Chapter 24

Introduction to Nursing

  • Overview of Nursing:

    • Nursing is characterized as hard work.

    • It can be physically and mentally taxing depending on the site of practice.

    • Nurses must master multitasking, managing multiple caring functions during patient encounters.

    • Examples of Nursing Interventions:

    • Readily apparent interventions:

      • Collecting vital signs data.

      • Changing dressings.

    • Less visible, yet equally important interventions:

      • Interpreting vital signs data.

      • Generating knowledge about the patient’s situation.

      • Using knowledge to inform practice.

  • Importance of the Therapeutic Caring Environment:

    • The subtle aspects of nursing like what nurses say, project, and do in a caring episode are crucial.

    • Advocacy for preserving the art of caring in nursing amidst technology advancements.

    • Definition of Nursing Science:

    • Derived from the American Nurses Association’s definition.

    • It is the ethical application of knowledge gained through education, research, and practice to provide patient services and interventions aimed at maintaining, enhancing, or restoring health.

    • Encompasses the acquisition, processing, generation, and dissemination of nursing knowledge to advance the profession.

  • Caring Functions in Nursing:

    • Includes therapeutic communication, listening, touch, and mindfulness, pivotal in aiding patients’ health.

  • Technology in Nursing:

    • New technologies (e.g., smart pumps, barcode medication administration systems, EHRs, wearables, smartphones) are introduced to improve efficiency, safety, and streamline nursing work.

    • Ethical questions regarding the disruption these technologies may cause in the nurse-patient encounter.

    • Inquiry into how to maintain effective patient care while integrating technology’s advantages.

    • Johnson and Carrington propose technology as a fifth dimension of the nursing metaparadigm (human, health, nursing, environment).

    • Quote: “To synchronize nursing practice with technology as part of what it means to be a modern-day human is to modernize nursing.” (p. 6)

Caring Theories

  • Defining Caring in Nursing:

    • Much theoretical work has gone into defining caring within nursing.

    • Caring concepts articulated by nurse theorists are applicable across all professional patient encounters.

    • Nurses can model caring behaviors to other professionals while providing patient care.

    • Definition by Boykin and Schoenhofer (2015):

    • Caring is described as an “altruistic, active expression of love and… the intentional and embodied recognition of value and connectedness.” (p. 343)

  • Nursing as Caring Framework:

    • Caring is fostered through moments of commitment to nurturing the patient.

    • Nurses must overcome challenges (e.g., technology, time constraints, staffing issues) by recognizing the importance of knowing the person in caregiving.

Jean Watson's Theory of Human Caring

  • Development of the Theory (1975-1979):

    • Dr. Watson developed her theory while teaching at the University of Colorado.

    • Focus was on nursing values, knowledge, and practices geared towards subjective healing processes and the life world of the patient.

    • Emphasized unique healing arts and introduced the framework of "carative factors" which stand in contrast to conventional medicine's "curative factors." (p. 322)

  • Definition of Caring in Watson's Theory:

    • Caring is described as “healing consciousness and intentionality to care and promote healing.”

    • Caring consciousness is the energy within the human-environmental field of a caring moment (Watson).

  • Evolution of Carative Factors to Caritas Processes:

    • Watson subsequently recognized a need for love and caring to converge for deeper transpersonal caring (Watson, 2015, p. 324).

  • 10 Caritas Processes:

    • Practice loving kindness and equanimity within caring consciousness.

    • Be authentically present and sustain the subjective life world of self and the one cared for.

    • Cultivate spiritual practices and go beyond ego self to connect with others.

    • Establish a helping-trusting, authentic caring relationship.

    • Support the expression of positive and negative feelings as connections to deeper spirit for both patient and caregiver.

    • Utilize creativity and all means of knowing as part of the caring process.

    • Engage in genuine teaching-learning experiences considering others’ frames of reference.

    • Create a healing environment on both physical and non-physical levels, enhancing wholeness, beauty, and comfort.

    • Attend to basic needs with intentional caring consciousness, aligning mind-body-spirit.

    • Address spiritual and existential dimensions of life and death (Watson, 2015, p. 325).

Cycle of Caring

  • Professional Attachment and Separation (Skovholt, 2005):

    • Involves professional attachments followed by appropriate separations.

    • Expert professionals are fully present with patients, balancing caring enough without overattachment, termed professional underattachment and overattachment.

  • Reflective Practice in Patient Encounters:

    • Reflection on one’s practice during patient encounters is encouraged to ensure genuine engagement.

    • Important behaviors include:

    • Greeting patients by name and acknowledging their visitors.

    • Observing non-verbal cues even when masked.

    • Prioritizing patient interaction over technology to avoid barriers in communication.

  • Impact of Technology:

    • O’Keefe-McCarthy (2009): Technology may become the strongest reference point directing nursing care.

    • Technology lacks consideration of the individual symptom presentation unique to each patient and cannot replace person-to-person interaction (O’Keefe-McCarthy, 2009).

Active Listening and Patient-Centered Care

  • Definition of Patient-Centered Care (Liberati et al., 2015):

    • Defined as a collective achievement, negotiated between patients and multiple health providers, integrating social practices and resources available in health organizations.

  • Outcomes of Focusing on Patient-Centered Care:

    • Patients' subjective input can improve various healthcare delivery aspects.

    • Care providers may enhance reflexivity, understanding their actions' implications.

    • Collaborative insights can foster innovation in healthcare processes and facilities (to better meet local needs).

  • Importance of Caring Presence:

    • The caritas processes and patient-centered care emphasize the concept of caring presence.

    • Strategies for enhancing caring presence are discussed in the latter part of the chapter.

Humanistic Nursing Theory

  • Definition and Concepts (Paterson and Zderad, Kleiman, 2010):

    • Humanistic nursing responds to health-related calls for help.

    • The call expresses various states of being (pain, joy, silence).

    • The nurse's response interweaves professional identity, education, and experiences, shaping their interaction with the patient.

    • Each person is perceived as existing “all-at-once.”

  • Creating One’s Own Tapestry in Nursing:

    • Nurses must consciously acknowledge themselves and the uniqueness of each patient during interactions.

    • Emotional energy is vital in addressing patient needs.

  • Avoiding Dehumanization:

    • Awareness is crucial to prevent dehumanizing the patient experience in technology-laden environments.

    • The humanistic nursing theory questions whether the nursing event is humanizing or dehumanizing (Kleiman, 2010, p. 349).

Coexistence of Technology and Caring

  • Challenging the Technology-Caring Dichotomy:

    • Recent literature suggests it is possible for technology and caring to coexist in nursing.

    • Key Arguments:

    • Martinez (2019): Technology supports knowing unknown aspects of a person, enhancing human connectedness as an expression of caring.

    • Locsin (2017): Technological knowing reveals a demonstration of intentional and authentic encounters in technologically advanced nursing settings.

  • Transactive Relationship Theory (TRETON):

    • Discussed by Tanioka et al. (2019), emphasizing effects of AI and humanoid robots in nursing.

    • Several organizations are researching care-assistive robots for routine functions that may disrupt nurse-patient relationships.

Presence in Nursing

  • Definition of Presence:

    • Presence is being there and with patients, focusing fully on their needs.

    • Described as an interpersonal process characterized by sensitivity, holism, intimacy, vulnerability, and adaptability.

  • Types of Presence (Penque and Snyder, 2014):

    • Physical Presence:

    • Competent in carrying out care but inattentive to communication.

    • Full Presence:

    • Acknowledges the patient through appropriate communication during encounters.

    • Transcendent Presence:

    • Requires self-centering and engagement of the patient through attentive and personal interaction.

  • Importance of Active Engagement:

    • Properly experiencing and expressing presence enhances patient satisfaction and engagement.

  • Example of Presence from Literature:

    • Illustrative example from Tuesdays with Morrie by Mitch Albom reflects true presence in communication, emphasizing focus solely on the person before you (pp. 135–136).