The Primacy of Caring

Contributor: Peggy Chinn
August 23, 2018

Authors – Patricia Benner, RN, PhD, FAAN and Judith Wrubel

Year First Published – 1989
Major Concepts

Embodied intelligence
Background meaning
Stress in Illness


Grand Theory

Brief Description

Caring is primary because it determines and constitutes what matters to people. Subsequently caring creates possibilities for coping, enables possibilities for connecting with, and concern for, others, and allows giving and receiving help. Caring determines what is stressful to people and how they will cope.
Drawing on Heideggerian phenomenology, Benner and Wrubel posit a phenomenologic view of the person central to this view of caring. The person is a self-interpreting being who is defined by the process of living and being in the world. The immediate grasping of situational meaning—self-interpretation—is possible because of the following human characteristics: (1) embodied intelligence, (2) acquisition of background meaning, and (3) concern.

Nursing is a process of helping people cope with the stress of illness, not by following sets of prescribed rules but by contextually dependent caring and concern. Understanding the illness experience of the patient is central to concern and caring. Illness is a central focus of nursing. Illness is not reducible to disease (cellular pathology), but it connotes human loss experiences and dysfunction precipitated by human loss. Because nursing concerns itself with the relationship between the disease process and the illness experience of self-interpreting beings, a concept of mind–body dualism is not possible.

Caring in the context of nursing depends on discerning problems; recognizing solutions; and helping patients implement, and live, a solution. Thus nursing is a moral act that goes beyond mere application of scientific knowledge. Caring concern is central to human (nurse and patient) understanding of the situation of illness. Concern allows both nurse and patient to be in touch with the patient’s lived experience.

Because human beings can inhabit a common world with common meanings, common stress and coping patterns will exist. Phenomenologically grounded scientific study of stress and coping would reveal those common themes, meanings, and personal concerns as a basis for understanding caring practices in nursing.
–adapted from Chinn, P. L., & Kramer, M. (2018). Knowledge Development in Nursing: Theory and Process (10th ed.). St Louis: Elsevier.

Primary Source

Benner, P., & Wrubel, J. (1989). The primacy of caring. Menlo Park, CA: Addison-Wesley.


Patricia Benner  and Judith Wrubel

Patricia Benner, professor of nursing at the University of California, and Judith Wrubel, medical researcher at the University of California-San Francisco, are two major writers in nursing theory who specialize in what can be termed a “developmental” or “interpretive” approach to the person as patient. In general, the basic concept of nursing here is based around an ethic of care that deals with the patient as a whole. Therefore, the main thrust of nursing is a type of care that deals with patient mental issues, stress and emotions as well as clinical practice. (

“Dr. Benner is the Chief Faculty Development Officer for She is a noted nursing educator and author of From Novice to Expert: Excellence and Power in Nursing Practice. Dr. Benner was the Director of this Carnegie Foundation for the Advancement of Teaching National Nursing Education Study, which is the first such study in 40 years. She additionally collaborated with the Carnegie Preparation for the Professions studies of Clergy, Engineering, Law and Medicine. Dr. Benner is a Fellow of the American Academy of Nursing. She was elected an honorary fellow of the Royal College of Nursing. Her work has influence beyond nursing in the areas of clinical practice and clinical ethics. She is the first author of Expertise in Nursing Practice: Caring, Ethics and Clinical Judgment with Christine Tanner and Catherine Chesla, and has co-authored 12 other notable books including a March, 2011 Second Edition of Clinical Wisdom and Interventions in Acute and Critical Care: A Thinking-in-Action Approach with Pat Hooper Kyriakidis and Daphne Stannard.” (from