A comparative analysis of lay-caring and professional (nursing) caring relationships

Acceptable definitions of the terms care and nursing have yet to be reached. Some may feel that lack of agreement on the meaning of these concepts is a rather esoteric or academic point: the argument put forward in this paper is that until a clearer perception of the concepts of care and nursing is arrived at, the profession will be limited in its ability to develop its expertise or to set standards related to the quality of care. The paper outlines the extent to which these concepts have been explored and details the developments and some of the limitations of present modes of thought. An alternative perspective is offered, based on a comparative analysis of the professional (nursing care) and lay-caring relationships. By this means, a set of characteristics similar in both relationships has been identified. Quality of care in the professional caring relationship is thought to relate to the extent to which aspects of caring activities implicit in the lay-caring relationship are carried into the professional nurse-patient relationship and made explicit. The ability of the nurse to do this emerges as one aspect of her therapeutic nursing function.     

The CCARE model of clinical supervision: bridging the theory-practice gap

Clinical supervision of nursing students is a key component of nursing education. The clinical setting provides students with an opportunity to develop a professional identity, knowledge base, and the ability to transfer classroom knowledge to the clinical setting. This paper suggests a model of clinical supervision that will address how to bridge the pre-existing theory-practice gap in nursing education through an attitude of caring and the utilization of caring behaviours based on Leininger's theory of culture care. Key concepts included in this model are: communication, collaboration, application, reflection and evaluation, these concepts comprise the CCARE model of clinical supervision.     

Care: what nurses say and what nurses do

Caring is neither simply a set of attitudes or theories, nor does it comprise all that nurses do. Nursing care is determined by the way nurses use knowledge and skills to appreciate the uniqueness of the person they are caring for (changing the care noun into a caring verb). The purpose of this article is to present a range of contemporary nurse theorists' ideas on caring and to examine these ideas using the backdrop of nursing as practiced in both Australia and Canada to demonstrate a range of national and international similarities and theoretical beliefs. Caring relationships set up the conditions of trust that enable the one receiving the care to accept the help offered, underpinning the nurse-patient relationship or the therapeutic relationship. Caring is always specific and relational such as that found in the nurse-patient relationship. We believe that caring theory has much to offer nursing practice worldwide. Caring must be considered in the caring context because the nature of the caring relationship is central to most nursing interventions. Nurses need to be able to actually practice caring rather than just theorize about it-using caring theories to inform their practice.     

Qualitative convergence of three nursing concepts: art of nursing, presence and caring

Title.  Qualitative convergence of three nursing concepts: art of nursing, presence and caring.
Aim.  This paper is a report of the development of a theoretical framework of nursing practice based on the convergence of the concepts art of nursing, presence and caring.
Background.  Convergence of similar concepts to form broad yet useful theories is a relatively unexplored area, despite the fact that systematically examining and integrating nursing concepts can help to build theory and leads to enhanced understanding of the discipline. Research results suggest that unarticulated similarities exist among the art of nursing, presence and caring; thus, qualitative convergence of these concepts is justified.
Data sources.  Findings from qualitative studies of the art of nursing (published between 1993 and the third quarter of 2006) and meta-syntheses of presence and caring (published in 2006 and 2007 respectively) were inductively analysed and integrated.
Results.  A theoretical framework of nursing practice was developed to illustrate the areas of convergence among the concepts art of nursing, presence and caring. Nursing involves an intimate relationship-centred partnership between the nurse and patient. Situation-specific nursing actions result from multiple forms of personal and professional knowledge and are based on a value system of holistic beneficence and patient empowerment. Nursing actions are promoted by a conducive work environment and result in enhanced well-being among patients and nurses.
Conclusion.  Results of this concept convergence provide an enhanced understanding of nursing practice and offer insight into areas of nursing practice that are not encompassed within the concepts art of nursing, presence and caring. Further work is recommended to expand the proposed framework, especially in terms of the wide variety of nurse–patient relationships that exist.     

Exploring boundaries in pediatric oncology nursing

Professional patient boundaries are an issue that is relevant across all realms of nursing practice. By nature, nurses are caring individuals. Therapeutic relationships are integral to the care of patients. When caring for patients on a daily basis for extended periods of time, it can be difficult for nurses to know when their care goes beyond professional boundaries. Providing care to patients in a pediatric oncology situation substantially increases this ethical dilemma. Length of stay, degree of crisis, embedded relationships, and emotional turmoil, along with the nurturing connection between adult and child, are among the reasons that boundaries are often blurred within the context of this sensitive patient population. This article explores the differences between nursing care, boundary crossings, and boundary violations. Strategies to evaluate nursing actions for appropriateness, along with reflection and development of individual boundaries, are offered. The information presented is relevant not only to nursing care of pediatric patients who are facing chronic or life-threatening conditions but also to each nurse-client relationship established in nursing practice.     

Professional caring: the moral dimension

The concept of caring, its intentions, actions and its achievements, as it relates to nursing is a concept on which many nurses'minds have been focused The concern and at times a major preoccupation with the need to explore and explain caring among the nursing body is a concern which is rooted in sociopolitical and cultural phenomena related to the evolution of nursing The need to explore and explain caring through philosophical discourse is a necessary and an ongoing part of this evolutionary process This paper represents an attempt to partake in such discourse More precisely, the paper undertakes an analysis of the concept of caring as it happens in both nonprofessional and in professional caring contexts and represents an attempt to characterize professional caring In an effort to do this the author considers the moral-ethical dimension of caring in the light of important theoretical positions on social morality When considered against these theories of social morality and against the professionally derived imperatives which guide caring actions, professional caring may be construed as a distinct mode of caring     

Caring theory and practice--entering a simultaneous concept analysis

PROBLEM. To better understand the approach of caring in nursing and the role of theory in practice, we wanted to consolidate the caring theory of Watson with the empirical findings from the three studies performed to reveal nurses' caring intentions and their lived experience of reflecting caring theory in practice. METHOD. Through a simultaneous concept analysis of nine concepts, caring science theory was consolidated with the findings of the three empirical studies to reveal the dynamics of caring theory and caring practice. FINDINGS AND CONCLUSION. These nine concepts were found to be interrelated with the advanced concept of mediating care, which emphasizes that mediating care calls for an authenticity of being and ability—an ability to be present to self and others in the dynamism of openness and frames of thought.     

Management and leadership: a dual role in nursing education

The purpose of this paper is to review the dual concepts of leadership and management in nursing education. It provides a consideration of caring as the end purpose of nursing education and argues that empowered caring makes use of professional academic credentials to form collaborative alliances that influence health care delivery. Inspiring and empowering leadership also transform educational services. In particular the key issues of investing in technology, supporting life long learning and creating a community workplace are addressed. It concludes with the suggestion that the nurse education ought to be led and managed differently.     

Do nurses really care? Some unwelcome findings from recent research and inquiry

This paper examines the position of nursing as a caring profession, in terms of an ethical code that stresses collegial relationships, a sense of obligation to a clientele that is realized in terms of expert service, and a clearly defined body of research-derived knowledge as the basis for practice. It also investigates the substance of the claim that nursing has tended to arrogate to itself another operational distinction—its exclusive capacity to blend physical and emotional support into care. A review of recent research and investigation, undertaken in a number of countries, suggests that nursing as practised, rather than as theorized, fails to fulfil its wider professional aspirations, and to fulfil its caring rhetoric. A related paper will consider how the absorption of nursing into higher education might begin to play a part in developing and consolidating the professionalization of nursing.     

Professional nursing care in Tanzania: a descriptive study of nursing care in Ilembula Lutheran Hospital in Tanzania

The purpose of this ethnonursing study is to find new knowledge of the professional nursing care practised in a Bantu cultural context in Tanzania The main questions are How do Bantu nurses describe nursing? What components are there in professional nursing care in Ilembula Lutheran Hospital? The data were collected through participant observation, interviews and personal working diaries in Ilembula Lutheran Hospital Six Tanzaman nurses were interviewed The findings indicated that nursing was based on formal training on one hand, and on a natural mother-child relationship on the other hand The idea of respect towards life, which is central to the Bantu philosophy of life, guided nursing care In professional nursing care there emerged curing and caring components Protection, encouragement and comfort were distinguished as the main constructs of caring     

Nursing care in labour and patient satisfaction: a descriptive study

This study examined the subjective needs of labouring patients. A convenience sample of 80 postpartum patients was interviewed. They described the nursing care they had received, indicated the most helpful nursing measure received, and rated their satisfaction with their nursing care. These answers were categorized into types of nursing care. These were supportive care nursing, physical care nursing, medications and combinations of these three. X2 calculations done between these categories and satisfaction scores indicated a significant relationship between the type of care a patient received and her satisfaction scores. Patients found combined care very satisfying, but supportive care was the decisive factor in the way patients viewed their nursing care. The most frequently mentioned element in supportive care was the ability of the nurse to be a sustaining presence. The nurse's ability to assess and to meet the patient's need or non-need for her presence was major factor in patient satisfaction with nursing care in this sample. The relationship between congruency (agreement between time wanted and time spent by the nurse at the bedside) and satisfaction scores was highly significant. Thus the ability to recognize and respond to the patient's need or non-need for her presence was a crucial factor in patient satisfaction and in the way in which a nurse allocated her time. The relationships between numbers of nurses caring for a patient, parity, length of labour, presence of visitors, worries about the baby and patient satisfaction scores were examined. All were non-significant. However numbers of nurses caring for a patient was defined as a contributing factor to the delivery of supportive care nursing. More nurses contributed to more supportive care nursing being given, but was not the major factor in the delivery of supportive care nursing. Finally it was shown that the administration of syntocinon to patients in this sample decreased patient satisfaction with nursing care. Implications and possible reasons for these results are discussed.     

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     

Continuities in caring? Emotion work in a NHS Direct call centre

Changes in technological and economic aspects of society have impacted on how we understand professional and client relationships. These relationships are constructed in terms of patients/users requiring care, and customers whose complaints have become a yardstick of satisfaction. A consequence of these changes is an interest in the related concepts of emotional labour and emotion work. For nurses, caring for people in illness and in health is central to their work, and it is this aspect of emotion at work that distinguishes nursing from other occupational groups. This paper is concerned with emotion work in a National Health Service Direct (NHS Direct) call centre in the United Kingdom. Drawing upon theoretical perspectives from organizational psychology and sociology it focuses upon the social processes that narrate emotion events in a specific context. It is based on a qualitative study exploring the experience and emotion work of nurses working in a call centre. Issues in caring without the face-to-face contact using communication technology were crucial to the way nurses perceived their work. These factors contributed to nurses' orientation to work and to the way that conflict and dissonance with expectations of callers and managers impacted on nurses' emotion work.     

Nursing on the medical ward

This paper considers some issues confronting contemporary medical nursing and draws upon psychoanalytic theories to investigate some seemingly straightforward and taken-for-granted areas of medical nursing work. I am arguing that the everyday work of medical nurses in caring for patients is concerned with bringing order to and placing boundaries around inherently unsettled and destabilized circumstances. I am also arguing that how nurses manage and organize their work in this regard stems from traditional practices that tend to be taken for granted and not explicitly thought about. It is therefore difficult for nurses to consider changing these practices that often have negative consequences for the nurses. I want to examine the impact upon nurses of the consequences of three taken-for-granted nursing practices: (i) the tendency of nurses to confine their reactions to what is going on so as to present a caring self; (ii) the tendency of nurses in their everyday talk to patients to confine, limit and minimize meaning; and (iii) the tensions and ambiguities that emerge for nurses in the policing function they perform in confining patients to the bed or the ward. Negative consequences on nurses of these practices potentially include stress and confusion regarding their ability to care for patients; an undervaluing of nursing skills; and a deterioration in the nurse-patient relationship. Clinical supervision for medical nurses is proposed as a means of facilitating greater understanding of the nature of nurses' relationships with patients and the complex dimensions of their medical nursing role.     

Boundaries: ethical implications for what it means to be therapeutic in the nurse-person relationship

The nurse-person relationship is sometimes regarded as the essence of professional nursing practice. Many biomedical nursing definitions and connotations have emerged over time for what it means to practice professional nursing with boundaries in a therapeutic nurse-person relationship. In this column the author compares, contrasts, and offers a unique disciplinary perspective with regard to these terms. Ethical implications for developing professional relationships through the nursing disciplinary lens of the human becoming school of thought are explored.     

Hospice experience and perceptions in nursing homes

The purpose of this study was to describe the experiences and perceptions of hospice nurses caring for residents in long-term care facilities. The study used a fax-back survey to gather data from 69 hospice nursing and nurse managers in 24 hospices across one Midwestern state. Respondents reported negative experiences with pain management and care coordination in the nursing home setting. Although hospice is thought to be a benefit to residents, hospice staff report frustration in caring for nursing home patients, especially in trying to control pain. The study identifies opportunities for improvement in hospice and nursing home staff relationships.     

Turkish nursing students' perception of caring

Although caring is a difficult entity to explain or define, many authors consider that caring is the central and unifying domain of nursing. It is important that nursing students understand what care is in order to be clear about what good nursing care is. This qualitative study was conducted to clarify Turkish nursing students' perception of caring. The sample was 19 last year undergraduate nursing students who volunteered to be involved in this study. Nursing students were asked to write incidents in which they observed nursing behaviours conducted in caring and noncaring ways. Then the students were interviewed to clarify why nursing behaviours that were addressed in their written incidents were considered as caring or noncaring. Data which obtain from students' reports and interviews were analyzed and themes of caring were formed into two groups: professional/helping relationship and technical competency.     

Esthetic abilities: a way to describe abilities of expert nurses in palliative home care

Aim. The aim of this paper is to focus on the abilities needed to create the caring relation in palliative home care and to find ways to describe these abilities and skills from an esthetic perspective. Background. Nurses in Palliative home care have to create a functioning relationship between themselves the patient and the patient's next of kin, this puts special demands on the nurse. A number of abilities, such as creativity, intuition, empathy and self‐knowledge are mentioned in literature related to the caring relation. Many nursing theorists have referred to the art and esthetic of nursing when trying to describe these abilities. Methods. Data were collected using semi‐structured interviews with eight expert nurses in palliative home care. The transcribed interviews were analysed using qualitative content analyses. Findings. Three main categories where found: The will to do good, Knowledge and Perceptiveness. Subcategories that can be seen as abilities where found in the main categories knowledge and perceptiveness. Conclusions. The main categories can be seen as expressions for abilities, personal qualities and skills needed to create the caring relation in palliative home care. We found interesting connections between the three main categories and the concepts of esthetics, ethics and science. We also found that nurses develop in a way, i.e. similar to an artist. Relevance to clinical practice. The concepts brought forward in this paper could be used in clinical supervision and education as well as in clinical practice. If nurses think about the three aspects: Knowledge, the will to do good and perceptiveness, the chance for a positive relation between the nurse and the patient, and the patient's next of kin might increase. One could speculate that perceptiveness is a vital ability in order to achieve the expert level of nursing and that this perspective should be taken in consideration when recruiting nurses and in curriculum development.