Chapter 7 - Caring

Summary of Theoretical Views

• Nursing caring theories have common themes

• Caring is highly relational

• It is obvious when caring is absent

• Enabling is an aspect of caring (e.g being with and helping someone do something until they can do it themself)

• Knowing the context of a patient’s illness helps you choose and individualize interventions that will actually help the pt

What is Watson’s theory?

places care before cure

Watson’s Carative Factors

• Human-Altruistic Value System (connect)

• Faith-Hope (e.g. pray)

• Sensitivity to Self’Others (Know self)

• Trusting/Human Caring Relationship

• Expressing Feelings

• Creative Problem Solving (Clinical Judgement)

• Promoting teaching/learning (together)

• Supportive environment (e.g. light, beauty, peace, comfort, dignity)

• Meeting human needs (toileting, hunger, etc)

• Allowing for existential/spiritual forces

Caring Assessment Tool

• Mutual problem solving (work WITH me)

• Attentive Reassurance (seem interested)

• Human respect (listen, accept, kindness)

• Encouraging manner (support me)

• Appreciation of unique meanings (my view)

• Healing environment (treat body carefully)

• Affiliation needs (e.g. family)

• Basic human needs (e.g. food, sleep)

Patient’s Perspective of Caring

Patients value the affective dimension of nursing
care

• Caring Assessment Tool

  • Measures patients’ perceptions of caring

• When patients sense that health care providers are
  sensitive, sympathetic, compassionate, and interested
  in them as people, they usually become active
  partners in the plan of care.

• Assess what your patient expects.

• Build a nurse-patient relationship to learn what is important to your patients.

What is caring?

an interaction of mutual respect and trust

What does ethic mean?

the ideals of right and wrong behavior

What is ethic of care?

An ethic of care is concerned with relationships between people and with a nurse's character and attitude toward others

Caring in Nursing Practice

• As you encounter patients in various states of health and illness in your practice, you grow in your ability to care and develop caring behaviors.

• Caring is one of those human behaviors that we can give and receive.

• Recognize the importance of self-care.

• Use caring behaviors to reach out to your colleagues and care for them as well

Providing Presence

• Providing presence is a person-to-person
  encounter conveying a closeness and sense of caring.

• Presence involves “being there” and “being
  with.”

• Nursing presence is the connectedness between a nurse and a patient.

• Establishing presence strengthens your ability to provide effective patient-centered care.

Touch

Provides comfort

• Creates a connection

  • Non Contact touch

  • Contact touch

  • Task-oriented touch (inserting IV)

  • Caring touch

  • Protective touch (catching from fall)

  • Therapeutic touch

• Because touch conveys many messages, use it with discretion.

Listening

• Necessary for meaningful interactions with
  patients.

• True listening leads to knowing and responding to what really matters to a patient and family.

• To listen effectively you need to silence yourself and listen with an open mind.

• Through active listening you begin to truly know your patients and what is important to them

Knowing the Patient

• The core of clinical decision making and patient-centered care

• Two elements that facilitate knowing are
  continuity of care and clinical expertise.

• Factors of knowing include:

  • Time

  • Continuity of care

  • Teamwork of the nursing staff

  • Trust

  • Experience

Spiritual Caring

• Spiritual health is achieved when a person can find a balance between his life values, goals, and belief symptoms and those of others.

• Spirituality offers a sense of intrapersonal,
  interpersonal, and transpersonal connectedness.

Relieving Symptoms and Suffering

• Reducing symptoms and suffering requires caring nursing actions that give a patient comfort, dignity, respect, and peace.

• Conveying a quiet, caring presence, touching a patient, or listening helps you to assess and understand the meaning of your patient's discomfort.

• Provide comfort through a listening, nonjudgmental, caring presence.

Family Care

• Caring for an individual includes a person's family.

• Nurses should help family caregivers be
  active participants.

• Understand the stress the patient’s illness places on family members.

The Challenge of Caring

• Challenges / Barriers

  • Task-oriented biomedical model

  • Institutional demands (e.g. overtime/ understaffed)

  • Time constraints (e.g. higher acuity patients)

  • Reliance on technology (what if Pyxis is down?)

  • Cost-effective strategies

• Standardized work processes

  Health care must become more
  compassionate to make a positive difference.