Caring

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Caring
 Caring is a dimension of human relating and is often referred to as the art of nursing.

 Caring is sharing deep and genuine concern about the welfare of another individual

 Caring is central to nursing practice.

Caring is at the heart of nursing’s identity; indeed, the root of the word nursing means
“nurturance” or “care.”

When clients perceive the encounter to be caring, their sense of dignity and self-worth is
increased, and feelings of connectedness are expressed.

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 Professionalization of Caring

Caring practice involves:-

Connection.

Mutual recognition.

Involvement between nurse and client.

 Examples of caring, emerging from nursing situations:” A client experiencing postoperative pain is given medication to control her
symptoms, and then the nurse talks quietly and holds her hand for a few minutes as the pain lessens. The nurse’s presence provides comfort
for the client”.

Caring is a process that develops over time, resulting in a deepening and transformation of the relationship.

By helping the other individual grow, the caregiver moves toward self-actualization.

Caregiver does not impose direction, but allows the direction of the other individual’s growth to help determine how to respond.

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 Types of Knowledge in Nursing

Nursing involves different types of knowledge that are integrated to guide nursing practice, which includes:-

Scientific competence (empirical knowledge).

Therapeutic use of self (personal knowing).

 Moral or ethical awareness (ethical knowing).

Creative action (aesthetic knowing).

An understanding of each type of knowledge is important for the nurse because only by integrating all ways of
knowing can the nurse develop a professional practice.

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 The nurse who practices effectively can integrate all types
of knowledge to understand situations more holistically.

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 Types of Knowledge in Nursing ( Cont…..)
Empirical Knowing: The Science of Nursing

Empirical knowing is formally expressed through facts, models, theories, and thematic descriptions.

Empirical knowing ranges from factual, observable phenomena (e.g., anatomy, physiology, chemistry) to theoretical analysis
(e.g., developmental theory, adaptation theory).

 Personal Knowing: The Therapeutic Use of Self

 Personal knowing enables the nurse to identify his/her responses, strengths and weaknesses in a situation and to be aware of
the individual biases affecting the quality of the nurse-patient relationship.

The nurses bring as much of themselves as possible to the relationship with the patients and use themselves for their benefit.

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 Types of Knowledge in Nursing (Cont..)
 Moral or ethical awareness (Ethical Knowing).

Ethical knowing focuses on the ethical components of nursing practice and tries to answer the question of
what is right and what is responsible.

Creative Action (Aesthetic Knowing).

Aesthetic knowing is the art of nursing and is expressed by the individual nurse through his or her
creativity and style in meeting the needs of clients.

The nurse uses aesthetic knowing to provide care that is both effective and satisfying.

Empathy, compassion, holism, and sensitivity are important modes in the aesthetic pattern of knowing.

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Developing Ways of Knowing

 Different methods are used for developing each type of knowledge.

 Personal knowing is developed through critical reflection on one’s own actions and feelings in
practice.

 Empirical knowing is gained from studying scientific models and theories and from making
objective observations.

 Ethical knowing involves confronting and resolving conflicting values and beliefs.

Aesthetic knowing arises from a deep appreciation of the uniqueness of each individual and the
meanings that individual ascribes to a given situation.

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 Nursing Theories of Caring

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 Caring, the Human Mode of Being (Roach)
 Roach (2013) focuses on caring as a philosophical concept and proposes that caring is the human mode of
being.

 Caring is unique in nursing, because caring is the center of all attributes she uses to describe nursing.

 Roach defines these attributes as the six C’s of caring : compassion, competence, confidence, conscience,
commitment, and comportment.

 Each category reflects specific values and includes virtuous actions by which a nurse can demonstrate
caring.

The sixth C's are considered beneficial to improving nurse and patient relationships and increasing a nurse's
chances for career advancement.
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 The Six C’s of Caring in Nursing
1. COMPASSION
Awareness of one’s relationship to others, sharing their joys, sorrows, pain, and accomplishments. Participation in the experience of another.
2. COMPETENCE
Having the “knowledge, judgment, skills, energy, experience and motivation required to respond adequately to the demands of one’s
professional responsibilities”.
3. CONFIDENCE
Comfort with self, client, and others that allows one to build trusting relationships.
4. CONSCIENCE
Morals, ethics, and an informed sense of right and wrong. Awareness of personal responsibility.
5. COMMITMENT
The deliberate choice to act in accordance with one’s desires as well as obligations, resulting in investment of self in a task or cause.
6. COMPORTMENT
Appropriate bearing, demeanor, dress, and language that are in harmony with a caring presence.
Presenting oneself as someone who respects others and demands respect.

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 Theory of Human Care (Watson)
 Watson’s theory (1997) of human care views caring as the essence and the moral ideal of nursing.

Watson emphasizes nursing’s commitment to care of the whole individual as well as a concern for the
health of individuals and groups.

The nurse and client are co-participants in the client’s movement toward health and wholeness, through
which the nurse enters the experience of the client, and the client enters the nurse’s experience.

By identifying with each other, the nurse and client gain self-knowledge and, in doing so, keep alive their
common humanity and avoid reducing the other to an object.

While the nurse maintains professional objectivity as a scientist, scholar, clinician, and moral agent, the
nurse is also subjectively engaged in the interpersonal relationship with the client.

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 Theory of Caring (Swanson)

Swanson defines caring as a nurturing way of relating to a valued ‘other,’ toward whom one feels a personal sense of commitment and

responsibility”.

A client’s well-being should be enhanced through the caring of a nurse who understands the common human responses to a specific health problem.

The theory focuses on caring processes as nursing interventions.

The five caring processes are described as:

(1) Knowing, which is defined as “striving to understand an event as it has meaning in the life of the other”;

(2) Being With, which is “being emotionally present to the other”;

(3) Doing For, or “doing for the other as he or she would do for the self if it were at all possible”;

(4) Enabling, which is defined as “facilitating the other’s passage through life transitions and unfamiliar events”;

(5) Maintaining Belief, or “sustaining faith in the other’s capacity to get through an event or transition and face a future with meaning”

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How does a nurse demonstrate caring?
(Caring Encounters)
Because caring is contextual, a nursing approach used with a client in one situation may be ineffective
in another.

Caring responses are as varied as clients’ needs, environmental resources, and nurses’ imaginations.

Common caring patterns include:-

 Knowing the client.
Nursing presence.
 Empowering the client.
Compassion.
Competence.

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 Knowing the Client

 Caring attends to the totality of the client’s experience.

 For example, The nurse asks: Who is this individual? What is the client’s history? Needs? Desires? Dreams? Spiritual
beliefs? Who loves and cares for this client at home? Where is home and what resources are there? What does this client need
today, from me, right now? Can this client tell me what is needed?

Personal knowledge of the client is a key in the caring relationship between nurse and client.

The nurse aims to know who the client is, in his or her uniqueness.

The nurse gains this knowledge by observing and talking with the client and family while using effective listening and
communication skills.

The nurse’s knowing the client ultimately increases the possibilities for therapeutic interventions to be perceived as relevant.

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 Nursing Presence

Caring in nursing always takes place in a relationship.

Mutuality within this relationship involves a partnership between the nurse and client.

Being present is a way of sharing in the meanings, feelings, and lived experiences of the client.

The nurse must create some space for awareness by being truly present and focused on the moment.

Authentic presence involves empathy and openness to positive or negative feelings, nonpossessive warmth, a
relaxed posture, and facial expressions that are congruent with other communications.

By being emotionally present to the client and family, the nurse conveys that they and their experiences matter.

Physical presence is combined with the promise of availability, especially during a time of need (This may be
as simple as responding promptly to a call light on a hospital unit ).
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 Empowering the Client
Through knowing the client and engaging in a mutual relationship, the nurse can identify and build on client
and family strengths.
Nurse empower clients and families through activities that enhance well-being, understanding, and self-care.
Empowering relationship includes mutual respect, trust, and confidence in the other’s abilities and motives.
Caring process of enabling includes coaching, informing, explaining, supporting, assisting, guiding,
focusing, and validating.
Enabling involves :-
Substitutive care (doing for the client who is unable to do for him- or herself), but doing no more than is
needed at the time.
Providing an environment in which the client can function safely and effectively.
The nurse should remain mindful of professional boundaries and responsibilities to avoid enabling
pathologic or undesirable choices by the client.

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 Compassion
The caring nurse is described as warm and empathetic, compassionate and concerned.

Compassion involves participating in the client’s experience, with sensitivity to the client’s pain
or discomfort, and a willingness to share in his or her experience.

 Compassion is given as part of the caring relationship, as the nurse shares the client’s joys,
sorrows, pain, and accomplishments.

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Competence
The competent nurse employs the necessary knowledge, judgment, skills, and motivation to
respond adequately to the client’s needs.

Just as competence without compassion is cold and inhumane, compassion without

competence is meaningless and dangerous.

The nurse’s abilities to assess, plan, implement, and evaluate a plan of care are focused on
meeting the client and family needs.

Practice of these skills requires a high level of cognitive, affective, technical, and administrative
skills.

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 Maintaining Caring Practice
As nurses take on multiple commitments to family, work, school, and community, they risk exhaustion,
burnout, and stress.

It is imperative that nurses attend to their own needs, because caring for self is central to caring for others.

Obstacles to self-care may be professional, related to the demands of a work setting, or may be personal,
such as poor health habits or unrealistic expectations of self.

Healthy nurse as one who “takes care of his or her personal health, safety, and wellness and lives life to their
fullest capacity” (The American Nurses Association, n.d.a ) .

When nurses are healthy, they are more likely to counsel clients about healthy behaviors.

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Caring for Self
Caring for self : helping yourself grow and actualize your possibilities (Mayeroff , 1990).
The nurse has a responsibility to model healthcare behaviors.
“Holistic nurses strive to achieve harmony and balance in their own lives and to assist others to do
the same.
Caring for self involves initiating and maintaining behaviors that promote healthy living and well-
being.
Nurse self-care includes:
A healthy lifestyle (e.g., nutrition, activity and exercise, recreation)
Mind–body therapies (e.g., guided imagery, meditation, yoga).
Nurse create healing environments for themselves by attending to their own well-being, letting go
of self-destructive behaviors and attitudes, and practicing centering and stress reduction techniques”

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Healthy Lifestyle

Everyone needs to pay attention to nutrition and exercise, and to avoid unhealthy lifestyle
practices.

Key words for a healthy lifestyle are balance and moderation.

Examples of healthy lifestyle includes:-

Nutrition .
Activity and exercise.
Recreation.
Avoiding unhealthy patterns.

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Mind–Body Therapies

The interconnectedness of the mind and body is the basis for the complementary therapies.
Complementary therapies bring balance to thoughts and emotions.
Practice of one or more mind–body therapies is an effective self-care strategy to help restore
peace and balance.
Examples of complementary therapies includes:-
Guided Imagery.
Meditation .
Storytelling
Music Therapy
Yoga.

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