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NHSH 1115










40%: assignment/quiz/OSCE/MEQ question/attendance/participation in class 60%: final semester 1 exam MCQ

Class: Every TUESDAY 11am

At the end of the learning session, the students should be able to: 1) Define caring 2) List caring limitation. 3) state the impact of effective caring practices.

Watson (1985) define (nurse) caring as the process by which the nurse becomes responsive to another person as a unique individual, perceives the others feeling

Can be viewed in multiple ways - Attitude - Ability - Attribute - Characteristic - A complex set of behavior

Todays fast paced health care environment had limiting the therapeutic relationship between patient & care givers = resulting the healthcare givers been perceived as cold & un sensitive to patients need

Technological advances - limiting the opportunity for interpersonal connections which are critical in therapeutic patient relationship. - are dangerous & inappropriate unless nurses practice with caring & compassion.

Have you ever been ill or having problem requiring health care intervention?

Think about the experience

Read the following scenario & select the situation that you believe most successfully demonstrate a sense of caring

Scenario A

A nurse enters a clients room,

greet the patient warmly while touching the client lightly on the shoulder; make eye contact, sits down for a few minutes and ask about clients thoughts & concerns, listens to clients story,

looks at intravenous solution hanging on the room, briefly examine the client then check vital sign summary before departing the room

Scenario B
A second nurse enters the room, Look at Iv solution hanging in the room, Check vital sign summary sheet, Acknowledge the client but never sit down & never touch the patient, Make eye contact from above The nurse ask few questions about client symptom and then leaves the room.

Lets comment.

What is your opinion?

Which ONE you should follow?


Caring practice among health care workers IMPACT on

Clients experience
Health outcomes

Healthcare cost

Clients experience: - Caring is reflected in how healthcare staff interact with client & their family members while receiving the treatment.

Activity: 1) Divide your class into small groups of three or four students each. 2) student A to share her experience in caring for sick person to B - Tell your friend her/his name - Medical problem/diagnosis - What did you do - How do you feel? 3) Share with others

Health outcomes - Fast recovery - Gain trust, cooperation from patient - Increase patients satisfaction

Healthcare cost - Reduce complaint - Minimize law suit - Minimize the usage of hospital facilities

CARING in essential in helping the individual reach positive outcomes

Caring in Nursing Practice. Page 96

At the end of the session, the students must be able to: 1) Compare theories on the concept of caring.

CARING is universal phenomenon influencing the ways in which people




Since Florence Nightingale nurses have studied caring from variety of philosophical & ethical perspectives.

Caring is importance to the practice of Nursing

Banner (1984) describes the essence of excellent nursing practice which is caring. Caring means that person, events, projects and things matter to people (being connected)

Caring determines WHAT MATTERS to a person

Caring create possibility = personal concern for things that provides motivation & direction for people to care

Caring is inherent feature of nursing practice whereby the nurses help clients recover in the face of illness, Give meaning to that illness Maintain or re establish connection

Caring also help nurses identify successful interventions (nursing care plan)

Caring is always specific & rational to EACH client base on their background of experience, values, & cultural perspectives

Caring facilitate nurses ability to know the client recognize clients problem = plan & implement individualized solutions

Through caring relationship, nurses learn to listen to clients stories about their illness so that they able to obtain an understanding of the meaning of illness. With this understanding, they provide therapeutic, client centered care.


From trans cultural perspective, Leininger (1978) describes the concept of care as the essence & central, unifying, and dominant domain that distinguishes nursing from other health disciplines.

Care assist an individual or group in improving human condition.

Act of caring refer to skillful activities, process & decisions to assist people in ways that empathetic, compassion & supportive.

Leininger (1988) stresses the importance of nurses understanding cultural caring behavior. For client to achieve cure nurses need to learn cultural specific behavior and words that reflect human caring in different cultures to identify and meet the needs of all clients

Nurse Caring Behaviors Example: - Providing time for family presence for Asian patient - Using touch to convey caring sometimes crosses cultural/religion norms - When listening to client; some culture view eye contact as disrespectful.

Clients & families expect a high quality of human interaction from nurses.

Watsons theory of caring suggested caring is a conscious intention to care promote healing & wholeness. human caring process with healing environment, incorporating the life generating and life receiving process of human caring & healing for nurses & their client.

Transpersonal caring looks for deeper sources of inner healing to - Protect - Enhance - Preserve human dignity, humanity, wholeness & inner harmony.

Watsons believe caring become almost spiritual. The focus emphasis on nurse client relationship

this model is transformative as the relationship influence both the nurse & the client, for better or for worse.

Watsons 10 Carative Factors.

1) Performing a human altruistic value system. - Use loving kindness to extend yourself. - You use self disclosure appropriately to promote a therapeutic alliance with your client.

What is self disclosure?

2) Instilling faith hope - Provide a connectedness with the client that offers purpose & direction when trying to find the meaning of illness

3) Cultivating a sensitivity to ones self and to others - Learn to accept yourself and others for their full potential. - A caring nurse matures into becoming self actualized nurse

4) Developing a helping-trusting, human caring relationship - Learn to develop and sustain helping trusting, authentic caring relationship through effective communication with your clients.

5) Promoting & expressing positive and negative feeling. - Support & accept your clients feeling. In connecting with your clients you show a willingness to take risks in what you share with one another

6) Using a creative problem solving caring processes - Apply the nursing process in systematic, scientific problem solving decision making in providing client centered care

7) Promoting transpersonal teaching learning. - Learn together while educating the client to acquire self care skills. - The client assumes responsibility for learning

8) Providing for a supportive, protective, and/or corrective mental, physical, societal and spiritual environment - Create a healing environment at all levels, physical & non physical. - This promotes wholeness, beauty, comfort, dignity & peace

9) Meeting human needs - Assist clients with basic needs with an intentional care & caring consciousness.

10) Allowing for existential phenomenological spiritual forces - Allow spiritual forces to provide a better understanding of your self & your client

Outcomes from application of Watsons caring model in practice, enhances nurses caring practices.

1) Increasing knowledge & understanding of caring helps nurses begin to understand a clients world and to change their approached to nursing care
2) The use of caring in nursing practices encourage more holistic approach to nursing care

3) As nurses use caring, they get to know their clients and therefore better meet their needs 4) The caring model involves closeness, commitment, and involvement in the nurse client relationship


Kristen Swanson (1991) studied clients & professional caregivers in an effort to develop a theory of caring for nursing practice. After analyzing the story & descriptions = she develop theory of caring.

The theory describes caring as consisting of 5 categories or process


Maintaining belief

Being with


Doing for




knowing Striving to understand an

event as it has meaning in the life of the other

Avoid assumptions Centering on the one cared for Assessing thoroughly Seeking cues Engaging the self or both




Being with

Being emotionally present to the other

Being there Conveying ability Sharing feeling Not burdening




Doing for

Doing for the others as he Comforting or she would do for the self Anticipating if it were all at possible Performing skillfully Protecting Preserving dignity

What is WRONG with this picture?




Enabling Facilitating the others

passage through life transitions (e.g., birth, death) and unfamiliar events

Informing Supportive/allowin g Focusing Generating alternatives Validating/giving feedback




Maintaining belief

Sustaining faith in the others capacity to get through an event or transition and face a future with meaning

Believing in/ holding in esteem Maintaining a hope filled altitude Offering realistic optimism going the distance

Swanson (1991) defines caring as a nurturing way of relating to a valued other, towards whom one feels a personal sense of commitment & responsibility.

Caring based counseling was tested. It shows a significant finding in reducing womens depression and anger, particularly for women in the first 4 month following miscarriage.

Summary of theoretical views

Nursing caring theories have common themes There is a mutual give & take for one another patient can sense nurses sincerity & commitment in treating them they expect nurses to putting the heart in it, makes client feel that you are with them

Understanding persons life & illness explore through questions how it happen? When did you realize it? How do you feel about it? Does it effect your relationship? Work? What is your plan?

At the end of the session, the students must be able to: 1) State the elements of caring.



1) 2) 3) 4) 5) 6) 7) 8) Courteous Tolerance Ready to help Proactive Sense of urgency Punctuality Confidentiality Respect human dignity

polite and considerate in manner Call me by my name. I want the nurse to be courteous. Treat me as an adult. I want a nurse who listens to me and talks to me

he ability or willingness to tolerate something, in particular the existence of opinions or behaviour that one does not necessarily. Example: tolerating patient behavior

Ready to help


Sense of urgency



Respect human dignity

At the end of the session, the student must be able to 1) Explain patients perception of nurse caring behavior.

IDENTIFYING nurse behaviors that client perceived as caring emphasizes what client expect from their caregivers. ESTABLISHING a Reassuring presence Recognizing an individual as unique Keeping a close attentive eye on the patient ARE CARING BEHAVIOR THAT CLIENT VALUE

Caring behaviours are defined as; Behaviors evidenced by nurses in caring for patients. The top ten caring behaviours, derived from nursing literature are; attentive listening, comforting, honesty, patience, responsibility, providing information so the patient can make an informed decision, touch, sensitivity, respect, calling the patient by name (Tabers 1993).

List 11 caring behaviours that are perceived by families: 1. being honest 2. advocate for clients care preferences 3. giving clear explanations 4. keeping family members informed 5. make the patient comfortable 6. showing interest in answering questions honestly 7. provide necessary emergency care 8. client privacy 9. all nursing services will be available 10. helping clients to do as much for themselves as possible 11. teach patient how to keep the relative physically comfortable

Healthcare is placing greater emphasis on client satisfaction. For example: what client experience in their interaction with healthcare professional or services & What they think of that experience Will determine how client use it and how they can benefit from it.

Lets think about this

You went to emergency department as you are having acute stomach pain. After the nurse done her assessment on you, she left you unattended while you are now shivering & suffering the pain for more than 1 hour.

When clients sense that health care provider are sensitive, sympathetic, compassionate & interested in them as people, they usually become active partners in the plan of care.

Client satisfaction with nursing care is an important factor in their decision to return to a hospital.

Identify the best approach to provide nursing care:

Nurses behavior are an excellent starting point

Example: You need to insert an IV cannula to patient. She is very nervous and refuse it Your action: Get the most experience staff to insert to ensure the insertion can be done only once = reduce patients pain & anxiety

By knowing your client,

it helps you to select the best approaches that are most appropriate to the client needs

Caring behaviors can be measured and enhanced to improve healthcare service users experience and outcomes & staff experience.

It can be improved through: Staff learning & development Staff renewal strategies Effective teamwork Appropriate leadership

At the end of the session, the students must be able to: 1) Explain how an ethic of care influences nurses decision making.

Ethic refers to the ideals of right and wrong

concerned with relationships between people and with nurse's character and attitude toward others

in any client encounter, a nurse needs to know WHAT BEHAVIOUR is ethically appropriate.

An ethic of care is concerned with relationship with people nurse character & altitude towards others

Nurse who function from an ethic of care are sensitive to patients needs.

At the end of the session, the students must be able to; 1) State how to provide presence when performing procedure. 2) List the guidelines during interaction with client.

CARING is a fundamental way of being in this world Is a product of own culture, values, belief, experience, relationship with others Person who do not experience care in their life often find it difficult to act in caring ways Caring is embedded within each encounter and each action that we share with patient

Providing presence
Being present involves a conscious awareness of the relationship with one another Presence represent being in tune with one another

According to Duis-Nittsche (2002) Nursing presence is a deep physical, psychological, spiritual & energetic connection between the nurse & the patient.
The initial moment we spend with a patient affect how the nurse patient relationship develops & evolves

When a nurse enter a patient personal space to first pause & center. Center act includes; - Hand washing - Greet the patient - Personal touch of eye contact or handshake

Guidelines when interact with client; 1) 2) 3) 4) 5) 6) 7) 8) Smile, Introduce yourself made eye contact to patient shake her hand Sit/stand near to patient sustains eye contact during interaction Touch patients shoulder Listen without interrupting Validate her status

When a nurse establishes presence, these thing act together to create an openness and understanding: 1. eye contact 2. body language 3. voice tone 4. listening 5. having a positive and encouraging attitude

Being able to establish presence with patient will enhances your ability to provide adequate & appropriate nursing care each time you are with the patient.

Giving reassurance & proper explanation about a procedure, remaining at patient bedside, & coaching the patient through the experience all convey a presence that is invaluable to the patients well-being

Is an approach that provide both physical & emotional calm. all nursing care plan emphasize on comforting, patients privacy & safety

any procedures plan to patient should be done with an intention to provide comfort.

The use of touch is one approach where nurse reaches out to clients to communicate concern and support.

Touch involves contact and non-contact. - Contact touch: involves obvious skin-to-skin contact - Non contact: refers to eye contact touch itself is a concern when cross cultural boundaries of either client or the nurse. - The client generally permit task orientated touch nurses & physician are given a license to enter client personal space to provide care.

In caring relationship the nurse establish trust, open lines of communication & listen what client has to say True listening leads to truly knowing & responding to what really matters to the client & family

Caring through listening enable the nurse to be participate in the clients life - Any critical or chronic illness affect all of a clients life choices & identity - Being able to tell the story helps the client break the distress of illness

The information you gain from the patient are worthwhile & by observing the expressions & body language of the client, nurses will find cues to assist the client in exploring ways to achieve greater peace.

Knowing the client

Knowing develops over the time as a nurse learns the clinical conditions, behavior & psychological responses of client.

To know a client means that the nurse: 1. avoids assumptions 2. focuses on client 3. engages in a caring relationship with client that reveals information and cues that facilitate critical thinking and clinical judgments

Success in knowing the client lies in the relationship you establish resulting in a bonding With bonding nurses will be able to help client become involved in his/her care & accept help when needed.

Spiritual caring
occurs when a person finds a balance between his or her own life values, goals, and belief systems and those of others An individuals belief & expectations do have effects on the persons physical & well being.

Spirituality offers a sense of connectedness - Interpersonally: connect with oneself - Interpersonally: connect with others & environment - Tran personally: connect with unseen God.

Family care
Caring for an individual cannot occur in isolation from that persons family.

Success with nursing interventions often depends on - family willingness to share information about the client - Family acceptance & understanding the therapy - Family supports & delivers the therapist recommended.

Caring for the family takes into consideration on clients illness & the stress it imposes on all members.

Tips: How Should You Deal With Your Patients Family

1) Be Truthful: - With your calm, honest, professional and sober attitude, youll be able to calm grieving and angry family members. 2) Do Not Volunteer Information: - do not give out reasons that can come back and bite you later. - Never over communicate. - Do not express your personal opinions as to how things are being run in the hospital and why you think the surgery was delayed.

3) Do Not Indulge In Personal Conversations: - Keep your conversations polite, calm, professional and to the point. - If it looks as though a patients family member wants to talk to you to relieve their anxiety, just assure them, repeatedly if you need to, that everything possible is being done. - Refuse to contribute to personal questions, gossip about the hospital and any other kind of personal talk.

4) Stay Calm In The Face Of Grief Or Anger - you need to stay calm. - Show your sympathy through your voice and your expression but stay detached. 5) Dealing With Ethical Issues That Involve Patients Family - the nurse will still have to support the patient through their decision and deal with the patients family calmly

Here are few tips on how to deal with ethical dilemmas that involve patients family: 1.Check hospital rules in each case, as well as what the law says. If you find the right guidance, go by it.

2.Talk to your seniors and get the majority opinion in critical cases. Abide by the majority opinion.

3.If the matter is left to you, make the choice that you have to make as part of the care giving team. When theres a choice, theres just one way to go, either left or right. You cannot please everyone.

4.Convey your decision to the family members as calmly as possible. Deal with their reactions in a professional manner. Let them know that when they trust you to provide care, they have to leave certain decisions to you.

5.Get someone from the staff to support you through any adverse family reactions.
6.Always keep your seniors and the administrators informed of any major decision you need to take. Obtaining their ok and support in advance can keep you safe.

At the end of the sessions, the nurse must be able to: 1) State the common challenge of caring practice?

Caring is a motivating factor for people to become nurses & it become satisfaction when nurses know they had made difference in their clients life.

Challenges in today healthcare are: Reliance on technologies Nurses shortage lack of time "its not my job" mentality

REFERENCES es/Applying-the-Ethics-of-Care-to-Your-Nursing-Practice.pdf

1) Nurse A hears a colleague tell a student nurse, she never touches the client unless she is performing a procedure or doing assessment. The nurse tells the colleague that A. B. C. D. she does not touch the client either touch is a type of verbal communication there is never a problem using touch touch form a connection between nurse & client

2) Which statement describe knowing the client? A. Anticipating the client cultural preferences B. Determining client preference C. Gathering task orientated information during assessment D. Establishing & enhanced understanding of the client needs

3) Helping a new mother through the birth experience demonstrates which of the 5 caring behavior?

A. B. C. D. E.

Knowing Enabling Doing for Being with Maintaining belief

4) The strategies to create an environment that enable nurses to demonstrate more caring behavior include

A. Increase working hour B. Flexibility, autonomy & improve staffing C. Increase input concerning nursing function from physician D. Increase monetary gain

5) A nurse demonstrate caring by helping family members A. B. C. D. Become active participants in care Provide activities of daily living Remove themselves from personal care Make health care decisions for the client

6) Listening not only taking in what a client says, it also includes A. Incorporating the view of physician B. Correcting any errors in the client understanding C. Injecting the nurse personal views & statement D. Interpreting & understanding what the client means

7) Presence involves a person to person encounter that A. B. C. D. Enable clients to care for self Provides a personal care to a client Conveys a closeness & a sense of caring Describes being in close contact with a client

8) Clients perceptions are important because health care A. Always act in the best interest of the client B. Is placing greater emphasis on client satisfaction C. Is under investigation for misappropriation of funds D. Is carefully watched & regulated by the government

9) When you change patients wound dressing, you only expose the wound & change the dressing without soiling the bed linen or pulling the skin unnecessarily. This actions exhibits A. B. C. D. Ebanling Being with Doing for Comforting

10) When you are able to demonstrate culturally specific behaviour that express caring, you are applyong the theory of caring develop by
A. B. C. D. Benner Radwin Swanson Leininger

11)Miss Ann unable to sleep and called out nurse frequently. Nurse A enter Miss Anns room, establish eye contact & holds her hand and asking Miss Ann, what has been bothering you?. this is an example of:
A. B. C. D. Anticipating Being with Centering Knowing

12) The action that best describes effective listening is A. B. C. D. Anticipating what patient has to say Establishing initial eye contact Observing a patients body languages Choosing actions to control patients behavior

13)Which of the following illustrates the principle of knowing the client? A. The nurse provide back rub to patient B. the nurse listens as the client describes his pain C. The nurse administer an antibiotic for client with penumonia D. The nurse collect the urine specimen 7 send to lab

14)The nurse sits with the client and holds the clients hand as his pain decreases. This is an example of the following caring practice
A. B. C. D. Nursing presence Assessment Knowing the client Empowering