertations, academic writings, cases, academic journals and academic books have been analyzed from the point of view of sustainability perspective. As a result it became evident that a structure of a business model and its implementation along with a strategy is often what leads companies to success. However, for the most part, overall business environment decides and delimits how the most optimal business model should be constructed in order to be effective and sustainable. The evaluation of key factors and elements in business model leading organization to sustainability should be examined throw triple bottom line perspective, where key dimensions are environmental, social and economic. It was concluded that dimensions should be evaluated as equal in order to attain total long lasting sustainability, contradicting traditional perspective in business where profit production is seen as only main goal of a business.

Securin, Cdc20 and Cdc27 in predicting the outcome of human breast cancer

Deregulated proliferation has been recognized among the most important factors promoting breast cancer development and progression. The aim of the project is to gain understanding of the role of specific cell cycle regulators of metaphase-anaphase transition and evaluate their potential in breast cancer prognostication and treatment decisions. Metaphase-anaphase transition is triggered by activation of anaphase promoting complex (APC) which is activated by a cascade of regulatory proteins, among them securin, Cdc20 and Cdc27. These proteins promote the metaphase–anaphase transition and participate in the timely separation of the chromatids. This study is based on a patient material of approximately 600 breast cancer patients and up to 22 years of follow-up. As the main observation, based on DNA cytometric and immunohistochemical methods, securin, Cdc20 and Cdc27 protein expressions were associated with abnormal DNA content and outcome of breast cancer. In the studied patient material, high securin expression alone and in combination with Cdc20 and Cdc27 predicted up to 9.8-fold odds for aneuploid DNA content in human breast cancer. In Kaplan–Meier analyses, high expression of securin systematically indicated decrease in breast cancer survival as compared to low expression cases. The adverse effect of high securin expression was further strengthened by combining it with Cdc20 or Cdc27 expressions, resulting in up to 6.8-fold risk of breast cancer death. High securin and Cdc20 expression was also associated with triple-negative breast cancer type with high statistical significance. Securin, Cdc20 or Cdc27 have not previously been investigated in a clinically relevant large breast cancer patient material or in association with DNA ploidy. The present findings suggest that the studied proteins may serve as potential biomarkers for identification of aggressive course of disease and unfavourable outcome of human breast cancer, and that they may provide a future research aim for understanding abnormal proliferation in malignant disease.

Att lindra ett lidande : en kvalitativ studie om lindrande av den mobbade elevens lidande

The study's aim is to achieve knowledge of how to relieve the suffering of the bullied student. The methodology in this study is hermeneutics. The theoretical perspective is the caritative theory. The questions in the study are: 1) What does it mean to relieve a suffering? 2) What can caregivers do to relieve the suffering of the young bullied pupil? 3) How do the caregivers experience their role in relieving the suffering? The review of previous research shows that bullying is a phenomenon that causes great harm to the health of young people. There are varying developed strategies to deal with bullying in the schools. Only one article studied the counsellor role in fighting bullying. There is a need to examine how a suffering can be relieved, how the caregiver experience handling bullying, and how caregivers can be involved in relieving the suffering the bullied youngster is going through. The empirical part of the study was conducted through qualitative semi-structured interviews with counsellors who work with high school students. The study was conducted in close collaboration with the project "Analys av ungdomsenkäten" conducted by the youth researchers at Åbo Akademi and the Swedish Ostrobothnia Youth foundation (SOU). The collected material was analyzed according to Elo and Kyngäs (2007) guidelines for inductive content analysis. The result shows that caregivers play an important role in relieving a suffering. Counsellors emphasize the importance of a mutual relationship in order to relieve the victims suffering. Lack of time was the main culprit. The core of alleviating a suffering can be compared with those factors the informants take into account in the caring encounter with the bullied pupil.

Hälsa i vårdande gemenskap : gemenskapens betydelse för äldre

The aim of the study and research questions: The aim of this study is to illuminate how caring communion can aid in promoting health as becoming in elderly people in the context of natural caring. The target group of the study consists of elderly citizens living at home. The focus of this thesis is on the concept of communion and how caring communion can affect the inner health resources in a patient’s inner health domain, as well as how caring communion can support health as becoming and inner health resources in the elderly. The main research questions of this study are the following: 1) what does communion mean? 2) what does caring communion mean? 3) what is the connection between caring communion and health? Theoretical perspective: The theoretical perspective of this qualitative study relies on the caritative caring theory as developed by scholars of caring sciences at the Åbo Academi University’s Vasa unit. The caritas motive is based on an ethos built on a consideration of togetherness, i.e. caring communion, a place where one feels at home and where one can be the person one was meant to be. Methodology: A hermeneutic research approach based on Gadamer (1997) permeates the study. This entails that understanding and interpretation become central. The study conducted in the thesis is divided into three sub-studies. Sub-study one and two are based on ontological determination whereas the third sub-study is carried out by contextual determination. The first sub-study is conducted by etymological and semantic analysis of the concept of communion (gemenskap) based on Koort (1975) and the second sub-study by determining the basic epistemological category of the concept based on Eriksson (2010b). Sub-study three is conducted through content analysis of 18 multidisciplinary and 13 caring science articles and dissertations based on Kvale (2009). The aim in the third sub-study is to define caring communions in various contexts of meaning based on Eriksson´s model of conceptual determination (2010b). All studies are interpreted through hermeneutic interpretation where the continuous movement from a part of a whole, to the whole, to part again, leads to new understanding. Finally, the findings from all the three sub-studies are compared to the concepts of pre-understanding and the inner-health-domain model of Wärnås (2002). Results: The results of the study offer a description of the dimensions of caring communion and a model that illuminates how caring communion can further health as becoming. The fundamentals of caring communion rest on the idea of a human being’s absolute right to dignity as a base for communion. The concept of communion contains a moral, an ethical, and a spiritual component. In communion, there exists a moral and ethical responsibility and a willingness to commit oneself. The individual is part of a connection or relation and knows the aim and course for the communion. A caring connection, a caring culture, a caring atmosphere and caring listening are characteristics of caring communion. In caring communion, the elderly feel trusting and see themselves as unique, powerful, and valuable. The model demonstrates that when the elderly are able to rest in caring communion, the virtues of courage and faith become strong and desire for life awaken within the elderly and health as becoming becomes possible. Conclusions: The outcome of the study is that all communion is not necessarily caring communion. In order for communion to be caring and for the elderly to achieve health as becoming, there are certain criteria that must be met. This is especially important when designing activities for the elderly in the context of natural caring.

Safety and outcome of coronary interventions with special reference to anticoagulation and stent type

University of Turku, Faculty of Medicine, Department of Cardiology and Cardiovascular Medicine, Doctoral Programme of Clinical Investigation, Heart Center, Turku University Hospital, Turku, Finland Division of Internal Medicine, Department of Cardiology, Seinäjoki Central Hospital, Seinäjoki, Finland Heart Center, Satakunta Central Hospital, Pori, Finland Annales Universitatis Turkuensis Painosalama Oy, Turku, Finland 2015 Antithrombotic therapy during and after coronary procedures always entails the challenging establishment of a balance between bleeding and thrombotic complications. It has been generally recommended to patients on long-term warfarin therapy to discontinue warfarin a few days prior to elective coronary angiography or intervention to prevent bleeding complications. Bridging therapy with heparin is recommended for patients at an increased risk of thromboembolism who require the interruption of anticoagulation for elective surgery or an invasive procedure. In study I, consecutive patients on warfarin therapy referred for diagnostic coronary angiography were compared to control patients with a similar disease presentation without warfarin. The strategy of performing coronary angiography during uninterrupted therapeutic warfarin anticoagulation appeared to be a relatively safe alternative to bridging therapy, if the international normalized ratio level was not on a supratherapeutic level. In-stent restenosis remains an important reason for failure of long-term success after a percutaneous coronary intervention (PCI). Drug-eluting stents (DES) reduce the problem of restenosis inherent to bare metal stents (BMS). However, a longer delay in arterial healing may extend the risk of stent thrombosis (ST) far beyond 30 days after the DES implantation. Early discontinuation of antiplatelet therapy has been the most important predisposing factor for ST. In study II, patients on long-term oral anticoagulant (OAC) underwent DES or BMS stenting with a median of 3.5 years’follow-up. The selective use of DESs with a short triple therapy seemed to be safe in OAC patients, since late STs were rare even without long clopidogrel treatment. Major bleeding and cardiac events were common in this patient group irrespective of stent type. In order to help to predict the bleeding risk in patients on OAC, several different bleeding risk scorings have been developed. Risk scoring systems have also been used also in the setting of patients undergoing a PCI. In study III, the predictive value of an outpatient bleeding risk index (OBRI) to identify patients at high risk of bleeding was analysed. The bleeding risk seemed not to modify periprocedural or long-term treatment choices in patients on OAC after a percutaneous coronary intervention. Patients with a high OBRI often had major bleeding episodes, and the OBRI may be suitable for risk evaluation in this patient group. Optical coherence tomography (OCT) is a novel technology for imaging intravascular coronary arteries. OCT is a light-based imaging modality that enables a 12–18 µm tissue axial resolution to visualize plaques in the vessel, possible dissections and thrombi as well as, stent strut appositions and coverage, and to measure the vessel lumen and lesions. In study IV, 30 days after titanium-nitride-oxide (TITANOX)-coated stent implantation, the binary stent strut coverage was satisfactory and the prevalence of malapposed struts was low as evaluated by OCT. Long-term clinical events in patients treated with (TITANOX)-coated bio-active stents (BAS) and paclitaxel-eluting stents (PES) in routine clinical practice were examined in study V. At the 3-year follow-up, BAS resulted in better long-term outcome when compared with PES with an infrequent need for target vessel revascularization. Keywords: anticoagulation, restenosis, thrombosis, bleeding, optical coherence tomography, titanium

Yhteiskuntavastuuraportointi kansainvälisissä öljy-yhtiöissä vuonna 2013

Tutkimuksen tavoitteena oli selvittää, kuinka suuret yhdysvaltalaiset ja eurooppalaiset öljy-yhtiöt raportoivat yhteiskuntavastuustaan vuonna 2013 sekä kuinka laadukasta ja laaja-alaista raportointi oli. Yhtiöiden raportointia tutkittiin GRI-viitekehyksen taloudellisen, sosiaalisen ja ympäristövastuun näkökulmasta. Yritysten raportointia arvioitiin myös maa-alue- sekä liikevaihtokohtaisesti tutkien, voidaanko eroja näiden suhteen löytää. Lisäksi raportoinnin laatua analysoitiin yritysten asettamien yhteiskuntavastuutavoitteiden määrän kautta. Tutkimuksessa selvitettiin myös GRI-viitekehyksen sekä muiden yleisimpien yhteiskuntavastuuviitekehyksien käyttöä tutkimusyrityksissä. Tutkimusaineisto koostui 30:stä listatusta yhdysvaltalais- ja eurooppalaisyrityksen vuoden 2013 yhteiskuntavastuuraporteista. Tutkimustapana käytettiin kvalitatiivista sisällönanalyysiä. GRI-viitekehys oli tutkimusyrityksissä käytetyin viitekehys. Tulosten mukaan eurooppalaisyritykset raportoivat pääsääntöisesti laadukkaasti vastuustaan ja raportointi oli Euroopassa selkeästi Yhdysvaltoja laadukkaampaa kaikilla vastuun osa-alueilla. Tutkimusyrityksen koko vaikutti raportoinnin laajuuteen sekä määrään vain Yhdysvalloissa. Suuremmat yhdysvaltalaisyritykset raportoivat pienempiä paremmin. Tulosten perusteella yrityksen koko ei vaikuttanut tavoitteiden määrään. Maantieteellinen sijainti vaikutti raportoinnin laatuun. Eurooppalaisyritykset raportoivat laajemmin, laadukkaammin sekä asettivat tavoitteita huomattavasti yhdysvaltalaisia yrityksiä useammin ja enemmän kaikilla vastuun osa-alueilla.

Den Äldsta – livet är ett tillägnande : en vårdvetenskaplig explorativ studie av ett meningsbärande budskap och en innerlig visdom

In the background of the thematic The Eldest – life is acquiring one finds both previews and myths. Wisdom belongs to these myths. The hermeneutical philosophy refers to thinking as o movement from myth to logos in a dialogical oneness. The research uncovers dimensions in the element wisdom as empowered. The experiences of older are saved for further learning and transformation to younger with reference to vulnerable situations where common regulations are no more usefull. The interest goes to an Eldest. The Eldest in the study is pictorial in accordance to the main literature in the study.The Eldest is etymological, fictive and symbolic: – a man who understands higher matters of life, even Gods holy matters. She will set the fulfillment of others as the highest endowment out of an innermost ethos and an innermost wisdom. The innermost is wisdom. The aim is to discover a meaningful message in life is acquiring. In order to see and to learn from the experiences the study aim to uncover the innermost, an innermost wisdom out of a caritative approach. This innermost is anticipated as a longing for unity and health in dayly matters and in a caring ability for the other. The main overstatement is: What will this most meaningfull and innermost by the Eldest out of a living in factual life mirrored in a caring perspective be? Two questions expired; what will the meaningful message in the acquiring be? What will the innermost wisdom in serving the good be? This message and its innermost wisdom will get an expanded meaning out of a caring sentence: Man who dare – seeing back with gratitude, seeing forward in confidence, seeing aside with love and upward in fate wear that dignity, that holiness and that mercy and empathy which belong to life in its basics. The persons attending the research are situated in two contexts. One group has roots in the Lutheran church and the other in a caring profession. The datamaterial is formed out of the usages from these persons, from the spoken (conversation) and the written word (a guestbook). The usages as particular and common are continually integrated in the leading caring sentence from the beginning of the study to the end. The usages stand by the methodological for the final message and wisdom and at the same they form the operative dimension in the study, the evident and the validity. The overarching methodological approach is in the hermeneutic philosophy in accordance with the abductive logic. The usages out of two research groups are most significant in this deductive, inductive and abductive strategy. The usages from the research groups are confronted with the caring sentence in dialogical spaces, halts. The meaning and the innermost searched for will be pictured through the abductive and hermeneutic interpretation and will stand for an articulation of and a successively expansion of meaning. A twine of horizons out of the entire dissemination, the deductive and the inductive, creates the result, as the final message as the ground for an understanding of an even more embracing meaning in an innermost wisdom. The identified bearing movement in the groups in accordance with the caring sentence goes for something higher, something higher than me, to the wellbeing of the other. A conclusion is made and a thesis is identified. This thesis is out from the usages: What can I do in a creating of this caritative? An antithesis is also identified, is a man able to look outside one own and go to something higher, something greater? The synthesis is articulated as a dialogical movement from something … to something higher. The bridge could be maturation, transcendence, the divine or wisdom. The statement finds its root in the attending groups but a difference is also identified. This higher matter is different. The contexts and their meaningfulness decide. A final statement is: learn to see man and her matters hold in life.

Incorporating Sustainability in Global Sourcing Process, Industry Focus- Apparel / Textile

This is a Master’s thesis research, which mainly aims at identifying the sustainability issues in sourcing process and to identify the core competencies in sourcing process through triple bottom line adaptation. The focus of this thesis is on apparel industry’s sourcing process. The purpose of this thesis is to examine global apparel industry’s reality in their sourcing process and how buyers-suppliers are cooperating with their sourcing process to incorporate sustainability. Other goal of this research paper is to provide recommendation for sustainable sourcing process for companies and how the stakeholders can be benefitted by sustainable sourcing. The literature review part of this paper has presented the research gaps from the earlier researches along with the key concepts, academic purposes and key definitions. Theoretical framework chapter has focused on global sourcing strategies and firm’s competencies and sustainable strategies. From the theoretical framework, author has presented essential theory which establishes the link between research questions and proposed hypotheses. Main results and findings have been presented in empirical findings and in data analysis chapter. This study is an exploratory research followed by deductive method and primary data has been used to evaluate the current situation of apparel industry; which will assist to build the recommendation model. Primary data has been collected through online questionnaires and secondary data has used to cover the literature and theoretical parts. Therefore, the potential outcome of this paper will display the importance of sustainable sourcing from academic point of view and also from the business perspective. As a final point, this paper has followed the research objectives and has generated some new directions for further studies.

Vidrörd av livet i dödens närhet - att varda som människa och vårdare i vårdandets gemenskap

The overall aim of the study is to create a theory model of “becoming” as a human being and health care provider in the caring communion at the end-of-life. The theoretical perspective of the study is caring science as it is developed at Åbo Academy University in Finland outlined in Eriksson's theory of caritative caring with focus on caring ethics. The thesis consists of four sub-studies reported as scientific articles and a summary section. The study has an overarching hermeneutic research approach. The sub-studies I-IV are reinterpreted from viewpoint of the overall question. Empirical assumptions could then be discerned from the substance of the four substudies, which raised questions. The answers to these questions were sought in dialogue with selected texts by Kierkegaard and resulted in a theory model. The theory model results in following theses: 1. To “become” as a human being is to remain in an endless guilt. Guilt is a form of love. It is guilt that give strength and willingness to act in love and mercy when caring for patients at the end-of-life. The guilt as love allows becoming as a human being to be at home in love and mercy. 2. The human being’s courage is characterized as the willingness to obtain contact with the life of fellow human beings. This courage develops over time to stand for itself, with a foundation of belief in human beings, and resulting in a selfless, loving way to help the patients grieve and reconcile at the end-of-life. 3. To be “touched” can be illustrated as an inner awakening; an inner movement towards consciousness for the examination of the love for one another, and to love unselfishly. 4. The human being’s evolution in its own understanding of life occurs in the care of another human being who is at the end-of-life, as well as to be at home in ethos, love and mercy. Becoming in this context means that the human being evolves to become responsive to the heart's inner voice; an inner strength and joy which opens to the eternal and holy. 5. To overcome external obstacles is characterized as serving human beings in a selfless love; a caring in love that has requirements that need to be expressed by what is true, beautiful and good for patients at the end-of-life. An awareness and understanding of what it means to become as a human being and health care provider in caring community can help health care providers to easily focus on the patient.