Caring in Nursing from an Islamic

Perspective: A Grounded Theory Approach

Rubina Barolia, MScN; BSN, BA, RN, Registered Midwifery and Rozina Karmaliani,
PhD; MScN, MPH, BSN, RN, Registered Midwifery
Aga Khan University
School of Nursing

Abstract
and practicing morally.
The aim of this study was to discover the key components of caring within an Islamic
Morse, Bottorof, Neader. and Sol berg
context. The grounded theory methodology was utilized to discover caring processes.
(1991) viewed caring as a moral trait with
Seven scholars were interviewed; four were nursing scholars and three were Islamic
moral attributes and a inoral imperative.
scholars. Literature was simultaneously searched for support of emerging concepts and
Newman, Sime, and Corcoran-Perry ( 1991 )
to fill in gaps in the emerging theory. The concepts emerging from the data are physical,
argued that if caring is an integral part of
ethical/moral, ideological, spiritual, and intellectual dimensions of human personality.
nursing then it should be reflected in all the
The five antecedents emerging from the data were the five Rs: response, reflection, rela-
nursing theories. The importance of devel-
tionship, relatedness, and role modeling. Balancing emerged as the core category.
oping contextual-based caring knowledge
Implications include caring instrument development, concepts to modify existing caring
was also emphasized by Eriksson (2002).
theories, and some recommendations for further research.
She claimed that the concept of caring calls
for humanistic knowledge and a hermeneu-
Key Words: Caring, Islam, grounded theory, focus of this stud) was to develop a caring tical dimension in order lo achieve real
qualitative research, balancing, ideological, lheor\' from the Islamic perspective, as progress in caring.Therefore, it is very im-
spiritual, intellectual practiced in PakisUin. portant to develop a caring framework that
is contextually based. Swanson (1991). in
Introduction Caring Theories in Nursing her meta analysis revised caring theories de-
Care as a central concept has led to the The philosophy ol' care deals with the in- veloped by different nursing scholars and
deveiopmeni of several caring theories. Two herited \ alues and belief ahoiii care in many philosophers. According to Swanson,
well-known theories were developed in the disciplines, such a.s ethics, sociology, and Nodding ( 1984) analyzed the concept of
1970s, Leininger's theory of cultural care psychology. A model of caring, therefore, caring from a philosophical perspective.
and Jean Watson's theory of human caring includes u call for hoth art and science. It Noddings' work on caring focused on the
(McCance,McKenna,&Boore200l). offers a framework that embraces and inter- area of the clients' stress and coping needs.
These theorists define caring from a variety sects with art. science, humanities, and new Caring is an act that is used to resolve oth-
of philosophical perspectives, which en- dimensions of spirituality (Watson, 2003). ers' discomfort through an empathetic ap-
compass humanistic, hermeneutic, existen- Many nursing theorists and scholars have proach. Gilligan ( 1982) and Ray (1987)
tial , psychosocial, and cultural views. justified their claims about ihe phenomena connected caring with women's sense of
However, caring from an Islamic perspec- of caring in their writings. Melis (1997) morality. Leininger's ( 1985) framework of
tive has not been systematically studied in cited many nursing theorists to summarize caring is termed as cultural care, as she fo-
the field of nursing (Rassool, 2000). Ihe different aspects of caring. According to cused care according to individual culture.
The rationale for the development of a Melis. Watson (1997. 2002) described car- Riemen (1986) and Larson (1984) exam-
nursing theory of care from an Islamic per- ing from the existential philosophy F>ersf>ec- ined the concept of caring from the client's
spective is based on the assumptions pro- livc and described the spiritual basis of perspective. Clients perceive caring as more
vided by many Muslim scholars, that caring. Lciningcr ( 1985) \ icwed caring than routine care, that is, they perceive it
existing models and frameworks of care from cultural pcrs|x:cti\ cs: while Johnson more as person-centered, protective, and
may not fulfill the holistic needs of Muslim ( 1994) anah zed the art ot caring and used comforting behaviors of the care providers.
patients (Ahemed, 1999; Rassool.2000; caring as a synonym for nursing. She has Swanson analyzed three phenomenological
Ross, 1999). Therefore, they call for theory identified five characters!es that nurses studies from which she defined caring as "a
deveiopment in the field of nursing from an should xjsses while caring. They are grasp- nurturing way of relating to a valued other
Islamic perspective. Since caring is the core ing meaning, connecting with patients, hav- toward whom one feels a personal sense of
component of the nursing discipline, the ing skills, determining the course of action. commitment and responsibility" (p. 261).

2008; Vol. 12, No. 1

Caring in Nursing from an Islamic Perspective
The origin of Roach's (1984) theory is
philosophy and theology, and caring, ac-
cording lo Roach, is described as a human
mode of being. Roach proposed compas-
sion, competence, confidence, conscience,
and commitment, well-known as the five Cs
of the caring framework. A metasynthesis of
14 qualitative research studies on caring
among faculty and students, conducted by
Beck (2001 ). analyzed five major metaphors
or themes that depict different kinds of car-
ing behaviors. They are presencing, sharing,
supporting, competence, and uplifting.
According to Narayanasamy and Andrew
(2000), there are more than 120 countries
where Muslims have their own communi-
ties and the number of converts is increas-
ing. They suggested that nursing education
institutions make their teaching context
based to enable nurses to take care of
Muslim patients and the Muslim commu-
nity appropriately. The available nursing
theories may not address the Islamic philo-
sophical underpinnings, although literature
available in the latter part of the last century
consistently suggests that nursing knowl-
edge and skills need to be associated with
spiritual and religious dimensions.
Newman (1972) emphasized that knowl-
edge relevant to nursing in the contextual
setting is required in the nursing discipline.
Until this is done, nursing practice will be
incomplete.
Caring in Islam
According to Muslim scholars, the con-
cept of caring is embedded in the theologi-
cal framework of Islam, during is a natural
outcome of love that one has for humanity.
Islam focuses not only on the physical as-
pect of a human being but it is concerned
witb the interrelationship between the mul-
tiple dimensions of a person. A human
being has a soul and an intellect that require
moral, ethical.and intellectual care in order
to stay healthy (Ameer Ali. 1967: Hunziii.
2003; Rassool, 2000).
The principles of caring in the Islamic
philosophy are based on the Divine revela-
International Journal for Human Caring
tion and on following the Prophet's habits
(sunnat). Rassool (2000) cited Bradshaw
(1994) whoclearh identified that caring in
Islam focu.ses on .SLT\ ice to God as he said,
"Care in Islam isa service to God. a voca-
tion that was the tiiltillment of God's
covenant, purpose and freely given mutual
service within society, which distinguished
it from an\ contractual or commercial bias"
(p. 1481 ). Howe^'cr. because of some con-
troversies in the loimdation of the philoso-
phy ol caring, some Muslim scholars in
nursing hiive argued lor the use of a western
Iramework in Islamic countries.
Rassool's (2000) arguments are justified
l\\ saying that the world \ iew of health and
illness is different in Islamic and Judeo-
Christian traditions. For example, those
Muslims who strictly follow the concept of
"Hai-am" and "Haiar'ftxjd "ill starve them-
selves until the\' gel food processed and
ccK)kcd under the Islamic sharia that is
Halal tbod. Moreover. Muslim patients be-
lieve that illness, sulfering. and dying arc a
part of life and coukt be a test whereby
Allah checks the belief ot the followers.
Therefore, .seeking: help from Allah and
praying during Ihc course of illness and dif-
licultles is encouraged and patients and
Iheir families are allowed to offer prayers
during illness, which might be considered
inappropriate in western countries. Based
on this ralionale. he further added, "There is
an urgent need tor Muslim nursing scholars
lo develop a nursing framework that would
IK applicable lo Muslim and non-Muslim
patients in Islamic countries"" (p. 1482).
Ami of the Study
The purptwe of this study was to discover
the kc) comixineni.s of caring and their pro-
ccsscsin ihc Islamic context.The outcome
(>r the study was tlic formulation of a
grounded theory of caring in nursing from
an Islamic pcrspectiv e.
Study Questons
I. What arc ihc processes of the caring
concepts in Islamic teachings that
are utilized in nursing care?
2. What are the processes of caring
practices in terms of Quranic and
Islamic teachings?
3. What are the factors that influence
caring behaviors in nursing practices
with respect to an Islamic per
spective?
Methodology
Study Design and Participants
Grounded theory methodology was uti-
lized to discover a comprehensive explana-
tion of the concepts and processes of caring
in nursing from an Islamic perspective
(Glaser & Strauss, 1967; Streubert &
Carpenter, 1995).
A purposive sample of seven participants,
who could contribute vastly to generate the
theory of caring in nursing from an Islamic
perspective, was theoretically chosen. All
participants were Muslims scholars: four
were nursing scholars and three were schol-
ars in Islamic teachings. The demographic
characteristics of participants are summa-
rized in Table I.
Data Collection
Data in this study were collected from
June 2003 to September 2003 by conduct-
ing unstructured formal interviews in
English. Data collection, literature review,
and data analysis were done simuitaneousiy
as per the requirement of the grounded the-
ory meLbod.
All seven participants were interviewed
four or five times at their preferred loca-
tions. Each interview lasted for 40 to 60
minutes. Sampling and data collection
sought the full range of variation in cate-
gories until saturation was achieved.
Saturation is reached when no new concept
emerges from the participants" repeated in-
terviews (Chenitz &. Swanson, 1986;
Hutchinson, 1993; Stem, I98.S; Streubert &
Carpenter, 1995). Literature was searched
based on the concepts that emerged from
the data, which further aided in the discov-
ery process (Hutchinson; Streubert &
 Caring in Nursing from an Islamic Perspective

Table 1
Demographic Characteristics of Participants

Code Degree Years of Field of experience No. of Duration of Place of interviews

experience interviews interviews
(minutes)

Islamic I-(X)1 PhD 35 Teaching Islamic philosophy 2 90 Participant's office

Nursing N-002 PhD 30 Teaching & administration 3 90 Participant's office

Nursing N-003 MSN 20 Teaching & administration 2 70 Participant's home

Nursing N-004 PhD 30 Teaching & administration 3 65 Participant's office

Islamic 1-005 PhD 30 Teaching Islamic philosophy 3 90 Participant's office

Islamic 1-006 PhD 35 Teaching Islamic philosophy 3 90 Participant's office

Nursing N-007 MSN 30 Teaching & administration 3 45 Telephone from

researcher home

Carpenter).
The final group meeting with ail the par-
ticipants was held for the purpose of sharing
the final concepts, their relationships, and
the resultant diagrams of the antecedents in
order to achieve member check. The partici-
pants agreed on most of the categories and
codes and the emergent themes. However, a
few changes in the dimensional relation-
ships were suggested by some participants,
which vvere then incorporated in the fmal
theory formulation.
Rigor
Credibility was ensured through the re-
searcher's previous dissertation work on
caring philosophy of Islam according to the
Holy Quran. Repeated interviews and sup-
porting Quranic sources, quoted during in-
terviews, gave further credibility to the
information.Transferability was achieved
through purposive selection of the partici-
pants. All the participants selected in this
study acquired expertise and content knowl-
edge. Supporting documentation from the
Holy Quran and prophetic traditions pro-
vided the thick description of the data.
Conformability was obtained through pro-
viding ihc participants" words that reflect
ihc emerging codes.
Ethical Considerations
Permission to conduct the study was ob-
tained from Ihe Human Subjects Protection
Committee. Informed written consent was
obtained al the time of ihc participants' first
interaction.
Data Analysis
Data collection and data analysis oc-
curred simultaneously, consistent with
grounded theor\ methods. Systematic pro-
cedures lor the data analysis, recommended
h\ Strauss and Corbin (1990). were utilized
lor data analysis. 1 hc>' consist of three lev-
els. Level I is open coding in which the re-
searcher examines the text (transcripts and
notes) and forms the categories. In level II,
or axial coding, the researcher identifies a
single ciitegory as the central phenomenon
and explores the interrelationship of all the
categories. Lc\ci III. or selective coding,
then builds on the prepositions that connect
the categories. Ixveis II and III use indue-
ti\ e and cdiii:ti\ c methods and the re-
searcher continues lo inters iew until no new
categories are formed. These abstract data
arc then categorized and compared with
other data to form a theoretical construct or
hypotheses (Glaser & Strauss. 1%7; Strauss
& Corbin). Next, literature is searched to
confirm the emerging theory and to fill gaps
in the theoretical concepts. All interviews
were transcribed and analyzed through the
use of NVIVO, a software package for qual-
itative data.
Findings
Balancing emerged as the eore category,
which was also articulated by each partici-
pant in interviews. It also met the criteria of
the core category, as mentioned by Strauss
and Corbin (1990) who stated that the core
category should be broad enough to cover
and relate to all other categories that emerge
from the data and should serve as the cen-
tral core of the integration process.
Data show that balancing five dimensions
of the human personality is essential for
providing nursing care from an Islamic per-
spective, as shown in Figure [.The five di-
mensions are the physical, ethical, moral or
ethical, spiritual.and intellectual dimen-
sions of a human being that are related to
the core category. According to the theory
of carins in nursins.if a nurse succeeds in

2008, Vol. 12, No. 1

Caring in Nursing from an Islamic Perspective
Figure 1. Theory of caring in nursing &om an Islamic perspective: An interactive model
keeping a balance among all the five dimen-
sions, the results are caring behaviors and
caring actions. Failure to maintain the bal-
ance results in disequilibrium or uncaring
gestures. For example, a participant stated:
We often focus on care in terms of the
body and ignore the rest. Those aspects
also require nourishment and attention
but, unfortunately, our eyes have not
been trained to catch those internal as-
pects. Care also includes all those as-
pects that you cannot see but whose
effects are manifested in the body. For
example, if a drug Is not working in a
depressed patient, then what could be
the reason? Maybe the spiritual, moral,
or intellectual aspects of that person are
ignored. (Code N 003, lines 223-232)
The five concepts have been identified as
antecedent categories, which are the re-
quirements that enable the nurse in main-
taining harmony among the five dimensions
International Journal for Human Caring
of the clienls or pensons while taking care of
ihem in practice settings. These have been
named ;LS the th e Rs: response, reflection,
relationships, relatedness. and role model-
ing.
All participants expressed that the slate of
maintaining a balance among various as-
|x;c;t.s of hitman life is the central theme of
ihe caring prtxrcss. u hich means that caring
in the Islamic perspective should be viewed
as a circular process and not in a linear
manner. The miijor themes under each di-
mension arc as follows.
Physical Dimension
f hree iriiiin themes emerged from the
data to form the category of physical care
from an Islamic pcrspect^c. These have
licen depicted in Figure 2. They are pain re-
lieving, piety (maintaining cleanliness), and
prc\ention. Participants further expressed
[lain in two Ibrms: physical and psychologi-
cal pain. Both forms of pain need patience,
which is also articulated in the category of
physical dimension of caring from an
Islamic perspective. The concept of piet>'
(cleanliness) is also expressed in physical
piety and the purity of heart/mind. Preven-
tion was also discussed in great detail by
participants as a theme required for physical
caring related to caring in Islamic context.
They also expressed the linear relationship
of pain and piety (cleanliness) with preven-
tion. Figure 2 indicates the relationship of
physical dimension of care with other di-
mensions of care.
While discussing psychological pain, a
participant (nursing scholar) responded:
It is not only physical pain that is en-
countered in the practice settings, there
is also psychological pain, termed
mental pain, as well. For example, a
baby txirn dead or malformed is a crisis
for the mother and a nurse is often

Patience
Physical
Figure 2. Physical dimension.
called upon to handle it. These phases,
if not dealt with properly, can result in
irreversible mental damage. These
types of traumatic pains also require
caring through guidance and reassur-
ance and religious prayer. (Code N
007, lines 194-206)
Ethical Dimensions
Themes from ethical dimensions focused
on the Islamic ethics, which is the decision-
making process based on the principle of
doing good to humanity. The principle of
ethics, like honesty, justice, maleficence,
and equity, were highlighted by partici-
pants. In addition, participants discussed
ethical caring as respecting the rights pro-
vided in Islam. An Islamic scholar stated:
Ethics involves our own judgments and
values and beliefs. Islam teaches us to
look after our fellow beings. Sick peo-
ple have the rights to be visited and to
get appropriate treatment. These rights
are prescribed for the betterment of the
people. These set rights are based on
the principle of benefits. Proving bene-
fits is the ultimateresult of our actions.
These benefits are seen in terms of a
community and a group, instead of per-
Caring in Nurying from an Islamic Perspective
Physical Care
Pain
4 Prevention
Relivins
Body
Psychological
.sonai benefits. (Code ! 001, lines 37-
46)
Scholars also shared the purpose and
meaning of Islamic practices, particularly
namaz (salat/prayer) and zakat as they re-
late lo equality a.s it supports equality of
mankind.The word zakat (Holy Quran 9:
60) means both "purification" and
" yrouih." Zakai is ihc amount of money
that cvcr> mentally stable, free, and finan-
cially able adull Muslim, male and female,
has to pay to support specific categories of
people.
An Islamic scholar stated in his inter-
\ icw:
The namaz [salal/prayer| is offered in a
Ma.siid |mosquc|. There is no specific
place for the rich people and poor peo-
ple. In a Masjid all the people are
equal. So namaz give.s the concept of
equality, that all people are equal be-
lore CkxI. and entire humanity is Allah's
05.lines 97-103)
imension
Ihree themes emerged as the ideological
dimension of the caring framework, which
lorms the basis of balanced ideology of
Islam. Kirst arc ihc duties (oward Allah,
Piety
\
Heart/
Mind
termed as Huquq-u Allah; second are duties
toward mankind, termed Huquq-u lbad;
and, finally, duties toward self, termed
Huquq-u Nafs. Ideological caring is thus
keeping a balance in performing all these
duties as shown in Figure 3.
While discussing the importance of keep-
ing the balance among three duties, a partic-
ipant stated:
For example, if a person is offering
prayers it is the duty toward Allah but
if we think rationally. Allah has no
need like human beings, it is performed
because it protects man from miscon-
ducts,and the additional prayers are
performed in order to make oneself
humble and thankful. Therefore, these
prayers are actually beneficial to peo-
ple themselves but they are also related
to God. (Code N 003. lines 44-51)
Spiritual Dimension
While describing the spiritual dimension
of a human personality, participants dis-
cussed the concepts of inner satisfaction
gained from the service, human bounding,
compassion, empathy, and hope, as one
scholar reflected:
One needs to look carefuUv at internal
2008, Vol. 12, No. 1
Caring in Nursing from an Islamic Perspective
HuququUah
Huququnafs
Rationale B Sacrifice
Huququllabad
Figure 3. Ideological dimension.
energies and fxjwer, as they are intangi-
ble. But their manifestations are
through external symptoms. For exam-
ple, a person's sense of spirituality
must be identified and respected as its
gives inner happiness. You must have
seen, many people are blessed with all
the material wealth, health, and pros-
perity but internally they are dissatis-
fied, not happy. Because spiritually
they feel sick, that may get reflected in
psychological symptoms. (Code N
003, lines 300-306)
Spirituality in an individual greatly af-
fects a person's daily work and lifestyle.
Developing compassion is a spiritual char-
acteristic and participants acknowledged the
characteristic of compassion to be essential
for spiritual caring. Participants also stated
that spiritual strength is gained by develop-
ing feelings for others and having a feeling
of connection. For example, one participant
sated:
Compassion refers not oniy to the emo-
tional ability to enter into another's
feelings, troubles, and sorrows but also
the ability to inject energy and strength
into an active will in order to alleviate
and/or share the other's plight. All
thoughts, moods, insights, and actions
that serve the interest of others arc re-
garded as compassionate. (Code N
004. lines 119-126)
Participants also highlighted that Islam
International Journal for Human Caring
focuses on empatheiic feeling. The teach-
ings of Islam stress the idea of caring for
others as much as caring for self. While de-
scribing the importance of empathy, a nurs-
ing scholar stated:
Both the teachings of Islam, and the
principles of Islam teach the concept of
empathy, which means, like for others
what you like for yourself. This inner
feeling is actually a kind of spiritual
reeling. It carries the idea of care and
concern for humankind, as there can be
no peace or harmony in a society un-
less individuals care for each other.
(CodelOOl.lines 45-49)
Intellectual Dimension
Under the intellectual dimension of car-
ing, almost all the participants stressed the
importance of the inquir\ process in Islam.
The Muslim scholars believed that Islam, as
a world\ iew. is roolcd in knowledge, wis-
dom, iniellectual exertion, and reason.They
highlighted that the Quran repeatedly in-
\ itcs people to ponder over the macrocos-
mic order of the physical universe (the
"horizons" or Iq) and the microcosm of
the inner reality of our selves (Anfus).
While discussing the intellectual aspect.
\^hich Islam has Ibcused.ihc participants
felt that many people have negative conno-
tations of Islam and ihink that it has no con-
neciion uiih the iiuellect: however, this is
not correct. Thev felt that intellectual nur-
turing with searching is taught through
many verses in the Holy Quran. While fo-
cusing on the importance of inquiry, a
Muslim scholar quoted a few verses that en-
Join the Muslims to search and use intellect
at all levels of caring:
We are instructed to "travel across the
earth and see how Allah originated cre-
ation," and we are given the tiding that
"He will similarly produce a later cre-
ation (the Hereafter), for Allah has
power over all things" (29:20). Here it
has been left upon us to look at, to care
for, and to search for the purpose of
creation. Thus, to me. searching for the
service of humankind and. especiaiiy,
those who are patients who need care
after thorough investigation of their
disease, their environment, and them-
selves. (Code A, lines 469-477)
The participants also related the process
of inquiry to nursing research. A nursing
scholar expressed her views on search by
saying:
To me now, research is the intellectual
search that is rooted in the fundamental
principal of Quran. In many places, the
Holy Quran lays emphasis on search,
on pondering, and on reflecting and ac-
cuses those who do not think and
search. (Code N 002. lines 90-95)
Discussion
The results of the study showed that bal-
ance in the five dimensions of a human
being is the core category in the theory of
caring in nursing from an Islamic perspec-
tive. The maintenance of balance in all di-
mensions of human beings, through the
process of response, reflection, relationship,
relatedness,and role modeling, which in
tum results in an action, is termed caring ac-
tion. The data depicted the universal and
humanistic core values of caring, which are
similar in any religion, such as the Catholic,
Protestant, or Jewish perspective. If one
looks at this cohesive nature of caring in
nursing, it supports the world view of uni-
versality of Islam that respects and cares for

all human beings.
The study was carried out on the basis of
the assumption that existing theories of car-
ing are made and utilized in the western
context, which could be different from the
Islamic context. However, the results of the
study showed that caring from an Islamic
perspective, like any other religious or non-
religious perspective's based on universal
moral values of nursing. Moreover, like in
Christianity, in Islam the body is respected
and is considered important because it car-
ries the soul. According to Aga Khan III.
"In Islam, there are no extreme renuncia-
tions, no asceticism, no maceration, above
all no flagellation to subjugate the body.
The healthy body is the temple in which the
flame of the Holy Spirit burns" (Aga Khan
III, 1977. p. 176).
The caring dimension identified from the
data is similar to the one in the human sci-
ences and the metaphysical dimensions
(Watson, 2003). For example, the concepts
of hope, relationship, positive and negative
responses, transpersonal teaching/learning
in the form of role modeling, and spiritual
forces are alike in both the theories.
Roach (1984), in her monograph on
human caring in nursing, described caring
in the human mode, whereas the emergent
theory describes caring in nursing as a value
and an action that maintains a balance. The
five Cs of caring described by Roach have
also appeared in the present theory.
Compassion and conscience fall in the spiri-
tual dimension, and competence and confi-
dence have been reflected in the intellectual
dimension. The unique focus of humanness.
stated by Boykin and Schoenhofer (2001 ),
is also reflected in all the dimensions of car-
ing in nursing from an Islamic perspective.
The cultural dimensions of care and car-
ing have led to the development of the the-
ory of cultural care (Leininger. 1985. 1988,
1991). Leininger \'iewed care diversities
and care universalities in relation to the
world view and stated that care should be
provided in a culturally congruent and cul-
turally appropriate way. However, fmdings
Caring in Nursing from an Islamic Perspective
I Vom caring in nursing from an Islamic per-
.spective did not highlight the concept of
culture. Nonetheless, it can be assumed that
since culuire is embedded in religion; there-
lore, cultural differences have not been
identified as a major concern by the partici-
pants while exploring caring in nursing
IVom an Islamic perspective.
Analyzing the caring concept from a
philosophical point of \ iew. Nodding
(l984).illigan(l982).Ray(1987),
Riemen (1984).and Larson (1984),from
tliffercm perspectives, focused on similar
physical, ethical, moral,and Intellectual di-
mensions as those re\'ealed through the
data, except for the tew concepts related to
spirituality. For example, the concept of pu-
rity of heart in Islam and that pure inten-
tions lead to pure actions. However, the
ideological dimension of caring highlighted
in the Islamic perspective has not been
identified in any of the above philosophies.
As far as the energ\ fields of honoring,
l(i\'c. |X)wer. crcaliv ity. and spirituality are
concerned, as defined hy Newman, Sime
and C'oron-Perr\' ( 1991). these have been
rcilcctcd in (he ethical and spiritual dimen-
sions ol caring in nursing in the Islamic per-
spective. Moreover. Newman, Sime, and
Coron-Pcrr\ suggested caring as a moral
Irait, which is also similar to the ethical di-
mension of caring in nursing from an
I.slamic pcrspccthc.(London (1992) and
Bowdcii ( 1997) viewed caring in nursing
Linder lhc private and public domain; the
public domain is relatively similar to the
concepts of carini in nursing from an
Islamic pcrspecti\i;.
Examination of the above theories and
the theory of ciirini: in nursing from an
Islamic perspecti\ e demonstrates that these
theories arc grounded in humanism and in
the notion thai carins: in nursing Is based on
human science [lerspcctives.The humanis-
tic nature of Islam, as rellected in the re-
sults, suggests that Islam focuses on
keeping a balance aiiionu lhc five dimen-
sions ot human personalit}. This is based on
philo.sophy of Islam and the Holy Quran.
Study Limitations
The sample size was a major limitation of
this study due to lack of Muslim nursing
scholars in Pakistan. A wider sample size
with broader coverage may have been pos-
sible if Islamic scholars from olher parts of
the world had been contacted for interv iews
about caring from an Islamic p)erspective.
Practitioners could have been included in
the study to fmd out their views about car-
ing from a practice perspective. Another
limitation may have been the religious fac-
tor, participants may have felt obliged to
convey to the researcher the positive as-
pects of religion or they may not have been
able to identify the negative aspects.
Moreover, in any kind of qualitative study
one must guard against the phenomenon of
"going native." Further research could be
done to eliminate these kinds of biases by
interviewing those non-Muslim scholars
who have a thorough understanding about
Islam.
Conclusion
This study has validated the existing car-
ing theories of nursing; however, few emer-
gent concepts, like relatedness and
relationship in a triad form, are new ideas in
the arena of concept of caring. However, it
remains to be discovered if inter\'ention
tools can be developed that can test this
framework and that will enable nurses to
conceptualize the meaning of care from an
Islamic perspectives.
This research also provides a basis for
further study. The research explicating the
processes of caring in nursing from an
Islamic perspective could be further modi-
fied and refmed by comparing it with the
viewpoints of Muslim and nursing scholars
from other Muslim countries. Another ap-
proach could be to interview Muslim pa-
tients to discover their views about caring in
nursing from an Islamic perspective, which
could be used lo expand the theory.
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Author Note
Rubina Barolia is an Assistant Professor and MScN ("(x>rdina!oiand Roziiia Karmaliani is an Associate Professor and Director MScN
Program at the Aga Khan University, School of Nursing. Karachi, i'akistan.
Correspondence concerning this article should be addressed to Rubina Barolina, Aga Khan University, School of Nursing, Stadium Road.
P.O. Box 3500. Karachi, Pakistan. Electronic mail ma> be sent via Internet to rbina.barolia@aku.edu
Acknowledgement from Rubina Barolia: I would like to ihank inv thesis committee member. Dr. Micelle Upvall for providing her technical
expertise on grounded theor\' method to furnish me with necessary advice. My special thanks are also extended to Dr. Azizullah Najeeb for his
prompt and valuable feedbacks on the Islamic ideas presented in this report. I would further like to record my gratitude to the institution fund-
ing agencies. Seed Money Grant, Aga Khan Universii}. and Rho Delta Chapter (STTI) for providing timely financial assistance for the com-
pletion of this research. 1 am also very thankful to Dr. Jean Waison who reviewed this research and provided very valuable and encouraging
comments. My word of thanks cannot be complete il" I do not mention the input of the study participants without whom this work could not
have been accomplished.

2008, Vol. 12, No. 1