Nursing: Caring, AONE Principles, and Theories

• Caring affects the nurse-patient relationship.
• There are various theories on caring.
• Evidence exists on patients' perceptions of caring.
• An "ethic of care" influences nurses' clinical judgment.
• Caring plays a key role in the nurse-patient relationship.
• Caring can be expressed through presence and touch.
• Listening to patients has therapeutic benefits.
• Knowing a patient impacts clinical decision making.
• Compassion has a relationship with caring.

AONE Guiding Principles for Nursing Delivery

• The core of nursing involves both knowledge and caring.
• Managing the patient's journey is a principle.
• Patient safety and quality are guiding principles.
• Focusing on the patient/population is essential.
• Care should be user-based.
• Relationships of care, both in-person and virtual, are important.
• Access-based knowledge is a principle.
• Synthesized knowledge is a guiding principle.

Theoretical Views on Caring

• Caring is viewed as primary.
• Leininger's Transcultural Caring theory exists.
• Watson's Transpersonal Caring theory is present.
• Swanson developed a Theory of Caring.

Leininger's Transcultural Caring Theory

• Human caring is considered a universal phenomenon.
• Leininger recognized the importance of caring in nursing early in her career.
• Patient appreciation led Leininger to focus on "care" as a central nursing component.

Watson's Transpersonal Caring

• Jean Watson developed a caring science model.
• The model is based on relationship-centered care.
• It supports personal and professional self-actualization.
• Watson's Theory of Human Caring/Caring Science is a holistic nursing model.
• It suggests that conscious intent to provide care promotes healing and wholeness.

Shifting to a more Holistic Approach (Watson)

• Jean Watson suggests healthcare should shift from a disease-cure focus.
• It should move to a holistic approach that includes values, beliefs, intentions, and caring consciousness.
• This shift combines social, psychological, and spiritual aspects.
• It involves interventions that reflect both the art and science of nursing.

Caring as a Metaphysical Event (Watson)

• Caring is a metaphysical event with far-reaching effects.
• Human bodies are manifestations of universal energy.
• Caring is transpersonal, transcending time, space, and the physical realm.
• "Transpersonal" means going beyond one's ego.
• It allows for deeper spiritual connections to promote comfort and healing.

Core Principles and Concepts (Watson)

• The core principles are:
  • Practice of loving-kindness and equanimity.
  • Authentic presence.
  • Enabling deep belief of others.
  • Cultivation of spiritual practice toward wholeness beyond ego.
  • "Being" the caring-healing environment.
  • Allowing miracles via openness.
• The original basis of Watson's theory was on 10 carative factors. These are now considered to be caritas processes.

Watson's Carative Factors 1-5

• Embrace altruistic values and practice loving-kindness with self and others
• Instill faith and hope and honor others
• Nurture individual beliefs and practices with sensitivity to self and others
• Develop helping-trusting-caring relationships
• Promote and accept positive and negative feelings while listening to another's story

Watson's Carative Factors 6-10

• 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.

Dorothea Orem Theory

• Dorothea Orem's Self-Care Deficit Theory of Nursing emphasizes self-care.
• Self-care is a means to maintain health.
• People are capable of caring for themselves.
• Nurses should help people regain independence.

4 Main Concepts in Orem's Theory

• Metaparadigm defines nursing practice.
• Person
• Health nursing
• The environment is the metaparadigm of nursing theories.
• These four listed are core concepts are identified in Orem's theory

Travelbee's Interpersonal Theory of Nursing

• Joyce Travel bee developed Interpersonal Theory of Nursing
• This was inspired by the psychiatric nurse practitioner, focusing on a human-to-human relationship model after a lack of compassion in nursing care.
• Travel bee advocated for a humanistic revolution.
• Caring functions toward the ill person were needed.

Travel bee's five Phases in interaction Process

• Includes phase of original encounter
• Includes phase of merging identities
• Includes phase of empathy
• Includes phase of sympathy
• Includes phase of rapport

Travel Bee's Interpersonal Theory

• Compassion is the core of the human-to-human relationship model.
• It is central to holistic nursing in Travelbee's Interpersonal Theory.
• Travelbee warned that a lack of compassion in nursing would lead consumers to seek other healthcare providers.

Swanson's Middle Range Theory of Caring

• Swanson's early work focused on healing after miscarriage.
• Her theory emphasizes the unique relational dynamics.
• It happens between individuals, promoting dignity, respect, and empowerment.
• 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 all caring relationships and can be enacted throughout all levels of caring in all healing organizations by every healthcare provider

Caring Behaviors

• Individuals enter nursing with a desire to help others and find satisfaction in caring.
• Sister Marie Simone Roach's model provides a foundation for caring behaviors.
• These behaviors form the essence of nursing care.
• Behavior transformations occur within real relationships.
• The focus is on caring functions and behaviors.
• It led to the Six Cs of Caring.
• Sister Roach's work left a legacy related to caring behavior.
• This includes theoretical and practical work in nursing care and ethics.

Key Points on Nursing Theory

• Leininger's Cultural Care Theory focuses on cultural congruity.
• It emphasizes nursing as a transcultural profession.
• Nurses must learn and use culturally specific behaviors to show caring.
• Watson's theory encourages a move to a holistic approach.
• It should incorporate values, beliefs, intentions, and caring consciousness.
• Caring science combines nursing interventions reflecting art and science.
• Travelbee's theory suggests compassion is central to nursing.
• Compassionate care is achieved through human-to-human relationships.
• Swanson describes five caring processes applicable to any relationship.
• Caring behaviors align with the Six Cs: compassion, competence, confidence, conscience, commitment, and comportment.
• Caring: Stems from a desire to help. Codependency: Stems from a need to be needed.
• Nurses should practice patient advocacy and provide compassionate care.
• Nurse's presence, consistency, predictability, touch, and listening solidify the nurse-patient relationship.
• Task-oriented and caring touch are common, requiring careful use to build trust and professionalism.

Caring in Nursing Practice

• As experiences with patients in varied health states grow, so will your capacity for care.
• Caring is a mutual behavior, something we give and receive.
• Importance of self-care should be recognized.
• Extend caring behaviors to colleagues as well.

Nursing Qualities and Behaviors

• Qualities and behaviors with an evidence base:
  • Presence
  • Consistency and Predictability
  • Active Listening
  • Evidence Based Practice

Providing Presence

• Presence consists of a person-to-person encounter that conveys caring.
• Involves being there and being with someone.
• Nursing presence means a connectedness between nurses and patients.
• Establishing presence strengthens ability in effective patient-centered care.

Touch in Nursing

• Touch provides comfort, creating a connection.
• There is noncontact touch and contact touch.
• Contact touch includes:
  • Task-oriented touch
  • Caring touch
  • Protective touch
  • Therapeutic touch
• Touch conveys many messages and should be used with discretion.

Patient's Perspective of Caring

• Patients value the affective dimension of nursing care.
• A Caring Assessment Tool measures patients' perceptions.
• When patients sense sensitivity, sympathy, compassion, and interest, they become active in care.
• The important behaviors in the nurse-patient relationship are:
  • Assess patient expectations
  • Build a nurse-patient relationship for learning what is important to patients

Ethic of Care

• Caring is an interaction of mutual respect and trust.
• "Ethic" refers to ideals of right and wrong behavior.
• An ethic of care concerns relationships and the nurse's character/attitude.

Listening

• Listening is necessary for meaningful interactions.
• True listening leads to knowing and responding to matters for patients/family.
• Effective listening involves silence and openness.
• Active listening will begin to truly know your patients and what is important to them.

Knowing the Patient

• The core of clinical decision making and patient-centered care
• Two elements that facilitate knowing are continuity of care and clinical expertise
  • Time
  • Continuity of care
  • Teamwork of the nursing staff
  • Trust
  • Experience

Spiritual Caring

• Balance between life values, goals, and belief makes spiritual health.
• Spirituality offers intrapersonal, interpersonal, and transpersonal connectedness.

Relieving Symptoms and Suffering

• Reducing symptoms requires caring actions to provide comfort, dignity, respect, and peace.
• Quiet presence, touch, or listening is key to access and discover your patient's discomfort.
• Provide comfort through listening, and nonjudgemental caring.

Family Care

• Caring includes a person’s family
• Nurses should assist family to be active participants
• Understand and identify stresses put on family members because of the patient’s illness

The Challenge of Caring

• Challenges can be task-oriented because of the biomedical model
• There are institutional demands, time constraints, and more reliance on technology
• We should incorporate cost-effective strategies and standardized work processes
• Health care should become more compassionate to bring a positive difference