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.     

Caring in nursing: investigating the meaning of caring from the perspective of cancer patients in Beijing, China

Aims. The aims of the study were to develop an understanding of caring in nursing from the perspective of cancer patients and attempt to identify the concept of caring in the Chinese cultural context. Background. Caring as a concept remains elusive, the acceptable definitions of the term care have not been reached. The expressions, processes and patterns of caring vary among cultures, but there is a lack of Chinese culture‐based study about caring in nursing. Methods. A qualitative research design was used and 20 cancer patients were interviewed using a semi‐structured interview guide. A qualitative content analysis was used to identify themes in the data. Results. Three themes emerged from the data, which suggested that caring is delivering care in an holistic way: nurses’ caring attitudes and their professional responsibility for providing emotional support, nurses’ professional knowledge and their professional responsibility for providing informational support and nurses’ professional skills and their professional responsibility for providing practical support. The caring behaviour of nurses as perceived by cancer patients involved the provision of emotional, informational, and practical support and help based on patients’ needs. A model of caring in nursing was formulated. Conclusions. Caring in nursing as perceived by cancer patients involves nurses having qualified professional knowledge, attitudes and skills in oncology and providing the informational, emotional and practical supports and help required by cancer patients. Relevance to clinical practice. Caring is manifested in nursing actions through nurse–patient communication process. Patients have their inner expectation for nurses’ caring behaviour and attitudes and nurses’ performance of caring or uncaring behaviour has a direct influence on the feelings of patients. It is necessary for all nurses to continue improving their oncology professional knowledge, attitudes and skills as well as their abilities of offering informational, emotional and practical support and help for their cancer patients.     

Oncology patients' and professional nurses' perceptions of important nurse caring behaviors

Background  

Caring is the essence of nursing. Caring to be meaningful needs to be based on mutual agreement between nurses and patients as to what constitutes nurse caring behaviors. As a result, healthcare professional can enhance patients' satisfaction of care by providing appropriate caring behavior. However, previous research that combined multiple types of patients, nurses and institutions demonstrated disagreement in prioritizing important behaviors. This paper reports a study that aimed at determining the caring behaviors which oncology patients and oncology nurses perceive to be the most important.     

Four Es of caring in contemporary nursing: Exploring novice to experienced nurses

Caring seems to be undervalued in the technologically‐advanced and fast‐paced clinical environment. To improve nursing practice, it is important to understand the meanings of caring to nurses. The aim of the present study was to explore nurses' perspectives of caring in the contemporary clinical environment. A focus group exploration was employed. Multiple perspectives were elicited from 80 nurses with different backgrounds: nursing students, nurse educators, registered nurses, advanced clinical nurses, and nurse executives. The qualitative data were analyzed using thematic analysis. Nurses' understanding of caring could be described using four Es: engaging in reciprocal relationships, embracing the essence of caring, engendering instances of caring, and embodying caring in practice. Participants described nurses as having the dual roles of caregiver and care recipient. The centrality of caring in nursing and the necessity of caring for caregivers were emphasized. The nurses also described various caring behaviors in daily practice. The present study revealed that nurses need empowerment to sustain their compassion. The findings provide new insights, which indicate that the revitalization of nurses' passion for caring in the contemporary clinical environment should begin with caring for caregivers.     

Caring in an environment of change and casemix funding

Caring has been defined by nurses and consumers of health care as an integral component of nursing. Florence Nightingale was the first nurse to describe an ethos of caring, and since then other theorists and clinicians have continued to support and develop a philosophy of care. Studies have highlighted that patients and their families also value care. However, concerns have been expressed that the current health care ideology is making caring practices more difficult to enact. The new priorities in health care award financial management a place that has the potential to overtake the importance of caring in nursing. This discussion examines the options that nurses have to defend and promote a philosophy of care.     

Caring for the adolescent with HIV infection or AIDS in the critical care setting.

Caring for the adolescent with HIV infection or AIDS in the critical care setting is challenging. This article discusses medical treatments for HIV, aspects of adolescent development that influence their behaviors, certain behaviors that put adolescents at risk for HIV acquisition, ethical and legal concerns for caring for this population, nursing implications for care, and the needs of nurses caring for this population.     

Wanted-nurses. Ethical issues and the nursing shortage

The persistent nursing shortage is challenging the values and beliefs of the nursing profession and causing nurses to ask how they can fulfill their ethical responsibilities to patients when there are an insufficient number and a maldistribution of nurses. Nurses are expressing job dissatisfaction, experiencing moral distress, and wondering about their inability to provide quality patient care. In this article, the author addresses the commitment to care for patients and the ethical dilemma with which nurses are grappling: caring for self versus caring for others. Recommendations for possible action include reenvisioning the profession of nursing, empowering nurses, providing support, and restructuring the work environment. Taken together, these actions have the potential to reduce the moral distress that nurses are experiencing and to enable them to honor their commitment to patient care.     

Considering nursing resource as 'caring time'

The present constrained economic climate faced by health care agencies underscores the need for nurse administrators to have an in-depth appreciation of how nursing services are being used The purpose of this investigation was to increase the understanding of nursing as a resource Using phenomenological research methodology, the investigator purposefully selected six patients and a chain sample of 14 professionals responsible for their care, including nurses, nurse managers and physicians Data collection methods included in-depth interviews, document reviews, and participant observation The inductive interpretation depicts the nature of nursing resource to be 'caring time' Caring was understood primarily in terms of time and was experienced by all participants as 'spending time' Caring time was spent through 'being with' and 'doing to/doing for' the patient Study participants experienced tension with regard to how best to spend precious 'caring time' Nursing resource was inextricably linked to both quantitative and qualitative expressions of nursing, and 'being with' patients was a highly valued, under-allocated, and unintentionally provided component of nursing resource The researcher concluded that nursing administrators, nurse managers and practitioners all have leadership roles to play in achieving recognition, allocation and promotion of caring time within their agencies     

A framework for caring in the human resource management process of nurses

The aim of this paper is to describe the provision of a human value system in nursing management that would lead to an environment conducive to quality of care to nurses. Caring is a complex phenomenon with caring concepts which emphasized the human element in human resource management in the health services. Watson (1985) focused on the philosophical and spiritual basis of caring. The ten carative factors as described by Watson (1985) were used as a framework for the application of caring to the human resource management process in nursing. This framework enables a basis for the development of a caring environment for the nurse manager, in which the nurse could experience caring. It served as a point of departure for a research study undertaken during 2000 on caring to the caregivers in health services.     

A longitudinal study into the perceptions of caring and nursing among student nurses

A longitudinal study of a cohort of student nurses was undertaken in order to investigate whether changes in perceptions of nursing and caring take place and how perceptions of nursing and caring are related. The Caring Dimensions Inventory (CDI) and the Nursing Dimensions Inventory (NDI) were employed for data collection at entry to nurse education and after 12 months. There were significant changes in the scores of a range of items in both inventories which suggested that student nurses lose some of their idealism about nursing and caring after 12 months in nurse education. While the overall ranking of items in the inventories was very similar, it was possible to distinguish between the inventories at entry to training and to observe a change, particularly in the CDI, over time by means of Mokken scaling. Nursing and caring would appear to become more synonymous to the student nurses after 12 months in nurse education. Factors scores, for factors identified in the CDI in a previous study, were used to investigate whether these scores changed at 12 months into nurse education compared with entry. No significant changes were detected.     

Caring: its meaning and place in the practice of nursing.

The School of Nursing at which the author is an instructor has decided to revise its curriculum. The new curriculum will use Jean Watson's Theory of Caring as its theoretical base. This qualitative study was undertaken to help clarify the meaning and value of caring in nursing practice as perceived by second-year diploma nursing students. When the data were analyzed, three categories of nurse behaviors emerged that were perceived as caring: giving of self, meeting patients' needs in a timely fashion, and providing comfort measures for patients and their families. The results of this study can be interpreted as a social constructive view of caring in the practice of nursing. These outcomes may help to define and teach caring nurse behaviors in a curriculum based on the Theory of Caring.     

Creating a profile of a nurse effective in caring

BACKGROUND: Watson's Theory of Caring and Caritas proposes that caring and love potentiate healing. Creating a profile of the characteristics of a "Caritas nurse" has implications for integrating caring and love into patient care, and measuring the impact of caring on patient and operational outcomes. METHODS: This psychometric study examined the profile of nurses effective in caring. The Caring Factor Survey and the Healthcare Environment Survey were selected to measure caring and work environment conditions as reported by the patient and by the nurse, respectively. RESULTS: The results of this study revealed that nurses of all ages who received high scores in caring were most frustrated with the work environment, were most experienced, worked only the hours scheduled, were most affected by the relationship with the patient, derived the most enjoyment from the relationship with their coworkers, and provided continuity of care most consistently. DISCUSSION AND IMPLICATIONS: Findings from this study indicate that further inquiry into the profile of nurses effective in caring and evaluation of the presence of caring and love on patient outcomes is warranted.     

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.     

Gender and perceived nurse caring in nurse-patient dyads.

The effect of nurse gender on nurse and patient perceptions of nurse caring was explored. Members of nurse-patient dyads (N = 145), equally distributed among the four possible gender combinations, completed matching forms of the Caring Questionnaire immediately following a shift. Perceptions of nurse caring that actually occurred during the preceding shift, as well as usual preferences about nurse caring, were measured. Results of two-factor ANOVAS showed no significant differences in actual caring according to nurse gender from either the nurse or the patient perspective. Expectations of certain nurse caring behaviours, however, were significantly lower for male nurses from both nurse and patient perspectives. The results suggest implications for nursing practice, education and further research.     

A socratic dialogue on the question 'what is love in nursing?

It is the thesis of the authors that the caring ethic and moral state of being of nurses ideally suffuses their professional caring and is thus implicit in their ethical decision making. Socratic dialogue is a technique that allows such moral attitudes to be made explicit. This article describes a Socratic dialogue conducted with nurses on the topic: 'What is love in nursing?' The conclusions drawn were based on the belief that the current western-style health care system restricts the practice of nursing in such a way as to limit professional caring and loving possibilities. Nurses who love in the practice of caring go beyond the role definition of the duty of care; they are people who are prepared to think differently about their practice as professionals, and are identified as competent risk takers committed to the betterment of the other. From this dialogue, 'love in nursing' was understood as the willingness and commitment of the nurse to want the good of the other before the self, without reciprocity.     

Caring and uncaring encounters in nursing in an emergency department

Background. Caring is a core characteristic of nursing. Nurses’ caring behaviour has been explored in several studies. When caring for trauma patients, the most important caring behaviour must be the procedures associated with lifesaving. However, it is important not to forget the patient's psychological needs. Aim. The aim of this study was to highlight encounters between injured patients and nurses in the trauma team and to explore whether the theory of caring and uncaring encounters in nursing and health care is applicable in emergency care. Data collection and analysis. Data were collected by videotaping caring episodes between slightly injured patients and nurses in the trauma team. Five episodes involving 10 nurses were studied. The analysis was carried out in four steps. First the videotapes were studied several times and then transcribed into narratives, which were reduced into courses of events. These were subsequently classified according to aspects of caring and uncaring. Results. The nurses’ verbal and non‐verbal communication was poor, and they adopted a wait‐and‐see policy. A new uncaring aspect, instrumental behaviour, emerged from this poor communication. One of the caring aspects, being dedicated and having courage to be appropriately involved, could not be identified. Most encounters included several aspects of caring and uncaring, but the uncaring aspects predominated. The dominance of uncaring aspects indicates a lack of affective caring behaviour. Conclusion. The result showed that the theory is partly applicable in emergency care. A new aspect, instrumental behaviour emerged. The nurses’ behaviour in the five episodes was labelled as uncaring. Authentic nurse–patient encounters are essential in nursing. Relevance to clinical practice. The importance of meeting patients’ psychological needs and nurses’ affective caring behaviour should be emphasized in trauma care, trauma courses and nursing education. It is necessary to measure the caring behaviour of trauma nurses.     

Exploring the concept of caring: novel strategies for a diverse student group

Caring for others and being cared for are part of every person s life. People do not care automatically, but learn to care through the caring example of others and who better to teach about the concept of caring than nurses. The author discusses a nursing elective, Concepts in Caring, that is open to all undergraduates in the university. The concepts of caring, health, illness, human need, and human potential are explored in the course using a variety of teaching strategies.