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What is Caring?
• Central focus of nursing
• More difficult in today’s fast pace health care
• Legalities of any aspect of health care has made the
aspect of caring appear missing to the client
• Technology have made some things easier but has
increased time spent away from the client
• We see many clients who remember the way it was
25-30 years ago
• With these changes we must make sure that we hold
the caring and compassion along side the knowledge

Caring is Universal
• Influences the way people think, feel and act
• Many nursing theorists have tired to “define”
caring – Nightingale was first
• Caring is the heart of nursing
Caring is Relational
• Patients value nurse Effectiveness
– Ability to perform tasks
• Also value nurse Affect
– Attitude or demeanor while performing the tasks
• Patients are more willing to participate if they
sense that they are cared about
Theoretical Views on Caring

• A universal phenomenon that influences

the way we think, feel, and behave
• Studied from a variety of philosophical and
ethical perspectives since the time of
Florence Nightingale
– Patricia Benner
– Benner and Wrubel

The Essence of
Nursing and Health
• Madeleine Leininger (1978)
• Caring is:
– Essential for well-being, health, growth, survival,
and facing handicap or death
• Trans cultural perspective
– Caring is essential for health and survival
– Caring is expressed in different ways in many cultures

Transpersonal Caring
• Jean Watson’s theory of caring (1979, 1988a, 1988b,
1995, 1999, 2003)
– Focuses on individuals and meaning for their quality of life
– Caring involves sensitivity, respect, and high moral and
ethical commitment
– Places care before cure
– Caring becomes the ethical standard by which we
measure nursing
– Caring preserves human dignity
– Caring is a choice
– Emphasis on nurse-patient relationship

• Watson defined nursing “as a human science
of persons and human health—illness
experiences that are mediated by
professional, personal, scientific, esthetic, and
ethical human care transactions” (Watson,
1988, p. 54)
• Carative factors, evolving into Caritas factors
• Transpersonal Caring Relationships
• Caring occasion/Caring moment
• Guides the core of nursing
• Carative factors attempt to “honor the human
dimensions of nursing’s work and the inner
life world and subjective experiences of the
people we serve” (Watson, 1997, p. 50).
• Contrasts the curative factors of medicine
(curative means to cure a disease)
• Carative factors evolve into Caritas factors
• Caritas has a greater spiritual dimension
• In Greek, caritas means “to cherish and to give
special loving attention”
Carative Caritas
• Faith and hope • Being authentically
present and enabling
the beliefs of the one
being cared for and
• Helping-trusting, the one giving care
human care • Developing and
relationship maintaining a
trusting, authentic,
caring relationship
(Watson, 1999,
Carative Caritas
• Creative problem solving • Creative use of self
caring process
• Expressing positive and • Being present to and
negative feelings supporting the positive and
negative feelings with a
connection of a deeper
• Transpersonal teaching- spirit
learning • Engaging in genuine
(Watson, 1999, p.62)
Transpersonal means to go beyond one’s own
ego and reach a deeper spiritual connection
while comforting a patient.
The transpersonal relationship depends on:
• A commitment from the nurse to enhance and
protect human dignity
• An awareness from the nurse that they have
the ability to heal
• The nurse must go beyond the objective role
• To preserve and protect a person’s humanity,
and dignity
• Preserve a patients spirit to ensure the patient
does not become an object
• This relationship allows the nurse and the
patient to to mutually seek out meaning and
in turn lead to a transcendence of suffering
(Watson, 2001).
• Watson (1998, 1999) stated that when human
caring is created the nurse and patient come
together to create a moment, this is known as the
caring occasion/caring moment
• Watson (1999) feels as though the nurse and the
patient must be aware of the caring moment so
as to make appropriate choices and actions,
thereby the nurse without knowing becomes a
part of the patients “life history”
Swanson’s Theory of Caring
• A composite of three studies
• Defines caring as
– A nurturing way of relating to a valued other
toward whom one feels a personal sense of
commitment and responsibility
• A central nursing phenomenon

Swanson’s Theory of
• Knowing
• Being with
• Doing for
• Enabling
• Maintaining belief

Expressions of Care
• Spiritual
– Being aware of & honoring patient’s beliefs
• Presence
– Being there
• Physically present
• Demonstrating understanding
– Being with
• Sharing oneself
• Touch
– Skin-to-skin
– Eye contact (nonverbal)
– Protective – to prevent injury
• Listening
– Taking in patient information
– Interpreting what has been taken in
• Knowing
– Understanding the client
– Understanding the planned interventions
– Avoid making assumptions
– Focuses on client
Can You Learn Caring Behaviors?

• Some of you already do caring behaviors

• You may have learned as a part of your values
and experiences
• As you continue as a student you may learn
new and different ways to care for others
• You will improve those behaviors as you work
toward being an expert nurse

Knowing the Patient
• A central aspect of nursing practice that
develops in the everyday practical work of
patient care
• The core of clinical decision making
• More than just collecting clinical data

Spiritual Caring
• Spiritual health is achieved when a person
finds a balance between life values, goals, and
belief systems and those of others.
• Watson (1979) describes the caring
relationship in a spiritual sense
• Spirituality offers a sense of connectedness.
– Intrapersonally, interpersonally, and trans

Family Care
• Individuals experience life through
relationships with others.
• Caring does not occur in isolation from a
patient’s family.
• Family is an important resource.

• You may have decided to go into nursing
because you care
• You will have the responsibility to maintain
the caring nature of nursing
• Begin here by developing that relationship
with other students and the carry that over
into your career

Ethic of Care
• Protects human dignity
• Often perceived as a moral imperative
• Requires awareness of potential unequality in
– This due to either real or perceived “power” that
patient assigns to the nurse
– Knowledge is power
1. Christina Shoemaker & Holly Smith,

2. Joyce Smith, Caring in Nursing Practice