An action research on the development of a caring curriculum in Taiwan

The purpose of this study was to plan, develop, implement, and evaluate the effectiveness of the first-year course of a 5-year nursing caring curriculum. An action research method involving participant observation investigated how 18 instructors in a junior college nursing program implemented caring in the course. Data gathered through observation, interviews, and questionnaires were used for evaluation and revision of the course. Results included development of the framework for the caring curriculum and the contents of the first-year course, Introduction to Caring. Course content included the concepts of caring ("love and sincerity," "caring communication," "empathy and respect," "acceptance and trust," and "offering of self"), performance of caring actions ("care of self," "care of family members," and "care of peers"), and caring motivations ("caring reinforcing factors" and "caring restraining factors"). Teaching strategies included role modeling, dialogue, reflection, journaling, and caring groups. Evaluation showed that student caring knowledge, attitudes, and behavior improved after course implementation.     

Meta-synthesis of presence in nursing

AIM: This paper reports a meta-synthesis of the concept of presence. BACKGROUND: Presence is a complex concept that is vague and poorly defined. It is often confused with other concepts such as caring, empathy, therapeutic use of self, support and nurturance. Adding to this confusion is the fact that presence has been fragmented into numerous types, used indiscriminately and combined with other concepts such as caring. METHOD: The nursing literature was searched using the cinahl, Dissertation Abstracts and Missouri Bibliographic Information User System databases and the keywords presence, concept analysis, qualitative studies, grounded theory, phenomenology and ethnography. The reference lists of the sources were also scrutinized. Four linguistic concept analyses and 14 qualitative studies of presence were identified and a meta-analysis was conducting using these. FINDINGS: Presence is an interpersonal process that is characterized by sensitivity, holism, intimacy, vulnerability and adaptation to unique circumstances. It consists of a process in which patients demonstrate a need for and openness to presence. In turn, nurses must be willing to enact presence and practice within an environment that is conducive to it. Nurses must also possess personal and professional maturity and base their practice on moral principles of commitment and respect for individual differences. The process results in enhanced mental well-being for nurses and patients and improved physical well-being for patients. In keeping with the nature of a process, the consequences of presence go on to influence its future enactment. CONCLUSION: Advanced concept analysis methods should be used to further explicate presence and differentiate it from other nursing constructs. Until this is done, scholars are cautioned against parsing the term and combining it with vaguely defined nursing concepts such as caring. Researchers are urged to consider how presence can be preserved using tele-health technology and in time-sensitive healthcare settings.     

The role of empathy in the care of dementia

The role of empathy in the care of dementia
The concept of empathy in relation to caring is reviewed. A variety of definitions of empathy are considered to show how empathy has been used within general nursing practice A wide range of literature is drawn on to gain insights into the multifaceted and diverse information on this topic. The differing perceptions that arise from various professional viewpoints are explored. A set of attributes are identified for empathy and these are considered in relation to clinical practice in elderly mental health.
Three examples of care are discussed to show how emotive empathy can be employed to give an improved direction to care of dementia clients. The concept is reviewed in relation to the particular needs of caring for dementia. It is suggested that it should be included in mental health training. It is concluded that emotive empathy has a vital part to play in the delivery of care for the elderly mentally ill.     

Caring and nursing: a dilemma

The history of caring is intertwined with the history of women and thus with nursing Although nurses have a professional mandate to provide care, the significance, meaning and function of care and caring remains undefined and intangible within nursing Many factors contribute to a dilemma that requires the professional responsibility to care while withholding recognition from those who provide such care Caring is often hailed as the hallmark of nursing This paper considers some of the questions and permutations related to the concept of caring in nursing     

End of life in an Icelandic nursing home: an ethnographic study

Aim: To examine care of the dying elderly in a nursing home in Iceland. Methods: An ethnographic study design was adopted. The study sample comprised all of the nursing home residents, their relatives, and all of the staff working in the nursing home, but with a particular focus on the 11 registered nurses (RNs) on the site. Data was collected through participant observation, semi-structured group interviews with the RNs, and an examination of the nursing home's official records. Underlying themes were discovered using interpretative phenomenology. Findings: Two main themes emerged: that palliative care is the most important element of care in the home, and that RNs are the pillars of caring for the dying elderly in the nursing home. Conclusions: The findings suggest that RNs' professional knowledge can greatly contribute to the care of dying elderly residents in nursing homes. There seem to be many parallels between the condition and wellbeing of very frail nursing home residents and patients in specialized palliative care units for the elderly. Public awareness of palliative care of the elderly in Icelandic nursing homes should be encouraged.     

Furthering caring through nursing education

The nursing students' main quest is for self actualization by attributing meaning to life through caring. To assist student nurses in this quest, the nurse educator needs to plan educational interventions according to an anthropological model that posits care and caring as innate human attributes. Further, the structural essence of what professional nursing caring entails should also be posited as a point of departure for curriculum planning. The author proposes such models. The main implications include that the nursing curriculum must increasingly attend to the emotional needs of nursing students. Curricular content and teaching strategies toward this goal are suggested.     

Lamentation and loss: expressions of caring by contemporary surgical nurses

AIM: This paper is a report of a phenomenological study of caring from the perspective of nurses working on surgical wards. BACKGROUND: While care and caring are complex foundational nursing concepts which have received considerable and ongoing attention from theorists, researchers and clinicians, there has been little research into caring on surgical units. METHOD: A convenience sample of ten nurses working on surgical units in a public teaching hospital in Canada was interviewed using van Manen's phenomenological approach. Data were collected during 2001 using semi-structured interviews. FINDINGS: The major theme of lamentation and loss was identified from the data. Participants revealed a dichotomous tension between what caring should be and what actually occurs. This tension was pervasive and generated lament - an expression of grief and mourning for the loss of caring. The essential structures supporting this theme included lack of time, lack of caring support, tasking, increased acuity, lack of continuity of care, emotional divestment and not caring for each other. Loss and sadness were articulated and participants lamented and grieved about the loss of care in contemporary practice. CONCLUSION: The forces and influences described by participants undermined caring in the new practice milieu. If this is a glimpse of the future, then the values of the nursing profession may be under siege. Caring as the central core, the essence or unifying concept of nursing may be subject to marginalization in contemporary practice.     

Care as a moral attitude in nursing.

The concept of care can be explained in various ways, and it can present a different meaning to each person. Nurses are increasingly aware that good nursing care consists of 'more' than the competent performance of a number of caring activities. For many nurses it is less clear what this 'more' means and what importance it has in nursing. This article will develop a view concerning care considered as a moral attitude. It is argued that care can be considered as a foundational normative concept in the ethics of the nursing profession. The aim is to clarify that nurses do not derive their specific caring identity just from the set of tasks that they perform but also from the way in which they commit themselves to the caring process.     

Exploring nurses' experiences of supporting a cancer patient in their search for meaning.

This article presents the findings from an interpretive phenomenology study looking at nurses' experiences of supporting cancer patients in their search for meaning. Eleven nurses were interviewed from a Medical Oncology Unit and a Bone Marrow Transplant Unit in a central London teaching hospital. Having analysed the interviews, six major themes were identified: the value of experience, understanding the search for meaning, the value of time, the relationships involved, caring and the skills used by nurses, and the difficulties nurses' experienced and the support they needed to continue this role. Like many aspects of nursing care that are intangible in nature, this aspect of care was seen as important and valuable to the nurses in the clinical environments of cancer care. The findings do not represent a definitive approach to this aspect of care, but offer an insight into nurses' experiences. In order to continue this aspect of cancer care, the findings suggest that nurses need support.     

Living a caring presence in nursing: a Heideggerian hermeneutical analysis

While the claim has been made that caring is the most important, central focus of nursing, often the meaning of caring presence in nursing and human caring in general is so deeply embedded in our consciousness and our cultural practices that its presence is invisible or taken for granted The purpose of this Heideggerian hermeneutical study was to illuminate nurses' shared practices and common meanings of living a caring presence in nursing Five nurses wrote a story, one they would never forget, of living a caring presence The stones were analysed and interpreted against a background of Heideggerian philosophy to reveal the constitutive pattern, 'caring as the presencing of being' Meaning and complexity of the pattern were revealed in themes that illuminate and articulate the essence of nursing and the phenomenon of caring Themes were the timelessness and spacelessness of caring, creating home, and the call to care as the call of conscience The results can help to answer the Heideggerian question of what a marginalized cultural practice like the profession of nursing can teach a levelling technological society about the meaning of being     

The rhetoric of caring and the recruitment of overseas nurses: the social production of a care gap

Aims and objectives. I will argue that overseas nurse recruitment is the consequence of a care gap, which arose from several policy shifts in the 1990s and in part from the rhetoric of a normative moral discourse in the UK which claims that caring is the moral essence of nursing. I will suggest that this discourse has masked the uncoupling of caring from nursing practice and that this uncoupling places the overseas nurses in a contradictory position. Background. In an increasingly competitive global labour market, the UK is faced with a nursing shortage and has been recruiting trained nurses from abroad (NMC 1993–2002). Design and methods. This paper is based on two related, qualitative studies using semi‐structured focus groups and individual interviews. The first explored the experiences of overseas nurses in the UK and the second investigated the equal opportunities and career progression of overseas nurses in the UK. Results. The data from these studies challenge the normative UK value that caring is at the heart of nursing. These data are the lens through which we see this contradiction explicitly played out. Overseas nurses observe that caring (as undertaken by health care assistants in care homes) is not nursing yet caring is being passed down the line as a process that marginalizes the overseas nurses and at the same time devalues their skills. I do not argue that overseas nurses care at a higher standard (although this may be the case) just that they care differently, that they expected UK nurses to deliver basic care and, instead, experience UK nursing practice as less autonomous and of a lower standard than they expected. Conclusions. I argue that the overseas nurses’ views help us understand the processes by which the uncoupling of caring from nursing has come about. Relevance to clinical practice. This paper discusses a workforce issue which is directly relevant to clinical practice because it focuses on the meaning of care; what is caring, what are caring activities and how are these represented in the discourse on caring in the literature? This paper also reveals significant worries among nursing managers about how to staff the nursing workforce and what nurses should be doing in the clinical areas.     

The essence of nursing care: Polish nurses' perspectives

AIM: This paper is a report of a study to identify Polish nurses' definition of the concept of nursing care. BACKGROUND: Polish nursing currently is in a period of scientific research focusing on development of precise definitions of concepts. Definitions of nursing are influenced by culture, social expectations and healthcare systems. Accepted scientific definitions of concepts should be based on empirical verification that takes theoretical and practical perspectives into account. METHODS: A survey questionnaire was constructed from analysis of a random sample of 27 essays about nursing care that had been completed by 300 Polish nurses. The survey questionnaire, which was designed to measure the essence of nursing care, was completed by 324 Polish nurses during 2004 and 2005. FINDINGS: Analysis of survey questionnaire responses revealed that the essence of nursing care encompasses providing care, communicating, supporting, helping, assisting, accompanying and managing. Participants indicated that nursing care recipients include healthy persons, ill persons and persons at risk for disease. CONCLUSION: The concept of nursing care encompasses several traits or characteristics that can be applied to both well and ill people.     

住院患者对护士关怀行为评价的研究

目的探讨住院患者对护士关怀照顾行为的评价。方法 2014年2-3月,便利抽样选择某市9所三级医院共344名住院患者,采用《关怀照护行为评价表》调查其对护士关怀照顾行为的评价。结果住院患者对护士关怀照顾行为评价总分均分为(3.50±0.50)分。住院患者对护士真诚、同情、尊重行为的评分为(3.52±0.49)分,对其专业照顾行为的评分为(3.46±0.54)分。男性,大学或以上教育程度的住院患者对护士真诚、同情、尊重行为的评分低于女性,高中、初中或以下教育程度的住院患者(均P0.05)。内科住院患者对护士真诚、同情、尊重及专业照顾行为的评分低于外科住院患者(均P0.05)。结论某市三级医院住院患者对护士关怀照顾行为的评价较高。护士应根据患者的需要,提供个体化、精细化的护理服务,以提高患者满意度。     

SARS: caring for patients in Hong Kong

Aim and objective. To explore in depth the experiences of nurses' caring for SARS patients in Hong Kong. Background. Severe Acute Respiratory Syndrome (SARS) dramatically demonstrates the global havoc that can be wreaked by a newly emerging infectious disease. The current literature either has a predominantly biomedical focus or deals with the psychological impact on healthcare workers. Published studies on the lived experience of nurses caring for SARS patients are currently lacking. Design. A phenomenological design. Methods. Using methods consistent with Husserl's philosophy, eight Registered Nurses working in three regional hospitals in Hong Kong were invited to participate in sharing their lived experience of caring for SARS patients and data were analysed using Colaizzi's approach. Results. The three major themes explicated were: the various emotions experienced in caring for SARS patients, the concept of uncertainty and revisiting the ‘taken for granted’ features of nursing. Conclusion. These themes, when taken together, describe the essence of the voyage undertaken by nurses who cared for SARS patients during the outbreak. The findings of this study indicate that extensive and ongoing support is needed to prepare and enable nurses to care for SARS patients during a crisis and make it easier for nurses to deal with the various uncertainties. Relevance to clinical practice. The essence of caring for SARS patients is highlighted in this study. The experience of caring for SARS patients prompts nurses to find meaning in their experience(s), and to develop knowledge and attitudes on how best to care for patients and prepare for a new crisis in the future. This paper considers a more in‐depth understanding of the lived experience of nurses during the crisis and the relevance of this perspective for education and support of nurses.     

An interpretive phenomenological method for illuminating the meaning of caring relationship

This study is a part of a larger project in which the aim is to illuminate the meaning of the caring relationship between patients and nurses in daily nursing practice. Empirical studies in this area inspired from the interpretive phenomenological method are not commonly used. The aim of this paper is to describe how an interpretive phenomenological method was used to illuminate the meaning of the phenomenon caring relationship in daily nursing practice. Data were collected during 16 nursing care proceedings using participant observation with field notes, and in addition to that two interviews, one patient and one nurse. The interpretation moved back and forth between the whole and the parts in a dialectic process. Initial interpretive understanding of interviews and field notes, meaning units and comprehensive understanding were presented. Themes from the patient's interviews were competence, lack of continuity, strain and vulnerability. Themes from the nurse's interviews were competence and striving. Themes from the field notes were interactions towards a goal. The use of interpretive phenomenology offered an opportunity for learning to understand the meaning of the phenomenon caring relationship in daily nursing practice with both strengths and limitations. This study gave an understanding of the phenomenon through the illumination of the patient's and the nurse's thoughts, feelings and actions in the nursing care proceedings that led to a more profound knowledge about how they together create an encounter through their unique competence.     

The empathetic response in nurses who treat pain: concept analysis

Title. The empathetic response in nurses who treat pain: concept analysis Aim. This paper is a report of a concept analysis of empathy. Background. It is widely accepted that an empathetic response is necessary for nurses to deliver adequate pain relief and therapeutic care. Previous work suggests that empathy is a learned behaviour, and thus can be blocked if necessary to diminish personal distress. Methods. A computerized search of the CINAHL, MEDLINE, PsycINFO, and Web of Science databases from 1980 to 2007 was conducted, using the keywords pain and empathy, both alone and in combination. Similar concepts such as sympathy, caring and compathy were included if the database distinguished between these concepts. Twenty‐five relevant articles were reviewed and Rodgers evolutionary concept analysis process was used to clarify the concept. Findings. The recent observation that a mirror‐like neural response occurs in the brain of a person witnessing another in pain provides compelling evidence that empathetic arousal may occur independent of the previously described attributes of prior experience or learned cognitive appraisal. Conclusion. While the empathetic response of care providers plays a central role in the recognition and treatment of pain, nurses are taught that regulation of this response is important to protect themselves against the traumatic effects of seeing patients in pain. However, there is emerging evidence that some elements of empathetic arousal are autonomic and therefore unable to be fully controlled; this may have important implications for nurses’ vulnerability.     

妇幼专科医院护士共情能力在正念水平与关怀能力间的中介作用

目的:调查妇幼专科医院护士关怀能力、正念水平及共情能力,并分析其相关性。方法:采用便利抽样法,于2021年6月选取无锡市某三级甲等妇幼专科医院424名护士作为研究对象,采用一般情况调查问卷、关怀能力量表、正念注意觉知量表和杰弗逊共情量表对其进行问卷调查。采用Pearson相关性分析正念水平、关怀能力及共情能力间的相关性,采用Amos 23.0软件建立结构方程模型,并使用Bootstrap法验证共情能力在正念水平与关怀能力间的中介作用。结果:妇幼专科医院护士关怀能力总分为(162.93±19.96)分,正念注意觉知总分为(64.09±13.10)分,共情能力总分为(104.42±17.02)分;Pearson相关性分析结果显示,关怀能力总分及各维度得分与正念注意觉知及共情能力总分及各维度得分呈明显正相关(P<0.01);Bootstrap法验证了共情能力在正念水平与关怀能力间起部分中介作用,中介效应占总效应的45.52%。结论:妇幼专科医院护士关怀能力处于较低水平,共情能力在正念水平与关怀能力间起部分中介作用,医院管理者应关注护士正念水平及共情能力的评估,为提高护士关怀能力提供借鉴...     

Compassionate care: a moral dimension of nursing *

This paper focuses on the concept of compassion and its meaning for nursing practice. Compassion is often considered to be an essential component of nursing care; however, it is difficult to identify what exactly comprises compassionate care. To begin with, there is a general discussion of the meaning of compassion and an examination of its common usage. An argument then is presented that compassion is more than just a natural response to suffering, rather that it is a moral choice. The paper outlines the extent to which this concept has implications for nursing care, highlighting some of the obstacles that nurses need to overcome in order to maintain this essential moral value of the caring role.