NURSING AS AN ART

TOPIC OUTLINE:
Nursing as an Art
Caring Practice Model
Caring for Self and Others
Communication
Therapeutic Communication
Helping Relationship
The Nursing Profession...
an Art or a Science?
The Nursing Profession has two different sides,
it is both Science and an Art

Science
Art
Nursing as a Science
It is the "body of knowledge" arrived through
scientific research and logical analysis
Is the scientific knowledge and skills in assisting
individual to achieve optimal health. It is the
diagnosis and treatment of human responses to
actual or potential problem
 What is an ART?
the expression or application of human creative skill
and imagination, typically in a visual form such as
painting or sculpture, producing works to be
appreciated primarily for their beauty or emotional
power.
What makes Nursing an ART?
the innate capacity to respond to the needs of
individual is the art of nursing. In studying nursing,
this vivacity is awakened through constant
interaction with the patients in various settings.
What makes Nursing an ART?
the art of nursing comes in as a nurse
independently does his or her job. The options s/he
considers in taking a certain action and ultimately
the action s/he does to respond to patient needs
are the art of nursing.
What makes Nursing an ART?
Nurses teach, support, communicate, medicate and
coordinate patient-care events
The art of nursing is in play when nurses just 'know'
what to do to meet a patient's emotional needs:
when to hold a patient's hand, stroke their brow,
crack a joke or even just sit and listen.
What makes Nursing an ART?

The science of nursing allows us to care for our

patient's bodies; but it is the art of nursing that
calls to the profession and allows each nurse to
touch souls.
"Nursing...its very essence lies in the
creative imagination, the sensitive spirit,
and the intelligent understanding that
provides the very foundation for
effective nursing care." Donahue, 1985
Nursing as an Art
Is the art of caring sick and well individual. It refers
to the dynamic skills and methods in assisting sick
and well inidivdual in their recovery and in the
promotion and maintenance of health. It involves
the creative application of knowledge in the service
of people.
 +
= Caring
 CARING
An Integral Aspect of Nursing
Introduction

In this age of technologic competence and efficiency, the

knowledge and skills embedded in caring practices are often
overlooked.
Technology does not negate caring; in fact, the isolation that may
accompany technology makes the significance of caring all the
more important (Diener & Hobbs, 2012).
Introduction

Caring is a dimension of human relating, and often referred to as

the art of nursing
Nursing cannot exist without caring. Smith, 2013
Caring is central to all helping professions, and enables people to
create meaning in their lives.
Caring is sharing deep and genuine concern about the welfare of
another person.
Caring Practice

involves connection, mutual recognition, and involvement between

nurse and client.
Examples of caring, emerging from nursing situations:
A client experiencing postoperative pain is given medication to
control her symptoms, and then the nurse talks quietly and
holds her hand for a few minutes, as the pain resolves. The
nurse's presence, in itself, provides comfort for the client.
Caring Practice

just as clients benefit from caring practices, the nurses involved in

these situations experience caring through knowing that they have
made a difference in their clients’ lives.
when nurses feel free to concentrate their attention on others, they
can make a positive difference to clients.
the ability to give clients focused attention means living the
egocentric self behind.
Caring as "Helping the Other Grow”

Caring is a process that develops over time, resulting in a deepening

and transformation of the relationship. Recognizing the other as
having potential and the need to grow, the caregiver does not
impose direction, but allows the direction of the other person's
growth to help determine how to respond.
MAJOR INGREDIENTS OF CARING
1. Knowing
understanding the other's needs and how to respond
to the needs.

2. Alternating Rhythms
signifies moving back and forth between the immediate
and long-term meanings of behavior, considering the past;

3. Patience
enables the other to grow in his own way and time.
4. Honesty
includes awareness and openness to one's own feelings
and a genuineness in caring for the other.

5. Trust
involves letting go, to allow the other to grow in his own
way and own time;

6. Humility
acknowledging that there is always more to learn, and that
learning may come from any source.
7. Hope
belief in the possibilities of the other's growth

8. Courage
is the sense of going into the unknown, informed by insight
from past experiences.
CARING PROCESS BENEFITS
Caring Process has benefits for the one giving care
Mayeroff 1990

helping the other person grow, the caregiver moves

towards self-actualization
caring and being cared for, each person "finds his
place”in the world
serving others through caring, individuals live the
meaning of their own lives.
NURSING THEORIES ON CARING

Culture Care Diversity and Universality, Leininger

Theory of Bureaucratic Caring, Ray
Caring, the Human Mode of Being, Roach
Nursing as Caring, Boykin and Schoenhofer
Theory of Human Care, Watson
Theory of Caring, Swanson
Caring with
COMPASSION
Awareness of one's relationship to others, sharing
their joys, sorrows, pain and accomplishments.
Participation in the experience of another.
Caring with
COMPETENCE
Having the knowledge, judgment, skills, energy,
experience and motivation required to respond to
the demands of one's professional responsibilities.
Caring with
CONFIDENCE
Comfort with self, client, and others that allows one
to build trusting relationships.
Caring with
CONSCIENCE
Morals, ethics and an informed sense of right and
wrong. Awareness of personal responsibility.
Caring with
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.
Caring with
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.
Qualities of a Healer
wisdom and insight
love of humanity
ability to shre another's pain
courage to offer hope
courage to face the unknown
profound compassion
presence and connectedness
comfort with own and other's spirituality
empowers others
sense of humor
MAINTAINING CARING
PACTICE
Caring for SELF
the concept of caring for self seems almost
foreign to many nurses and students of nursing
because of the professional emphasis on
meeting others’ needs.
nurses take on multiple commitments to
family, work, school and community that they
are at high risk of exhaustion, burnout and
stress
Caring for SELF
self-care, when defined as responding to one's
own needs to grow, is the opposite of the self-
complacency that often accompanies
egocentricity.
Caring for self means taking the time to nurture
oneself.
it involves initiating and maintaining behaviors
that promote healthy living and well-being.
Caring for SELF
self-care focuses on care of the self in the
deepest sense.
self-awareness and self-esteem are intimately
connected to self-care.
Types of Self-care
Physical
Social
Mental
Spiritual
Emotional
COMMUNICATION
COMMUNICATION
is the effective sharing or transmission of facts,
opinions or emotions by two or more people.

The components of communications are:

SENDER
MESSAGE
RECEIVER
FEEDBACK
Why do we communicate

to express our emotions

achieve joint understanding
to get thing done
pass on and obtain information
reach decision
develop relationship
COMMUNICATION PROCESS

refers to the exchange of information (message)

between 2 or more people, to succeed, both parties
must able to exchange information and understand
each other.
In nursing, communication is a dynamic process used
to gather assessment data, to teach and persuade, and
to express caring and comfort.
It is an integral part of the helping relationship
COMMUNICATION PROCESS

Nurses who communicate effectively are better able to

collect assessment data, initiate interventions,
evaluate outcomes of interventions, initiate change
that promotes health, and prevent the safety and legal
problems associated with nursing practice.
The communication process is built on a trusting
relationship with a client and support people.
Effective communication is essential for the
establishment of a nurse-client relationship.
MODES OF COMMUNICATION
Written – letter, memos, reports
Spoken - conversation, interviews phone calls, requests
Visuals – photographs paintings, videos, film

Non-verbal – facial expression, postures, actions, voice tone, silence

Proxemics- the branch of knowledge that deals with the amount
of space that people feel it necessary to set between themselves
and others.
Phonetics- the study and classification of speech sounds.
Multimedia – television, newspaper, magazines, internet
ELECTRONIC COMMUNICATION
ADVANTAGES
Fast
Efficient
Legible
Improves communication, continuity of care

DISADVANTAGES
Risk of breach of client confidentiality
Socioeconomics
EFFECTIVE WRITTEN COMMUNICATION

Does not convey non-verbal cues

Same as verbal
Appropriate language and terminology
Correct grammar, spelling, punctuation
Logical organization
Appropriate use and citation of resources
CHARACTERISTICS OF GOOD COMMUNICATION
1. Simplicity
use of commonly understood word and completeness
2. Clarity
involves saying exactly what is meant, needs to speak slowly,
repeat the message as needed and reduce distractions
3. Timing and Relevance
require choice appropriate time and considerations to client’s
interest and concerns. Ask question at a time and wait for an
answer before making another comment.
CHARACTERISTICS OF GOOD COMMUNICATION
4. Adaptability
involves adjustment on what the nurse says and how it is said
depending on moods and behavior of the client.

5. Credibility
means worthiness and belief, that needs knowledge the topic
being discussed
THERAPEUTIC COMMUNICATION
a fundamental component in all phases of the nursing process
and for establishing effective nurse-client relationship.
Effective nurse-client relationship
is a helping relationship which is growth-facilitating and
provides support, comfort and hope.
NURSE-PATIENT RELATIONSHIP
it is an interaction between two person’s in the nurse offers a
series of purposeful activities and practice that are useful to
particular patient.
CHARACTERISTICS OF AN EFFECTIVE
NURSE-PATIENT RELATIONSHIP

Focuses on client’s well-being

Based on mutual trust, respect and acceptance
Maximizing the client’s abilities to participating
in decision-making
FACTORS INFLUENCING
COMMUNICATION PROCESS
Development and Gender
Sociocultural characteristics
Values and Perception
Personal space and territoriality
Roles and relationships
Environment
Congruence
Attitudes
DEVELOPMENT
language and communication skills develop through
stages
communication techniques for children
play
draw, paint, sculpt
storytelling, word games
reading books, movies and videos
writing
GENDER
females and males communicate differently
from early age
BOYS- establish independence, negotiate status
GIRLS- seek confirmation, intimacy
SOCIOCULTURAL
culture
education
economic level/status
VALUES AND PERCEPTION

VALUES- standards that influence behavior

PERCEPTION- personal view of an event
unique personality traits, values, experiences
requires validation
PERSONAL SPACE

personal space influences communication in social and professional

interactions. Encroachment into another individual's personal space
creates tension.

defined as distance peope prefer in interactions with others

Proxemics
Intimate distance- frequently used by nurses
Personal distance- less overwhelming
Social distance- increased eye contact
Public distance
TERRITORIALITY
space and things
individual considers as belonging to self
"knock before entering"
may be visible
curtains around bed unit
walls of private room
ROLES AND RESPONSIBILITIES
between sender and receiver
first meeting versus developed relationship
informal with colleagues
formal with administrators
length of relationship
ENVIRONMENT
can facilitate effective communication
key factors
comfort
privacy
CONGRUENCE
Congruence
verbal and nonverbal cues match
seen by nurse and client
Incongruence
sender's true meaning in body language
Improving nonverbal communication
Relax; use gestures judiciously
Practice; get feedback on nonverbal
ATTITUDES
Interpersonal attitudes
attitudes convey beliefs, thoughts, feelings
caring, warmth, respect, acceptance
facilitates effective communication
Condescension, lack of interest, coldness
inhibits communication
Effective nursing communication
Significantly related to client satisfaction
BARRIERS TO COMMUNICATION
Stereotyping Rejecting
Agreeing and disagreeing Changing topics
Being defensive Unwarranted reassurance
Challenging Passing judgment
Probing Giving common advice
Testing
HELPING RELATIONSHIP
HELPING RELATIONSHIPS
Nurse-client relationship are referred to by some
as interpersonal relationship, by others as
therapeutic relationship, and by still others as
helping relationship.
A helping relationship may develop over weeks of
working with a client, or within minutes after
initial interaction.
HELPING RELATIONSHIPS
Helping is a growth-facilitating process that strives to
achieve three basic goals (Egan, 2014):
1. Help clients manage their problems in living more
effectively and develop unused or underused
opportunities more fully.
2. Help clients become better at helping themselves in
their everyday lives.
3. Help clients develop an action-oriented prevention
mentality in their lives.
HELPING RELATIONSHIPS
The personal and professional characteristics of the nurse and
the client influence the helping relationship.
AGE, GENDER, APPEARANCE, DIAGNOSIS, EDUCATION,
VALUES, ETHNIC and CULTURAL BACKGROUND,
PERSONALITY, EXPECTATIONS, and SETTING can all affect the
development of the nurse-client relationship
consideration of all these factors, combined with good
communication skills and sincere interest in the client's
welfare, will enable the nurse to create a healping relationship.
KEYS TO THE HELPING RELATIONSHIP

a. the development of trust and acceptance between the

nurse and the client

b. an underlying belief that the nurse cares about and

wants to help the client
DEVELOPING A HELPING RELATIONSHIP
The following points are important to develop a nurse-client
relationship or helping relationship

*Listen Actively
*Be Honest
*Be aware of Cultural Differences
*Maintain Client Confidentiality
*Know your role and limitations
HEALTH PROMOTION
HEALTH PROMOTION

are activities directed toward increasing the level of

well-being and self-actualization

*by assisting individuals in taking control and be

responsible for their health risk and improve quality
of life.
TYPES OF HEALTH PROMOTION PROGRAMS

Information Dissemination
Health Appraisal Wellness Assessment Programs
Life style and Behavior Change
Environmental Control Program
Health Promotion Model by Nola Pender
conceptualized that motivation to participate
in health-promoting behavior is influenced by
cognitive-perceptual and modifying factors.
LEVELS OF PREVENTION
PRIMARY PREVENTION
encourages optimal health and to increase the
person’s resistance to illness (health promotion and
specific protection).

ex: smoking cessation

regular exercise
immunization
SECONDARY PREVENTION
known as health maintenance, involves early
diagnostic\detection and prompt treatment to limit
disability

Example:
1. Monthly Breast Self-Examination for woman who
are 20 years and above
2. Sputum exam for tuberculosis
TERTIARY PREVENTION
supports client’s achievement of successful
adaptation to known risks. Optimal reconstitution and
establishment of high-level wellness.

Example:
1. Self-monitoring of blood glucose level
2. Physical Therapy after Cerebrovascular
Accident/Stroke
NOTHING FOLLOWS