Nightingale to Watson:

Nursing Quality, Research,

and Caring
Coming of Age
32nd International Association for Human Caring
Conference
th
San
Antonio,
Texas
June
4
, 2011
Donald D. Kautz, RN, PhD,
CNE,

CRRN
Associate Professor of Nursing
UNC Greensboro
ddkautz@uncg.edu

Publishing Quality Caring

Intersections
7- B

Practice/Clinical

32nd International Association for Human

Caring
Conference, San Antonio, Texas
June 3, 2011
Donald D. Kautz, RN, PhD, CNE,
CRRN
Associate Professor of Nursing
UNC Greensboro
ddkautz@uncg.edu

Publishing Quality Indicators of

Caring

Formal reporting of quality care indicators is a

requirement for all health care facilities
Focusing ONLY on Quality Indicators without
ensuring caring may promote mechanistic,
technical care.
On the other hand, no matter how caring staff are,
if they are not competent, and quality is not
ensured, care may become dangerous.
I have had the privilege of assisting nurses to
publish their work, and from 2007 2011, I am a
coauthor on 30 published articles. and am
currently working on 30 more, which are in various
stages.
In the next few minutes, I will highlight a few of
these articles. A more complete list is on your
DVD, I will be happy to e-mail you any of these
articles if you e-mail me.

Don wants you to Promote Family

Integrity
Kautz, D.D. and Van Horn, E. (2009). Promoting
family integrity to inspire hope in rehab patients:
Strategies to provide evidence-based care,
Rehabilitation Nursing, 39, 168-173.
Kautz, D.D. & Van Horn, E. R. (2008). An exemplar of
the use of NNN language in developing evidencebased practice guidelines. International Journal of
Nursing Terminologies and Classifications, 19, 14-19
Van Horn, E. R. & Kautz, D.D. (2007). Promotion of
family integrity in the acute care setting. Dimensions
of Critical Care Nursing, 26, 101-107.

Don wants you to Promote Family

Integrity
Kautz, D.D. and Van Horn, E. (2009). Promoting
family integrity to inspire hope in rehab patients:
Strategies to provide evidence-based care,
Rehabilitation Nursing, 39, 168-173.
Kautz, D.D. & Van Horn, E. R. (2008). An exemplar of
the use of NNN language in developing evidencebased practice guidelines. International Journal of
Nursing Terminologies and Classifications, 19, 14-19
Van Horn, E. R. & Kautz, D.D. (2007). Promotion of
family integrity in the acute care setting. Dimensions
of Critical Care Nursing, 26, 101-107.

Don wants you to Inspire Hope

Kautz, D.D. (2008) Inspiring hope in our
rehabilitation patients, their families and
ourselves, Rehabilitation Nursing, 33, 148-153.
Kautz, D.D. (2007). Reading childrens books to awe
and inspire nursing students. Nurse Educator, 32,
223-226.
Smith, A.D. & Kautz, D.D. (2007). Case study: A day
with Blake: Hope on a Medical-Surgical unit.
MEDSURG Nursing, 16, 378-382.

Don wants you to Address Sexuality

and Intimacy Concerns
Kautz, D.D., Van Horn, E. R., and Moore, C.
(2009). Sex after stroke: An integrative
review and recommendations for clinical
practice. Critical Reviews in Physical and
Rehabilitation Medicine, 21, 99-115.
Kautz, D.D. (2007). Hope for love: practical
advice for intimacy and sex after stroke.
Rehabilitation Nursing, 32, 95-103.

Don wants you to meet patients

spiritual needs
Williamson, W. and Kautz, D.D. (2009). Lets
get moving, lets get praising: Promoting
health and hope in an African American
Church. ABNF Journal, 20(4), 102-105.
Hubbartt, B., Corey, D., Kautz, D.D., and
Rasmussen, B. (2009). Nurse, please pray
with me. RN Journal. Available at http://
rnjournal.com

Published Caring Quality

Intersections

Montana C. & Kautz, D.D. (2011). Turning the

nightmare of complex regional pain syndrome
into a time of healing, renewal and hope.
MEDSURG Nursing, 20(3), 139-142.
Christina is a nurse anesthesia student who
has had CRPS since 2004
The article tells the story of her illness and
treatment with excellent recommendations for
providing high quality nursing care, to ensure
a hospitalization that helps the patient to
heal and experience renewal and hope

Montana & Kautz, continued

In addition to aggressively treating pain,
preventing post-op complications, and providing
individualized comfort measures, we
recommend taking a few minutes to sit and talk
with the patient to provide hope and renewal.
Margo McCafferywrote more than 30 years
ago, when your patients still in pain dont just
do something: sit there. She recognized the
importance of a nurses presence with a patient
in pain to provide comfort and hope for both of
them.

Published Caring Quality

Intersections

Ziel, R. and Kautz, D. D. (2009). The highest

priority in the Emergency Department may be a
patients spiritual needs. Journal of Emergency
Nursing, 35, 50-51.
Ruth, the charge nurse in a busy ED, received a
call that they were getting a transfer to their E.D.
of John, a gravely ill elderly man.
At the familys request, Ruth arranged for a priest
to be present when John arrived at the E.D. to
administer last rites. The hospital chaplain
conveyed to the family who lived hours away, that
last rites had been administered.

Ziel & Kautz - continued

John survived to be transferred to the ICU
after resuscitation in the emergency
department, and Ruth went on with the days
work. While we do not know his outcome, we
reflect on this sequence of events and feel
certain that Ruths small act was critical for
this patient and his family. This act, on that
busy, busy day, is the one that she will always
remember, and the memory of this event gives
us hope on particularly frustrating days.

Published Quality Caring

Intersections

Levigne, D. and Kautz, D.D. (2010). The evidence

for listening and teaching may reside in our
hearts. MEDSURG Nursing, 19, 194-196.
Debbie describes the care of the Mrs Logan and
her husband in the special care unit (ICU stepdown)
The expert care of bathing, turning her,
ensuring there are no wrinkles in the sheets
bothering her shingles lesions, as well as
administering medications and treatments.
But also taking the time to listen and teach

Levigne & Kautz continued

the primary evidence for listening and
teaching may be in the gratitude of
patients and families, the nurses
knowledge he or she has done the right
thing, and a feeling today was a good day
to be a nurse

Published Quality Caring Intersections

Kautz, D. D. (2011). Great rehabilitation
nurses combine art and science to create
magic. Rehabilitation Nursing, 36(1), 13-15,
24. Published in January 2011
Don describes the care of a new quadriplegic
young mother who was especially
challenging helping her cope, aggressively
treating her pain, getting her ready for
rehab, and truly involving her in decisions
about her care at times using some
unconventional methods

Published Caring Quality

Intersections
In the June 2011 issue of Nursing Clinics of North
America, Monsivias writes: Not only does clinical
expertise include knowledge of research findings at all
levels but also includes knowledge of the most effective
interpersonal approaches for dealing with challenging
patients. Kautz provides a stunning example of provider
expertise. His knowledge and experience guide his
patient interaction in a rehabilitation in a way that wont
be found in any clinical practice guideline, and couldnt
be taught, yet worked in that situation. Expert clinicians
have an internalized knowledge and sense of effective
strategies and know when an unconventional approach
might be effective.

The bottom line:

Everyone here has great stories to
tell of caring quality intersections
Submit your stories for publication
there are many, many options.

Nightingale to Watson:
Nursing Quality, Research,
and Caring
Coming of Age
32nd International Association for Human Caring
Conference
th
San
Antonio,
Texas
June
4
, 2011
Donald D. Kautz, RN, PhD,
CNE,

CRRN
Associate Professor of Nursing
UNC Greensboro
ddkautz@uncg.edu

2010 was the 100

Anniversary
of Florence Nightingales Death
and
The International Year of the
Nurse

Randy L. Williams, II, RN, MSN,

MBA
Associate Faculty, Watson Caring Science

Objectives
1.
Apply Nightingales philosophy &
Watson's science to quality, research, and
caring in our everyday practice.
Nightingale's philosophy, research and
practice transformed hospitals and nursing.
Watson's evolution of caritas science
assists
each
of us to see the
connectedness
between nursing quality,
research, and our care.
2.
Illustrate Watsons tenets through
patient
scenarios and story telling.

Plan for this session

Nightingale and Watson the similarities and
how we have come of age.
- Research
- Evaluating quality care
- Caring
Patient scenarios which illustrate research
quality and caring intersections
A wonderful book Grandads Prayers to show
that when we reach for unattainable goals,
reflect on our practice and are proud, speak
from the heart, and remember that when we
change ourselves, we change the world

Nurse Educator

Nurse Educator
Vol. 32, No. 4, pp. 223-226
Copyright 2007 Wolteers Kluwer
Health I
Lippincott Williams & Wilkins

Reading Childrens Books to Awe

and Inspire Nursing Students
Donald D. Kautz, PhD, RN, CNRN, CRRN-A

Reading illustrated childrens books in the classroom to nursing students is 1 way

to inspire students to be great nurses. After offering guidelines for the types of
books to use and the courses books can be used in, the author describes the
effects on student learning.

Why do I read childrens books to

nurses?
Years after having one of my classes a nurse told me
I will never forget the book, the Whispering Cloth
and how important it is for me to help my patients
tell their own stories for them to heal and to be able
to picture a future full of hope. With that simple
line, these graduates not only show their own
ability to be great nurses, they also in essence tell
their own story and picture their future as nurses,
full of hope. As instructors, we are reminded of why
we became nurses in the first place, and we are
filled with hope as we light the way for those who
will come after us.
Kautz, 2007, p. 226

Nightingales Legacy

Believing nursing is a profession

Cleaning up the hospitals
Changing soldiers outcomes
Statistical analysis of outcomes
Philosophy of nursing from:
Notes on nursing: What it is, and what it is not
THUS theory & research drive professional
practice
And because of ALL of these, she became

Lady with the Lamp

Before and After

Dons Mom, Alice (a.k.a.

Florence)

In more theoretical terms,

Nightingale:

Challenged nurses to the full use of self, by

connecting ourselves to:
The divine all around us
All of humanity
Our environment
The nature and cosmos
As a means of learning, understanding,
caring and healing.
Watson, 2010
Illustrated by Amies patient
(Smith & Kautz, 2007)

Statistics Legacy
McDonald, 2010

Nightingale
Was a passionate statistician
Belief based on her faith in a God of order
Used statistics to indicate serious problems,
assist in policy making, monitor outcomes
Legacy for Nursing
Statistics is a required course in BSN programs
Even though.....
We are all taught, we must show the effect of
our care......

Unfortunately our data....

Nursing is still billed as part of the room charge
Nurses enter data everyday which is never
used...... This data is rarely available to
practicing nurses.
Legacy for nurses in 2011
We say that our practice is based on evidence,
but much of our care is still based on tradition.
The technology is here for us to now to use ALL
the data we collect. There will be more and
more and more changes to come...

Is it STILL the Crimean War?

Here? Today? NO? Yet we act
like it is!

Through the continued development of theory,

science, and practice we can continue to
REDUCE the rare incidences of:
Nosocomial infections
Patient Falls
Medication Errors
I believe Nightingale would be horrified we
continue to focus our measurement of quality
on the reduction of rare occurrences. But this
is where nursing needs to come of age
We need to truly use the data we collect and
enter into the electronic medical record.

A nurse caring for an elderly man who had an elective hip

replacement the day before should be able to walk in and
say:
I see from this mornings print out that:
Your wound was clean and dry yesterday, and the surgeon
changed the dressing this morning. You inspected the
wound, and told the surgeon how you would care for it at
home. You were also able to state all the signs of
infection, and when you should come back to see your
doctor after you are discharged. Your blood pressure and
temperature have been normal. You ate all of your dinner
and breakfast without nausea, had a bowel movement,
have been up to the bathroom with help, and walked 100
feet in the hallway. Your pain has never been above a 3
by taking Vicodin every 4 hours. Your son, Joe, from
Milwaukee is here to stay with you for the next week, and
you should be ready to go home tomorrow.

Nightingales Personality Type

(Dossey, 2010)
I (Introversion)
Nightingale was an introvert.
When she was alone, she
experienced her best ideas
her intuition and brilliance
flourished when she worked
by herself

N (Intuition)
Nightingales greatest gifts
came from her intuition
flashes of inspiration, insights
into relationships of ideas and
meaning of symbols.

T (Thinking)
Nightingales preference was
to make decisions based on
her logical analysis of the
facts and her own
experience. She was proud
that she had never been
swayed by a personal
consideration of anothers
feelings.

J (Judging)
Nightingale loved to live her
life in a manner that is
decided and settled.
Nightingale had a system for
everything, a planned life,
sustained effort, and
acceptance of routine.

INTJ Personality Type

A major legacy for nursing
Traditionally, nursing has valued nurses who are
independent, individualistic, single-minded,
love rules and order, and tough minded with
others and follow the leaders who think and
act just like them.
The pitfall is that nursing leaders may have
difficulty letting go of impractical ideas, ignore
the impact of their leadership style on others,
and criticize others who strive for the ideal.
Some would argue that this personality type has
led us to be a profession that
New leadership models are emerging!

New Leadership Models

A Caring Leadership Model for Nursings Future
Williams, McDowell, and Kautz, 2011

Caring Leadership Model

Model of Care
Patient/Family, Team, Self, Community

McDowell-Williams
Core Values of Caring Leadership
Always live with kindness, compassion and equality

Generate hope and faith through co-creation

Actively innovate with insight, reflection and wisdom
Purposely create protected space founded upon
mutual respect and caring
Embody an environment of caring-helping-trusting
for self and others
Shared Decision-Making

Exemplar of Caring Leadership:

I have two RNs in my

department who desire to cut
back on their work hours.
These employees are longtime, seasoned nurses. I sat
down with both of these
employees and allowed them
to discuss their concerns and
wishes. I could have ignored
their request but instead have
worked with them to create
work hours that meet their
personal needs. I allowed
them to vent and gave them
guidance and support. We
are in a trial period with their
schedules.
~~C. M.

New Leadership Models

Goldin, M. & Kautz, D.D. (2010) Nurturing
Nursing Students During Intensive Care Unit
Clinical Practicum. Dimensions in Critical Care
Nursing, 29(5), 238-240.
With Marlienne Goldins leadership, staff
transformed the ICU using Watsons 10 Caritas
processes:
Practice of loving kindness
Staff nurses love having students
Relationship based care (based on Watson
science)

New Leadership Models

Goldin, M and Kautz, D.D. (2010) Applying
Watsons caring theory and caritas processes
to ease life transitions. International Journal
of Human Caring, 14, 11-14.
This personal account of Mariliennes transformed
life illustrates how as a clinical expert, confronted by
a major change, Marlienne applied Watsons (2008)
caring theory and caritas processes to her life. By
sharing her story our hope is that others who find
their lives turned upside down can see it is possible
to take control, heal and grow.

Nightingales Challenge for

Nurses
Dossey, 2010
Nightingales INTJ personality allowed her to be a
practicing mystic, mange her chronic illness, and
her ability to create new models of nursing care.
Nightingales legacy is a challenge for nurses to:
- educate political leaders to create health reform
- integrate healing, spirituality AND technology
- respond with the same courage she
demonstrated in carrying our vision to the world
Nightingale would argue there is still a need for a
rebirth of the true values of nursing which is
what Watson argues
For an eye-opening source on rebirth of nursing
see the Future of Nursing: Leading Change,
Advancing Health (www.nap.edu) (Often referred
to as the IOM report)

In summary, Nightingale
was:
A nursing theorist
A visionary
A statistician
A nursing instructor
And also believed

Some of Watsons Basic Tenets

Art and the artistry of beginning and advanced
caring-healing arts
Return nursing and health-care to wholeness
Honoring the unity of body/spirit
Restoration of individuals and systems seeking
harmony with environment, nature, and God
Being authentically present
Transformation in the caring moment

Illustrated in Lillys gift from Africa (Kautz & Kautz,

2011)

Lillys Gift from Africa

Lilly describes seeing a very poor boy, of 4 or 5
playing in a mud puddle letting the water sift
through his fingers and laughing.
I wrote: Lillys story reminded me that our
patients are so much more than the reason
theyve come to see us. Her story also made me
think that in order to recruit teens to nursing
careers, we must share the hope, joy, and wonder
we experience in our practice. We need to tell
them that as nurses, we have the opportunity to
experience life in its simplest terms.

Lilly wrote:
At that moment, in watching this boy, I came
to understand two things. First, happiness is
temporary, but so is sadness. This boys life
was obviously filled with hardship, but for the
10 minutes that I watched him play, this
seemed to enter his mind.
Second, even though this child might die soon,
hed experienced true pleasure. His mother
didnt have to buy him presents to make him
understand happiness. At this point in his life,
he was truly and incandescently happy.

Lilly wrote:
As we drove away, I began to laugh. I
hoped that one day Id find my puddle of
happiness. When that day comes, Ill run
my fingertips across its shimmery surface
and find pleasure in the soft feeling
drifting across my fingers. Seeing the joy
in that boys face, Ive seen what some
people never get the chance to see. Ive
seen life, in its simplest terms, at its
core.

Nightingale and Watsons work

Nightingales work expanded:
From thoughts on nursing and guidelines for practice
to a Philosophy of Nursing
Watsons work expanded:
From a theory of caring with Caritive factors
To a Caritas Ethic/Science with Caritas Processes
The major difference between theories and a science
or philosophy is
The MAIN difference between Nightingale & Watson

Just as Don believes

Our outcomes are better that ever,
through care provided every day
We often see the connectedness of what we do
every day, with everyone else our spiritual side
Don also believes we all need to be reminded
And to help reduce the complexity of Watsons
model
My gift to you is to hear Nightingales philosophy
and Watsons caring science in a childrens book.

Grandads Prayers
This childrens book was written to help a boy
who forgot how to pray.
As I read the book, think about the times you
have forgotten why you became a nurse
Or, think of someone else who has forgotten
You will see the connectedness to the earth
and to all people that Nightingale and
Watson see in what we do everyday

Watson & Nightingale see

When we provide care to others, we
Reach with the trees
Are silent with the rocks
Reflect with the lakes
Laugh and Play with the streams
Breathe with the flowers
Sing with the wind

Watson & Nightingale see:

There are GREAT rewards as we:
Reach for unattainable goals
Are silent to listen and learn
Reflect on our practice and are proud
Laugh and find humor
Breathe the spirit that we all share
Sing with joy about what we do

Watson & Nightingale see

There are GREAT rewards as we:
Greet each new day
Remember what holds us together
Speak from the heart
And remember that when we change
ourselves, we will change the world.

Watson & Nightingale also see

We will be rewarded when we:
Greet each new patient
Show through our theory, science, and
practice that the care we provide is
I believe that all of us are GREAT caritas
nurses
And if we speak
But in order to do that
Because in that moment, when we change
I believe, I

Articles on Nightingale all from the

March 2010 (Volume 28, Issue 1)
issue of the Journal of Holistic
Nursing

Dossey, B. M. (2010). Florence Nightingale: Her

personality type. Journal of Holistic Nursing, 28(1), 5767.
McDonald, L. (2010). Florence Nightingale: Passionate
statistician. Journal of Holistic Nursing, 28(1), 92-98.
Watson, J. (2010). Reflections: Florence Nightingale and
the
enduring legacy of transpersonal human caringhealing.
Journal of Holistic Nursing, 28(1), 107-108.

Kautz and Colleagues sources

Kautz, D. D. and Kautz, L. (2011). Lillys gift from Africa.
Nursing, 41(4), 53-54. doi:
10.1097/01.NURSE.0000395205.88237.5a
Williams, R.L. III, McDowell, J. and Kautz, D.D. (2011). A caring
leadership model for nursings future. International Journal of
Human Caring, 15(1),
Kautz, D. D. (2011). Great rehabilitation nurses combine art and
science to create magic. Rehabilitation Nursing, 36(1), 13-15,
24
Goldin, M. and Kautz, D. D. (2010). Nurturing nursing students
during intensive care unit clinical. Dimensions in Critical Care
Nursing, 29, 238-240. doi: 10.1097/DCC.0b013e3181e6cd55
Goldin, M. and Kautz, D. D. (2010). Applying Watsons caring
theory and caritas processes to ease life transitions.
International Journal of Human Caring, 14, 11-14.
Smith, A. and Kautz, D. D. (2007). A day with Blake: Hope on a
medical-surgical unit. MEDSURG Nursing, 16, 378-382.