caring models of nursing.pdf

FUNDAMENTALS OF NURSING Nursing as anART AILEEN G. SYPONGCO, RN, RM, MN State University of Northern Negros NURSING AS AN ART  The art of nursing refers to the highly valued qualities of care, communication and compassion. (three core principles guiding nursing practice)  These pr...

FUNDAMENTALS OF NURSING Nursing as anART AILEEN G. SYPONGCO, RN, RM, MN State University of Northern Negros NURSING AS AN ART  The art of nursing refers to the highly valued qualities of care, communication and compassion. (three core principles guiding nursing practice)  These principles encompass all aspects of patient care, including bio-psychosocial needs, cultural preferences and spiritual needs. CARING PRACTICE M O D ELS I. JEAN WATSON THEORY OF HUMAN CARING THEORY OF HUMAN C A R I N G  concerned on how nurses express care to their patients  stresses humanistic aspects of nursing as they intertwine with scientific knowledge and nursing practice THEORY OF C A R I N G  According to Watson, caring is central to nursing practice, and promotes health better than a simple medical cure.  She believes that a holistic approach to health care is central to the practice of caring in nursing. S O C I A L A N D E T H I C A L RESPONSIBILITIES OF N U RS E S I N RELATION TO C A R I N G The nurse must care for the self to care for others. Nurses must remain committed to human care ideals. Cultivation of a higher/deeper self and higher consciousness to caring. Human care can only be demonstrated through interpersonal relationship. Education and practice systems must be based on human values and concern for the welfare of others. II. KRISTEN SWANSON’S THEORY OF CARING AND HEALING THEORY OF CARING AND HEALING  The theory aims at helping nursing personnel to deliver care that promotes dignity, respect, and empowerment.  This model was framed to ensure consistent caring behaviors which would, in turn, improve patient satisfaction.  THEORY OF CARING AND HEALING  Caring: a nurturing way of relating to a valued other towards whom one feels a personal sense of commitment and responsibility.  Caring is growth and health-producing (nurturing) occurs in relationships (relating) to the one cared-for (a valued other); individualized and intimate (personal), with a sense of commitment (passion), accountability and duty (responsibility). CARING PROCESSES KNOWING: one perceives events according to the meaning they have in the life of the other. It involves a thorough assessment of all the aspects of a patient’s condition and reality, engaging the self or person-hood of the nurse as well as the patient, in a caring style of approach. When the process knowing occurs there develops a bond of empathy and understanding between the care provider and the care recipient. CARING PROCESSES BEING-WITH: as well as being emotionally present conveys to patients the message that they and their experiences are significant to the nurse. emotional presence is a technique by which the nurse shares the meanings, feelings and lived experience of the one-cared for. the message is,“you are not alone, what happens to you matters to us and we are here for you”.  CARING PROCESSES DOING FOR: the real meaning of doing for is found in the definition of nursing: “The unique function of a nurse is to assist the individual, sick of well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that s/he would perform unaided if s/he had the necessary strength, will, or knowledge and to do this in such a way as to help her/him gain independence as rapidly as possible.”  CARING PROCESSES DOING FOR: refers to the activities in which a nurse engages with patients for what they would do for themselves if at all it were possible to them. They include comforting patients, anticipating their needs, performing procedures skillfully, protecting them from harm and ultimately preserving their human dignity. CARING PROCESSES ENABLING: facilitating the other’s passage through life transitions and unfamiliar events. enabling fosters an environment of self-healing. enabling process enhances the patient’s capacity to heal, actualize oneself and in particular practice self-care. The cornerstone of enabling is appropriate communication with patients and their families. CARING PROCESSES MAINTAINING BELIEF: an orientation to caring begins with a fundamental belief in persons and their capacity to get through events and transitions and face their future with meaning. is the base or foundation for the practice of nursing care. whatever health conditions the patient is facing, a nurse believes in her/his capacity and power to accept or welcome upcoming days with meaning.  III. Virginia Henderson Basic Nursing Care Model  Basic Nursing Care Model  The theory emphasizes the importance of increasing the patient’s independence so that progress after hospitalization would not be delayed.  Her emphasis on basic human needs as the central focus of nursing practice has led to further theory development regarding the needs of the patient and how nursing can assist in meeting those needs. 14 BASIC HUMAN NEEDS 1. Breathe normally 2. Eat and drink adequately 3. Eliminate bodily wastes 4. Move and maintain 5. Sleep and rest 6. Select suitable clothes 7. Maintain body temperature within normal range  14 BASIC HUMAN NEEDS 8. Keep the body clean and well-groomed and protect the integument 9. Avoid dangers in the environment and avoid injuring others 10. Communicate with others in expressing emotions, needs, fears or opinions 11. Worship according to one’s faith 12. Work in such a way that there is a sense of accomplishment 13. Play or participate in various forms of recreation 14. Learn, discover, or satisfy the curiosity that leads to normal development and health THREE MAJOR ASSUMPTIONS IN HER MODEL OF NURSING. states that “nurses care for a patient until a patient can care for him or herself,” though it is not stated explicitly. states that nurses are willing to serve and that “nurses will devote themselves to the patient day and night.” states that nurses should be educated at the college level in both sciences and arts.  IV. SR. SIMONE ROACH CARING THE HUMAN MODE OF BEING  THE HUMAN MODE OF BEING  Focuses on caring as a philosophical concept and proposes that caring is the human mode of being.  All individuals are caring, and develop their caring abilities by being true to self, being real and being who they truly are.  Roach defines the 6 C’s of caring.  THE HUMAN MODE OF BEING Roach proposed that “we care, not because we are nurses, physicians, social workers, parents, etc., we are care because we are human beings. We differ in how we care, not in that we care Roach suggested that there are 6 attributes to caring referred to as the 6C’s in caring SIX C’S OF CARING COMPASSION: Is the suffering we experience through another’s suffering and our desire to help. It allows nurses to “treat people as individuals and not as a disease”. Compassion lies in the way in which nurses provide care that respects human rights of all background, age and race.  SIX C’S OF CARING COMPASSION: Awareness of one’s relationship to others, sharing their joys,sorrows, pain, and accomplishments. A compassionate nurse should be empathetic Empathy – attempts to identify with another understand something as experienced by another. To be able to empathize with a patient my depend on our level of sensitivity and common understanding of life and life’s events SIX C’S OF CARING COMPETENCE: A competent nurse meets standard that promote quality care based on contemporary, relevant and well founded knowledge. A competent nurse will then use this evidence based knowledge coupled with interpersonal skills such as compassion and confidence to work ethically, legally and within their own scope of practice. SIX C’S OF CARING COMPETENCE: Having the knowledge, judgment, skills, energy, experience and motivation, required to respond adequately to the demands of one’s professional responsibilities. SIX C’S OF CARING CONFIDENCE: Is our trust and understanding of our own competence. Confidence is built through experience, practice and development of knowledge. SIX C’S OF CARING CONFIDENCE: A confident nurse has a strong belief in self, conscience and in how their work has a positive contribution to the patient and the community. Comfort with self, client and others that allows one to build trusting relationships. SIX C’S OF CARING COMMITMENT: is the ability to treat every task, every moment and every interaction with the highest level of care. SIX C’S OF CARING COMMITMENT: As a nurse we have moral and ethical commitment to provide holistic care that is person-centered and aligns with a person’s care and concerns and we have an overall commitment and responsibility to ensure the delivery of safe and quality care. SIX C’S OF CARING 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. SIX C’S OF CARING CONSCIENCE: Our sense of right or wrong within our scope of practice. It obliges a nurse to do their duty for the sake of the patient.As the nurse’s primary professional responsibility is to people requiring nursing care. SIX C’S OF CARING CONSCIENCE: Morals, ethics, and an informed sense of right and wrong. Awareness of personal responsibility. SIX C’S OF CARING COMPORTMENT: Is our professional presentation. It’s our appearance, attitude and how we behave. Nurses must monitor and promote personal health through self care in order to care for others. SIX C’S OF CARING 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.  V. Dorothea Orem’s Self-Care Deficit Theory  Self-Care Deficit Theory  focuses on each “individual’s ability to perform s elf- care, defined as ‘the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being.'” Self-Care Deficit Theory Self-care agency is the human’s ability or power to engage in self-care and is affected by basic conditioning factors. Self-care: is the performance or practice of activities that individuals initiate and perform on their own behalf to maintain life, health, and well- being. Self-Care Deficit Theory Therapeutic Self-care Demand is the totality of “self-care actions to be performed for some duration in order to meet known self-care requisites by using valid methods and related sets of actions and operations.” Nursing Agency is a complex property or attribute of people educated and trained as nurses that enables them to act, to know, and to help others meet their therapeutic self-care demands by exercising or developing their own self-care agency. Self-Care Deficit Theory Basic conditioning factors are age, gender, developmental state, health state, socio-cultural orientation, health care system factors, family system factors, patterns of living, environmental factors, and resource adequacy and availability.  NURSING SYSTEM Wholly Compensatory System – the nurse provides total care because the patient is completely unable to meet their own needs. Partly Compensatory System – the nurse and the patient share responsibilities for self-care Supportive-Educative System – the nurse provides support, education, and guidance to help the patient regain or improve their self-care capabilities.  APPLICATION IN NURSING PRACTICE Assessment: Nurses assess the patient’s ability to meet their self-care needs and identify any deficits. This includes evaluating physical, emotional, and developmental factors. Planning: A care plan is developed to address the identified self-care deficits. Goals are set to either provide care or teach the patient how to regain their independence.  APPLICATION IN NURSING PRACTICE Implementation: The nurse provides care based on the type of nursing system required (wholly compensatory, partly compensatory, or supportive-educative). Evaluation: Nurses continuously evaluate the patient’s progress and adjust the care plan as needed to promote independence.  VI. Lydia Hall Theory of Care, Core and Cure Nursing Theory of Care, Core and Cure Nursing  The major purpose of care is to achieve an interpersonal relationship with the individual that will facilitate the development of the core.  Care – the nurturing component  Core – the patient- centered component  Cure – the medical or treatment-oriented component  APPLICATION IN NURSING PRACTICE Patient-centered care: The nurse focus on building strong relationships with patients, addressing their emotional needs and empowering them to participate in their own care. Example; providing emotional support to a patient adjusting to a new chronic illness. Holistic care: A nurse caring for a cancer patient might provide physical care (managing symptoms), emotional care (listening to fears) and medical care (administering treatments).  APPLICATION IN NURSING PRACTICE Collaboration with the Healthcare team Nurses work alongside physicians and other healthcare professionals, integrating the “Cure” aspect into holistic care. End-of-life care: The theory is applicable in palliative care, where the focus is on nurturing (care), supporting the patient and family emotionally (core), and managing symptoms (cure)  VII. CAROL GILLIGAN’S THEORY OF FEMININE MORALITY  THEORY OF FEMININE MORALITY Gilligan argued that women’s moral judgments necessarily include feelings of compassion and empathy for others, as well as concern for commitments that arise out of relationships. Women engage in “care reasoning,” not “justice reasoning,” and thus consider their own and other’s responsibilities to be grounded in social context and interpersonal commitments. STAGES OF M O R A L D E V E LOPMENT LEVEL 1: SELF-ORIENTED (CARING FOR ONESELF) Focus is on the needs of oneself. The survival of oneself is of sole concern. The transition to level 2 begins with the recognition of the conflict between one’s own needs and the needs of others (i.e., what one owes to oneself vs. what one owes to others). STAGES OF M O R A L D E V E LOPMENT LEVEL 2: OTHER ORIENTED (CARING FOR OTHERS) Focus is on the needs of others. The self-adopts the traditional conception of feminine goodness, the maternal morality of self-sacrifice, whereby the good is equated with caring for others. The transition to level 3 begins with the recognition that the self cannot be left out, but must also be an object of one’s caring. STAGES OF M O R A L D E V E LOPMENT LEVEL 3: UNIVERSAL ORIENTED (CARING FOR SELF AND OTHERS) Focus is on the universal obligation of caring. Care is a self-chosen principle that condemns exploitation, violence, and neglect and demands active response to suffering. Caring for oneself and others is seen as intertwined because the self and others are recognized as interdependent.Thus, all acts of caring are seen as beneficial to both self and others. VIII. MADELEINE LEININGER Culture Care Diversity and Universality CULTURE CARE DIVERSITY AND UNIVERSALITY  Care according to Leininger, “IS A DISTINCT, DOMINANT, UNIFYING,AND CENTRAL FOCUS OF NURSING.”  Her theory of culture care diversity and universality is based on the assumption that nurses must understand different cultures in order to function effectively. CULTURE CARE DIVERSITY AND UNIVERSALITY  Caring is assistive, supportive, and enabling experiences or ideas towards others with evident or anticipated needs, to improve a human condition or lifeway.  C A R I N G PATTERNS 1. K N O W I N G THE CLIENT 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.  C A R I N G PATTERNS 1. K N O W I N G T H E CLIENT Knowing the client and family ultimately involves the nurse and client in a caring transaction. The nurse’s knowing the client ultimately increases the possibilities for therapeutic interventions to be perceived as relevant.  C A R I N G PATTERNS 2. N U R S I N G PRESENCE Establishment of caring relationship depends on a moral commitment by the nurse and the nurse’s ability to assess and realize another person’s state of being.  C A R I N G PATTERNS 2. N U R S I N G PRESENCE Authentic presence involves empathy and openness to positive or negative feelings, non-possessive warmth, a relaxed posture and facial expression that are congruent with other communications.  C A R I N G PATTERNS 3. E M P O W E R I N G THE CLIENT The empowering relationship includes mutual respect, trust and confidence in the abilities and motives. They empower the clients and families through activities that enhance well-being, understanding and self-care.  C A R I N G PATTERNS 4.C O M P A S S I O N Compassion involves participating in the client’s experience, with sensitivity to the person’s pain or discomfort, and a willingness to share in their experience.  C A R I N G PATTERNS 4.C O M P A S S I O N Compassion is given as part of the caring relationship, as the nurse shares the client’s joys, sorrows, pain and accomplishments. Attention to spiritual needs is a part of compassionate care particularly in the face of death and bereavement.  C A R I N G PATTERNS 4.C O M P A S S I O N Comfort is often associated with compassionate care and many nursing interventions are carried out to provide comfort. Nurses are challenged to be creative and innovative, basing interventions on knowledge of the client’s preferences in order to provide comfort care. C A R I N G PATTERNS 5.C O M P E TE N C E The competent nurse employs the necessary knowledge, judgment, skills and motivation to respond adequately to the client’s needs The competent nurse understands the client’s condition, treatment and associated care.  MAINTAINING CARING PRACTICE C A R I N G FOR SELF  Caring for self means taking time to nurture oneself which involves initiating and maintaining behaviors that promotes healthy living and well- being EXAMPLES: Healthy lifestyle (nutrition, activity and exercise and recreation) Mind-body therapies (guided imagery, meditation and yoga)  APPLICATION IN NURSING PRACTICE Assessment Nurses assess patient’s cultural backgrounds, values, and preferences as part of holistic care. Example: asking a patient about their dietary restrictions or religious practices during admission Planning Care: Developing individualized care plans that incorporate patient’s cultural beliefs and practices. Example: including family members in decision-making process for a patient from a collectivist culture  APPLICATION IN NURSING PRACTICE Communication: Using culturally appropriate communication styles, including language, tone, and nonverbal cues. Example: using an interpreter to ensure clear communication with a non-English speaking patient. Advocacy: Advocating for patients’ cultural needs within the healthcare system. Example: ensuring a hospitalized patient has access to spiritual leaders or religious ceremonies  APPLICATION IN NURSING PRACTICE Education: Educating patients and families about healthcare practices while respecting their cultural beliefs. Example: teaching a patient about diabetes management while incorporating culturally relevant foods into their meal plan. COMMUNICATION IN NURSING Exchanging information, thoughts, and feelings among people using speech or other means The patient conveys their fears and concerns to their nurse to help them make a correct diagnosis Nurses being able to communicate effectively are overwhelmingly critical PURPOSE OF COMMUNICATION To collect assessment data To initiate intervention To evaluate outcome of intervention To initiate change which help in promoting health To take measures to prevent legal problems associated with nursing practice To analyze factors affecting health team Having good communication skills is essential to collaborating on teams with your fellow nurses and colleagues from other disciplines. It also important to patient centered care. Nurses who take time to listen and understand the concerns of each of their patients are better prepared to address issues as they arise, resulting in better patient outcomes. On the other hand, poor communication, or lack of communication in health care, can lead to patients misunderstanding directions and failing to follow treatment protcols VERBAL COMMUNICATION  Excellent verbal communication is key  Aim to always speak with clarity, accuracy, and honesty  It’s also important to know your audience and speak appropriately according to the person’s culture, and level of health literacy  If you are feeling stressed out or frustrated, be aware of your tone of voice and don’t let these emotions leak into your patient interaction VERBAL COMMUNICATION  Encourage patient to communicate by asking open questions like “Can you tell me a bit more about that?”  Avoid condescending pet names like “honey” or “sweetie” and instead use the patient’s first name or name of choice  Speak in clear, complete sentences and avoid technical jargon  NON-VERBAL COMMUNICATION Using elements of nonverbal communication – such as facial expressions, eye contact, body language, gestures, posture, and tone of voice- is also essential in creating rapport Simply smiling can go a long way. You can also: Show interest in what the patient is saying by maintaining eye contact and nodding your head. Smile but don’t stare Sit down when you can and lean forward to show you’re engaged Use nonthreatening body language that conveys openness.  ACTIVE LISTENING Means listening in order to understand the other person’s experience The highest and most effective form of listening requires complete attention and engagement This skill is important not only for clinical nurses but also for nurse executives and other healthcare providers as a tool for building and commitment with their staff  ACTIVE LISTENING Active listening includes both verbal and nonverbal communication skills. For example: Nod your head, but never interrupt Lean forward and maintain eye contact to let the person know you’re engaged Include minimal verbal encouragement, such as “I understand”, and “Go on”  WRITTEN COMMUNICATION Are essential for effective nurse-to-nurse communication As a nurse, you will be responsible for creating and updating the patient’s medical record. It is critical that the medical record is accurate and current so that patients can receive the best care possible Also, remember to protect patient confidentiality  WRITTEN COMMUNICATION Make notes immediately following patient care so you do not forget anything Write legibly and clearly, using simple language Be sure to note accurate dates and times  PRESENTATION SKILLS Effective presentation skills are most applicable during “handover’ or “endorsement” – when you are transferring patient care to another nurse or other healthcare providers. These skills will also help you demonstrate your knowledge and expertise clearly in a variety of workplace settings, such as presenting at conferences, participating in job interviews, giving case reports to physicians  PRESENTATION SKILLS Plan out your presentation and practice Pay attention to both your verbal communication and body language Add visuals to your presentation for a better explanation Understand your audience and know what they want and need from the presentation  PATIENT EDUCATION (PATIENT TEACH - BACK) Nurses are in charge of most of the communication between the healthcare team and patients This includes informing patients and family members of heath conditions, diagnoses, treatment plans, and medication protocols The skill is especially important for nurses who work with patients and families to provide health and education counseling  PATIENT EDUCATION (PATIENT TEACH - BACK) Patient Teach-back is an effective communication strategy where providers ask patients to repeat the information back to them. This method improves patient understanding and encourages adherence to care instructions. Poor understanding of information can cause patients and their family members to feel anxious or become defensive.  PATIENT EDUCATION (PATIENT TEACH - BACK) Example: “We’ve gone over a lot of information. Now I’d like you to repeat it back to me to make sure you remember everything.” “Can you repeat the instructions for taking this medicine back to me?” “Let’s review what we just discussed. Can you explain it to me in your own words?”  MAKING PERSONAL CONNECTIONS It’s important to get to know the person behind the patient. Patient-centered relationships are critical in helping patients feel safe and comfortable. Creating meaningful connections with patients can improve outcomes and trust. Example:  Spend a couple of extra minutes every day with each patient getting to know them.  Find out a fun fact about each patient.  Show interest in their lives and share stories of your own.  TRUST It’s important for healthcare professionals to inspire trust in patients by listening actively and taking every complaint and concern seriously. Building trust takes time. Healthcare settings are scary for some patients. It’s important to make them feel as comfortable as possible. Trust is something that nurse-educators and leaders should also cultivate as they work to develop the next generation of nurses.  TRUST To inspire trust, nurse leaders and educators should: Always tell the truth. Share information openly. Be willing to admit mistakes.  CULTURAL AWARENESS You will likely work with people every day who come from a wide range of social, cultural, and educational backgrounds. Every patient and coworker is unique, and it’s important to be aware and sensitive. For example, gauge the patient’s fluency with English and grade your vocabulary accordingly or bring in a translator if necessary and possible. With trans and gender nonbinary patients, be sure to use their preferred name and pronoun.  COMPASSION Conveying compassion is an essential communication skill in healthcare. According to the Journal of Compassionate Healthcare, “studies show that compassion can assist in prompting fast recovery from acute illness, enhancing the management of chronic illness, and relieving anxiety.” You can deliver compassionate nursing care by putting yourself in the patient’s shoes and understanding their needs and expectations. Thank you