LEC 3: Nursing as an Art

Caring

Assisting, supporting, or enabling another individual or group with evident or anticipated needs to ameliorate or improve a human condition or lifeway, or to face death

Caring

Dimension of human relating, and often referred to as the art of nursing

The art of nursing

What is caring referred to as?

Smith (2013)

Who suggested nursing cannot exist without caring?

(1) helping professions

(2) meaning

Caring is central to all (1) ___ ___ and enables people to create (2) ___ in their lives

(1) deep

(2) genuine

(3) welfare

Caring is sharing (1) ___ and (2) ___ concern about (3) ___ of another person

Caring Practice

Involves connection, mutual recognition, and involvement between nurse and client

1. Aside to administering a pain reliever, a nurse also strokes the hand of a patient who is experiencing pain post-surgery

2. To an elderly female patient, a student nurse gives a bed bath, combs their hair, and gives them light makeup to boost the confidence of the patient.

2 Examples of Caring Practice

knowing that they have made a difference in their client’s lives

Just as clients benefit from caring practices, the nurses involved in these situations experience caring through [???]

(1) focused attention

(2) egocentric self

The ability to give clients (1) ___ ___ means leaving the (2) ___ ___ behind

Milton Mayeroff (1990)

Who proposed Caring as “Helping the Other Grow”?

Caring as “Helping the Other Grow”

What did MIlton Mayeroff (1990) propose?

Milton Mayeroff’s Caring as “Helping the Other Grow”

Caring is a process that develops over time, resulting in a deepening and transformation of the relationship.

Recognizing the other as having the potential to grow, the caregiver does not impose direction, but allows the direction of the other person's growth to help determine how to respond.

1. Knowing

2. Alternating Rhythms

3. Patience

4. Honesty

5. Trust

6. Humility

7. Hope

8. Courage

8 Major Ingredients of Caring (Mayeroff)

Knowing

One of the 8 Major Ingredients of Caring (Mayeroff)

Understanding the other's needs and how to respond to these needs

The nurse notices the patient shivering so the nurse lowers the temperature of the room.

What is an example of “Knowing”?

Alternating Rhythms

One of the 8 Major Ingredients of Caring (Mayeroff)

Moving back and forth between the immediate and long-term meanings of behaviour, considering the past

Patience

One of the 8 Major Ingredients of Caring (Mayeroff)

Enables the other to grow in his own way and time

For a patient requiring a dietary change, the nurse should not implement the changes immediately but gradually work towards the dietary goal.

What is an example of “Patience”?

Honesty

One of the 8 Major Ingredients of Caring (Mayeroff)

Includes awareness and openness to one's own feelings and a genuineness in caring for the other.

Trust

One of the 8 Major Ingredients of Caring (Mayeroff)

Involves letting go, allow the other to grow in his own way and own time

Humility

One of the 8 Major Ingredients of Caring (Mayeroff)

Acknowledging that there is always more to learn, and that learning may come from any source

A patient that has undergone long term treatment needs to take an additional medication. Before imposing a specific time on the patient to take the medication, the nurse should be open to hearing the input of the patient, who knows their bodies’ reaction to their current medication.

What is an example of “Humility”?

Hope

One of the 8 Major Ingredients of Caring (Mayeroff)

Belief in the possibilities of the other's growth

Courage

One of the 8 Major Ingredients of Caring (Mayeroff)

Sense of going into the unknown, informed by insight from past experiences.

1. Caring as a moral imperative

2. Caring as an affect

3. Caring as a human trait

4. Caring as an interpersonal relationship

5. Caring as a therapeutic intervention

5 Viewpoints (Morse, Solberg, Neander, Battorff, & Johnson)

Caring as a Moral Imperative

One of the 5 Viewpoints (Morse, Solberg, Neander, Battorff, & Johnson)

When nursing our patient, it is a must that caring is included

Caring as an Affect

One of the 5 Viewpoints (Morse, Solberg, Neander, Battorff, & Johnson)

How we are presenting ourselves, our demeanor

Caring as a Human Trait

One of the 5 Viewpoints (Morse, Solberg, Neander, Battorff, & Johnson)

As a person, caring is innate

Caring as an Interpersonal Relationship

One of the 5 Viewpoints (Morse, Solberg, Neander, Battorff, & Johnson)

Caring usually involves more than 2 people

Caring as a Therapeutic Intervention

One of the 5 Viewpoints (Morse, Solberg, Neander, Battorff, & Johnson)

Caring is what we usually do to give comfort to patients

1. By religiously monitoring the vital signs, input and output (all fluids) of the patient, staff nurses show that they care.

2. Rather than just turning on the IV fluid, the nurse religiously counts the amount of drops per minute to ensure if the rate is correct.

3. For a patient that is about to undergo chemotherapy for the first time, the nurse remains physically by the side of the patient.

3 Examples of “Caring as a Therapeutic Intervention”

Culture Care Diversity & Universality

What is the theory of Leininger?

Leininger

Who founded the theory of Culture Care Diversity & Universality?

Leininger’s Culture Care Diversity & Universality

Proposes that "caring is the essence of nursing, and the distinct, dominant, central and unifying focus of nursing"

In order to provide care that is congruent with cultural values, beliefs and practices, the nurse must understand these differences and similarities

1. By preserving the client's familiar lifeways

2. By making accommodations in care that are satisfying to clients

3. By repatterning nursing care to help the client move toward wellness

According to Leininger’s theory of Culture Care Diversity & Universality, what 3 major ways cultural congruent care is provided?

Theory of Bureaucratic Caring

What theory did Ray find?

Ray

Who founded the Theory of Bureaucratic Caring?

Ray’s Theory of Bureaucratic Caring

Focuses on caring in organizations (e.g. hospitals) as cultures

Caring is contextual and is influenced by its organizational structure

The meaning of caring varied in different hospital department

ICU provides technological caring (monitors, ventilators, etc) while the oncology unit provides intimate, spiritual caring (family-focused, comforting, compassionate)

Example that exemplifies Ray’s Theory of Bureaucratic Caring

Human Mode Model

What theory did Roach find?

Roach

Who founded the Human Mode Model?

Roach’s Human Mode Model

Focuses on caring as a philosophical concept and proposes that caring is the human mode of being

Defined the 6 Cs of caring

1. Compassion

2. Competence

3. Confidence

4. Conscience

5. Commitment

6. Comportment

The 6 Cs of caring according to Roach’s Human Mode Model

Compassion

One of the 6 Cs of caring according to Roach’s Human Mode Model

Awareness of one's relationship to others, sharing their joys, sorrows, pain and accomplishments

Competence

One of the 6 Cs of caring according to Roach’s Human Mode Model

Having the "knowledge, judgment, skills, energy, experience and motivation required to respond adequately to the demands of one's professional responsibilities

Confidence

One of the 6 Cs of caring according to Roach’s Human Mode Model

Comfort with self, client and others that allows one to build trusting relationships

Conscience

One of the 6 Cs of caring according to Roach’s Human Mode Model

Morals, ethics and an informed sense of right and wrong

Awareness of personal responsibility

Commitment

One of the 6 Cs of caring according to Roach’s Human Mode Model

Deliberate choice to act in accordance with one's desires as well as obligations, resulting in investment of self in a task or cause

Comportment

One of the 6 Cs of caring according to Roach’s Human Mode Model

Appropriate bearing, demeanor, dress and language that are in harmony with a caring presence

Presenting oneself as someone who respects others and demands respect

Nursing as Caring

What theory did Boykin & Schoenhofer find?

Boykin & Schoenhofer

Who founded the theory of Nursing as Caring?

Boykin & Schoenhofer’s Nursing as Caring

Respect for persons as caring individuals

Respect for what matters to them

Theory of Nursing Care

What theory did Watson find?

Watson

Who founded the Theory of Nursing Care?

Watson’s Theory of Nursing Care

Views caring as the essence and the moral ideal of nursing

Human care is the basis for the nursing's role in society

Theory of Caring

What theory did Swanson find?

Swanson

Who founded the Theory of Caring?

Swanson’s Theory of Caring

Caring: nurturing way of relating to a valued "other" toward whom one feels a personal sense of commitment and responsibility

Assumption: Client's well-being should be enhanced through the caring of the nurse who understands the common human responses to a specific health problem

Focuses on caring processes

1. Knowing

2. Being With

3. Doing for

4. Enabling

5. Maintaining Belief

5 Caring Processes according to Swanson’s Theory of Caring

Knowing

One of the 5 Caring Processes according to Swanson’s Theory of Caring

Striving to understand an event as it has meaning in the life of the other

1. Avoiding assumptions

2. Centering on the one cared

3. Assessing thoroughly

4. Seeing cues

5. Engaging the self of both

Subdimensions of the “Knowing” Caring Process according to Swanson’s Theory of Caring

Being With

One of the 5 Caring Processes according to Swanson’s Theory of Caring

Being emotionally present to the other

1. Being there

2. Conveying ability

3. Sharing feelings

4. Not burdening

Subdimensions of the “Being With” Caring Process according to Swanson’s Theory of Caring

Doing For

One of the 5 Caring Processes according to Swanson’s Theory of Caring

__ __ the other as he/she would do for the self if it were possible

1. Comforting

2. Anticipating

3. Performing competently/skillfully

4. Protecting

5. Preserving Dignity

Subdimensions of the “Doing For” Caring Process according to Swanson’s Theory of Caring

Enabling

One of the 5 Caring Processes according to Swanson’s Theory of Caring

Facilitating the other's passage through life transitions and unfamiliar events

1. Informing/explaining

2. Supporting/allowing

3. Focusing

4. Generating alternatives/thinking through

5. Validating/giving feedback

Subdimensions of the “Enabling” Caring Process according to Swanson’s Theory of Caring

Maintaining Belief

One of the 5 Caring Processes according to Swanson’s Theory of Caring

Sustaining faith in the other's capacity to get through an event or transition and face a future of meaning

1. Believing in/holding esteem

2. Maintaining a hope-filled attitude

3. Offering realistic optimism

4. "going the distance"

Subdimensions of the “Maintaining Belief” Caring Process according to Swanson’s Theory of Caring

The Primacy of Caring

What did Benner & Wrubel find?

Benner & Wrubel

Who founded the Primacy of Caring?

Benner & Wrubel’s Primacy of Caring

Caring is primary because it sets up the possibility of giving and receiving help

Requires attending to the particular client over time, determining what matters to the person and using this knowledge in clinical judgments

Individuals, groups, families, or communities

Patients, clients, persons

According to the ANA, who are the recipients of nursing care?

Direct & Indirect

2 Types of Care

Direct Care

One of the types of Care

___ personal interactions between the nurse and the patient

Indirect Care

One of the types of Care

they work on behalf of the client to improve health status

1. Health Promotion

2. Illness Prevention

3. Health Restoration

4. End-of-Life Care

4 Purposes of Nursing Care

Health Promotion

One of the purposes of nursing care

Activities are any that foster the highest state of well-being of the recipient of activities

Includes the WHO Definition of health

A state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity

WHO Definition of Health

Illness Prevention

One of the purposes of nursing care

Focuses on avoidance of disease

Activities are targeted to decrease the risk of developing an illness or to minimize the risk of exposure to disease, to avoid & to know the causes, route of disease transmission

Health Restoration

One of the purposes of nursing care

Encompasses activities that foster a return to health for those already ill

1. Providing hygiene and nutrition for someone unable to do so independently

2. Assessing an ill client's health status

3. Performing diagnostic tests on a client

4. Administering medications or treatments

5. Counseling individuals or groups

6. Tracking clients with communicable disease to ensure that they receive appropriate therapy

7. Lobbying for community changes to decrease the prevalence of disease within a community

7 Health Restoration Activties

End-of-Life Care

One of the purposes of nursing care

Nurses have been active in promoting the respectful care of those who are terminally ill or dying-

Nursing activities for the dying are designed to promote comfort, maintain quality of life, provide culturally relevant spiritual care, and ease emotional burden of death

1. Knowing the Client

2. Nursing Presence

3. Empowering the Client

4. Compassion

5. Competence

5 Caring Encounters

Knowing the Client

One of the 5 Caring Encounters

The nurse aims to know who the client is in his/her uniqueness

Gained by observing and talking with the client and family, using listening and communication

Nursing Presence

One of the 5 Caring Encounters

Being emotionally present to the client and family

Empowering the Client

One of the 5 Caring Encounters

The nurse identifies and builds upon the client/family strengths.

An empowering relationship includes mutual respect, trust and confidence in the other's abilities and motives

May be integrated to Swanson's caring behavior of enabling

enabling

The caring encounter “Empowering the Client” may be integrated to Swanson’s caring behavior of ____

Compassion

One of the 5 Caring Encounters

The caring nurse is described as warm and empathic, ___ and concerned.

To demonstrate empathy, the nurse should imagine "walking in his client's shoes" in regard to some part of the client's life experience

___, like empathy, involves participating in the client's experience

Attention to spiritual needs is part of ___ care; the nurse does not impose his or her own spiritual beliefs but rather assists in drawing upon the client's own beliefs as spiritual resources

spiritual needs

Included in the caring encounter of “Compassion” is attention to ___ ___, in which the nurse does not impose his or her own spiritual beliefs but rather assists in drawing upon the client's own beliefs as spiritual resources.

Competence

One of the 5 Caring Encounters

The ___ nurse employs the necessary knowledge, judgment, skills and motivation to respond to the client's needs