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© WCSI. All Rights Reserved.
Human CaringMultiple Ways of Knowing
Mary Rockwood Lane PhD RN FAAN
© WCSI. All Rights Reserved.
Holistic Nursing ConferenceMay 3 , 2013
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Mary Rockwood Lane PhD, RN, FAAN
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• Associate Professor College of Nursing
• Shands Arts In Medicine Director Emeritus
• Center of Spirituality in Healthcare
• WCSI Faculty
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© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
History of Caring Science and Art as Healing Force
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“Caritas” comes from the Latin word meaning cherish, to appreciate, to give special attention, if not loving, attention to: connotes something that is very fine, that indeed is precious.
Eriksson in Finland has used the word caritas in her theory to convey similar meanings.
“Caritas” comes from the Latin word meaning cherish, to appreciate, to give special attention, if not loving, attention to: connotes something that is very fine, that indeed is precious.
Eriksson in Finland has used the word caritas in her theory to convey similar meanings.
Caritas/Christ Church Oxford University
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Watson Caring Science InstituteCaritas‐Ways of Being‐Becoming
1. Loving Kindness2. Heart-centered Authentic Presence; • Compassionate Forgiveness• Gratitude- Appreciation• Energetic Caritas Consciousness• Giving –Receiving • Stillness-Silence• Connecting with field of Universal Love• Manifesting Caritas Field - to sustain caring and
our humanity• Other – Infinite
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Personal and ProfessionalPractices of Caring
• Nursing is the most noble profession – our work is sacred and precious.
• Self care is a essential aspect of our work.
• Remember the promises we are privileged to keep: to honor connections of body and spirit in all relationships, with a sustaining passion, from the present until we are old.
• Being in right relation with self and others
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The Core of Caring Theory1. Heart/Soul – Source of
Compassion; Philosophy, Ethics, Love, Values & Human Spirit Connection
1. Voice – Language & Structure -Caritas Processes
1. Hearth – Where Theory Lives –• “In the Caring Moment”
1. Mind - Caring as Consciousness, Presence, Intentionality & Informed Moral Action
1. Hands/Praxis – Caritas Modalities, Artistry: All Ways of Knowing/Being/ Becoming/Doing
1. Heart/Soul – Source of Compassion; Philosophy, Ethics, Love, Values & Human Spirit Connection
1. Voice – Language & Structure -Caritas Processes
1. Hearth – Where Theory Lives –• “In the Caring Moment”
1. Mind - Caring as Consciousness, Presence, Intentionality & Informed Moral Action
1. Hands/Praxis – Caritas Modalities, Artistry: All Ways of Knowing/Being/ Becoming/Doing
1. Practice Loving Kindness2. Instill Faith and Hope3. Nurture Individual Spiritual Beliefs
and Practices4. Develop Helping – Trusting
Relationships5. Promote & Accept Expressions of
Positive & Negative Feelings6. Use Creative Scientific Problem-
Solving Methods for Decision Making7. Perform Teaching and Learning that
Address Individual Needs and Styles8. Create a Healing Environment for the
Physical and Spiritual Self which Respects Human Dignity
9. Assist with Physical, Emotional and Spiritual Human Needs
10. Allow Space for Miracles to Take Place
Caritas: the basis of love for the ultimate meaning and
destiny of other humans.
© WCSI - 2011
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Alex Grey ‘Sacred Mirror’
ExpandedView of Person:
LightEnergy
Consciousness: MindBodySpiritConnectedness
Heart-Connectedness with Source
© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
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Era III – Non LocalTranscendent Consciousness
• Connecting with Universal Source• Holographic Notions• Consciousness Transcends Time and
Space, and Physicality• Consciousness is Joined• Consciousness – Omnipresent, Infinite,
Immortal and Ultimately One; Unitary Being; Unitary Field
• Evolving Heart-Centered Human –Deepening /Sustaining Our Humanity
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Alex Grey
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“Nightingale ‘Divine Laws”
Electromagnetic Field of the Heart
Caritas Process 8: Becoming the Healing Environment – Setting the Tone
Giving
Stillness
Receiving
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The heart radiates an electromagnetic field that energetically affects each others’moods, attitudes and feelings.
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Source: Caring/Compassion –Inner Truth; Beauty, Our Very Humanity
16Watson – WCSI Copyright 2010 – HM Slide with Permission
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Contemplative Pause: Reconsidering Nightingale
18© WCSI. All Rights Reserved.
Nightingale Caring-Healing Modalities: Auditory, Visual, Sensory, Consciousness, Tactile, Voice,Environmental, Healing Arts
• Beauty, aesthetics
• Light (bed should face outdoors/nature)
• Water, Clean air
• Mood – quiet, soft voices
• Human Touch
• Smell, Taste, Sight, Sound
• Imagination, (Visualization)Movement, Attitude and Relationships
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Florence Nightingale Caring Science
Ancient wisdom and contemporary science/art/spirituality converge •
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Nightingale: Health for All
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Caring Science as Sacred Science
• Ethics of ‘Belonging’ - Infinite Field of LOVE – Sustaining Divinity of Humanity – Grace and Dignity
• Connectedness of All – Relational Cosmology
• Dwelling and Aligning with Infinite Field of Universal Love
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Connecting
• Purposeful emphasis on integrating the wholeness of the patient, patient patterns and patient meaning into the nursing initiatives .
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BACK TO BASICS OF HUMANKIND
© WCSI. All Rights Reserved.
Energy, Intent and Multiple (All) Ways of
Knowing
Diane Swengros Caritas Coach InovaHealth 2009 © WCSI - 2009
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Fundamental Patterns of Knowing - Carper
• Empirics – Scientific Knowing
• Esthetics – Artistic Knowing
• The component of “personal knowledge”•• Ethics – Moral knowing in Nursing
Carper, B., Advances in Nursing Science (1978) 1 (1) 13-23.
© WCSI - 2011
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Aesthetic
Ethical
Personal
Empirical
Spiritual
Creative
Intuitive
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Ways of Knowing
• EMPIRICAL• Factual, objective, and
verifiable by “outcome measures”
• Application of theories• Body of knowledge that
is research based and systematically organized
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Ways of Knowing
• AESTHETIC• Holistic expressions
and perceptions of creativity, openness, meaning, and empathy
• Expanding caring healing modalities to include voice, touch, presence, poetry, music, aroma therapy or any other aesthetic medium
© WCSI - 2011
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Ways of Knowing
• PERSONAL• Knowing, encountering
and actualizing of the self
• Self-actualization through interpersonal processes and interactions
• Present meaning that are brought into relationship with © WCSI - 2011
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Ways of Knowing
• ETHICAL• Make choices within
situations involving moral judgments
• Analysis and clarification of shared values; justice, compassion
• Examining what is worth being and preserving
© WCSI - 2011
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Ways of Knowing
• SOCIOPOLITICAL• Changing environments
toward highly integrated, continuum-based and multifaceted
• Engaging issues such as gender, diversity, culture, power
• Caritas Path to Peace
© WCSI - 2011
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Ways of Knowing
• EMANCIPATORY• Engaging issues of
equity, justice and transformation, attends to social barriers
• Creates clearing for bringing together art, science, spirituality for new depth for “unabashed love” for caring & healing
ti© WCSI - 2011
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Caritas Process 1: Humanistic – Altruistic Values –Practice of Loving-Kindness and Equanimity with Self and Other
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Magnetic Reminders: Pausing - Practicing Presence: Loving Kindness
• VALUES: Preserving Human Dignity:
Magnets on Patientʼs Door
INOVA Health, Fairfax, VA
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Caritas Expression of Loving Kindness
• Practice from what is in your HeArt• With loving expression using voice and
touch; - one word from your heart can express profound kindness
• Value what Jean Watson has taught us, “that what we hold in our heart matters”
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Caritas Process 2:
Faith and Hope,Being Present Authentically
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Art is A Caring Moment
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Caring Moment
• A heart centered love-filled, energetic field; a turning point; A call to higher/deeper consciousness, intentionality; An authentic choice of caring/living; Requires presence-centering-search for meaning; New level of authenticity- potentiating self healing and wholeness.
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Caritas Process 3:Sensitivity to Self & Others, Ongoing Spiritual Development
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TS Eliot ‘The Still Point - in midst of chaos.” Healthcare: What is Basic health and human caring?
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Love: Intelligent Heart Centered Human-to-Human Caring Practice
• “Love… The Old Unfamiliar Name...
• Behind the Hands, Not Known
• Because Not Looked For,
• But Hidden in the Stillness,
• Behind the Scenes
T.S. Eliot
Where is Our Patient?
Lifelong skills: Meaning
• Relaxation
• Meditation
• Guided imagery
• Prayer
• Creativity
• Trust
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Caritas Process 4:Developing AuthenticTrusting Caring Relationships
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Caritas Process 5:Allowing Expression of
Positive-Negative Feelings: Listening to Another’s Story
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Caritas Process 6:Creative Problem-Solving Caring Process
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Creativity and Spirituality In Healthcare
• Arts In Medicine Programs: Practice
• Spirituality in Healthcare groups: Practice
• Shamanism
• Artist as healer
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Caritas Process 7:Relational TeachingLearning / Inner Subjective Meaning
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From “Implementation”to “Partnering”
• From doing to and for the patient to being with the patient- mutual process
• Giving information to a patient in away they can understand-genuine teaching –learning staying within the other’s frame of reference. Creating a caring healing relationship
• How can I best help you learn about your medications?
• What will life be like for you when you go home on a low sodium diet?
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From “Evaluation”to “Reflection”
• Evaluation is often done by the nurse to the patient
• Reflecting involves open communication- “how do you feel?”
• What are you experiencing?
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Caritas Process 9:
Creating a Healing Environment• Physical Environment: Privacy/Windows
• Healing Garden/ Nature
• Light, color, sounds, flow of movement
• Nurse as Environment: Voice, touch, eye contact, energy, feelings
• Family connection
• Health care team collaboration
Healing Arts Program
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Creating a Healing Environment
• Guided Imagery
• Music, Dance, Poetry, Art
• Listening
• Healing touch
• Artistic expressions
• Human interactions
• Beauty / Nature
Healing Environments
• Gardens
• Rooms
• Views
• Altars
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Caritas Process 9:Assistance With Basic Needs – Sacred Acts
• Embodied Spirit:•
Touching• Mind• Body• Spirit•
Not Just Body Physical
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Bea “Everyday a patient should have something beautiful to look at...” Nightingale
blooming in midst of thorns 55
Health Outcomes
• Patient care humanized
• Quality of life improved
• Clinical practice enhanced
• Environments illuminated
• Cost effectiveness
57© WCSI. All Rights Reserved.
Caritas Heart Moment:What song does your heart Sing?
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Caritas Process 10:Open to Existential - Spiritual Unknowns: Allow for Mystery & Miracle
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Caritas Nursing Praxis
Application of Learning to Practice – Study of Practice
• “Informed Passion”
Caring Practices
• New Caring Modalities
• Practice of Knowing and Being and Doing in Caring Relationship
• Natural Healing Modalities
Practice is informed by our world view and our knowledge base
60Watson Caring Science Institute © WCSI. All Rights Reserved.
Connected to Infinite Love and Grounded to the Earth
Healing Touch Meditation by Cynthia Hutchinson
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© WCSI. All Rights Reserved.
Art as a Way of Caring
© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
Art as A Healing Force
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© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
Call to Artists
Everyone is an Artist
“If you can walk You can Dance
If you can talk You can Sing!”
Call to Healers
• Human Caring
• Reclaiming the art
• Bringing in art
• Starting a program
• In your life
• In your practice
© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
Art As a
Way of Caring
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Shands Arts in Medicine
• Artist in residence:
• Visual artist
• Musician
• Dancer
• Poet
• Storyteller
• Theatre
The Hospital as a Healing Community
• Sacred Space
• For all
• How does it feel?
• Its broken, fix it
• Healing spirit
Art as Healing
• On the walls
• Content
• Meaning
• Story
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Art Heals
• Yourself
• Others
• Neighborhood
• Earth
Enhanced Practice
• Loving
• Mindful
• Present
• Caring
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Art as Advanced Therapeutics
• Leadership
• Facilitator
• Advocate
• Do it yourself
• Be Creative
• Enhanced practice
Research
• Develops a knowledge base
• Defines art in healing
• Defines health outcomes
• Changes practice
Research Findings
• David Speigel, support group patients • Diane Tusek, One hospital day shorter ,
decreased meds • Ulrich- art on the walls and a window
shortened hospital stay and ½ pain meds • Candice Pert Psychoneuroimmunology
endorphins and neurotransmitters from relaxation
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Physiology:Symptom Reduction with art Physical
• Decreased muscle tensionDecreased painIncreased oxygenation Increased circulationImproved sleepImprove appetite
Psychological
• Decreased anxiety Increased intuitionImproved clarity in thinkingEnhanced faithIncreased acceptance
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Caring Science Outcomes
• “The outcomes we have seen since adopting Caring Science, include improved nurse retention, increased satisfaction scores and improved benchmarking on our clinical outcomes.” Lance Anastasio, President and CEO
Winterhaven Hospital, Winterhaven, FL
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79© WCSI. All Rights Reserved.
Rational for Assessing and Measuring
Improvement of Caring Practices; Mindful –Intentional Interventions;
Benchmarking Settings, Structures for Improvement;
Tracking Caring Against Routine-Robotic Practices; (from Bio-cidic to Bio-genic)
Evaluating Caring-Non-Caring: Patients/Practitioners
80© WCSI. All Rights Reserved.
Rational for Assessing and Measuring
• Improvement of Caring Practices; Mindful –Intentional Interventions;
• Benchmarking Settings, Structures for Improvement;
• Tracking Caring Against Routine-Robotic Practices; (from Bio-cidic to Bio-genic)
• Evaluating Caring-Non-Caring: Patients/Practitioners
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Caring Science Research:Caring assessment instruments
Assessing
Measuring Caring and
• Outcomes
2009
2012
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82© WCSI. All Rights Reserved.
CPAS©
Caritas Patient Assessment Score
1. Develop a Quick and Easy Instrument to Administer and Measure Patient Perceptions of Caring – An “APGAR Score”
Maintain Integrity of Caritas Processes
2. The 5 Items Selected Account for 78% of the Explained Variance of Caring
3. #1 – “Providing Care with Loving Kindness” Accounts for the Majority of Variance – 67.8%
4. Develop Instrument for Use by Facilities Interested in Measuring Patient’s Perceptions of Caring Practices
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WCSI International Comparative Caring Research (University of AZ – Dr. B. Brewer PI )
• To Apply the Watson Caritas Patient Score Instrument in multiple hospitals using Caring Theory as Professional Practice model
1. To Use the Data for Ongoing Performance Improvement and Clinical Investigation – unit level comparison; quarterly reports online;
2. To Build an Accurate and Reliable National Comparative Database of Authentic Caritas practices Perceived by Patients; relationship bx caring system, nurse sensitive patient safety and quality indicators;
3. To Improve the Validity and Reliability of the WCPS
84© WCSI. All Rights Reserved.
Empirical – Theoretical Measurement of Authentic CaringWCPS© –Tool
Watson Caritas Patient Score - WCPS(Apgar* score of caring)
WCPS© - ©Watson Caring Science Institute: Watson, Brewer, & DʼAlfonso, 2009
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New Caring Science Criteria:New Outcome Indicators
Human Flourishing: Staff and Patients, Family, Community. Purposive Involvement: Contributing to
Something Larger Than Self – Inspired Vision. Building Capacity: Inspired Organizational
Leadership, Workgroup Cohesion, Workgroup Learning Processes. Honor and Use of Unique Individual
Talents for Advancement – Progression; Relational Coordination Allowance for Creative Emergence
Leaders/Managers NOW Seek ʻEvidenceʼ of:
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Caritas HeartMath PilotBaptist Health, Jacksonville, FL
• Personal Clinical Indicators of Stress (e.g. Outlook, Motivation, Fatigue, Resentful, etc.) – 10 or 10 Indicators Improved with Caritas HM Program After 1 Month
• Organizational Qualities (e.g. Work Attitude, Strategic Understanding of Organizational Goals, Goal Clarity, Value of Contributions, Communication Effectiveness, Productivity, Time Pressure, Morale Issues and Intention To Quit.)
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Opportunities For Ritual “Handwashing”An ACT Initiative
• PROVIDES A PAUSE TO:• Quiet Busy Mind
• Wash Away Old Experience
• Center in Caring Intention
• Honor Self and Other
• Reconnect to Core Values
• Bless and Release Last Person/Situation
• Purify Sacred Space for Authentic Presence
• Open to Ability to Give and Receive Next Person/Situation
The Children’s Hospital, Denver
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Angie Fontaine, RN Caritas Coach, Jacksonville Baptist, FL , 2009
Into “The Caritas Staff Retreat”with a Stone Waterfall Feature
• From Smoking Area to Caritas Garden
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Cultivating Consciousness and Listening for Meaning
• Afternoon Tea Where:
• Reflective Practice is Cultivated
• Where Nurse’s Own Experiences are Shared
• Where We Learn to Listen for the
Wyoming Medical Center88
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Healing Environment Quiet Time
The Children’s Hospital Denver
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CP: 10 Sanctuary –Healing Room for Nurses
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Kaiser - Antioch Medical Center
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Reflections
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Vijali’s Three Questions
• What is your essence?
• What keeps you from getting there?
• What can you do to achieve it?
• No Fear
• Open heart
• Total commitment
A Sacred Pilgrimageor Vision Quest
• Go Into peace
• and silence
• Listen
• Remember
• Return
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My heart leaps up when I behold a rainbow in the sky! by William Wordsworth (1802)
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May beauty be all around you
• Come join us………….
• “Walk on a rainbow trail. Walk on a trail of song and all around you will be beauty.
• There is a way out of every dark mist.
• It is over a rainbow trail.”Navajo Poem
© WCSI. All Rights Reserved.
Individual Artistic Renderings
Multiple Ways
To Express Experience
Books
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© WCSI. All Rights Reserved.
Spirit Body Healing
A phenomenological hermeneutic study of the lived experience of art in healing
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Themes in Art and Healing
–pain and darkness going elsewhere being creative in a turning point slipping through the veil knowing the truth and trusting the process embodying spirit feeling healing energy and compassion
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© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
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© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
Pain
© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
Trigger
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© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
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© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
Going Elsewhere
© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
Pet Therapy:Something to Care for and Love
Watson – WCSI Copyright 2010 111
Marlienne Goldin, RN Caritas Coach & Faculty
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© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
Art as Turning Point
© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
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© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
Slipping Through the Veil
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© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
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© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
Healing Energy
© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
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Habitat for Healing
• Influencing the Environmental Field
• Using Creative Caring-Healing Modalities
• For Staff, Patients and Families
Wyoming Medical Center121
© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
Embodiment of Spirit
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© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
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© WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
Transcendence
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Thank You!
Each one of you is the light and beauty of the rainbow of caring.
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Reflections