Mount Auburn Hospital Adopts Kristen Swanson's Caring Theory Kristen Swanson, RN, Ph.D, FAAN

Today’s Goals Understand why the Department of Nursing is adopting a Nursing Theorist Learn about Swanson’s Caring Process Discuss how Swanson’s Caring Process can be applied to Practice

Purpose of a Nursing Theory Nursing Theory is a body of wisdom that is used to support nursing practice. Nursing theory comes from experiential learning, nursing research and non-nursing sources. It can provide a framework for practice. For example - what to: ask observe focus on think about

Why Swanson ? 4 Theorist were researched by the CNS group and presented to Nursing Leadership Council 2 Theorists (Watson and Swanson) were investigated further since both had a caring focus Reasons Swanson was chosen: * Definable * In line with the hospital’s mission and goals * Supports hospital’s patient experience initiatives * Applicable to any nurse-patient relationship in any clinical setting * Can incorporate with other nursing initiatives

Swanson’s Caring Processes

Swanson’s Key Definitions Nursing: Informed caring for the well-being of others Person: Unique dynamic beings with thoughts, feelings and behaviors Health: A complex process of establishing new meanings restoring integration and emerging into a sense of renewed wholeness Environment : Any context that influences or is influenced by the patient. Defined situationally

What is Caring ? Caring is the nurturing way of relating to a valued other. This “valued other” is one whom you feel a personal sense of commitment and responsibility

5 Caring Processes

Striving to understand an event as it has meaning in the Knowing: Striving to understand an event as it has meaning in the life of the other How to accomplish KNOWING: Avoid assumptions Assessing thoroughly Being observant as to what is said and not said Asking probing questions Seeking cues from the patient Being engaged with the patient Feeling Understood

Being with: Feeling Valued How do we accomplish BEING WITH: Being emotionally present to the other How do we accomplish BEING WITH: Being there when needed Conveying availability Sharing feelings Not burdening the patient with YOUR feelings or experiences Feeling Valued

Doing for others as they would do for themselves if it were at all possible How do we accomplish DOING FOR: Doing for but doing no more than that Anticipating others needs Performing competently and skillfully Preserving dignity Feeling Safe and Comforted

Enabling: Feeling Capable How do we accomplish ENABLING: Facilitating the other’s passage through events or transitions by providing support and validation How do we accomplish ENABLING: Informing and explaining Generating alternatives Validate and give feedback on progress Empowering others to care for themselves Feeling Capable

Maintaining Belief: Feeling Hopeful Sustaining faith in the other’s capacity to come through events or transitions and face a future with meaning How do we accomplish MAINTAINING BELIEF: Sustaining faith Hold patients in esteem Be hopeful but realistic Offer optimism Helping one find meaning by creating memories Recognizing the sacredness of someone’s experience Feeling Hopeful

Using the Caring Theory to mentor our new nurses

Knowing Ways to demonstrate KNOWING: Striving to understand talents and skills and assessing their past and present performance Ways to demonstrate KNOWING: Getting to know their past experience and skill set Listening and seeking first to understand Staying open and suspending judgement Observing actions and asking open ended questions Investigating opportunities for learning Providing feedback

Being with Ways to demonstrate BEING WITH: Demonstrates availability and conveying that a person’s experience matters. Diversity is honored and promoted Ways to demonstrate BEING WITH: Staying focused on the new person Acting with thought, not reacting Conveying emotions and expressing empathy Using words and gestures that suggest understanding Sharing feelings of where they are in their career Sharing feelings after a difficult situation

Doing For Ways to demonstrate DOING FOR: Doing for new nurse as they learn how to do for themselves. Providing a helping hand while preserving the dignity of them as a nurse Ways to demonstrate DOING FOR: Providing resources Responding to emergencies Anticipating when they need further support Providing privacy when giving feedback and maintaining confidentiality

Serve as a developer, educator, and trainer of new staff Enabling Serve as a developer, educator, and trainer of new staff Encourage autonomy. Ways to demonstrate ENABLING: Provide information proactively and consistently Teach skills and strategies to manage an assignment Developing learning guides and checklists Promoting teamwork and shared problem solving Validate progress through feedback

Maintaining a positive attitude for long term success Maintaining Belief Maintaining a positive attitude for long term success as a Mount Auburn nurse Ways to demonstrate Maintaining Belief: Building upon the strengths of the individual and showing faith in their ability to perform Acting with honesty, respect, and regard for each other Respecting and valuing new employee’s worth and offering encouragement Creating and regularly communicating a vision for success

Using the Caring Theory to provide Patient Education

Knowing How to demonstrate KNOWING with patient education: Striving to understand our patients. What is their literacy level, language, culture, and age. Be sensitive to their disabilities and the emotions this hospital encounter may be causing How to demonstrate KNOWING with patient education: Identify any learning barriers or disabilities Who are they? What is their educational level, age, and what language is spoken and read at home What are their learning preferences? Reading, listening, video, return demonstration

Being with How to demonstrate BEING WITH for patient education Demonstrate your availability and desire for them to ask ?s Tailor education for this patient as an individual How to demonstrate BEING WITH for patient education Create a teaching environment that is safe, and responsive to the patient’s unique needs: (ie.) Privacy, interpreters Spend time explaining things to the patient. Convey your desire to make sure they understand Ask patients to repeat back what they learned to validate their understanding

Doing For How to demonstrate DOING FOR for patient education Some education may need to be demonstrated and role modeled before a patient can take the next step of returning the demonstration. How to demonstrate DOING FOR for patient education Explaining to patients what we are doing for them while they are in the hospital and identifying when they are capable of providing that care themselves Skill demonstration

Enabling How to demonstrate ENABLING: Confirming understanding by asking questions Offer patients resources to learn more about what they need to learn Evaluate the patients ability to do for themselves. Can they take their medications properly Can they change their dressing Do they know what to look for when they go home Giving patients the tools to promote self care

Maintaining Belief How to demonstrate MAINTAINING BELIEF: Being reassuring and hopeful that the patient will be able to acquire the knowledge and skills needed to manage the change in their health How to demonstrate MAINTAINING BELIEF: Be the cheerleader Point out the patient’s progress Investigate alternatives to manage the patient care needs when needed to promote a safe transition from the hospital

Using the Caring Theory to Provide Pain Management

Knowing How to demonstrate KNOWING with pain management Thoroughly assess the type and level of pain Don’t make assumptions about the patient’s pain What does this pain mean to the patient Seek physiological cues to pain Be aware of cultural differences in the demonstration of pain

Being with How to demonstrate Being with for pain management Convey availability Taking the time to listen to how their pain is being managed Make sure they know you are there for them to address their pain needs

Doing for How to demonstrate Doing for with pain management Anticipate their pain needs to help them help themselves Recognizing the patients pain level and identifying what they need help with Optimizing their environment to maximize what they can do for themselves

Enabling How to demonstrate enabling with pain management Explaining pain progression Accepting the patient’s pain as described by the patient Generating ideas or thinking through alternatives to manage pain Teaching how to take care of their pain. (take medication before pain escalates, coping strategies)

Maintaining Belief How to demonstrate Maintaining Belief with pain management Being optimistic about being able to make them comfortable Maintaining a hopeful attitude that they will get through this painful event Helping patients through this painful transition in their life Helping them find some meaning for this experience

Applying the Theory of Caring to Practice