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Original article

Nurses as guests a study of a concept in light of


Jacques Derridas philosophy of hospitality
nup_557

117..126

Stina resland* RNT PhD, Kim Lutzn RN PhD, Astrid Norberg RN PhD,
Birgit H. Rasmussen RN PhD and Sylvia Mtt** RN PhD
*Senior Lecturer, Department of Health Sciences, Buskerud University College, Drammen, Buskerud, Norway, Professor, Department of Neurobiology, Care
Sciences and Society, Karolinska Institutet, Professor, Department of Nursing, Ume University, Department of Palliative Care Research, Ersta Skndal
University College, Stockholm, Senior Lecturer, Institute of Health and Care Sciences, Gteborg University, and **Director, Center for Gender Equal Care,
Gteborg, Vstra Gtaland, Sweden

Abstract

As revealed in previous empirical research, nurses describe their position


in home-based nursing care (HBNC) as that of guests in the patients
home. Such a description is problematic as guests might not be considered to belong to the realm of professionalism.As Jacques Derridas work
on hospitality has received wide publicity, sparking theoretical and philosophical discussion about host and guest, the aim of this study was to
explore how the concept guests can be understood in the light of
Derridas philosophy of hospitality.The study revealed that (a) guest must
be considered a binary concept; and (b) hospitality should be regarded as
an exchange of giving and receiving between a host and a guest. The
present study demonstrated that it is important to reflect on the meaning
of the concepts used by nurses in HBNC. Further theoretical and empirical exploration of the concept hospitality would be fruitful, i.e. what is
patients understanding of hospitality and hostility related to nurses
descriptions of themselves as guests in the patients home.
Keyword: Derrida, guest, host, hospitality, binary concept, home-based
nursing care.

Introduction
You are a guest in someones home . . . you must take this
into account.
Correspondence: Dr Stina resland, Senior Lecturer, Buskerud
University College, Department of Health Sciences, Postbox
7053, 3007 Drammen, Norway. Tel: +47 93643831; fax: +47
32869883; e-mail: stina.oresland@hibu.no

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Nursing Philosophy (2013), 14, pp. 117126

This statement is typical of nurses description of


their position in home-based nursing care (HBNC).
However, their description is problematic, as an
everyday concept from private life such as guest
might not generally be considered to belong to the
realm of professionalism and work. Nurses use of
guest as a description of the position they assume
when entering the patients home has been explored
in previous research (Bowers, 1992; Bauer, 2001;

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Spiers, 2002; Milton, 2005; resland et al., 2008; Santos


Salas & Cameron, 2010). However, these studies do
not address the meaning of nurses use of guest and
no thick description of what a guest-like approach
implies is provided. This lack of depth gives rise to
questions and a wish to know more about the concept
guest and how it can be understood in the context of
HBNC. Derridas work on hospitality has been highly
influential, inspiring theoretical and philosophical discussion about host and guests. Hence, this study
explores how nurses descriptions of themselves as
guests in patients homes can be understood in the
light of Jacques Derridas philosophy of hospitality.

A starting point
Many images spring to mind when reflecting on the
conceivable meaning of the concept guest. We may
think of persons being invited to stay in someones
home, in a hotel or participate in a social relationship. Dictionaries (http://www.merriam-webster.com;
http://www.dictionary.com; Ernby, 2010) reveal that
guest can be a noun, a verb or an adjective related to
a person. A dictionary definition of the meaning of
guest is a person entertained in ones home and a
person to whom hospitality is extended (http://www.
merriam-webster.com). A guest can also be someone
who for reasons of friendship, business, duty, travel,
or the like visits anothers home (http://www.
dictionary.com). A guest can be a familiar person or a
stranger a visiting foreigner (http://dictionary.
babylon.com). These definitions imply that a guest
can be an invited, expected or unexpected visitor to a
persons home.
Furthermore, guest seems to be closely related to
host, defined as; a person who receives or entertains guests at home or elsewhere (http://www.
dictionary.com). The host is responsible for the guest
while the latter is in her/his home (http://www.
merriam-webster.com;
http://www.dictionary.com;
Ernby, 2010). The host is also expected to provide
hospitality, described as; a friendly welcome and
treatment of guests and strangers and the quality
or character of receiving and treating guests and
strangers in a warm, friendly way (http://www.
dictionary.com). Thus hospitality a priori requires the

concept of guest. Etymologically, the concepts guest


and host are derived from the Latin hostis-potis
(Hellquist, 1922), which also includes hostiles and
originally combined the figures of stranger, guest,
enemy and host, while potis (potes, potential) unites
the semantic of power, mastery, and despotic
sovereignty (Gibson, 2003). Thus, in ancient Rome,
hostis-potis was a concept for both guest and host,
i.e. one concept for two phenomena that semantically
connected ideas of power, sovereignty, friendliness
and unfriendliness. In the Greek, there is the same
duplicity as in the Latin; xenos meaning both host
and guest (Derrida, 2000; Korstanje, 2008), which is
also the case with the French term hte (Levinas,
1969), meaning both host and guest. According to
Derrida & Duformantelle (2000), hospitality takes
place on a personal level when welcoming a stranger
to ones home and at the level of individual countries.
For Derrida, the reciprocal connection of personal
and public cannot be excluded (Caputo & Derrida,
2003; Wyschogrod, 2003). However, in the following,
only the personal level of hospitality will be
considered.

Jacques Derrida
Jacques Derrida (19302004) was a French philosopher whose critique of Western philosophy had a
major influence on the intellectual world in the late
20th century. In particular, his philosophy on hospitality had an impact on a wide range of disciplines and
areas of study, i.e. philosophy (Naas, 2005), education
(Kameniar, 2007), feminist studies (Hamington,
2010), tourism (Sherlock, 2001; Gibson, 2003), geography (Popke, 2004) and nursing research (Cheek &
Rudge, 1994; Peters, 2002; Rolfe, 2006). One example
is Whiteheads (2011) use of a Derridean discourse
analysis framework for health promotion literature
focusing on nurses and nursing practice.

Derrida and deconstruction


In the mid-1960s Derrida developed a philosophical
approach called deconstruction. Deconstruction can
be divided into literary and philosophical parts. The
literary aspect concerns textual analysis, where cre-

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Nurses as Guests A Study of A Concept

ation is vital for finding hidden alternative meanings


by exposing the tension, inconsistency and heterogeneity of a text (Caputo & Derrida, 2003). The
philosophical aspect involves the core aim of deconstruction: the metaphysics, which, in Derridas view, is
hospitality and unlimited openness to the Other.
According to Derrida (1976), language, and thereby
our thoughts are structured in as binary oppositions
that create meaning and maintain social hierarchies.
He claimed that they have a value hierarchy inherent
in them. These opposing terms are dependent on the
other part of the binary to be understood, i.e. the
binary concepts host and guest. Each term is loaded
with positive meaning and associations in relation to
the other term. By creating meaning in systems of
binary oppositions, the power relationship is concealed and the reality polarized. By separating and
analysing pieces of text in relation to hidden values,
deconstructionists try to illuminate and reduce the
gap between binary oppositions. Thus, Derrida is critical of traditional philosophy that tries to stabilize
meaning and finalise the position of specific texts,
traditions, beliefs etc.Whenever deconstruction finds
a concealed maxim or condensed truism it welcomes
the text, traditions, beliefs etc. and break it to open it
up (Caputo & Derrida, 2003).
Derridas work on hospitality has received much
attention, reviving theoretical and philosophical discussion about ways of relating guest and host. Exposing binary oppositions such as guest and host is a way
to illustrate and thereby highlight more or less hidden
values and norms that underpin dominant ways of
thinking about ourselves and others.

Derrida and Levinas


Drawing on the work of the philosopher Emmanuel
Levinas (19061995), one of the chief influences on
his thoughts, Derrida presented a comprehensive philosophy of hospitality as a complement to his core
vision, the absolute distinctiveness of responsibility to
the other.
Drawing on the French term hte (meaning both
guest and host), Levinass philosophy focused on
the ethical command of the other person and is
grounded in an ethical moment in the face-to-face

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encounter with the Other (Levinas, 2002). According


to Levinas, our potential to open ourselves in the
direction of the Other without conditionality establishes not only our potential to develop ethical relationships but also our capacity to be human. For
Levinas, we are not hostage to particular Others
because of any historical or social relationship. Our
responsibility for the Other precedes ontology
(Levinas, 2002; Popke, 2004; Hromas, 2009), thus,
ethical responsibility for the Other is prior to personal
existence (Hromas, 2009). Being ethical means being
open to and unprepared for the radical difference
(alterity) of the Other. Levinas holds that the Other is
essentially different, which means that the Other is
not the same as I am. I must meet the Other unconditionally without any preconceived notions or
knowledge about her/him. This means that ethics and
the imperative of ethical responsibility are prior to
knowledge and a priori phenomenon. The Others
position has no significance for me as I am responsible
for the Other as Other, as a human being, rather than
as a guest, host or stranger. The relation with the
Other is a responsibility that should not be expected
to be reciprocal.
According to Caputo & Derrida (2003), by building
on Levinas, Derrida developed the view that; deconstruction is a philosophy to the Other, where everything turns on the Other (p. 109) and is in a way the
same as hospitality as it implies welcoming the
Other (which includes text), without any condition,
as an unlimited welcoming; a philosophy, a thought,
writing, a doing of hospitality (p. 109). In this way,
deconstruction becomes respectable.
In order to understand the binary opposition of the
concepts of guest and host and the guesthost relationship in Derridas philosophy, it is necessary to
start with his philosophy of hospitality. Its focus is the
home, the relationship between a host and a guest and
the limits of the threshold (Derrida, 2000; Derrida &
Duformantelle, 2000; Westmoreland, 2008). Hospitality is defined as welcoming a guest into a home. The
guest receives and the host gives (Hamington, 2010).
Accordingly, there can be no guest without a host
offering hospitality and there can be no host without
a guest receiving it. Furthermore, there can be no
guest without a host who has the power to exclude or

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invite, nor a guest who has the power to accept or


refuse to enter into a relationship (Derrida, 2000;
Derrida & Duformantelle, 2000; Kameniar, 2007).

Unconditional and conditional hospitality


According to Derrida, two types of hospitality have
coexisted since Indo-European prehistory. On the
one hand, hospitality has been regarded as absolutely
unconditional and, on the other, as conditional
(Derrida, 2000; Derrida & Duformantelle, 2000). In
line with this, Derrida differentiates between the law
of hospitality and the laws of hospitality. Thus, an
encounter between host and guest is ruled both by the
law of hospitality and the laws of hospitality. At the
heart of Derridas philosophy is an idea of unconditional hospitality (Bell, 2007) governed by the law of
hospitality and impossible to negotiate. Unconditional hospitality is absolute in that it requires an
individual to provide hospitality without asking any
questions, imposing any limits or requiring anything
in return (Kameniar, 2007; Westmoreland, 2008). In
line with Derridas philosophy, Bell (2007) argues that
a host offers hospitality unconditionally, completely
and endlessly. There is also conditional hospitality, a
reciprocal system of social rights and obligations that
derives from and is embedded in culture (Derrida &
Duformantelle, 2000) as well as ruled by the laws of
hospitality. Thus Derrida makes a distinction between
unconditional and conditional hospitality, which has
contributed to elucidating the concepts of guest,
host and hospitality as ethical encounters (Floriani
& Schramm, 2010). As Westmoreland (2008) claims,
there is a potential conflict between the law of hospitality and the laws of hospitality. It can be seen as a
lack of agreement between the reality in an encounter
and an ethical ideal, as an is-and-ought conflict. Hospitality is conditional in the sense that the host does
not have to offer hospitality to an unknown guest
(OGorman, 2007; Westmoreland, 2008). The laws of
hospitality are social and cultural prescriptions for a
host and a guest to act in certain ways (Kameniar,
2007). In accordance with Derrida (2000), OGorman
(2007) stated that conditional hospitality takes place
in the shadow of the impossible of unconditional hospitality. As Friese (2004) commented, this tension

arises as conditional hospitality involves the possibility of selecting guests. The tension is also because of
the fact that conditional hospitality insists on agreement on, among other things, ethical principles, duties
and virtues (Friese, 2004). However, as Secomb (2007)
pointed out, conditional hospitality is in the end not
hospitality, for the kindness and generosity must be
reciprocated or the host praised for this minor act of
welcome.

The gift
Derrida pointed out that hospitality is not objective
knowledge, but an act of donation, the giving of something to someone, the aporai of the gift. The gift can
be given either conditionally or unconditionally: conditionally when the gratitude of the guest is expected
and unconditionally if no reciprocity is anticipated
(Wyschogrod, 2003). The only real gift is given anonymously and unconditionally, i.e. nothing is expected in
return and not recognized as a gift by the receiver or
the giver. If the giver starts to consider her/himself as
a giver she/he begins to;
. . . pay himself with a symbolic recognition, to praise
himself, to approve of himself, to gratify himself, to congratulate himself, to give back to himself symbolically the value of
what he thinks he has given or what he is preparing to
give . . .

(Derrida, 1992, p. 14)

A gift requires that there is no obligation, reciprocity, exchange or debt, as when the giver begins to
congratulate her/himself and the recipient feels a
sense of gratitude, it annuls the genuine gift situation.
For Derrida, the condition for the possibility of the
gift is at the same time the condition for the impossibility of the gift;
If the other gives me back or owes me or has to give me back
what I give him or her, there will not have been a gift . . .
(Derrida, 1992, p. 12)

A host is only a host if he owns the property and


retains ownership. This is the paradox of the Derridian gift. Recognition of the gift as a gift negates it
(Derrida, 1992).

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Nurses as Guests A Study of A Concept

Hostipitality
Derrida holds that there is always an element of hostility in hosting and hospitality, constituting what he
termed hostipitality (OGorman, 2007). According
to Caputo & Derrida (2003), an essential aspect of
Derridas philosophy of hospitality is the fact that the
welcome extended to the guest is a function of the
power of the host to maintain mastery of the property.
The idea of having and maintaining mastery underlies
hospitality:
Make yourself at home! This is a self-limiting invitation . . . it means: please feel at home, act as if you were at

Hence, hospitality is impossible as it simultaneously


requires both an unconditional welcome and the sovereignty of the host a paradox.
The threshold inversion
According to Derridas philosophy of unconditional
hospitality, a form of exchange takes place between
the host and the guest. This exchange is an inversion
that occurs when the guest steps across the threshold
of the hosts home. Derrida & Duformantelle (2000)
stated that the welcome reverses the guest and the
host positions. The guest becomes the host:
. . . it is indeed the master, the one that invites, the inviting

home, but remember, this is not true, this is not your home

host, who becomes the hostage . . . and the guest, the invited

but mine, and you are expected to respect my property.

hostage, becomes the one who invites the master of the

(Caputo & Derrida, 2003, p. 111)

house. The guest becomes the hosts host.

This tension between sovereignty and unlimited


welcoming inherent in hospitality creates a paralysis
a paradox:
If I say welcome I am not renouncing my mastery . . . his
tension built in hospitality, this aporia or paralysis how
can I graciously welcome the other while still retaining my
sovereignty, my mastery of the house?

(Caputo & Derrida,

2003, p. 111)

The question How can I limit my gift? starts when


the host experiences the paralysis, pushes against it
and in so doing invites hospitality to cross its own
self-limitation. Hence, the host must make an unlimited gift of her/his belongings and a kind of godliness
may occur. This is not hospitality but excess, and the
only way the guest can feel completely at home
(Caputo & Derrida, 2003). This tension is the condition of the possibility (and impossibility) of hospitality going beyond hospitality, which means that
hospitality is occupied from within, inwardly concerned with the tensions, but also open to hospitality:
to keep it on guard against itself . . . for it is only that internal
tension and instability that keeps the idea of hospitality
alive, open, loose. If it is not beyond itself, it falls back into
itself and becomes a bit of ungracious meanness, that is,
hostile.

(Caputo & Derrida, 2003, p. 112)

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(p. 125)

Unconditional hospitality requires that the relationship between the host and the guest is inverted
(Floriani & Schramm, 2010). Floriani & Schramm
(2010) tried to make this inversion clearer by stating
that the relationship between the giver and the recipient of the hospitality must be inverted to achieve
unconditional hospitality, as the host welcomed the
guest into her/his home, which can overturn her/his
sovereignty. When transferred to HBNC, this means
that, in order to be hospitable, the patient/host must
rid her/himself of her/his authority and power over
the property, guarantee security and unconditionally
welcome the nurse/guest into her/his home. In the
threshold inversion, the stranger/guest is the patient
who needs help as she/he is suffering. The nurse
becomes the host, the one who unconditionally welcomes the guest, the patient. Without expecting anything in return, without any hope of being accepted as
host, the nurse must, welcome and be receptive to the
needs of the guest. Thus, as a host the nurse is the one
who has the power and responsibility for providing
care while the former host, the patient, is the
stranger who receives the care. In this way, the nurse
is in a position to unconditionally receive the patient.
Invitation and visitation
In Derridas philosophy, unconditional and conditional hospitality are related to the difference

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between the concepts of visitation and invitation. A


visitation is unconditional and ideal. In comparison to
an invited guest, a visitor is defined as a known or
unknown non-invited guest. According to the law of
hospitality, a host should open her/his house to a
visitor without asking questions such as who are
you? and where do you come from? Such questions
are conditional. Thus, visitation belongs to the realm
of unconditional hospitality and as such is linked to
the inversion of positions (Westmoreland, 2008).
However, if a guest is invited by a host to her/his
home, the invitation is conditional and thus ruled by
the laws of hospitality. With an invitation, the threshold inversion does not occur, the host remains master
of the home and the guest remains the guest. When
the guest is invited, the demands on her/him are conditional as she/he has to adjust to the order of the
house, speak the language of the host etc. (Derrida &
Duformantelle, 2000; Westmoreland, 2008).

Are nurses visitors or are they invited?


So, how can nurses descriptions of themselves as
guests in the patients home be understood in the light
of Derridas philosophy of hospitality? If the patient
acts according to the law of hospitality, the nurses can
be seen as visitors, i.e. the host unconditionally welcomes the nurse/guest. In this case there is a challenge
in Derridas philosophy of unconditional hospitality,
as it requires unlimited sacrifices on the part of the
patient. If a patient offers a nurse unconditional hospitality, her/his host position is violated in that it is
inverted to that of guest. If this is what nurses mean
when they claim to be guests in the patients home,
they expect too much from the patient. As the nurses
visit the patients home to provide care, it seems a
contradiction that a patient has to relinquish her/his
position in order to be unconditionally hospitable.
However, if nurses act according to the laws of hospitality, they can be seen as visitors and guests, and their
behaviour as a ticket to enter the patient/hosts home.
The host, on the other hand, is expected to act in line
with accepted social obligations and duties. If the
patient/host acts according to the laws of hospitality
the nurses can be regarded as invited by her/him. In
this case, conditional hospitality can be considered a

different kind of exchange between patient/host and


nurse/guest. The patient/host imposes certain conditions upon the guest. First, the patient/host might ask
questions to identify the nurse/guest: who are you?,
what do you want? and where do you come from?
Second, the patient/host may place restrictions upon
the nurse/guest: as my guest, you must adapt to my
routines and habits, i.e. Please come early on Thursday; I have something I must do that day.
If the nurses behave as invited guests in accordance
with the laws of hospitality prescribed by the society
in which they live and work, i.e. not intruding or
obtruding, treating their patients/hosts with respect
etc., then the expression guest might be a reasonable
description of nurses position in HBNC.
On the other hand, in accordance with the threshold inversion, the patient/host can be seen as a
visitor, a guest who the nurse as a host must welcome
and help unconditionally, without any hope of her/his
position being accepted. This is an odd experience for
the nurse, an exercise in separation from a traditional
and assimilated form of involving others, without,
losing sight of the know-how to perform nursing
duties. This is not an equal situation, as mutuality is by
no means guaranteed. However, it is a way to expose
and indicate to the Levinasian Other that the nurse is
open to her/him, in order to develop an ethical relationship with whoever accepts unconditional ethical
responsibility.
However, there is still one problematic aspect. The
nurses described themselves as guests without considering the fact that they were not invited by the
patients/hosts. Instead, they had received a referral
that guided them in their work as nurses. If the medical
referral can be considered an invitation, the nurses can
be deemed invited. However, the referral was not an
invitation from the patients but from the physician to
the nurses to do their job not an invitation to be a
guest in the patients/hosts homes. Hence, the nurses
were not invited by the patients/hosts to be guests in
their homes they were there as nurses.

Hospitality for pleasure or out of a sense of duty


In line with Derrida, Telfer (2000) argued that different intentions underpin conditional hospitable acts;

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Nurses as Guests A Study of A Concept

hospitality is born out of a sense of responsibility and


duty or engaged in for pleasure. In the context of
HBNC, it is unlikely that patient/host intentions in
terms of hospitality for the nurse/guest are grounded
in the provision of hospitality for pleasure, but more
probably out of a sense of duty. According to Derrida,
these intentions are because of the ethos, disposition,
character or fundamental values of a specific person,
people or cultural movement that guide host performance in relation to a guest. The performance of a
guest is equally grounded in the ethos of the culture,
i.e. how a guest ought to act in a given culture and at
a specific time.
Transferred to the context of HBNC, the guest/
nurses intention in terms of receiving hospitality
from the patient/host might not be pleasure, but more
probably a sense of duty related to her/his profession
as an HBNC nurse. On the other hand, the patient/
hosts intention when providing hospitality to the
nurse/guest is probably also related to a sense of duty
grounded in an ethos that regulates the position of
host. Thus, the host/patients and the guest/nurses
intentions when providing or receiving hospitality are
grounded in duty not pleasure.

Is a nurse considered a guest or a parasite?


According to Telfer (2000), people choose to pursue
the virtue of hospitableness because they are
attracted by the ideal of hospitality but not at any
price. Hospitality entails conditions (Derrida &
Duformantelle, 2000):
Not all new arrivals are received as guests if they dont have
the benefit of the right to hospitality. . . . Without this right, a
new arrival can only be introduced in my home, in the hosts
at home, as a parasite, a guest who is wrong.

(Derrida and

Duformantelle, 2000, p. 59)

Hence, can the nurse be considered a guest or a


parasite in the light of the laws of hospitality when
transferred to the context of HBNC? The patient and
nurse have no personal knowledge of each other and
come to the initial encounter as strangers. From the
perspective of the patient/host, as a stranger the nurse
could be a parasite (Derrida & Duformantelle,
2000), an outsider who preys on the hosts goods.

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Derrida & Duformantelle (2000) stated that hospitality does not extend to a stranger without a name or
family. For example, if the nurse does not introduce
her/himself by name, the patient/host has no obligation to invite the nurse into her or his home, as
naming someone is to call her/him into being, to
render the invisible visible and to endow a person
with a certain character (Derrida & Duformantelle,
2000).
In an empirical study on HBNC, the patients discursively described themselves as safeguarding their
place, routines, habits and objects in everyday life
(resland et al., 2009), which might indicate that the
patients considered the nurses parasites as opposed
to invited guests.

The nurse as a giver and/or receiver


The question still remains: how can nurses descriptions of themselves as a guest be understood in the
light of Derridas philosophy of hospitality? According to Hamington (2010), Derrida stated that hospitality is related to giving and doing in a relationship
between humans. One may wonder whether this
giving and doing can be linked to the nurses
descriptions of themselves as guests. It is assumed that
a guest receives and the host gives conditionally or
unconditionally. The question is: what does a patient/
host give and what does a nurse/guest receive? In the
context of HBNC, a nurse/guest is one who receives
and a patient/host one who gives. One interpretation
is that a patient/host gives her/his hospitality and a
nurse/guest receives it. However, the relationship
between a patient and nurse in HBNC has a specific
purpose. From the nurses point of view, the purpose
is to care for patients in their own homes. According
to Lavoie et al. (2006), the mission of care is to take
care of the other human being and the relationship
between the patient and caregiver must be conceived
in terms of proximity and asymmetry. They state that
the relationship is by nature asymmetrical; the patient
is the one who needs and the caregiver the one who
provides care. Nor can it be the other way around
the care-receiver can never take care of nor assume
responsibility for the caregiver. The relationship
between the nurse/caregiver and patient/care-

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receiver is thus non-reciprocal and cannot be considered a same-level relationship. It is the nurses
responsibility to be receptive to the needs of the
patient and care for her/him. However, if the relationship between nurse and patient is conceived as one
between a guest and a host, both the guest and the
host are a priori responsible for the other. As mentioned above, as the owner of her/his home, the
patient/host has a moral imperative to provide hospitality in accordance with the laws of conditional hospitality (Derrida & Duformantelle, 2000). At the
moment of the interpersonal encounter, when a
nurse/guest first meets the patient/host, a need for
protection arises. Even before the encounter there is a
demand and thereby a fixed bond between the nurse/
guest and patient/host (Clancy & Svensson, 2007). In
line with Levinas (1969), Derrida (1981) stated that
our ability to open ourselves to the other without any
conditionality establishes not only our potential to
develop an ethical relationship but also our capacity
to be human. This means that the nurse/guest does
not encounter the patient as a host, but as a fellow
human being, implying that the positions of guest
and host lack significance in an ideal ethical encounter. The host is the unknown Other for whom the
nurse must assume responsibility and the reverse also
applies, i.e. the nurse is the unknown Other for whom
the host must assume responsibility.

Reflections
The aim of this study was to explore how nurses
description of themselves as guests in the patients
home can be understood in the light of Derridas
philosophy of hospitality. The study revealed that (a)
guest must be considered a binary concept; and (b)
hospitality should be seen as an exchange of giving
and receiving between a host and a guest.

Guest as a binary concept


The starting point of this study was the lack of investigation into the meaning of the concept of guest in
HBNC. However, merely highlighting it was insufficient, as it failed to reveal how it is interrelated with
the concept of host. Highlighting concepts such as

guest and host as binaries is a way of illustrating the


relationship between them with its inherent, albeit
more or less concealed, values and norms. The
concept of guest is so close to that of host that they
are etymologically, linguistically and philosophically
two sides of the same coin, intimately connected to
the concept of hostility. Accordingly, Derrida also
linked the concept of guest to the ethics of hospitality. As Derrida (1976) stated, in order to be understood, the two concepts in a binary opposition depend
on each other. By creating meaning in binary opposition systems, relationship is revealed by polarization
of the concepts. Thus, according to Derrida (1976),
exploring binary oppositions can be a method for
understanding the relationship between concepts
such as guest and host.
Guest and nurse are binary and relational concepts. However, as stated previously, nurse is often
mentioned in a dichotomy related to the concept of
patient (resland et al., 2008). It is therefore interesting to note that the nurses in empirical studies
(Milton, 2005; resland et al., 2008; Santos Salas &
Cameron, 2010) did not describe the binaries host
guest as Derrida did, but guestpatient. Hence, even
if nurses consider themselves guests, they do not
denote patients as hosts.

The threshold inversion


When the nurse and the host go through the threshold
inversion, a difficulty emerges for the Derridean proposal. The threshold inversion challenges the traditional power (im)balance between patient and nurse
in home health care. As such, it constitutes detachment from the traditional and assimilated form of
relating to others as a nurse. However, when the nurse
takes the position of host, providing an unlimited
welcome to the patient, it may wipe out the professional knowledge and know-how involved in the performance of nursing care (resland et al., 2008).

Hospitality as an exchange
Derrida & Duformantelle (2000) posed the question
if and how traditional laws of hospitality give rise to
hierarchical positions in the relationship between

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Nursing Philosophy (2013), 14, pp. 117126

Nurses as Guests A Study of A Concept

guest and host. One answer to this question is to


understand hospitality as a form of exchange, which
has important consequences for the thoughts about
and expectations of hospitality. It might also have
consequences for the hostguest relationship. Thus,
according to Derrida & Duformantelle (2000), in the
ethos in our culture, there is an assumption about
hospitality that the hosts must offer something in
terms of facilities such as place and time, while the
guests receive the benefit of the hospitality. Transferred to the context of HBNC, the nurse/guest
should be subordinate to the patient/hosts will and
needs, respect the patient/host and try not to violate
her/his authority and rules. Consequently, nurses can
describe themselves as guests in the home of a
patient/host if such conditions are fulfilled.
Hospitality can also be seen as a payback
exchange relationship between the host/patient and
the guest/nurse. The nurse provides care and the
patient/host hospitality; both are givers and receivers
as in a contractual relationship where both parties
benefit. Another way to answer the Derridean question is to understand hospitality as a reciprocal
exchange built on mutual respect and humility. Consequently, reciprocal exchange situates the guest and
host in a kind of horizontal relationship. This is not
an equal relationship, but one in which both parties
know they can flourish thanks to the other and treat
each other with dignity not as a payback exchange
but one born of caring and responsibility for the
Other despite differences in position.

Conclusion
This study demonstrates that it is important to reflect
on the meaning of the concepts used by nurses in
HBNC. As previously revealed, there is a tendency to
use concepts without closer reflection on the discourse from which they originate and to which they
are related. One example is the concept guest, traditionally used in discourses related to private matters,
here transferred to a professional discourse in the
context of HBNC.
Despite the fact that the issue of nurses descriptions of themselves as a guest has been explored,
some uncertainties still remain. Do nurses play down

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Nursing Philosophy (2013), 14, pp. 117126

their professional knowledge when describing themselves as a guest in the patients home? What is the
benefit of such a description? Maybe the nurses use
of the concept guest lacks substance and is just used
pragmatically? Should this be the case, there might be
a risk that the concept will serve as a semantic
magnet, i.e. a buzzword used as a routine expression
by nurses in HBNC. There might also be a possibility
that the nurses description of being a guest in the
patients home is narrow and does not match the
patients expectations. The patient may not expect a
guest, but a nurse. Thus, there is a risk that the
patients and nurses expectations of each other
differ. Further theoretical and empirical exploration
of the concept of hospitality related to care would be
fruitful, for example; what is patients understanding
of hospitality and hostility related to nurses
descriptions of themselves as guests in the patients
home?

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