Caring in Nursing PDF

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Fundamentals of Nursing, Caring in nursing, book summary, lecture notes, Fundamentals of Nursing, Caring in nursing, book summary, lecture notes, review questions...

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Caring in Nursing Caring Caring, according to the American Nurses Association (ANA) Code of Ethics (2010), is having concern or regard for that which affects the welfare of another. As a profession, nursing can trace its earliest beginnings to activities that demonstrate caring, such as taking time to be with a suffering person, actively listening, advocating for the vulnerable, valuing and respecting all individuals, attempting to relieve pain, and making the healing process an act of the body, mind, and spirit. Professional caring involves compassion, which is a deep understanding of another’s suffering and pain. A compassionate, caring nurse demonstrates empathy and concern, which strengthens and comforts the sufferer.

Selected Nursing Theories The concept of caring is universal and greatly influences the ways in which people think, feel, and behave. A number of nursing scholars have developed theories on caring because of its importance to nursing practice. These theories complement one another but approach the idea of caring and nursing from very different paradigms. The nursing theories of caring provide insight to enrich and guide nursing practice and are positive influences in nursing.

Four nursing theories of caring are: 1. Leininger’s Cultural Care Theory 2. Watson’s Theory of Human Caring/Caring Science 3. Travelbee’s Human-to-Human Relationship Model 4. Swanson’s Middle Range Theory of Caring 1.) Leininger’s Cultural Care Theory Leininger’s Cultural Care Theory is based on the belief that nursing is a transcultural care profession and that the concept of care is at its center. The practice of transcultural nursing addresses the cultural dynamics that influence the nurse-patient relationship. The foundation of Leininger’s theory is to provide care that is in harmony with an individual or group’s beliefs, practices, and values. As a nurse and anthropologist, Madeline Leininger found that human caring was a universal phenomenon. Early in her career, she recognized the importance of caring in nursing. Frequent statements of appreciation from patients for care received prompted Leininger to focus on “care” as a central component of nursing. Leininger described the concept of care as the essence and central unifying and dominant domain that distinguishes nursing from other health disciplines. Care is an essential human need, necessary for the health and survival of all individuals.

According to Leininger, there are three nursing actions that all nurses should strive to reach in order to provide cultural congruent care. These nursing actions are: 1. Preserving or maintaining the patient’s cultural health practices 2. Accommodating, adapting, or adjusting healthcare practices 3. Repatterning or restricting some cultural practices, as needed The Leininger theory stresses the importance of nurses’ understanding cultural caring behaviors. In short, for caring to be effective, nurses must learn culturally specific behaviors that reflect caring in different cultures to identify and meet the needs of all patients. Leininger’s Three Nursing Actions Nursing Action 1 Description: Preserving or maintaining the patient’s cultural health practices. Example:Mrs. Fazhim is a 31-year-old Islamic woman at 24 weeks gestation, diagnosed with gestational hypertension. Before she considers pharmaceutical interventions, she insists on trying her native herbal remedies. The nurse arranges for a joint meeting with the patient and her family, the dietician, and the health care provider to discuss her options. Nursing Action 2 Description: Accommodating, adapting, or adjusting healthcare practices. Example:At 35 weeks gestation, Mrs. Fazhim’s placenta abrupted. Due to excessive blood loss, she must have an emergency caesarean. Because her family prays five times daily, her husband will not allow the operation until after their next prayer session, which is in 45 minutes. To accommodate the family, the nurse makes sure the OR team is prepared and ready to begin surgery promptly after the prayer session. She also monitors Mrs. Fazhim and provides comfort measures while she waits. Nursing Action 3 Description: Repatterning or restructuring some cultural practices, as needed. Example:In the early morning after surgery, Mrs. Fazhim is too weak to get out of bed, but she must face in the direction of Kaaba for her morning prayer. In this case, her hospital bed must be repositioned to face the window so that she can conscientiously pray. The nurse moves Mrs. Fazhim’s bed to face the window. 2.) Watson’s Theory of Human Caring/Caring Science Watson’s Theory of Human Caring/Caring Science is a holistic model of nursing that suggests a conscious intention to care promotes healing and wholeness. The theory integrates human caring (the art) with healing environments (the science), incorporating life-generating and life-receiving processes for nurses and their patients.

Jean Watson believes that health care needs to move from a total disease-cure focus based solely on scientific inquiry to a more holistic approach that incorporates values, beliefs, intentions, and the caring consciousness. This includes combining the social, psychological, and spiritual aspects with interventions that reflect both the science and art of nursing. In Watson’s view, caring is a metaphysical event with far-reaching effects on both humanity and the universe. Human bodies are manifestations of universal energy, and caring is transpersonal, transcending time, space, and the physical realm. The term “transpersonal” means to go beyond one’s own ego and the here and now, as it allows one to reach deeper spiritual connections in promoting the patient’s comfort and healing. Core concepts of Watson’s theory The concepts at the heart of Watson’s theory are:  A relational caring for self and others based on a moral/ethical/philosophical foundation of love and values.  Transpersonal caring relationship by going beyond ego to higher spiritual caring created by caring moments.  Caring occasion or caring moments gleaned from heart-centered encounters with the patient.  Discovering multiple ways of knowing. Caritas Processes The structure of Watson’s theory originally was built on 10 carative (rather than curative) factors, which are now referred to as caritas processes. Watson’s Caritas Processes  Embrace altruistic values and practice loving kindness with self and others.  Instill faith and hope and honor others.  Be sensitive to self and others by nurturing individual beliefs and practices.  Develop helping-trusting-caring relationships.  Promote and accept positive and negative feelings while listening to another’s story.  Use creative, scientific problem solving for caring decision making.  Share teaching and learning that addresses individual needs and comprehension styles.  Create a healing environment for the physical and spiritual self that respects human dignity.  Assist with basic physical, emotional, and spiritual human needs.  Be open to mystery and allow miracles to enter. 3.) Travelbee’s Human-to-Human Relationship Model

Joyce Travelbee (1971), a psychiatric nurse practitioner, was inspired to develop the Human-to-Human Relationship Model after noting that nursing care being given to patients lacked compassion. Travelbee felt that a humanistic revolution was needed to rectify this situation. According to Travelbee, the purpose of nursing is achieved through human-tohuman relationships. The quantity and quality of nursing care delivered to an ill person are greatly influenced by the nurse’s perception of the person and the relationship that is established. Travelbee believed that building a genuine human-to-human relationship could only be accomplished through an interaction process.

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She identified five phases in the interaction process. Original encounter Emerging identities Empathy Sympathy Rapport

A Model of Compassion At the core of the Travelbee Human-to-Human Relationship model is the concept of compassion. Travelbee noted that compassion is central to holistic nursing. She warned that if the profession of nursing did not return to compassion, the consumer would demand the services of a new and different kind of healthcare worker. Travelbee’s model describes steps toward compassionate and empathetic care, including building rapport, showing empathy, and developing compassion. 4.) Swanson’s Middle Range Theory of Caring wanson’s Middle Range Theory of Caring is built upon Watson’s framework and resembles it, but Swanson brings caring theory into a more practical sphere by describing five caring processes as well as practices for putting the processes into action. Swanson identified five interrelated processes that characterize caring: KNOWING – Understanding events BEING WITH – Emotionally present. DOING FOR – Doing for the other, what they would do for themselves. ENABLING – Facilitating patients to care for themselves. MAINTAINING BELIEF – Sustaining faith in the capacity of people. Although Swanson defines nursing as informed caring for the well-being of others, the emphasis placed on the five caring processes is not unique to the nurse-

patient relationship. The processes are present in any caring relationship, and they can and should be enacted throughout all levels of caring and in all healing organizations and by every healthcare worker.

Caring and Codependency Most people who choose nursing as a career do so out of a genuine desire to help others and because they find great satisfaction in the caring role. Sometimes, however, those who enter helping professions such as social work, nursing, or medicine have an intense need to be needed. The term that is commonly used to describe this type of behavior is codependency. The table highlights the contrast between caring and codependency in nursing. Caring Codependency Caring is having concern or regard for Codependency is a dysfunctional relationship that which affects the welfare of in which the person who wants to help acts in a another. manner that enables harmful behavior by another person. Examples of caring behaviors are Examples of codependent behaviors include showing compassion, taking time to be asserting direct control over the dependent person, making excuses for the dysfunctional with a suffering person, actively behavior, or protecting the person from listening, advocating for the vulnerable, respecting all individuals, negative consequences (Oakley, 2010). and facilitating appropriate measures to restore patient self-sufficiency. Caring behaviors support patients in Codependent behaviors may prevent patients from healing and moving toward independence attaining treatment goals. A caring nurse will practice patient advocacy (Abernathy, 2006). while enabling patients to reach their treatment goals while providing compassionate care.

Overview of Caring in Nursing Behaviors Elaborate on some of the most important qualities and behaviors that you can display which will demonstrate caring in your nursing practice. 1.) Presence – By simply being present in a patient’s room, nurses have the potential to calm the fears of a patient and family and demonstrate caring.

It is a great honor and privilege to be part of, or even to simply be present at, some of life’s most important events, such as a birth or a death, in a pre-op room before surgery, or with patients and families as they go through a life-changing illness. Being present with patients and families at these critical times while applying the unique knowledge and skills of professional nursing practice demonstrates holistic care.

2.) Consistency & Predictability – When nurses are consistent in providing competent care that is delivered on time and matches the patient’s expectations, patient anxiety is reduced and a supportive environment that provides a sense of security is created. Nurses provide consistent care by providing treatment based on standardized best practices and clinical guidelines allowing all patients to receive similar high-quality care. The nurse provides predictable care by:  Explaining what is going to take place or why things are happening.  Following through with the promised care in a timely fashion.  Setting up a schedule with the patient and adhering to it.

3.) Listening – In a caring nurse-patient relationship, the nurse takes responsibility for establishing trust, making sure that the lines of communication are open and that the nurse accurately understands not only what the patient is saying but also that the nurse is clearly understood. Active listening means paying careful attention and using all of the senses to listen rather than just passively listening with the ears. It requires energy and concentration and involves hearing the entire message—what the patient means as well as what the patient says. This type of listening focuses solely on the patient and conveys respect and interest.

4.) Evidence-Based Practice – Patients in an acute care setting rated the quality of their health care experience on the basis of the nurses’ caring behaviors. The most important caring behaviors, according to the nurses, included:  Knowing how to give injections.  Encouraging the patient to call if there was a problem.  Giving information so that the patient could make decisions.  Appreciating the patient as a human being and showing concern for the patient (Tanking, 2010). 5.) Touch – Touch is the intentional physical contact between two or more people. It occurs so often in patient care situations that it has been deemed to be an essential and

universal component of nursing care. Touch must be used carefully with patients to build trust and to provide appropriate professional care.

6.) Task-Oriented Touch Task-oriented touch includes performing nursing interventions such as giving a bath, changing dressings, suctioning an endotracheal tube, or giving an injection. Taskoriented touch should be done gently, skillfully, and in a way that conveys competence. Every task-oriented procedure should be explained to the patient, followed by feedback indicating patient understanding, before care is initiated. 7.) Caring Touch Caring touch is considered by most people to be a valuable means of nonverbal communication. In today’s highly technical world of nursing, caring touch is an essential aspect of patient-centered care. Caring touch can be used to soothe, comfort, establish rapport, and create a bond between the nurse and the patient. 8.) Problems With Touch Nurses must use discretion when using touch. Even when the nurse’s intentions are to provide comfort, touch can be perceived as being intrusive or hostile by some patients, such as those who are confused or suspicious, those who have been abused, or those under the influence of drugs or alcohol. Additionally, nurses must be sensitive to how touch may be perceived by patients from a different culture than their own. Summary Caring is a universal phenomenon influencing the ways in which people think, feel, and behave. Care is the central unifying and dominant domain that distinguishes nursing from other healthcare disciplines. Several scholars have developed theories on caring because of its importance to the nursing practice. The supporting theories of the concept of caring include:  Leininger’s Cultural Care Theory  Watson’s Theory of Human Caring/Caring Science  Travelbee’s Human-to-Human Relationship Model  Swanson’s Middle Range Theory of Caring Professional caring involves compassion, which is a deep understanding of another’s suffering and pain. In sharing the other’s suffering, the compassionate nurse expresses empathy that strengthens and comforts the sufferer. There exists a fine line between caring and codependency. It is critical for the nurse to understand the boundaries that exist in caring for a patient and the dysfunctional behaviors that define codependency.

Some of the most important concepts that demonstrate care include the nurse’s presence, consistency and predictability, the importance of listening and the use of touch. Touch must be used carefully with patients to build trust and to provide appropriate professional care. The comforting approach of using touch communicates to patients the nurse’s concern and support. Review Questions 1.) Through what means is the purpose of nursing fulfilled, according to Travelbee's theory? Human-to-human relationships 2.) Which are components of the interaction process in Travelbee's Theory of Caring? Select all that apply. Empathy Original Encounter Sympathy 3.) A nurse is working with a 38-year-old Lebanese patient in the hospital recovering after surgery. The patient explains that it is Muslim tradition to visit the sick, and she needs everyone around to help her recover. The nurse closes the curtain to allow privacy. According to Leininger's Cultural Care Theory, what nursing action is being displayed to provide cultural congruent care? The nurse is accommodating the health care practices of the patient's cultural practices by allowing family but closing the curtain to provide nursing care. 4.) What should be the focus of compassionate nursing care, according to Travelbee? Human Relationships 5.) Which are nursing theories of care? Select all that apply. Leininger's Cultural Care Theory Swanson's Middle Range Theory of Caring Watson's Theory of Human Caring

6.) When choosing a life-long career, what motivates people to choose nursing? Desire to help people.

7.) Which statement is true regarding codependency? Codependency may lead to controlling behavior. 8.) Which behaviors are demonstrated by a caring nurse? Select all that apply. Actively listening to the patient Establishing trust through open lines of communication 9.) What is an example of an important caring behavior in nursing? Administering shots 10.) In today's technical world of nursing, what is considered the most valuable method of nonverbal communication? Caring Touch 11.) A nurse is teaching a group of nursing students about the importance of caring touch. What task-oriented behaviors exhibited by the nursing students would show that the lesson on touch was effective? Select all that apply. Giving A Bath Starting An IV Suctioning an NG Tube 12.) When is a nurse touching the patient perceived as being intrusive or hostile by the patient? Select all that apply. *-When the patient is under the influence of drugs or alcohol* *-When the patient is a previous victim of abuse*

13.) A nurse is teaching a group of students about behaviors of being a caring nurse. The nurse distinguishes between caring and codependency in a nurse. Which of these is a characteristic of a caring nurse? Patient Advocate

14.) A nurse is teaching an orientation class for new nurses. In discussing the difference between caring and codependency, which behavior would the nurse most likely identify as an example of a destructive behavior that can facilitate codependency? Gambling 15.) A 55-year-old female Muslim patient is on the surgical floor on the second postoperative day. According to Leininger's Cultural Care Theory, which nursing actions would be appropriate for this patient? Lowering the height of the bed and offering a prayer mat. 16.) A 48-year-old, obese female of Middle Eastern origin is admitted with a diagnosis of type 2 diabetes. The health care provider recommends an oral antidiabetic medication, but the patient insists on trying some of her herbal supplements first. After the nurse discusses the patient's wishes with the health care provider, a pharmacist and dietician are consulted for the patient and her family. Which part of Leininger's Cultural Care Theory is the nurse implementing with this action? Preserving cultural practice. 17.) In Watson's Theory of Human Caring, what is suggested to promote healing and wholeness? Conscious intention to care 18.) According to Watson's Theory of Caring, what does the term "transpersonal" mean? To go beyond one’s own ego. 19.) Which type of factors was Watson's Theory of Caring originally built on? Caratiive...