PPN WEEK 2
CARING
Caring is part of being human
•Caring is an altruistic act or feeling of concern for another
•Caring involves being there for the patient or family in whatever way is needed at the time
•Caring reflects a high regard for clients as human beings
•Caring is an abstract concept yet notoriously ambiguous
” (Brilowski & Wendler, 2005, Erisson, 2002 as cited in Adams, 2016 (p. 2
Florence Nightingale, Leininger and Rogers argued that caring is the
essence
of nursing in their theories/philosophies
•Watson argues for the inclusion of caring into the metaparadigm of nursing
(person, health, environment, nurse)
•Nursing often described as both an art and science
•“Caring allows for a delicate balance between the scientific knowledge base that nurses hold and their humanistic practice behaviors” (Watson, 1979 as cited in Adams, 2016, p. 2)
Common words, phrases associated with Caring (Adams).
Caring is considered as a noun when the nurse cares for the patient when the client is unable to care for themselves.
Caring as an adjective-when a nurse displays actions of compassion, kindness and concern. Considers the context- place where caring occurs
Other adjectives-Respecting the client; Preserving their dignity;
The nurse is genuine; authentic, honest, acts with integrity; is an ethical being, observes closely the client, is attuned to client’s needs; Being with the client
Challenge to caring
Adams (2016) suggests that caring is no longer central to nursing in a technologically dominated setting
Suggests that caring as a construct in nursing is facing opposition despite involving trust, intimacy, and responsibility
–all elements of professional relationships
Once thought to be unquestionably central to the practice of nursing, caring faces challenges about its centrality in the profession of nursing (Adams, 2016)
Threat to caring
Technological advances, increased workloads, higher acuity patients may challenge “time” to spend caring.
•The current emphasis on the medical model–focus on the disease and not the person.
•Removal of caring from a sanctioned definition of nursing (American Nurses Association)
•Nurse theorists who challenged the value of caring …..
•Nightingale, in her later work, focused on the importance of observation and lost sight of caring
•Peplau noted that caring was not the essence of nursing, and believed that as long as caring was included in nursing, it would block men from entering the profession
•Rogers came to believe that caring was not the essence of nursing and was “foolish” to believe it was.
Mary Secord is
Another perspective on challenges of caring in nursing
Lazenby (2013) suggests that the ascendency of nursing as a science has led to the de-valuation of caring ; nursing has moved from its origins as a profession that is based in the humanities
•He does not refuse nursing as a science or denounce the value of nursing research; but argues that “the natural home of nursing “is the lived human experience
•The focus on nursing research on clinical and laboratory sciences separates nursing from its connection to the lived experience–…”the lived experience of nurses and those whom they care for–are the humanities of nursing. Nursing is not nursing without them” (p. E10).
Lazenby (2013) suggests that the focus on positivistic nursing research and the primacy of evidence-based medicine has shifted the focus of nursing
Believes that the alignment of nursing with atomistic evidence has created a “silent crisis” in nursing
Such evidence has become the measure of nursing quality i.e. Nursing practice in hospitals is measured by metrics such as falls per 1,000 patient days and is evidence of quality
He argues that regarding nursing as a positivistic science is that it leads to the humanistic aspects of nursing losing ground; less valued
Without the humanities of nursing–inclusive sympathy, self- examination, nurses caring for the sick and dying, will be lost
Caring in nursing today
Caring has had a turbulent journey through the profession
•Some proponents believe that caring will make a resurgence in spite of the technological/medical/financial pressures to do otherwise
•Caring will emerge to demonstrate its importance for its benefit to the sick and compromised
•Research continues to demonstrate the effectiveness of caring–both from a humanistic perspective and a pragmatic one (i.e. decreased length of stay)
•Caring remains at forefront of advanced nursing practice roles in a variety of setting
Solutions to conundrum of caring
Nursing needs to develop a focused and unified statement about caring and nursing-this would increase the credibility of caring within nursing
Nurse theorists who challenged the value of caring did not base their ideas on research–minimal validity to their statements –they need to be challenged
Challenge the Cartesian dualistic approach to the mind/body and embrace holism of mind/body
Continue to consider nursing as an art and a science.
FRAMEWORK #1
Watson’s caring science
Caring is defined as “a conscious judgment that manifests itself in concrete acts interpersonally, verbally and nonverbally” (Gallagher-Lepak. p. 171)
A transpersonal caring intervention (TCI) “connects and embraces the spirit and soul of the other through the processes of caring and healing and being in authentic relation in the moment” (p. 171)
TCI’s provide comfort, pain control, well being, wholeness and healing.
WATSON HUMAN CARING MODEL
Dr. Jean Watson originally created Caring Science and
Human Caring Theory in the 1970’s
Caring science embraces the whole person; focuses
on the unity of mind/body/spirit
It is a “model of caring includes a call for both art
and science”
Within the theory, she originally generated 10 carative factors which she later adapted to 10 Caritas Processes
Formation of humanistic altruistic system of values
Instillation of faith-hope
Cultivation of sensitivity to ones self and to others
Development of a helping-trusting human caring relationship
Promotion acceptance of expression of positive and negative feelings
Systematic use of creative problem solving caring process
Promotion of transpersonal teaching-learning
Provision for supportive protective and or corrective mental physical societal and spiritual environment
Assistance with gratification of human needs
Allowance for existential phenomenological spiritual forces
Caring, according to Watson, is fundamental to nursing practice and serves as the unifying force of nursing.
FRAMEWORK 2
Compassion can promote physical and mental health
There is need to address compassion and how it can become an integral part of nursing care (Firth-Cozens & Cornwell, 2009, as cited in Bramley & Matiti, p. 2791)
•Questions remain as to how compassion is experienced by patients
•Compassion may overlap with concepts such as empathy and caring
•Compassion care is more than witnessing suffering; it is about entering into the patient’s experience and maintaining their dignity and independence
•Compassion sometimes regarded as a moral virtue in nursing
COMPASSION
“….the way in which we relate to human beings. It can be nurtured and supported. It involves noticing another person’s vulnerability, experiencing an emotional reaction to this and acting in some way with them, in a way that is meaningful for people” (Royal College of Nursing (RCN) International Conference as cited in Bramley & Matiti, 2014)
Caring VS Compassion
Compassion care is more than witnessing suffering; it is about entering into the patient’s experience and maintaining their dignity and independence
•Compassion sometimes regarded as a moral virtue in nursing
THEME WHAT IS COMPASSION?
Knowing me and giving me your time
•Providing encouragement in adversity and being available to be with individuals.
•Personalizing the experience to individual needs.
Attending to patient-centered assessment and planning.
•Making time to listen to patients, despite pressures.
•Happens with small gestures.
Understand impact of compassion
How would I feel in their shoes?
Being empathetic
Understanding how it feels to be them
Having understanding for times when other nurses do not show compassion
Being more compassionate
Essence of nursing and communication
Quality vs something that can be molded and taught
Culture of getting the job done
Communication is a pillar of passion