CARING
Professionalization of Caring Nursing Theories on
Caring
CARING
• -is sharing deep and genuine concern about the
welfare of another person.
• Is a dimension of human relating and often
referred to as the art of nursing.
• Smith[2013] proposes that nursing cannot exist
without caring.
• Is a central to all helping professions and enables
people to create meaning in their lives.
PROFESSIONALIZATION OF CARING
• ​CARING PRACTICE​ – involves connection,
mutual recognition and involvement between a
nurse and client.
Example:
• A client experiencing postoperative pain is given
medication by the nurse to control symptoms. The
nurse talks quietly and holds the client’s hand for a
few minutes as the pain resolves. The nurse’s
presence provides comfort for the client.
• The nurse helps the immobilized client to do
personal hygiene then makes herself presentable
and helps her into the wheelchair to greet the family.
The client feels grateful and her sense of dignity
was enhanced by this personal care.
• Student Nurse helps the breastfeeding mother the
proper way of breastfeeding-sense of fulfillment on
the part of the nurse
• ​MILTON MAYEROFF​- noted philosopher,
proposed that to care for another person is to help
him grow and actualize himself.
• Caring is a process that develops over time
resulting into a deepening and transformation of the
relationship. Recognizing the other as having
potential and the need to grow, the caregiver does
not impose direction,but allows the direction of the
other person’s growth to help determine how to
respond.
MAJOR INGREDIENTS OF CARING
KNOWING​ – understanding the other’s needs and
how to respond to this need
ALTERNATING RHYTHMS​-signifies moving back
and forth between immediate and long term
meanings of behavior considering the past.
PATIENCE​- enables the others to grow in his own
way and time
HONESTY​ – includes awareness and openness to
one’s own feelings and genuineness in caring for
others
TRUST​- involves letting go, to allow the other to
grow in his own way and own time.
HUMILITY​-means acknowledging that there is
always more to learn, and that learning may come
from any source.
HOPE​- is belief in the possibilities of the other’s
growth
COURAGE​- is the sense of going into the
unknown,informing any insight from past
experiences.
MILTON MAYEROFF
Proposes that the caring process has benefits for
the one giving care.
o By helping the other person grow, the caregiver
moves toward self-actualization.
o By caring and being cared for,each person “finds
his place” in the world
o By serving others through caring, individuals live
their meaning in their own lives.
NURSING THEORIES ON CARING
Culture Care Diversity and Universality –Leininger
Theory of Bureucratic Caring – Ray
Caring, The Human Mode-Roach
Nursing as Caring Theory: Anne Boykin and
Savina Schoenhofer
Theory of Human Care -Watson
Theory of Caring -Swanson
Culture Care Diversity and Universality •
-Leininger
• Caring as nurturing behavior has been present
throughout history and is one of the most critical
factors in helping people maintain or regain health.
Emphasizes care as a “distinct, dominant, unifying
and central focus of nursing”.
• ​Transcultural nursing​ is defined as a learned
subfield or branch of nursing which focuses upon
the comparative study and analysis of cultures with
respect to nursing and health illness caring
practices, beliefs, and values with the goal to
provide meaningful and efficacious nursing care
services to people according to their cultural values
and health-illness context.
• Transcultural nursing- focuses on both the
differences and similarities among persons in
diverse cultures.
• . Culturally congruent care is provided in three
major ways:
(a) by preserving the client’s familiar lifeways
(b) by making accommodations in care that are
satisfying to clients
(c) by repatterning nursing care to help the client
move toward wellness.
Leininger holds that creative nursing approaches
incorporatingthe above activities are needed to
make care both meaningful and helpful to clients.
She further defines caring as “those assistive,
supportive, and enabling experiences or ideas
towards others with evident or anticipated needs, to
ameliorate or improve a human condition or lifeway”
(Leininger & McFarland, 2006, p. 12).
•​ Ethnonursing​- is the study of nursing care beliefs,
values, and practices as cognitively perceived and
known by a designated culture through their direct
experience, beliefs, and value system (Leininger,
1979).
•​ Nursing i​s defined as a learned humanistic and
scientific profession and discipline which is focused
on human care phenomena and activities in order
to assist, support, facilitate, or enable individuals or
groups to maintain or regain their well being (or
health) in culturally meaningful and beneficial ways,
or to help people face handicaps or death.
Three modes of nursing care decisions and
actions
(a)​ Cultural care preservation​ is also known as
maintenance and includes those assistive,
supporting, facilitative, or enabling professional
actions and decisions that help people of a
particular culture to retain and/or preserve relevant
care values so that they can maintain their
well-being, recover from illness, or face handicaps
and/or death.
(b) ​Cultural care accommodation​ also known as
negotiation, includes those assistive, supportive,
facilitative, or enabling creative professional actions
and decisions that help people of a designated
culture to adapt to or negotiate with others for a
beneficial or satisfying health outcome with
professional care providers.
(​c) Culture care repatterning​, or
restructuring-includes those assistive, supporting,
facilitative, or enabling professional actions and
decisions that help a client(s) reorder, change, or
greatly modify their lifeways for new, different, and
beneficial health care pattern while respecting the
client(s) cultural values and beliefs and still
providing a beneficial or healthier lifeway than
before the changes were established with the
client(s). (Leininger, 1991)
•​ Culture shock​ may result when an outsider
attempts to comprehend or adapt effectively to a
different cultural group. The outsider is likely to
experience feelings of discomfort and helplessness
and some degree of disorientation because of the
differences in cultural values, beliefs, and practices.
Culture shock may lead to anger and can be
reduced by seeking knowledge of the culture before
encountering that culture.
Cultural imposition​ refers to efforts of the outsider,
both subtle and not so subtle, to impose his or her
own cultural values, beliefs, behaviors upon an
individual, family, or group from another culture.
(Leininger, 1978)
Theory of Bureucratic Caring – Ray
• Focuses on ​caring in organizations​ [Ex. Hospital]
as cultures
• Theory suggest that caring in nursing is contextual
and is influenced by the ​organizational structure​.
• Caring varied in the , ER department,
ICU[dominant value on technologic caring-
Ex.monitors, ventilators etc., ]Oncology
department[intimate and spiritual caring- family
focused, comforting and compassionate] and other
areas of the hospital.
• Caring i​nfluenced by role and position​ a person
held. o Staff nurses-caring related to client
o Administrators- value caring as systems
related-safeguarding the economic well-being of
the hospital.
Bureaucratic System Technological
1. Educational
2. Physical
3. Spiritual-Ethical Caring
4. Legal
5. Socio-cultural
6. Political
7. Economic
 = these factors influence the spiritual ethical
caring
Caring, The Human Mode-Roach​ •
The 6 C’s of Caring
• ​Sister Simone Roach’s 6 C’s of caring ​–
commitment, conscience, competence,
compassion, and confidence and comportment- are
highly applicable to the nursing profession in the
workplace.
Commitment
• The deliberate choice to act in accordance with
one’s desires as well as obligations,resulting in
investment of self in a task or cause.
• The life of a nurse can be challenging at times,
commitment to patients cannot be sacrificed.
Nursing staff members must continually dedicate
themselves to putting their best foot forward. The
act of committing yourself to work means going
above and beyond normally expected behaviors
and pledging to uphold ​strong values​.
• In addition to providing a focus for daily activities,
commitment to your career also involves continually
improving one’s knowledge and skills. One way to
do this is by seeking out higher education. Pursuing
an ​online nursing degree​ is an excellent way to gain
a higher level of understanding about the
profession. The devotion toward furthering your
education will improve your capabilities and
enhance the level of care delivered to patients.
Conscience
• Morals, ethics and an informed sense of right and
wrong. Awareness of personal responsibility.
• Delivering the best possible care to patients
involves a resilient sense of moral responsibility
born of a strong conscience. Conscience helps
guide your actions even when focus on stress or
personal matters can challenge the consistent
application of best practices. Adherence to your own
conscience will always help to put you on the right
course.
Competence
• Having the knowledge ,judgement ,skills, energy,
experience and motivation required to respond
adequately to the demands of one’s professional
responsibilities.
ways nurses can demonstrate competence in the
workplace:
a. Consistently arriving to work on time and
presenting yourself in a professional manner is one
way.
b. to hold yourself to a high standard of excellence
when fulfilling daily tasks, regardless of the
behavior of others or the circumstances. It is also
important to ask for help or clarification when there
is uncertainty about a specific duty or method,
rather than attempting to move forward if you are
unsure.
Compassion
• Awareness of one’s relationship to others, sharing
their joys ,sorrows, pain and accomplishments.
Participation in the experience of another.
• Having compassion is essential for anyone in the
health care profession as it takes compassion to
give patients a positive experience.
Compassionate nurses empathize with their patients
and provide kind and considerate treatment at all
times. In return, they may receive an inspiring sense
of human connection and affirmation of the
importance of their work.
• The more that nurses nurture their sense of
compassion, the more compassion grows (and the
greater positive effect it has on patient care and
work relationships).
• The Online Journal of Issues in Nursing
recommends using nurse mentors, or new-nurse
groups, to help individuals develop skills that
expand the impact of empathy in hospitals​, medical
centers, and other health care organizations.
Confidence
• Comfort with self, client and others that allows one
to build trusting relationships.
• Confidence is the aspect of caring that ties the
other 4 of the 5 C’s together. It takes confidence in
personal skills and knowledge to act with
commitment, follow conscience, consistently act in
a competent manner, and express compassion,
even in the most difficult of situations.
• Confidence in experiences, education, and skills
will ensure that nurses continually put their best
foot forward. A confident nurse can help patients
and family members deal with difficult news, and a
strong sense of self will invoke positive change in
patient care.
Comportment
• Appropriate bearing , demeanor, dress, language
that are in harmony with a caring presence.
Presenting one self as someone who respects
others and demands respect.
Nursing as Caring Theory : Anne Boykin and
Savina Schoenhofer
• The purpose of the discipline and profession of
nursing is to know people and nurture them as
individuals living and growing in caring.
• Respect for people as caring individuals and
respect for what matters most to them.
• Emphasizes the importance of nurse knowing self
as caring person. • The awareness of self allows the
nurse to authentically care for others in nursing
practice.
• The nurse approaches client as a caring person
,whole and complete in the moment. The idea of
wholeness includes the understanding that people
are not perfect, but constantly growing and
changing.
• By living nursing as caring ,the nurse establishes a
mutual relationship of trust and respect with the
client.
• The nurse energizes self and others to grow as
caring individuals.
Major Concepts
1. Person
• The theorist gives the emphasis on the concept
that every individual is a caring and nurturing human
being. That to live as human means is to have its
intrinsic nature to care. At the same time the
individual is committed and with the intention to
know others as caring individuals, committed to
recognize nurture caring at all times. (BT
Basavanthappa, 2007)
2. Environment
• Basing on the two major perspectives presented
by the theory that conception of nursing as
discipline and profession, discipline of nursing
derived from the principle that it is a duty to care
and value other, and that the development of
nursing awareness is associated or affected with all
intrinsic and extrinsic aspects while professions of
nursing are believed to be based on the day to day
life encounter and reactions from one another. This
in turn leads to a “moral obligation the quality of
which is a measure of being in a place on the world”
(BT Basavanthappa, 2007)
3. Health
• There was no detailed emphasis done by Boykin
and Schoenhofer regarding health aspect. Although
by meeting the ultimate aspect of care to one’s self
and with the integration of other theories such as
theory of Henderson, to achieve optimum health is
to be in control of the environment (Anonuevo, et
al., 2000) will lead to a maximum healthy state of
well being.
4. Nursing
• This theory gives a direct emphasis that caring is
the ultimate essential and integral part in the
provision and assistance of meeting basic needs
not only on the physiological side but in all other
aspects of human needs. It evolves in holistic
nursing care.
Theory of Human Care-Watson
• “Caring (and nursing) has existed in every society.
Every society has had some people who have
cared for others. A caring attitude is not transmitted
from generation to generation by genes. It is
transmitted by the culture of the profession as a
unique way of coping with its environment.”
Human being ​is a valued person to be cared for,
respected, nurtured, understood, and assisted.
Health​ is the unity and harmony within the mind,
body, and soul; health is associated with the
degree of congruence between the self as
perceived and the self as experienced.
Nursing ​is a human science of persons and human
health – illness experiences that are mediated by
professional, personal, scientific, esthetic, and
ethical human care transactions.
Actual caring occasion​ involves actions and
choices by the nurse and the individual. The
moment of coming together in a caring occasion
presents the two persons with the opportunity to
decide how to be in the relationship – what to do
with the moment.
The​ transpersonal concept​ is an intersubjective
human-to-human relationship in which the nurse
affects and is affected by the person of the other.
Both are fully present in the moment and feel a
union with the other; they share a phenomenal field
that becomes part of the life story of both. (Watson,
1999)
Phenomenal field
The totality of human experience of one’s being in
the world. This refers to the individual’s frame of
reference that can only be known to that person.
Self
The organized conceptual gestalt composed of
perceptions of the characteristics of the “I” or “ME”
and the perceptions of the relationship of the “I” and
“ME” to others and to various aspects of life.
Time
The present is more subjectively real and the past is
more objectively real. The past is prior to, or in a
different mode of being than the present, but it is not
clearly distinguishable. Past, present, and future
incidents merge and fuse. (Watson, 1999)
Nursing interventions related to human care
originally referred to as carative factors have now
been translated into clinical caritas processes
(Watson, 2006):
Watson’s (1979) ordering of needs:
a. Lower Order Needs (Biophysical Needs)
• Survival Needs
The need for food and fluid
The need for elimination
The need for ventilation
b. Lower Order Needs (Psychophysical Needs)
Functional Needs
The need for activity-inactivity
The need for sexuality
c. Higher Order Needs (Psychosocial Needs)
Integrative Needs
The need for achievement
The need for affiliation
d. Higher Order Need
(Intrapersonal-Interpersonal Need)
Growth-seeking Need
The need for self-actualization.
The allowance for existential-phenomenological
forces becomes: “opening and attending to
spiritual-mysterious and existential dimensions of
one’s own life-death; soul care for self and the
one-being-cared-for.”
Theory of Caring-Swanson
• Defines Caring as “ a nurturing way of relating to a
valued “other” toward whom one feels a personal
sense of commitment and responsibility.
• An assumption of her theory is that a client’s
well-being should be enhanced through the caring
of a nurse who understands the common human
responses to a specific health responses to a
specific health problem.
• Theory focuses on caring processes as nursing
intervention.
• The Swanson theory developed through
interactions with parents at the time of
pregnancy,miscarriage and birth.
• CARING PROCESSES[post-partum clients]
1. KNOWING-striving to understand an event as it
has meaning in the life of the others
2. BEING WITH- being emotionally present to the
other
3. DOING FOR- doing for the other as he /she
would do for the self if it were at all possible
4. ENABLING-facilitating the other’s passage
through life transitions and unfamiliar events
5. MAINTAINING BELIEF-sustaining faith in the
other’s capacity to get through an event or
transition and face a future with meaning.
Types of Knowledge in Nursing
• Identified by Carper, 2009
• Method for developing each type is unique.
• Integrating all types leads to holistic care.
• ​Empirical knowing​: the science of nursing • From
factual, observable phenomena to theoretical
analysis
• Personal knowing:​ the therapeutic use of self •
Promotes wholeness, integrity in personal
encounter • Achieves engagement
• Ethical knowing: ​the moral component
• "Matters of obligation on what ought to be done"
• Beyond observing code of ethics
•​ Aesthetic knowing:​ the art of nursing
• Expressed by individual nurse's creativity and style
in meeting needs of clients
• Care that is effective and satisfying
Developing ways of knowing
• Methods required for one pattern cannot be used
to develop knowledge within another pattern.
• Effective nurses integrate all types to understand
situations holistically.
Caring Encounters
• Contextual
• Caring responses as varied as clients' needs
• Clients experience:
• Increased sense of dignity and self-worth
• Expression of feelings of connectedness
Knowing the Client
1. Uniqueness
2. Physiological variables
• Perception of pain
• Meaning of diagnosis, surgery
3. Support persons and family
4. Increases possibilities for therapeutic
interventions to be perceived as relevant
Nursing Presence
• Mutuality •​ A healthy lifestyle ; ​Activity and exercise
• Transpersonal caring relationship 1. Per week: 150 minutes of moderate-intensity
• Openness and consciousness of self and client • or 75 minutes of vigorous aerobic activity
Authenticity 2. Moderate to high intensity
• Emotional, physical presence muscle-strengthening 2 or more days
• Responding promptly
• Recreation
Empowering the Client 1. Reward
• Mutual respect, trust, confidence in other's abilities 2. Spontaneity
and motives •​ A healthy lifestyle
• Substitutive care, but no more than is needed at • Recreation
the time • Downtime
• Environment in which client can function safely,
effectively • Avoiding unhealthy patterns
• Advocating • Thought patterns
• Mindfulness of professional boundaries • Identify negative feelings
• Refocus on positive
Compassion • Positive affirmations
• Warm, empathetic
• Concerned • Mind–body therapies
• Requires courage and openness • ​Guided imagery
• Attenuation to spiritual needs 1. • Imagination as therapeutic tool
• Comfort 2. • Promote relaxation
• Based on individual's perceptions 3. • Decrease anxiety
• Creative, innovative interventions based on client's 4. • Enhance psychological, spiritual insight
preferences • Meditation
• Focusing mind on present
Competence • Relaxation through deep breathing
• Necessary knowledge, judgment, skills, motivation
to respond adequately to client's needs • Storytelling
• Understanding of client's condition, treatment, and • Communicate life experience for greater
associated care understanding • Deeper meaning of clinical
• Ability to assess, plan, implement, and evaluate a experiences
plan of care
• Cognitive, affective, technical, and administrative • Music therapy
skills • Listening, singing, rhythm, body movement
• Can be effective distraction technique
Maintaining Caring Practice
• Emphasis on meeting others' needs • Obstacles to • ​Yoga
self-care • Unites body, mind, spirit
• Professional • Improves balance, flexibility, mental alertness,
• Demands of particular work setting calmness
• Personal
• Poor health habits Reflection on Practice
• Unrealistic expectations of self • Reflection
• Thinking from a critical point of view
Caring for Self • Analyzing why one acted in a certain way
• Care of self is central to care of others. • Helping • Assessing the results of one's action
oneself grow and self-actualize • Taking time to • Thinking about what happened in a nursing
nurture oneself • A healthy lifestyle situation • Becoming aware of how one feels about
•​ Nutrition oneself • Requires discipline, action, openness, trust
1. Making good choices in foods eaten • Reflective journaling
2. Eat regular meals • Partnership with a mentor or teacher
3. Determine healthy weight
Framework for reflective journaling- refer sa
chart
Box 25-6