Nursing as Caring: Nursing as Caring: A Model for Transforming Practice A Model for Transforming Practice

Anne Boykin, PhD, RNAnne Boykin, PhD, RN Savina O. Schoenhofer, PhD, RNSavina O. Schoenhofer, PhD, RN

Marguerite J. Purnell, PhD, RN; AHN-BCMarguerite J. Purnell, PhD, RN; AHN-BCFlorida Atlantic UniversityFlorida Atlantic University

ContentsContents

CaringCaring Major assumptionsMajor assumptions Key ConceptsKey Concepts Focus of nursingFocus of nursing The nursing situation The nursing situation Direct invitationDirect invitation Calls for Nursing and Nursing Calls for Nursing and Nursing

responses of caringresponses of caring Dance of Caring PersonsDance of Caring Persons

6 Major Assumptions6 Major Assumptions

Major assumptions are stated by the theorists to presentMajor assumptions are stated by the theorists to presenttheir values that ground the theory, and to illuminate their values that ground the theory, and to illuminate

theirtheirworldviews . This means that you know “where they areworldviews . This means that you know “where they arecoming from”. The theory of Nursing As Caringcoming from”. The theory of Nursing As Caringin grounded in 6 major assumptions which providein grounded in 6 major assumptions which providedistinctive meanings:distinctive meanings: Persons are caring by virtue of their humanness.Persons are caring by virtue of their humanness. Persons are caring moment to moment.Persons are caring moment to moment. Persons are whole or complete in the moment. Personhood is living grounded in caring.Personhood is living grounded in caring. Personhood is enhanced through participating in nurturing Personhood is enhanced through participating in nurturing

relationships with caring others.relationships with caring others. Nursing is both a discipline and a profession.Nursing is both a discipline and a profession.

CARINGFollowing are excerpts from

the Theory of Nursing as Caring (2001)

All persons are caring by virtue of their humanness – All persons are caring by virtue of their humanness – caring is an essential feature and expression of being caring is an essential feature and expression of being human. The view of person as caring and complete is human. The view of person as caring and complete is intentional – prevents segmenting into parts, such as intentional – prevents segmenting into parts, such as mind, body, and spirit.mind, body, and spirit.

Fundamentally, potentially, and actually, each person is Fundamentally, potentially, and actually, each person is caring.caring.

Each person, throughout life, grows in the capacity to Each person, throughout life, grows in the capacity to express caring. Being a person means living caring.express caring. Being a person means living caring.

Through knowing self as caring, I am able to be authentic Through knowing self as caring, I am able to be authentic to self and others.to self and others.

Caring is living in context of relational responsibilities.Caring is living in context of relational responsibilities. Caring is responsibility to self and others.Caring is responsibility to self and others. Caring shapes relationships.Caring shapes relationships.

About Caring About Caring

KEY CONCEPTSKEY CONCEPTSThese are important concepts These are important concepts that can be operationalized, i.e. that can be operationalized, i.e. they can be put into action andthey can be put into action andstudied, recognized, described or measured

Caring in NursingCaring in Nursing: The intentional and authentic : The intentional and authentic presence of the nurse with another who is recognized as presence of the nurse with another who is recognized as person living in caring and growing in caring. If you look person living in caring and growing in caring. If you look at the 6at the 6thth basic assumption listed, it states that nursing is basic assumption listed, it states that nursing is both a discipline and a profession. This assumption both a discipline and a profession. This assumption supports and validates how a nurse approaches supports and validates how a nurse approaches professional caring practice, that is, from an informed professional caring practice, that is, from an informed stance grounded in disciplinary knowledge. This clearly stance grounded in disciplinary knowledge. This clearly distinguishes “lay” caring from professional nurse caring.distinguishes “lay” caring from professional nurse caring.

Authentic Presence:Authentic Presence:Authentic presence may be understood as one’s Authentic presence may be understood as one’s intentionally being there with another in the fullness of intentionally being there with another in the fullness of one’s personhood.one’s personhood.

Caring communicated through authentic presence is the Caring communicated through authentic presence is the initiating and sustaining medium of nursing within the initiating and sustaining medium of nursing within the nursing situation.nursing situation.

Key Concepts con’tKey Concepts con’t

Person as Whole and Complete in the MomentPerson as Whole and Complete in the Moment Person as caring centers on valuing and celebrating Person as caring centers on valuing and celebrating

human wholeness, that is, the human person as human wholeness, that is, the human person as living caring and growing in caring; valuing and living caring and growing in caring; valuing and respecting each person’s beauty, worth, and respecting each person’s beauty, worth, and uniqueness.uniqueness.

The person is at all times whole. To encounter a The person is at all times whole. To encounter a person as less than whole fails to encounter person.person as less than whole fails to encounter person.

Personhood is Personhood is living grounded in caring living grounded in caring

Personhood implies living out who we are as caring Personhood implies living out who we are as caring persons.persons.

Personhood implies living the meaning of one’s life.Personhood implies living the meaning of one’s life. Personhood implies demonstrating congruence between Personhood implies demonstrating congruence between

beliefs and behavior.beliefs and behavior.

The Focus of The Focus of Nursing Nursing ((What do nurses think about while theyWhat do nurses think about while they are nursing?) are nursing?)

The focus of nursing is nurturing The focus of nursing is nurturing persons living caring and growing in persons living caring and growing in caring.caring.

Nursing Situation Nursing Situation The nursing situation is the shared, lived experience in The nursing situation is the shared, lived experience in

which the which the caring betweencaring between nurse and nursed enhances nurse and nursed enhances personhood.personhood.

(What does the nurse (What does the nurse dodo?)?)

It is in the nursing situation that the It is in the nursing situation that the nurse nurse attends to calls attends to calls for caring, creating caring responsesfor caring, creating caring responses that nurture that nurture personhood.personhood.

Calls for NursingCalls for Nursing

A A call for nursing call for nursing is a call from the is a call from the one nursed, perceived in the mind of the nurse. one nursed, perceived in the mind of the nurse. This call for acknowledgement and affirmation of This call for acknowledgement and affirmation of the person living caring in specific ways in the the person living caring in specific ways in the immediate situation.immediate situation.

Calls for the nurturance that is Nursing are Calls for the nurturance that is Nursing are personal expressions that communicate in some personal expressions that communicate in some way - “know me as caring person and affirm me.”way - “know me as caring person and affirm me.”

What the nurse does…What the nurse does…

In the nursing situation:In the nursing situation:

The nurse enters into the world of the other with the The nurse enters into the world of the other with the intention of knowing, affirming, supporting, and intention of knowing, affirming, supporting, and celebrating other as caring person. celebrating other as caring person. Direct invitationDirect invitation is is integral to this.integral to this.

Nurses should offer the direct invitation Nurses should offer the direct invitation as part of their as part of their coming to know other. The direct invitation raises coming to know other. The direct invitation raises awareness of nurse and nursed that nursing IS the awareness of nurse and nursed that nursing IS the service that nursing offers.service that nursing offers.

The Direct Invitation The Direct Invitation opens the door to explicit opens the door to explicit “caring between.” “caring between.”

Example of Direct invitationExample of Direct invitation

InsteadInstead of asking “What can I do for you?” - of asking “What can I do for you?” - turn the turn the focusfocus away from yourself away from yourself to the one you are nursing. to the one you are nursing.

Ask, in your own words, sincerely desiring to Ask, in your own words, sincerely desiring to know: know: What What matters to you most, right nowmatters to you most, right now??””

This is a very powerful question – wait forThis is a very powerful question – wait for

the answer in stillness, with patiencethe answer in stillness, with patience..

The one being nursed will The one being nursed will respond to the invitation respond to the invitation in in many different ways with unique many different ways with unique calls for nursing calls for nursing that that arise from what matters. arise from what matters.

Nursing responses of caringNursing responses of caring

The nurse responds to these calls for nursing The nurse responds to these calls for nursing with with specific caring resspecific caring responses to sustain and ponses to sustain and enhance the other as caring person.enhance the other as caring person.

This This caring nurturance caring nurturance is what we call the is what we call the nursing response.nursing response.

Caring betweenCaring between

Presence develops as the nurse is willing to risk Presence develops as the nurse is willing to risk entering the world of the other, and as the other entering the world of the other, and as the other invites the nurse into a invites the nurse into a special, intimate space.special, intimate space.

The encountering of the nurse and the nursed The encountering of the nurse and the nursed gives rise to the phenomenon of gives rise to the phenomenon of caring betweencaring between, ,

within which personhood is nurturedwithin which personhood is nurtured..

The nurse as caring person is fully present and The nurse as caring person is fully present and gives the other time and space to grow. Through gives the other time and space to grow. Through presencepresence and and intentionalityintentionality, the nurse is able to , the nurse is able to know the other in his or her living caring and know the other in his or her living caring and growing in caring.growing in caring.

The Caring Between…The Caring Between…

This This full engagementfull engagement within the nursing within the nursing situation allows the nurse situation allows the nurse to truly experienceto truly experience

nursing as caring, nursing as caring, and to shareand to share that experience that experience with the one nursed.with the one nursed.

This is the This is the caring between, the shared caring between, the shared relation within which nursing is created relation within which nursing is created

and experiencedand experienced..

Dance of Caring PersonsDance of Caring Persons

(Nursing As Caring: A Model For Transforming Practice(Nursing As Caring: A Model For Transforming Practice, 2001, p. 37) , 2001, p. 37)

Dance of Caring PersonsDance of Caring PersonsA Person-Centered, Caring-Focused Relational ModelA Person-Centered, Caring-Focused Relational Model

Acknowledgement that all persons have the capacity to care by virtue of their humanness

Commitment to respect for person in all institutional structures and processes

Recognition that each participant in the enterprise has a unique valuable contribution to make to the whole and is present in the whole

Appreciation for the dynamic though rhythmic nature of the Dance of Caring Persons, enabling opportunities for human creativity

ReferencesReferences

Boykin, A., & Schoenhofer, S. O. (1991). Story as Boykin, A., & Schoenhofer, S. O. (1991). Story as link between nursing practice, ontology, link between nursing practice, ontology, epistemology. epistemology. ImageImage,, 23 23, 245-248., 245-248.

Boykin, A., & Schoenhofer, S. O. (2001). Boykin, A., & Schoenhofer, S. O. (2001). Nursing Nursing as caring: A model for transforming practice. as caring: A model for transforming practice. Sudbury, MA: Jones and Bartlett.Sudbury, MA: Jones and Bartlett.

Mayeroff, M. (1971). Mayeroff, M. (1971). On caringOn caring. NY: Harper and . NY: Harper and Row.Row.