Chapter 7: Caring in Nursing

Providing Presence

"Being there" and "being with." -sensitivity, wholism, intimacy, vulnerability, adaption to unique circumstances. -body language. -listening. -eye contact. -tone of voice. -positive and encouraging attitude.

Leininger's Transcultural Caring

-Caring is an essential human need. -Caring helps an individual or group improve a human condition. -Caring helps to protect, develop, nurture, and sustain people.

Questions to understand the context of a person's life and illness

-How was your illness first recognized? -How do you feel about your illness? -How does your illness affect what you do each day?

Examples of presence and caring:

-awaiting test results -prep for unfamiliar procedure -plan to return home after a serious illness

Family Care

-caring includes family -family is an important resource -learn who + family roles -create openness and willingness to share

Intrapersonally, interpersonally, and transpersonally

-connected with oneself -connected with others/environment -connected with unseen, God, or a higher power.

Clinical decision making relies on

-knowing the patient -response to therapies -routines/habits -coping resources -physical capacities/endurance -body typology/characteristics -experiences, feelings, behaviors, perceptions

Patient and nurse come together to know each other by

-mobilizing hope -interpretation or understanding of illness, symptoms, or emotions acceptable to the patient. -assist patient in using social, emotional, or spiritual resources. -recognizing that caring relationships connect us human to human and spirit to spirit.

Effective Listening

-silence yourself -listen with an open mind -concentrate on what they're saying -give full, focused attention

Swanson's definition of caring

A nurturing way of relating to an individual

Caring

A universal phenomenon influencing the ways in which people think, feel, and behave in relation to one another.

10.) Allowing for existential-phenomenological-spiritual forces. (Watson's 10 Carative Factors)

Allow spiritual forces to provide a better understanding of yourself and your patient.

6.) Using creative problem-solving, caring processes. (Watson's 10 Carative Factors)

Apply the nursing process in systematic, scientific problem-solving decision making in providing patient centered care.

2.) Being with (Swanson's Theory of Caring).

Being emotionally present to the other. -being there -conveying ability -sharing feelings -not burdening

QQ #1: A female patient has just found a large lump in her breast. The physician needs to perform a breast biopsy. The nurse helps the patient into the proper position and offers support during the biopsy. The nurse is demonstrating: A.) Enabling B.) Comforting C.) A sense of presence D.) Maintaining Belief

C.) A sense of presence. Rationale: Providing presence is a person-to-person encounter conveying closeness and sense of caring. "being there" and "being with."

Core of nursing

Caring and knowledge

Jean Watson

Caring is a central focus of nursing

8.) Providing for a supportive, protective, and/or corrective mental, physical, societal, and spiritual environment. (Watson's 10 Carative Factors)

Create a healing environment at all levels, physical and non-physical. This promotes wholeness, beauty, comfort, dignity, and peace.

QQ #2: When a nurse enters a patient's room and says "Good Morning!" before starting care, the nurse combines nursing tasks and conversation. An important aspect of care for the nurse to remember is the need to: A.) Establish a relationship B.) Gather assessment data C.) Treat discomforts quickly D.) Assess the patient's emotional needs

D.) Assess the patient's emotional needs. Rationale: In Swanson's Theory of caring, "being with" is being emotionally present for another person. By taking the time to assess patients emotional needs, the nurse is exhibiting caring behavior.

3.) Doing for (Swanson's Theory of Caring).

Doing for the other as he or she would do for self if it were at all possible. -comforting -anticipating -performing skillfully -protecting -preserving dignity

4.) Enabling (Swanson's Theory of Caring).

Facilitating the other's passage through life transitions (birth, death) and other unfamiliar events. -Informing/explaining -Supporting/allowing -Focusing -Generating alternatives -Validating/giving feedback

Why are nurses and patients often in unequal relationships?

In health care settings, patients and families are often on unequal footing with professionals because of lack of information, the patient's illness, regression caused by pain and suffering, and unfamiliar circumstances.

Transformative

Influences both the nurse and patient for better or for worse.

9.) Meeting human needs. (Watson's 10 Carative Factors)

Intentionally help patients meet basic needs with a caring consciousness.

3.) Cultivating a sensitivity to one's self and others. (Watson's 10 Carative Factors)

Learn to accept yourself and others for their full potential. A caring nurse matures into becoming a self-actualized nurse.

4.) Developing a helping, trusting, human caring relationship. (Watson's 10 Carative Factors)

Learn to develop and sustain helping, trusting, authentic caring relationships through effective communication with your patients.

7.) Promoting transpersonal teaching-learning. (Watson's 10 Carative Factors)

Learn together while educating the patient to acquire self-care skills. The patient assumes responsibility for learning.

Summary of Theoretical Views

Nursing caring theories have common themes -human interaction and communication -mutuality -appreciating the uniqueness of individuals -improving welfare of patients and families

Care Ethics

Places caring at the center of decision making.

2.) Instilling faith-hope (Watson's 10 Carative Factors)

Provide a connection with the patient that offers purpose and direction when trying to find the meaning of an illness.

The Transpersonal Caring Theory

Rejects the disease orientation to healthcare and places care before cure.

Contact touch

Skin to skin contact known as therapeutic touch. -patient's cultural practices/past experiences -could be perceived as invasive or a threat

Spiritual Caring

Spiritual health is achieved when a person can find a balance between his life values, goals, and belief symptoms and those of others. Spirituality offers a sense of intrapersonal, interpersonal, and transpersonal connectedness.

1.) Knowing (Swanson's Theory of Caring).

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 clues to clarify -engaging the self or both

5.) Promoting and expressing positive and negative feelings. (Watson's 10 Carative Factors)

Support and accept your patient's feelings. In connecting with your patients, you show a willingness to take risks in sharing in the relationship.

5.) Maintaining Belief (Swanson's Theory of Caring).

Sustaining faith in the other's capacity to get through an event or transition and face a future with meaning. -believing in/holding in esteem -maintaining a hope-filled attitude -offering realistic optimism "going the distance."

Compassion

The feeling that arises when a person is confronted with another's suffering and feels motivated to relieve that suffering. Shows kindness, caring, and a willingness to help others.

Kristen Swanson

Theory of caring. (1991) Studied patients and professional caregivers in 3 perinatal studies involving interviews with women who miscarried, parents and healthcare professionals in a NICU, and mothers who were socially at risk and received long-term public health intervention.

1.) Forming a human-altruistic value system. (Watson's 10 Carative Factors)

Using loving kindness to extend yourself. Use self-disclosure appropriately to promote a therapeutic alliance with your patient (share a personal experience in common ex. child-rearing, illness, parental experience.)

Spirituality

a sense of connectedness with God or some other higher spiritual being.

Knowing a patient

an in-depth knowledge of a patient's patterns of responses within a clinical situation and knowing the patient as a person. -core of clinical decision making and patient centered care. -2 elements that facilitate knowing: continuity of care and clinical experience.

Comforting

approach that reaches out to patients to communicate concern and support.

Transcultural

concept of care extending across cultures that distinguishes nursing from the other health disciplines.

Ethic of Care

concerned with relationships between people and with a nurse's character and attitude towards others.

Task-oriented touch

done when performing tasks/procedures -any procedure is more effective when it is explained and administered carefully and in consideration of any patient concern.

Protective touch

form of touch that protects the nurse and/or patient. -can be positive or negative -positive: prevents an accident (ex. fall) -negative: RN withdrawl when unable to tolerate suffering or tension.

Non-contact touch

known as eye contact

Caring touch

known as nonverbal communication. -could be holding patient's hand, back massage, gently positioning, or engaging in conversation. -tends to physical and emotional needs.

Presence

person-to-person encounter conveying a closeness and sense of caring.