Nursing more than other health care professions involves establishing relationships with patients. Effective relationships enable healing and provide the patient maximum opportunity to return to optimal health. The caring aspect has been recognized in nursing organizations’ positions as being an essential part of expert nursing. The American Nurses Association 2002 Agenda for the future emphasizes that the nursing profession is critical because of nurses’ specialized knowledge, skill, and caring to improve the public’s health. The American Organization of Nurse Executives states that caring is a key component in patient experience of health care. The Institute Of Medicine’s Crossing the Quality Chasm, recommendation 4, stated that continuous healing relationships must be the goal and the process to that goal involves understanding patient needs, patients are in control, knowledge is shared, and these are the characteristics of a caring, relationship centered nurse practice. (1) It has been noted that nurses are ‘obliged to care’ in a society that does not value caring.(2) However, nurses have the power to change that indifference.
There has been much discussion in this and other spaces about how to fix health care in the nation. It is acknowledged that nurses have and will form a large part of health care transformation and improvement. Much of the improvements have centered around the symptoms of the health care crisis involving economics, better technology, organization of the workspace, addressing the nurse shortage etc. More nurse scholars and leaders in field of nursing are questioning whether the real solution lies within each nurse. Is the nation coming to the realization that the business model as applied to health care may not contribute to high quality?
Are nurses caught in the middle between their values and calling to improve society’s health, and the demands created by a technological, biomedical, task oriented, hurried workplace? Are current workplace demands based on outmoded practice patterns that nurses have little control over? Do nurses feel constrained to have purpose and to practice with meaning?
Nursing has traveled back in its history to refresh the basic tenets of the profession. The literature on the caring aspect of nursing goes back 2 decades but present day nursing leaders have reexamined its principles and created professional practice models and theories based on nurse caring.
In the limited space of this post we can only briefly discuss a few highlights of nurse caring to hopefully get readers curious to find out more.
What are the components and science of caring? How can it be measured? How can caring be moved from concept to practice? What are examples of successful implementation?
There have been several prominent nurse scholars who have written extensively on caring in nursing among them Leininger, Watson, and Swanson.
Watson has developed caring theory/caritas nursing. It includes these aspects: caring process, transpersonal caring relationships, caring moment, and caring and healing modalities. Providing love and holistic care begins the caritas process. Caritas is the Greek word for cherish and special loving attention. The nurse acknowledges the spirit of the patient as well as their body. The transpersonal relationship is a 2 way relationship between the nurse and the patient where both benefit from their interaction.
Watson believes that preserving dignity and harmony create a healing environment. For example de-escalating skills, reduction in the use of restraints, fall prevention programs, creating space that is quiet and clean with proper lighting and artwork and calming music are examples that provide a healing environment.
She is committed to moving caring from science and theory to practice and to that end has created the International Caritas Consortium among other initiatives. Her work has also discussed importance of caring between colleagues as a means of fostering caring for patients.
At John C. Lincoln North Mountain Hospital B. Brewer implemented an example of the caring environment. By consensus nurses there decided to develop a caring framework as a basis for an effective professional practice model. Dr. Watson’s theory was chosen. At a meeting representing all levels of nursing it was decided that they would invite other professional colleagues outside of nursing. They wanted to move from theoretical language to words used in daily practice. Part of their strategy was to identify how caring was already present in the workplace.
Many activities were implemented to educate staff and to further the theory of caring. Their quarterly retreat emphasizes how staff can care for each other (caring for the caregiver). In the retreat 2 questions were posed: Why did you become a nurse and describe a patient that has been important to you in your career. The ambiance the retreat encouraged sharing in a relaxed atmosphere. This sharing has created bonding between colleagues.
There has also been renewed interest in Swanson’s theory of caring which includes these factors: knowing, being with, doing for, enabling, and maintaining belief. Virginia Mason Medical Center is developing a model of care based on her work.
Other theorists have stated that the caring theory can be further validated by seeing caring from the view of the patient. Of the assessment tools developed to measure caring few are from the patient perspective. One study did develop a Caring Assessment Tool that allowed patients to assess nurses’ level of caring. The factors that were included in the survey correlated with both Watson’s and Swanson’s theories and include 8 aspects of caring. They are: mutual problem solving, attentive reassurance, human respect, encouraging manner, appreciation of unique meanings, a healing environment, affiliation needs, and basic human needs. The Caring Assessment Tool used non technical easily understood English and was easy to administer. Other possible uses for the CAT include educating new nurses, assessing improvement of nursing practice or to correlate nurse practice with nursing sensitive patient outcomes. (3)
A professional practice model based on relationships and caring must reveal the value of nursing by showing results. Fostering discussion of caring will enable other health care disciplines to learn from nurses’ experience. The answer for better health care lies more within human qualities and less on external factors. Nurses know intuitively, have and will prove that the business model of health care is not the foundation of health CARE but skilled knowledgeable, compassionate, and caring people are.
- Sources:
1. Dimensions of Caring: Psychometric Evaluation of the Caring Assessment Tool Advances in Nursing Science Vol. 30 No. 3 pp 235-245
2. Educating Nurses: A Call for Radical Transformation 2010 Jossey Bass p xi
3. Dimensions of Caring: Psychometric Evaluation of the Caring Assessment Tool Advances in Nursing Science Vol. 30 No. 3 pp 235-245
From Theory to Practice: Caring Science according to Watson. Nursing Science Quarterly Oct 2009 Vol. 22 No. 4 pp 339-345
Developing a Practice Model for Watson’s Theory of Caring Nursing Science Quarterly Jan 2011 Vol. 24 No.1 pp 27-30
http://www.nursezone.com/Nursing-News-Events/more-news/Nursing-Advocacy-Standing-Up-for-Patients-and-the-Profession_36974.aspx
http://www.watsoncaringscience.org
© Young Lion Incorporated 2011 - Photo Courtesy of ChristianaCare
