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Kozier & Erb's

Fundamentals of Nursing
Concepts, Process, and Practice
TENTH EDITION

Caring
CHAPTER

25
Kozier & Erb's Fundamentals of Nursing, Tenth Edition
Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
All Rights

Learning Outcomes
1. Discuss the meaning of caring.
2. Identify nursing theories that focus on
caring.
3. Analyze the importance of different types of
knowledge in nursing.
5. Describe how nurses demonstrate caring in
practice.
6. Evaluate the importance of self-care for
the
professional nurse.
7. Identify the value of reflective practice in
nursing.
Kozier & Erb's Fundamentals of Nursing, Tenth Edition
Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
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Introduction
Caring means that people,
relationships, and things matter.
Sharing deep and genuine concern
about the welfare of another person
Clients and families with illness suffer
from an impersonal health care system.
Nurses can create a more relationshipcentered health care system.
Kozier & Erb's Fundamentals of Nursing, Tenth Edition
Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
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Professionalization of
Caring
Caring practice involves connection,
mutual recognition, and involvement
between nurse and client.
Mayeroff (1990) proposed that
Caring is helping growth and
actualization of another.
Caring process develops
over time.
Supports client's potential and need to
grow
Kozier & Erb's Fundamentals of Nursing, Tenth Edition
Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
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Caring as "Helping the Other


Grow"
Mayeroff (1990) proposed Major
ingredients of caring

Knowing
Alternating rhythms
Patience
Honesty
Trust
Humility
Hope
Courage
Kozier & Erb's Fundamentals of Nursing, Tenth Edition
Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
All Rights

Kozier & Erb's Fundamentals of Nursing, Tenth Edition


Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
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Culture Care Diversity and


Universality (Leininger)
Understand different cultures in order
to function effectively
Actiondecision care approaches
Preservation of client's familiar lifeways
Accommodations that help clients adapt
to or negotiate for satisfying care
Repatterning nursing care to help client
move toward wellness

Kozier & Erb's Fundamentals of Nursing, Tenth Edition


Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012 , 2008


Pearson Educatio n, Inc.
All Rights Reserved

Theory of Bureaucratic Caring


(Ray)
Caring is contextual, influenced by
organizational structure.
Meaning of caring varies in emergency
department, intensive care unit,
oncology unit, etc.
Role and position of staff members

Spiritual-ethical caring influences


each
branch of bureaucratic system
Kozier & Erb's Fundamentals of Nursing, Tenth Edition
Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
All Rights

Figure 251

Concept map reflecting the theory of bureaucratic caring.

Kozier & Erb's Fundamentals of Nursing, Tenth Edition


Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
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Caring, the Human Mode of Being


(Roach)
Center of all attributes used to describe
nursing
All individuals are caring and develop
caring abilities by being true to self,
being real, and being who they truly
are.
Six C's as broad framework

Kozier & Erb's Fundamentals of Nursing, Tenth Edition


Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
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Box 251

rsing

The Six C's of Caring in Nu

Kozier & Erb's Fundamentals of Nursing, Tenth Edition


Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
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Nursing as Caring (Boykin and


Schoenhofer)
Know people and nurture them
Person as whole and complete in the
moment

Importance of nurse knowing self


People are not perfect, but constantly
growing and changing.

Kozier & Erb's Fundamentals of Nursing, Tenth Edition


Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
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Theory of Human Care (Watson)


Basis for nursing's role in society
Commitment to care of the whole
person as well as individuals
and groups
Transpersonal human caring
Metaphysical

Each person seeks harmony within


mind, body, and soul, actualizing real
self.
Kozier & Erb's Fundamentals of Nursing, Tenth Edition
Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
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Theory of Caring (Swanson)


One feels a personal sense of
commitment to a valued "other"
Five caring processes as nursing
interventions

Kozier & Erb's Fundamentals of Nursing, Tenth


Audrey Berman | Shirlee Snyder | Geralyn Frandsen
Edition

, 2012, 2008
Pearson
Education,
Inc.
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Kozier & Erb's Fundamentals of Nursing, Tenth Edition


Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
All Rights

Types of Knowledge in Nursing


Nursing
that

involves different types of knowledge

are integrated to guide nursing practice.


Empirical
knowing
includes
personal knowing
focuses
on scientific
theself, ethical
competence,
requires moral/ethical
awareness,
knowing and
aesthetic knowing is the creative art of nursing.

Kozier & Erb's Fundamentals of Nursing, Tenth Edition


Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
All Rights

Figure 252

The four ways of knowing.

Kozier & Erb's Fundamentals of Nursing, Tenth Edition


Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
All Rights

Types of Knowledge in Nursing


Empirical knowing: the science of
nursing
From factual, observable phenomena to
theoretical analysis

Personal knowing: the therapeutic use


of self
Promotes wholeness, integrity in
personal encounter
Achieves engagement
Kozier & Erb's Fundamentals of Nursing, Tenth Edition
Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
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Types of Knowledge in Nursing


Ethical knowing: the moral component
"Matters of obligation on what ought to
be done"
Beyond observing code of ethics

Aesthetic knowing: the art of nursing


Expressed by individual nurse's
creativity and style in meeting needs of
clients
Care that is effective and satisfying
Kozier & Erb's Fundamentals of Nursing, Tenth Edition
Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


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Caring Encounters
Caring encounters are influenced by the diversity of
human responses.
Common caring patterns include knowing the client,
nursing presence, empowering the client, compassion,
and competence.
Caring responses as varied as clients' needs
Clients experience:
Increased sense of dignity and self-worth
Expression of feelings of connectedness
Kozier & Erb's Fundamentals of Nursing, Tenth Edition
Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


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Knowing the Client


Uniqueness
Physiological variables
Perception of pain
Meaning of diagnosis, surgery

Support persons and family


Increases possibilities for therapeutic
interventions to be perceived as
relevant
Kozier & Erb's Fundamentals of Nursing, Tenth Edition
Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


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Nursing Presence
Mutuality
Transpersonal caring relationship
Openness and consciousness of self and
client
Authenticity

Emotional, physical presence


Responding promptly

Kozier & Erb's Fundamentals of Nursing, Tenth Edition


Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
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Empowering the Client


Mutual respect, trust, confidence in
other's abilities and motives
Substitutive care, but no more than is
needed at the time
Environment in which client can
function safely, effectively
Advocating
Mindfulness of professional
boundaries
Kozier & Erb's Fundamentals of Nursing, Tenth Edition
Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
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Compassion

Warm, empathetic
Concerned
Requires courage and openness
Attenuation to spiritual needs
Comfort
Based on individual's perceptions
Creative, innovative interventions based
on client's preferences
Kozier & Erb's Fundamentals of Nursing, Tenth Edition
Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
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Competence
Necessary knowledge, judgment, skills,
motivation to respond adequately to
client's needs
Understanding of client's condition,
treatment, and associated care
Ability to assess, plan, implement, and
evaluate a plan of care
Cognitive, affective, technical, and
administrative skills
Kozier & Erb's Fundamentals of Nursing, Tenth Edition
Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
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Maintaining Caring Practice


Emphasis on meeting others' needs
Obstacles to self-care
Professional
Demands of particular work setting
Personal
Poor health habits
Unrealistic expectations of self

Kozier & Erb's Fundamentals of Nursing, Tenth Edition


Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
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Caring for Self


Caring for self is central to caring for others. initiating and
maintaining behaviors that promote healthy living and wellbeing.
Nurse self-care includes a healthy lifestyle (e.g., nutrition,
activity and exercise, recreation, and avoiding unhealthy
patterns) and mindbody therapies (e.g., guided imagery,
meditation, story telling, music therapy, yoga).

Kozier & Erb's Fundamentals of Nursing, Tenth Edition


Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
All Rights

Reflection on Practice
Critical thinking, self-analysis, and
reflection are required in order to learn from
ones experience.
The student nurse matures as a practitioner
by
reflecting on practice.
Through reflection, nurses can grow
and participate more fully in caringhealing relationships.
continued on next slide
Kozier & Erb's Fundamentals of Nursing, Tenth Edition
Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
All Rights

Reflection on Practice
Reflection
Thinking from a critical point of view
Analyzing why one acted in a certain way
Assessing the results of one's action
Thinking about what happened in a
nursing situation
Becoming aware of how one feels
about
oneself
Requires discipline, action,
openness, trust
Kozier & Erb's Fundamentals of Nursing, Tenth Edition
Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
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Reflection on Practice
Reflective journaling
Writing reflections in a journal provides
a space for the student to look at and
acknowledge the deeper self.
Guidance from a mentor or teacher can
help the student view a nursing
situation from many different
perspectives.

Kozier & Erb's Fundamentals of Nursing, Tenth Edition


Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
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Box 256

A Framework for Reflective Journaling

Kozier & Erb's Fundamentals of Nursing, Tenth Edition


Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
All Rights

Question 1
Which example best illustrates the principle of
knowing the client?
a. The nurse provides a back rub to help the client
relax, and then makes the bed with clean
linen.
b. The nurse listens as the client describes how he
has been caring for his diabetes at home.
c. The nurse administers a piggyback antibiotic for a
client with pneumonia.
d. The nurse collects a urine specimen to send to
the lab, and explains to the client the reason for
the test.
Kozier & Erb's Fundamentals of Nursing, Tenth Edition
Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
All Rights

Question 2

a.

b.
c.
d.

Leininger's theory, culture care diversity and universality, would


provide the best framework for assessing which nursing
situation?
The Indonesian parents of an infant prefer to use hot/cold
therapies to prevent seizures so they withheld the prescribed
seizure medication (phenobarbital).
Staff nurses on a hospital unit discuss how to reorganize
client care to provide more continuity of staff with clients.
Nurses in a community agency search for learning resources
about intravenous therapy in the home setting.
A nurse manager explores ways to assist new nursing graduates
to develop clinical skills on the hospital unit.

Kozier & Erb's Fundamentals of Nursing, Tenth Edition


Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
All Rights

Question 3
The nurse sits with the client and holds
the client's hand as his pain
decreases. This situation is an
example of which caring practice?
a.Nursing presence
b.Assessment
c.Knowing the client
d.Empowering
Kozier & Erb's Fundamentals of Nursing, Tenth Edition
Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
All Rights

Question 4
The nursing student reviews the
pathophysiology of myocardial
infarction in preparation for the next
day's clinical experience. This activity is
an example of which type of
knowledge development?
a.Empirical knowing
b.Aesthetic
knowing c.Personal
knowing d.Ethical
knowing
Kozier & Erb's Fundamentals of Nursing, Tenth Edition
Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
All Rights

Question 5
A nurse sitting quietly in a chair,
breathing deeply and focusing on the
mental image of a crystal is using
which mind-body therapy?
a.Storytelling
b.Yoga
c.Music
therapy
d. Meditation
Kozier & Erb's Fundamentals of Nursing, Tenth Edition
Audrey Berman | Shirlee Snyder | Geralyn Frandsen

Copyright 2016, 2012, 2008


Pearson Education, Inc.
All Rights

02/01/38