Fundamentals of Nursing Practice - Lecture

STUDENT ACTIVITY SHEET BS NURSING / FIRST YEAR

Session # 3

LESSON TITLE: NURSING AS AN ART : CARING Materials:

Pen and notebook
LEARNING OUTCOMES:

Upon completion of this lesson, you can:

1. Discuss the role that caring plays in building the Reference:
nurse-patient relationship; and, Potter, P. A., Perry, A.G., et al. (2021). Fundamentals
2. Compare and contrast theories on caring. of nursing (10th ed.). Singapore: Elsevier.

LESSON PREVIEW/REVIEW
Take a lesson review by answering the clinical application practice based on your learning. Here is the scenario:

Mrs Smith is in the hospital recovering from hip replacement surgery. Her surgery involved insertion of a new type of hip
replacement prosthesis and newer postsurgical care. The certified nurse practitioner is preparing her discharge
medication and rehabilitation prescriptions. The clinical nurse specialist is preparing to transfer Mrs Smith to a
rehabilitation facility. The nurse educator is conducting bedside rounds to explain the new prosthesis and related
postoperative care.

1. Discuss the roles of the certified nurse practitioner, clinical nurse specialist and nurse educator.

 The certified nurse practitioner is preparing her discharge medication and rehabilitation prescriptions.thenurse
works without the supervision of a doctor which they work independently in treating the patients.
 The clinical nurse specialist is preparing to transfer Mrs Smith to a rehabilitation facility. Stated the rolewhich
provides direct patient care.
 The nurse educator is conducting bedside rounds to explain the new prosthesis and related postoperativecare.
Explaining and educating the patient what was his/her conditions, what are the things that was implanted to the
patient’s body, and telling the advantages, cautions, and possible outcome result to the patient if she/he did that and
more.

2. What is the educational preparation for each role?

Each has a distinctive role which is to serve and help the ones in need where the nurse educator can be at school or in
hospital level guiding the patient, and both the clinical nurse specialist and the nurse practitioner must be in the hospital
level to secure the patient’s lives, wants, and needs to their well-being state in the healing process.

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MAIN LESSON
You will study the contents of this lesson and read your book, if available.

• Caring is central to nursing practice.

• The demands, pressure, and time constraints in the healthcare environment leave little room for caring practice,
which results in nurses and other health professionals becoming dissatisfied with their jobs and cold and
indifferent to patient needs (Watson, 2009; 2010).
• The increasing use of technological advances for rapid diagnosis and treatment often causes nurses and other
health care providers to perceive the patient relationship as less important. However, it is important to preserve a
relationship-centered approach to patient care for all aspects of nursing, whether the care focuses on pain
management, teaching self-care, or basic hygiene measures (Winsett and Hauck, 2011).

• The American Organization of Nurse Executives (AONE)

describes caring and knowledge as the core of nursing,
with caring being a key component of what a nurse brings
to a patient experience.

AONE guiding principles for

future care delivery.

It is time to value and embrace caring practices and expert knowledge that are the heart of competent nursing practice
(Benner et al., 2010). When you engage patients in a caring and compassionate manner, you learn that the therapeutic
gain in caring makes enormous contributions to the health and well-being of your patients.

Question: Have you ever been ill or experienced a problem requiring health care intervention? Think about that
experience. Then consider the following two scenarios and select the situation that you believe most successfully
demonstrates a sense of caring.

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A nurse enters a patient's room, greets the patient warmly while touching him or her lightly on the shoulder, makes eye
contact, sits down for a few minutes and asks about the patient's thoughts and concerns, listens to the patient's story,
looks at the intravenous (IV) solution hanging in the room, briefly examines the patient, and then checks the vital sign
summary on the bedside computer screen before leaving the room.

A second nurse enters the patient's room, looks at the IV solution hanging in the room, checks the vital sign summary
sheet on the bedside computer screen, and acknowledges the patient but never sits down or touches him or her. The
nurse makes eye contact from above while the patient is lying in bed. He or she asks a few brief questions about the
patient's symptoms and leaves.

Answer: There is little doubt that the first scenario presents the nurse in specific acts of caring. The nurse's calm
presence, parallel eye contact, attention to the patient's concerns, and physical closeness all express a patient-centered,
comforting approach. In contrast, the second scenario is task-oriented and expresses a sense of indifference to patient
concerns.

Both of these scenarios take approximately the same amount of time but leave very different patient perceptions. It is
important to remember that, during times of illness or when a person seeks the professional guidance of a nurse, caring is
essential in helping the individual reach positive outcomes.

Theoretical Views on Caring

• Caring: a universal phenomenon that influences the way we think, feel, and behave.
• Since Florence Nightingale, nurses have studied caring.
• Caring is at the heart of a nurse’s ability to work with all patients in a respectful and therapeutic way.

Dr. Patricia Benner

● Described the essence of excellent nursing practice as CARING after listening to staff nurses’ stories and
analyzing their meaning.
● Caring determines what matters to a person.
● Caring helps you provide patient-centered care.

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Madeleine Leininger
● 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.
● Leininger (1991) stresses the importance of nurses’ understanding cultural caring behaviors. Even though human
caring is a universal phenomenon, the expressions, processes, and patterns of caring vary among people of
different cultures. For caring to be effective, nurses need to learn culturally specific behaviors and words that
reflect human caring in different cultures to identify and meet the needs of all patients.
● For caring to be effective, nurses need to learn culturally specific behaviors and words that reflect human caring in
different cultures to identify and meet the needs of all patients.

Dr. Jean Watson

● Watson’s Transpersonal Caring
● According to Watson, caring becomes almost
spiritual.
● Promotes healing and wholeness
● Rejects the disease orientation to health care
● Places care before cure
● Emphasizes the nurse-patient relationship

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Watson's 10 Carative Factors (Watson, 2008)

Carative Factor Example in Practice

Use loving kindness to extend yourself. Use self-disclosure appropriately to
Forming a human-altruistic value promote a therapeutic alliance with your patient (e.g., share a personal
system experience in common with your patient such as a child rearing experience, an
illness, or an experience with a parent who needs assistance).
Provide a connection with the patient that offers purpose and direction when
Instilling faith-hope trying to find the meaning of an illness.
Cultivating a sensitivity to one's self Learn to accept yourself and others for their full potential. A caring nurse matures
and to others into becoming a self-actualized nurse.
Developing a helping, trusting, Learn to develop and sustain helping, trusting, and authentic caring relationships
human caring relationship through effective communication with your patients.
Promoting and expressing positive Support and accept your patients' feelings. In connecting with your patients you
and negative feelings show a willingness to take risks in sharing in the relationship.
Using creative problem-solving, Apply the nursing process in systematic, scientific problem-solving decision
caring processes making in providing patient-centered care.
Promoting transpersonal Learn together while educating the patient to acquire self-care skills. The patient
teaching-learning assumes responsibility for learning.
Providing for a supportive,
protective, and/or corrective Create a healing environment at all levels, physical and nonphysical. This
mental, physical, societal, and promotes wholeness, beauty, comfort, dignity, and peace.
spiritual environment
Meeting human needs Help patients with basic needs with an intentional care and caring consciousness.
Allowing for
Allow spiritual forces to provide a better understanding of yourself and your
existential-phenomenological
spiritual forces patient.

Kristen Swanson
o Swanson’s Theory of Caring
o Defines caring as a nurturing way of relating to an
individual
o States that caring is a central nursing phenomenon but is
not necessarily unique to nursing practice

o Swanson’s theory of caring includes five caring

processes:

□ Knowing
▪ 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 the event
● Engaging the self or both

□ Being with
▪ Being emotionally present to the other
● Being there
● Conveying ability
● Sharing feelings
● Not burdening

□ Doing for
▪ Doing for the other as he or she would do for self if it were at all possible
● Comforting
● Anticipating

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 ● Performing skilfully
● Protecting
● Preserving dignity

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

□ Maintaining belief
▪ 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”

Summary of Theoretical Views

• Nursing caring theories have common themes.
• Duffy et al. (2007) identify these commonalities as human interaction or communication, mutuality, appreciating
the uniqueness of individuals, and improving the welfare of patients and their families.
• Caring is highly relational.
• Caring theories are valuable when assessing patient perceptions of being cared for in a multicultural environment.
• Enabling is an aspect of caring.
• Knowing the context of a patient’s illness helps you choose and individualized interventions that will actually help
the patient.

CHECK FOR UNDERSTANDING

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to the
correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in your answer/ratio is not
allowed.

Matching Type. Write the answer of your choice in each item in the space provided.

COLUMN A COLUMN B
1. Maintaining belief A. Comforting
2. Meeting human needs B. Learn together while teaching the patient
3. Knowing C. Apply the nursing process in providing care
4. Defines caring as a nurturing way of relating to an D. Transpersonal Caring
individual
5. Forming a human altruistic value system E. Validating or giving feedback
6. Being with F. Dr Patricia Banner
7. Caring is an essential human need G. Swanson’s Theory of Caring
8. Promoting transpersonal teaching-learning H. Avoiding assumptions
9. Describes caring and knowledge as the core of I. American Organization of Nurse Executives
nursing
10. Instilling faith-hope J. Believing in / holding on esteem
11. Caring becomes almost spiritual K. Transcultural Nursing
12. Caring determines what matters to a person L. Use loving kindness to extend yourself
13. Doing for M. Sharing feelings
14. Using creative problem-solving, caring process N. Provide connection with patient that offers purpose
15. Enabling O. Help patient with basic needs

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ANSWERS:
1. J 6. M 11. D
2. O 7. K 12. F
3. H 8. B 13. A
4. G 9. I 14. C
5. L 10. N 15. E

RATIONALIZATION ACTIVITY
The instructor will now provide you the answers to this activity. You can now ask questions and debate among yourselves.
Write the correct answers beside the image presented in the CHECK FOR UNDERSTANDING part. Make sure to use
another pen color (preferably red ink) for easy distinction.

LESSON WRAP-UP

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: CAT: MUDDIEST POINT

This technique will help the students determine which key points were missed.

In today’s session, what was least clear to you?

I don’t have any questions or

misunderstanding towards this session rather I
found it quiet entertaining and fun because we
have tackled it last semester.

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