Chapter 3

NURSING as an ART
 CARING
 a universal phenomenon influencing that ways in which people think,
feel and behave in relation to one another
the unique characteristic of the nursing profession
knowledge, skills and caring attitude
caring is the key component that brings nursing to a patient experience
technological competency should be couple with caring
caring makes enormous contribution to the health and well-being of the
patients
caring results to respectful and therapeutic interaction with people
nursing is CARING
Caring Practice Models

Benner and Wrulbel

Transcultural Caring by Madelein
Leininger
Transpersonal Caring by Jean Watson
Theory of Caring by Swanson
 Benner and Wrulbel (1989)
 THE PRIMACY OF CARING: a theory of what it is to be a person and
what it is to live in the world
 nurses’ behaviors and decisions are an expression of CARING
 caring means that people, events, projects and things that MATTER to
people
 it means BEING CONNECTED
 through caring, nurses help patients recover from illness, give
meaning to that illness and maintain or to restablish connection
Patricia Benner and Judith Wrubel
“ Care is the essence and the central,
unifying and dominant to characterize
nursing”

“Human caring is a universal

phenomenon, but the expressions,
process and patterns vary among
cultures”
Cultural Aspects of Care:
1. Know the patient’s belief and attitudes regarding health care and
caring practices.
2. Know the patient’s cultural practices regarding end-of-life care. In
some cultures, it is insensitive to tell the patient that she is dying.
3. Determine if the member of the patient’s family or cultural group is
the best resource to guide the use of caring practices such as
providing presence or touching
4. Know the patient’s cultural practices regarding the removal of life
support
5. Know the patient’s cultural practices regarding care of the body after
death.
The 3 modes of nursing care decisions & action:

1. culture care preservation and maintenance

2. culture care preservation and accomodation
3. culture care restructuring or repatterning
 The 6 C’s of Caring
Care - it defines us
Compassion - how care is given through empathy, respect and dignity
Competence - the ability to understand individual’s health and social needs
and the expertise, clinical and technical knowledge to deliver effective care
and treatment
Communication - “ no decision about me without me”; it is essential in
successful caring relationship
Courage - doing the right thing for the people we care for
Commitment - building the commitment to improve the care and
experience of our patients
 CARING in Nursing Practice
PROVIDING PRESENCE
person-to-person encounter providing closeness and sense of caring
“ being there” and “ being with”
being there means nurse is being attentive to patient
being with means making time, being available to the patient
to create openness and understandin: requires presence, eye contact, body language,
voice tone, listening and postive / encouraging attitude
nursing presence improves patient satisfaction, calms anxiety and fear
TOUCH OR COMFORTING
touches reaches out to patient; communicates concern and support
can be contact ( skin-to-skin) and uncontact touch ( eye contact)
 nurse must be AWARE FIRST of the patient’s cultural practices and past experiences
regarding touch
touch can be perceived as invasive or as a threat
must be use with DISCRETION because patietn may respond positively or negatively
1. TASK-ORIENTED TOUCH - convey sincerity and competence of skill in performing
procedures to reduce anxiety of patient
2. CARING TOUCH - a nonverbal communication that influences a patient’s comfort,
self-esteem and mental well-being; holding a patient’s hand,
give a back massage; connecting physically and emotionally
3. PROTECTIVE TOUCH - to protect the nurse and/or patient
 TYPES OF PERSONAL SPACE
PROXEMICS - the study of space in human social interactions

1. Intimate Distance - direct body contact; can provide comfort,

acknowledgement or protection; unwanted touch can be interpreted as
assault or harassment
2. Personal Distance - maintains 1-4 feet distance; may convey respect and
professionalism in work interactions
3. Social Distance - maintians 4-12 feet distance; ideal for situations
requiring formality
4. Public Distance - maintains 12-25 feet distance; for large audience for
public speaking; necessary to effective learning
LISTENING
Caring through listening
active listening to what the patient says leading to knowing and responding to
what really matters
enables the nurse to become a participant in the patient’s life
to be effective, silence yourself: mouth and mind and gve focused attention
can be difficult to do especially when the nurse is distracted with many things
to do at work
KNOWING THE PATIENT
a complex process but essential in patient-centered care
the core of clinical decision-making process
it results from a caring relationship between the nurse and patient
nurse intentionally engages in continuous assessment, noting the needs of
the patient in all aspect of his health
2 essential elements in knowing:
1. continuity of care
2. clinical expertise
knowing develops over time and it is affected is care is fragmented
nurse avoid assumptions but rather be keen on information and cues to
facilitate critical thinking and sould cliical judgment
not knowing a patient can lead to accidents
SPIRITUAL CARING
spirituality is a sense on connectedness intrapersonally ( with onself) and
interpersonally ( connected with the unseen, with God or a higher power)
according to Jean Watson:
1. It mobilizes hope for the patient and the nurse
2. It finds an interpretation of understanding of illness, symptoms or emotions
that is acceptable to the patient.
3. It will asissts the patient in using social, emotional or spiritual resources
4. It recognizes that caring relationship connects human to human, spirit
to spirit
the nurse’s individual life values, goals and belief system will affect his own
physical well-being
nurses whose spiritual caring practices are developed early will incorporate
these practices into the routine care
RELIEVING SYMPTOMS and SUFFERING
more than giving medications
involves nursing actions that give patient the comfort,dignity, respect and peace
means giving necessary comfort and support measure to the family and significant
others
human suffering is multifaceted; affecting the patient physically, emotionally, socially
and spiritually
FAMILY CARE
signifcant support system to the patient
also needs caring relationship with the family
nurse caring behaviors can be perceived by the family positively or negatively
The challenges of NURSING
Compassion Fatigue

BURNOUT -
the condition that occurs when
perceived demands outwieght
the perceived resources;
 a state of physical and mental
exhaustion that often affect
health care providers because of
the nature of their work
environment
optimal care is compromised
Secondary Traumatic Stress (STS)
negative behavior and fear
trauma after having witnessed the trauma
suffered by others
it usually affects the nurses working in
emergency dept, oncology unit, ICU
can affect the delivery of high quality care to