Keith Rischer RN, MA, CEN, CCRN Can Caring Be Taught??? Keith Rischer RN, MA, CEN, CCRN Is caring the primary virtue ethic in nursing? Define caring??? Can caring be taught???

Nursing’s Historical Legacy of Caring “The spirit in which she does her work makes all the difference. Invested as she should with the dignity of her profession and the cloak of love for suffering humanity, she can ennoble anything her hand may be called upon to do, and for work done in this spirit there will ever come to her a recompense far outweighing that of silver and gold…. Isabel Hampton Robb- 1860-1910-one of the most important leaders in early American nursing and nursing education First to implement a grading policy for nursing students so students needed to prove their competency in order to graduate 1889 appointed head of Johns Hopkins nursing school Served as president of what is currently known as the National League for nursing and the American Nurses Association and founded the American Journal of Nursing Recognized the importance of not only doing nursing well with high standards of competency but the PRE-EMINENCE of ones MOTIVATION for serving in the nursing profession….love and care for suffering humanity and recognizing that anything can be dignified by serving with this spirit Though old school this ethic remains valid and essential to holistic care today

Caring Defined… “Swanson defines…“Caring is a nurturing way of relating to a valued other toward whom one feels a personal sense of commitment and responsibility”

“Practicing in a caring manner leads to the nurse’s well being, both personally and professionally. Personal outcomes of caring include feeling important, accomplished, and whole. Professionally practicing caring leads to enhanced intuition, empathy, clinical judgment and work satisfaction.” Kristen Swanson RN, PhD, FAAN Chair of Family and Child Nursing University of Washington Empirical Development of a Middle Range Theory of Caring 1991 Framework of caring is used nationwide as “First Touch” First Touch- Hello-relate to pt as a person Retouch Final Goodbye How caring benefits nurses

How This Caring Theory Came to be… I. 20 women who miscarried “What constituted caring in the instance of miscarriage?” II. 19 careproviders in the NICU “What is it like to be provider of care in the NICU” III. 8 high risk young mothers who received LT public health nursing intervention “How did you recall and describe your nurse-patient relationship after intervention?”

Swanson’s Framework of Caring Knowing (Empathetic Understanding) Striving to understand an event as it has meaning in the life of the other Avoiding assumptions Centering on the one cared for Assessing thoroughly Seeking cues Engaging the self Subcategories are the nursing interventions DESIRE TO UNDERSTAND THE PERSONAL REALITY OF THE ONE BEING CARED FOR RECOGNIZE THE OTHER PERSON AS SIGNIFICANT AND HAVING INHERENT VALUE WHEN KNOWING OCCURS, BOTH CAREGIVER AND CLIENT ARE ENGAGED Avoiding assumptions-don’t assume how the person may be feeling if dx with CA for example…”What is this like for you?” Center on the one cared for-client is the center and they know it Assess thoroughly-look at NV Seeking cues-NICU Engaging self-when you begin to understand whats going on for another person-can’t help but get yourself engaged—one human being to another As this becomes evident moves to next level..BEING WITH

Swanson’s Framework of Caring Being With (Emotionally Present) Being emotionally present to the other Being there Conveying availability Sharing feelings Not burdening Presence and sharing are done in such a way that the one caring does not burden the client Being with goes one small step beyond knowing-it is more than understanding anothers situation, it is becoming emotionally open to the others current reality THE MESSAGE CONVEYED WITH BEING WITH IS THAT THEIR EXPERIENCE MATTERS TO THE CAREGIVER Example of women who miscarried and had D&C-” the nurse tried to comfort me as much as possible-he tried to be gentle as possible-he even became teary eyed. He made me feel like he cared. As it became painful he kept saying its just a matter of time. You know he was so sorry.” Being there-client senses that they really matter-no matter how bad things may be Give them time and give of yourself Convey availablity-here’s the call light I am always here for you Sharing feelings-you are right there with your client what is happening Not burdening-when sharing feelingsdo not burden with your experience of their experience… OCCUPATIONAL HAZARD-GETTING TOO CLOSE-NEED TO KNOW YOUR LIMITS

Swanson’s Framework of Caring Doing For (Enact For) Doing for the other as he/she would do for oneself…but no more Anticipating their needs Performing competently/skillfully Preserving dignity When the client is dependant it can be very embarassing—therefore the caregiver must consciously act to preserve the dignity of the other Dependance upon another for care of the body constitutes an indignity only when the person being cared for becomes an object for the caregiver Anticipating their needs-pain control Perform competently-when asked what demonstrates caring 95% pts choose this-90% nurses think it is listening spending time with pt.

Swanson’s Framework of Caring Enabling (Empowering) Facilitating the other’s passage through life transitions and face a future with meaning Informing/explaining patient education Validating-giving feedback Generating alternatives-thinking it through AN ENABLING CAREGIVER IS ONE WHO USES THEIR EXPERT KNOWLEDGE TO THE BETTERMENT OF THE OTHER PURPOSE OF ENABLING IS TO FACILITATE THE CLIENTS CAPACITY TO GROW, HEAL AND PRACTICE SELF CARE INCLUDES PROVIDING EXPLANATIONS AS WELL AS EMOTIONAL SUPPORT BY VALIDATING THE CLIENTS FEELINGS

Swanson’s Framework of Caring Maintaining Belief (Esteem) Sustaining faith in the other’s capacity to get through an event/transition and face a future with meaning Believe in/holding in esteem Maintaining a hope filled attitude Offering realistic optimism CARING THAT MAINTAINS BELIEF IS THE SUBCATEGORIES NURSES SEEK TO ASSIST CLIENTS TO ATTAIN, MAINTAIN OR REGAIN MEANING IN THEIR HOSPITAL EXPERIENCE

Application in Clinical Setting CLINICAL WEEK #1 I.Knowing (Empathetic Understanding) Striving to understand an event as it has meaning in the life of the other Choose at least 2 to implement Nursing Caring Interventions Evaluation (Client Response) 1. Avoiding Assumptions 2. Centering on the one cared for *Did my cares when time was best for client *Allowed client quiet time with minimal interruptions *Always verbalized to client what I was coming in for next and told him if there was anything more I could help him with to feel free to ask *Allowed client to maintain sleep/rest *Client did not feel like a burden when using call light *Felt that this conveyed trust between client and nursing student 3. Assessing thoroughly 4. Seeking cues 5. Engaging of self *After surgery I was conveying availability-this was important for the client who was experiencing pain *I was able to get warm blankets and ice water for my client to ensure comfort *I ensured the client that I was there and could help him with anything he needed *Client felt as if I really cared for him and that he was not alone *He felt that he could trust me and was a little more relaxed to know someone was there *Non-verbal cues-client was less anxious and was able to remain comfortable to rest

Application in Clinical Setting II. Being With (Emotionally present) Being emotionally present to the other Choose at least 2 to implement Nursing Caring Interventions Evaluation (Client Response) 1. Being there *Talking to client and sitting at eye level *Placing a hand on the client’s shoulder to let them know that you care and are “present” *Taking time to explain what you are doing and answer questions and make sure client fully understands *Allow pt. to express feelings without putting judgements on them *Client was able to talk to me on a more personal level *Putting hand on shoulder was comforting and caring-helped client realize I was “there” *Client ws able to put trust in me and know what to expect and let him know what was next *Client expressed sensitive topics with me about being overweight and was able to not worry about feeling judged 2. Conveying availability *Stating, “is there anything else I can do for you…I have time?” *Do not approach client in a rushed nature *Periodically assessing client and asking how they are doing without making them put on their call light and feel like they are a burden *Client gets needs met immediately and does not feel rushed *Client does not feel like they are being a pain because they know that they are not bugging you when you are busy *Does not feel rushed and they feel that they have time to ask questions or review personal nature of self more readily 3. Sharing feelings 4. Not burdening