1. Caring In Nursing Practice

2. Caring
Caring is the essence of nursing. It is at the core of our ability as nurses to work with clients in a respectful and therapeutic way. Caring and compassion have been shown to make enormous contributions to the health and well-being of clients

3. Theories of Caring Benner(1984)/ Benner/Wrubel (1989)
Caring = Persons, events, projects, things matter to people
“Caring creates possibility”
Caring is inherent to nursing
Caring makes nurses notice which interventions are successful
Caring is specific and relational
Benner and Wrubel studied caring by reviewing stories told by expert nurses. After listening to their stories, they analyzed them and this is the result of that study. They found these things true about caring.
Persons, events, projects, and things matter
Caring creates possibility because of the time taken when caring and the relationship that is developed w/ caring, When you know more about a person you will be able to do more and work differently with them.
Caring is inherent to nursing= nurses focus on helping others to recover from illness and prevent illness. Just doing this= caring
Caring makes nurses notice when interventions are successful= Being alert and involved make us take notice of what is working or not
Caring is specific and relational- each relationship is a new experience, each client has their own experiences, culture, values that they bring with them, it requires that we as nurses take time with each client to develop a relationship.

4. Theories of Caring Leininger (1978)
“Care is the essence and central, unifying, and dominant domain that distinguishes nursing from other health disciplines.”
Care is an essential human need
Care helps protect, develop, and nurture
Care is personal
Care should be transcultural
Madeleine Leininger (1978)
Care is an essential human need- it is necessary for the health and survival of all individuals
Care helps protect, develop,and nurture- Vital to receivery from illness and to the maintenance of healthy life practices
Care is personal- Again care will differ for each client
Care should be transcultural- Because each client is different and comes from different backgrounds, we need to be sensitive to each person’s background and culture.

5. Theories of Caring Watson (1979, 1988)
Conscious intention to care potentiates healing and wholeness
Care before cure
Client and nurse are both influenced by caring relationship
Watson feels that a conscious intention to care helps w/ healing, it compliments traditional medicine and science.
Watson does not want to make the disease the focus but likes to focus on the caring, care before cure. The caregiver looks beyond the disease and looks to other sources of inner healing. Watson feels that caring almost becomes spiritual. It’s called transpersonal healing
She feels that both the nurse and the client are affected and influenced by the relationship they have developed.

6. Theories of Caring Swanson (1991)
Caring is a nurturing way of relating to a “valued other” toward whom one feels a personal sense of commitment and responsibility.
Caring consists of 5 categories (Table 7-1)
Knowing, being with, doing for, enabling, maintaining belief
Swanson conducted interviews w/ 3 different groups: women who had miscarried, parents and health care professionals in a NICU, moms who had received public health info. Each group was asked several questions about how care was expressed or experienced in their situation. After analysing her data she came up w/ this theory of caring.
Her theory provides good foundation for developing caring strategies to be used in our clinical practice. Swanson categories in table 7-1 include a definition of each with subdimension that describe techniques that can be used in practice (Knowing- definition= striving to understand an event as it has meaning in the life of another, subdimensions= avoiding assumptions, centering on the one cared for, assessing thoroughly, seeking cues, engaging the self or both.
Being there= being emotionally present for the other
Doing for= doing for the other as he or she would do for the self if it were at all possible
Enabling= Facilitating the other’s passage through life transitions (birth, death, grief) and unfamiliar events
Maintaining belief= Sustaining faith in the other’s capacity to get through an event or transitions and face a future with meaning

7. Caring is: Highly relational More than doing tasks
Highly invisible at times
Empathy and compassion
A commitment to the client
When comparing all of the theories, this is what they all seem to have as common components of caring
Highly relational= It’s a relationship, much more that checking off duties or tasks that need to be done. Relationship is being built while the tasks are being completed.
Highly invisible= can’t always see respect, concern, support, empathy and compassion. Book points out= It however becomes very obvious when caring is not present.
A commitment to the client= When caring is practiced the client feels a connection with the nurse, that connection builds a relationship that allows the nurse to be more effective in understanding client needs and planning care.

8. Client’s Perception of Caring
Clients associate caring with:
Attentiveness
Partnership
Individualization
Rapport
Client perception= important because facilities are placing emphasis on client satisfaction and serving clients needs more effectively.
Clients think we care when we:
Are attentive- Means being physically present, checking up on clients, encouraging them to call when they need something
Partnership- Work with the client as part of the team, we are working with them toward their goals. Also we need to build relationships that allows us to know what is important to our clients and determine the approach our client needs
Individualization= They are treated like a person rather than a disease (this study was done on oncology patients, where many times they are all getting similar treatments)
Rapport= a close or sympathetic relationship, agreement or harmony

9. Ethic of Care Ethics focus on right and wrong behavior
Some say caring is a moral imperative
Caring allows human dignity to be protected, enhanced, and preserved
In any interaction with our client we must know what is ethically appropriate, what is right and wrong . Because nurses care we do not make decision about our clients based solely on science or intellect.

10. Caring in Nursing Practice
We can demonstrate caring behavior by:
Providing presence
Touch
Listening
Knowing the client
Providing spiritual care
Providing family care
Ask students how they see these qualities:
Providing presence= person to person encounter, checking in on clients, being there(not just physically, but communication and understanding.
Touch= A way of reaching out, communicates concern and support, we use touch naturally with almost every aspect of care. We can touch with care or not
Listening= Giving full attention to your client, includes interpreting and understanding what is said and giving feedback. For clients to be able to tell the story of their illness or grief helps with the stress of the situation. Listeners need to silence themselves and listen with openness (slience mouth and mind)
Knowing the client= Understanding of a specific client and choosing appropriate interventions. Knowing takes time and experience as the nurse gains experience in their specialty (and understands the varied conditions and responses of clients). So avoid assumptions, focus on the client, and engage in a therapeutic relationship.
Spiritual caring= Research shows us there is a relationship between spirit, body, and mind. A persons beliefs and expectations affect their physical well being.
Family care= No man is an island, family is a part of client’s relationships. It is very important that we know our client’s family as well as we know the client. A family is a valuable resource to us and the client.