Statement on nursing: a personal perspective.

Contemporary nursing is based on a conglomerate of theoretical nursing models. These models each incorporate four central concepts: person, health, environment, and nursing. By defining these concepts, nurses develop an individual framework from which they base their nursing practice. As an aspiring nurse practitioner in the gastroenterology field, I have retrospectively assessed my personal definitions of person, health, environment, and nursing. From these definitions, I am able to incorporate specific theoretical frameworks into my personal belief system, thus formulating a basis for my nursing practice. This foundation is comprised of the influence of nursing theorists Jean Watson, Sister Callista Roy, Kolcaba, Florence Nightingale, and Ida J. Orlando; the Perioperative Patient-Focused Model; Watson's Theory of Human Caring; theories regarding transpersonal human caring and healing; and feminist theories. Therefore, this article describes self-examination of nursing care by defining central nursing concepts, acknowledging the influence of nursing theorists and theories, and developing a personal framework from which I base my nursing practice.     

Caring as a Scripted Discourse versus Caring as an Expression of an Authentic Relationship between Self and Other

As health care has become increasingly complex, the human caring associated with nursing has become eclipsed by financial bottom lines and managed care initiatives. Because patients and others expect a caring health care system, hospitals have responded in varying ways to re-infuse caring into the patient's experience. This article examines two approaches (the Jean Watson Caring Science Approach and the Studer Group Approach) and considers the effect of each on the authenticity of the nurse patient relationship.     

Holistic care in the critical care setting: application of a concept through Watson's and Orem's theories of nursing

For the critical care nurse, two concerns increase the complexity of competent nursing care. First, the intrusion of technology into the critical care environment is more conducive to the use of the medical model than to a nursing theoretical framework. Technology has quantified body functions that were once elusive to man, enabling practitioners to treat dysfunction and disease. Technology, which has provided health care equipment that can maintain breathing, circulation and other important quantifiers of life, is welcomed by a society that fears finality. Second, the critical care nurse must remain cognizant that technology cannot care for the whole being who is in a health care crisis. Holistic caring, the being-with, the empathy, the interconnected experience of need and response within a nursing theoretical framework is the nurse's art. It is this art of caring that is the qualifier of life. It is the balance of technological competency with the art of nursing that promotes adaptations in health crises. Application of holistic caring through established nursing theories such as Watson's theory of nursing and Orem's theory of nursing enable the critical care nurse to acquire an expert level of nursing care.     

Two portraits of caring: a comparison of the artists, Leininger and Watson

Two nursing leaders, Madeleine Leininger and Jean Watson, have devoted their careers to studying and evolving the meaning of caring. The theme of caring as presented by each theorist was explored along with their views of the nature of nursing, use of theory development strategies, and their individual contributions to the development of nursing knowledge. Both identify nursing as a humanistic science, with the concept of caring being the central unifying domain of nursing. Consistent with their belief that the humanistic sciences require a different research methodology to study that which is uniquely human, both have utilized qualitative research methodologies in their study of care. The evolution of each theorist perspective of care reflects their own background and experiences. Each theorist, therefore, has painted a different portrait of caring, demonstrating a differing emphasis on philosophical, cultural and empirical concerns. For Leininger, caring must be placed in a cultural context since caring patterns can differ transculturally. Watson has focused on the philosophic (existential--phenomenological) and spiritual basis of caring and sees caring as the ethical and moral ideal of nursing. Both Leininger and Watson have demonstrated their artistry in their individual portraits of caring and in their contributions to the development of nursing knowledge.     

The human care perspective in nursing administration

Current environmental and economic forces in health care delivery systems have dramatically influenced the practice of nursing administration. The concept of human care is presented as a basis for nursing leadership and management. Philosophical trends that impact the role of the nurse administrator are explored, with specific reference to the evolution of the concept of care as a central domain in nursing practice. Nursing administrators are urged to maintain and enhance the human caring values inherent in professional nursing practice.     

Caring is more than kindness: modeling its complexities

In today's competitive health care environment, the term "caring" is used to promote positive consumer response to services, but little attention is paid to its substantive nature. Today's nurse executives must be able to articulate the value of nursing to other decision makers as choices are made about where limited health care resources should be distributed. Managerial decision makers are familiar with analyzing problems aided by quantitative data. This presents a challenge to nurse executives because the professional practices of nursing do not always lend themselves well to quantification. Caring is a central focus of nursing practice which is difficult to advance because of problems with its definition and measurement. Presented here is a model of caring which illustrates its complex nature, and which is supported by both quantitative and qualitative data.     

The effects of care and economics on nursing practice

The constant challenge for nurse executives is to provide a caring element for the practice of nursing and the care of patients. While nurses have always viewed human caring as the most important element in nursing, economic issues are challenging the current vision of human care. In this article, the author describes a research project which examined human care and economics in the hospital nursing environment.     

Role modeling excellence in clinical nursing practice

Role modeling excellence in clinical nursing practice is the focus of this paper. The phenomenological research study reported involved a group of 8 nurses identified by their colleagues as exemplary. The major theme revealed in this study was that these exemplary nurses were also excellent role models in the clinical setting. This paper details approaches used by these nurses that made them excellent role models. Specifically, the themes of attending to the little things, making connections, maintaining a light-hearted attitude, modeling, and affirming others are presented. These themes are discussed within the framework of Watson [Watson, J., 1989. Human caring and suffering: a subjective model for health services. In: Watson, J., Taylor, R. (Eds.), They Shall Not Hurt: Human Suffering and Human Caring. Colorado University, Boulder, CO] "transpersonal caring" and [Bandura, A., 1997. Social Learning Theory. Prentice Hall, Englewood Cliffs, NJ] "Social Learning Theory." Particular emphasis in the discussion is on how positive role modeling by exemplary practitioners can contribute to the education of clinical nurses in the practice setting.     

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.     

A charter for caring

The Charter of the Royal College of Nursing commits its membership 'to promote the science and art of nursing'. Nursing is essentially synonymous with caring. The caring role is central to nursing but shared with patients themselves, their relatives and with other health professions. It consists of acts of helping and assisting with daily living activities which may be simple or complex. Giving help may involve not only acting for or doing something for another but guiding, supporting, teaching and providing the right environment for another. The art of helping is built on a scientific basis. Knowledge of underlying scientific principles is needed as a basis of judgement for nursing action. The implications of this view of the primary role of the nurse for education, efficiency and specialization in nursing are reviewed.     

The impact of self-care practices on treatment of interstitial cystitis

Self-care, as a theoretical base of practice in caring for patients with interstitial cystitis (IC), has been suggested as a model of holistic health. Those living with IC look to the nurse/health care practitioner for intervention and care. Nurses operating from the self-care nursing framework may find this model useful in caring for patients with IC. These patients are educated by the nurse regarding preventative measures, interventions, and advanced treatments and therefore may be in a better position to participate in achieving the goal of optimal health. Self-care nursing helps the client to care for themselves through education, resource acquisition, and role-modeling positive behavioral outcomes.     

Development of a framework for person-centred nursing

This paper presents the development and content of a person-centred nursing framework. BACKGROUND AND RATIONALE: Person-centred is a widely used concept in nursing and health care generally, and a range of literature articulates key components of person-centred nursing. This evidence base highlights the links between this approach and previous work on therapeutic caring. METHODS: The framework was developed through an iterative process and involved a series of systematic steps to combine two existing conceptual frameworks derived from empirical studies. The process included the mapping of original conceptual frameworks against the person-centred nursing and caring literature, critical dialogue to develop a combined framework, and focus groups with practitioners and co-researchers in a larger person-centred nursing development and research project to test its face validity. FINDINGS: The person-centred nursing framework comprises four constructs -prerequisites, which focus on the attributes of the nurse; the care environment, which focuses on the context in which care is delivered; person-centred processes, which focus on delivering care through a range of activities; and expected outcomes, which are the results of effective person-centred nursing. The relationship between the constructs suggests that, to deliver person-centred outcomes, account must be taken of the prerequisites and the care environment that are necessary for providing effective care through the care processes. CONCLUSION: The framework described here has been tested in a development and research project in an acute hospital setting. Whilst there is an increasing empirical base for person-centred nursing, as yet little research has been undertaken to determine its outcomes for patients and nurses. The framework developed can be described as a mid-range theory. Further testing of the framework through empirical research is required to establish its utility for nursing practice and research.     

An analysis and evaluation of Watson's theory of human care

Despite a high priority placed on theory-testing in nursing, there continues to be minimal research undertaken which adequately tests nursing theories A study was planned to contribute to theory-testing in nursing by testing an aspect of Watson's (1988) theory of human care Watson essentially believes that nursing is an intersubjective human process and places a high value on the caring relationship between the nurse and the recipient of care Before proceeding with the intended study, the following analysis and evaluation of Watson's theory presented here was undertaken, with guidance from a tool developed by Fawcett & Downs (1992) In this tool, the analysis identifies the concepts and propositions that make up the theory and the evaluation includes the criteria of significance, internal consistency, parsimony, testability and empirical adequacy of the theory being tested Overall, this analysis and evaluation found two areas of Watson's work which were in need of further development     

Reconsidering caring in the home

Section editor’s note: Years ago I came across the writings of Jean Watson and was absolutely awed by the depth and clarity of her thinking in nursing. Her work on caring as the moral ideal of nursing provides fundamental underpinnings of who nurses are and why their services are critical to public health and well-being. Recently, it has been my pleasure to work with Dr. Watson, who has just completed an epilogue for one of my books, Home Care Nursing Practice: Concepts and Application, 3rd edition, which was published this fall by Mosby. It is my privilege to share this work and Jean with you. Robyn Rice, RN-C, PhD(c)     

Essential managerial attributes of the nowadays nursing service manager in the South African context

Nursing service managers need certain essential managerial attributes in taking the lead in effective management of the nowadays health care organisations in South Africa. Major changes in restructuring and human resources planning are taking place through transformation of health services and specific managerial attributes are needed in this scenario. Without nursing service managers with the necessary managerial attributes, change in the health care environment will be hampered and planning, organising, directing and control of the delivering of quality care will be negatively influenced. The research problem was addressed in the following question that guided the study: Which essential attributes/characteristics should a nursing service manager possess to run a health care service effectively? It was unclear what the opinions of all level of nurse managers were regarding the necessary managerial attributes the health services manager currently need to run the current health care services effectively. This study aimed at highlighting the necessary attributes of the nowadays nursing service manager in running a health care institution in the current health care environment of South Africa. Purposive sampling was done and forty-five functional, middle and top-level managers registered for a second year degree course in Health Services Management at a South African university participated in the study. The findings indicated important managerial and leadership attributes, which the current nursing service manager should possess. This article will only discuss the important managerial attributes needed. A conceptual framework came to the fore according to which an example of a self-evaluation instrument was compiled for nursing service managers for future use. The results of the data analysis indicated that the nursing service manager should promote good interpersonal relationships with colleagues, subordinates and patients through the attributes of openness, being inviting and empowering behavior. The purpose of this article is to make nursing service managers more aware of the necessary attributes they should possess and should develop to manage nursing services more effectively.     

The functions of the nurse in an integrated national health service.

The British National Health Service was reorganized in 1974 when the hospital services and the community health services, previously administered separately, were brought together into one organization: the Area Health Authority. The reorganization was a culmination of developments triggered off as long ago as 1589 when the first Poor Law Act was passed, but more particularly, the reorganization was the natural outcome of a number of important government and professional nursing reports published during the past 30 years. From 1974 the community and hospital nursing services have, therefore, been amalgamated under the direction of one head of the nursing services: a district (or area) nursing officer, who, together with medical, administrative and financial colleagues, manages the health services on a day-to-day basis in a team managing by consensus. The nurse's role in the management teams is both executive and professional: the nurse's unique contribution is that he/she brings a nursing perspective to management. The new nursing service organization has provided new opportunities for reorientating middle nurse managers to a clinical role. It has also provided opportunities for innovating integrated teams of community and hospital nurses and for developing specialist nursing roles. Nurses are also now able to make other additional contributions to health care by their involvement in health care planning team activities and by their membership of the statutory area and regional nursing and midwifery advisory committees. But, on the whole, changes and influence on health care have been brought about chiefly by changes in the managerial structure of British nursing, which is a perspective of the British nursing profession that seems to have been all pervasive since Florence Nightingale's reforms and which is perpetuated by the powerfully socializing agent of British nurse training. As health care and nursing service organizations should be means towards the end of good patient care, it may be timely to focus on the suggestion of autonomous nurse practitioners supported by a separately organized administrative structure.     

What are the principles and processes of inspiring hope in cognitively impaired older adults within a continuing care environment?

This study focuses on the principles and processes that psychiatric/mental health (P/MH) nurses use to inspire hope in cognitively impaired older adults within a National Health Service (NHS) continuing care environment. Using a grounded theory method, the data were coded and analysed, in an attempt to produce an integrated conceptual framework of hope inspiration. This comprised four core variables: applied humanistic code, pragmatic knowledge, interpersonal relations and nurse as utilizer. The authors postulate a relationship between the function of caring, the activity of helping and the practice of instilling hope, as a basis for suggesting that inspiring hope to clients is one of the primary acts of P/MH nursing. The authors conclude that the four core variables are intertwined and inseparable from one another, and bound up with P/MH nursing practice. From this position, it is suggested that the processes of inspiring and instilling hope cannot be separated from the qualities of being a P/MH nurse. However, a more detailed and complete understanding of the concept of hope can increase the nurse's effectiveness as a carer.     

Innovations in United States genetics nursing: Practice and research

Aim: Clinical and research applications from human genome discoveries are growing and creating both opportunities and challenges to the integration of genetic concepts into practice and research. Nurses have a long history of caring for individuals, families, and groups with genetic conditions. In the past two decades, a small group of nurses in the USA have used a variety of strategies to further develop the field of genetics nursing. In this paper we identify innovative approaches to identifying genetics‐related nursing roles and opportunities, as well as successful collaborative efforts beyond nursing to address the emerging health and societal challenges related to human genetics discoveries. Methods: The information presented here comes from a variety of sources where the authors or genetics nurses directly participated, including: (i) a systematic literature review of genetics nursing; (ii) a comprehensive research study of models of delivering clinical genetics services and the roles of health professionals; and (iii) participation in numerous national research, planning, programmatic, and advisory groups involved with clinical genetics‐related health services, research, education, and public policy. Results: Genetics nurses in the US have developed innovative responses to genetics‐related challenges within and beyond the profession of nursing. These include: (i) establishing an organization for nurses in genetics and gaining formal recognition of genetics as a specialty of nursing; (ii) defining the scope of genetics nursing practice and developing a new genetics nursing credential; (iii) establishing a multiprofessional genetics education coalition and defining genetic competency for health‐care practice; (iv) creating new clinical practice roles for nurses that integrate emerging genetics concepts and skills into diverse clinical practice areas; (v) expanding nursing involvement in genetics‐related research; and (vi) participation in high‐level genetics advisory groups. Conclusions: The US experience shows that nurses have made substantial progress in expanding their involvement in genetic services through visionary leadership, innovative approaches to challenges, establishing support with nurse colleagues, and engaging in multiprofessional efforts. The most important first step is developing a supportive environment for nurse advancement. In the US, the genetics nurses’ organization known as the International Society of Nurses in Genetics (ISONG) has provided this base.     

The timeless caring connection

Caring is the essence of nursing. However, one cannot assume that caring is enough, especially if the recipient has not perceived the message of caring. The nursing connection is defined as the successful communication of caring by a nurse, whereby the recipient of care can trust the message of caring and respond to the message in its entirety. The caring connection has special significance today because of the changing societal trends, the domination of chronic illness as the major player in the population's morbidity and mortality, and the need for the public to practice prevention and/or management of chronic disease through lifestyle changes. The challenge for nursing is presented in the role of the nurse as a coach. Key strategies for establishing a caring connection in the nurse-client relationship are identified. An authentic caring connection is an empowering dialogue and exchange of the human spirit-nothing but the sacred ground in nursing practice.