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 development of caring in the perioperative culture: nurse leaders' perspective on the struggle to retain sight of the patient

This article focuses on Swedish nurse leaders and is aimed at achieving a more complete and differentiated understanding of what constitutes caring in the perioperative culture as well as their knowledge and responsibility for the development of caring. Interviews with open-ended questions were conducted with 10 nurse leaders, in which they described their experiences of developing perioperative caring. The interpretation process was based on Gadamer's philosophy of hermeneutics. The findings indicate that developing a perioperative caring culture is a struggle to retain sight of the patient, a process that includes the following 6 phases: (1) when the nurse leaders understood perioperative caring as a process, the nurse's and patient's shared world became obvious to them; (2) safeguarding the patient's position as a unique human being; (3) safeguarding the nurse's welfare by creating a compassionate atmosphere; (4) promoting an idea means never giving up; (5) attaching importance to being trustworthy; and (6) being involved in a dynamic interaction, comprising communion and reciprocity. The most important goal of nursing leadership is to safeguard the welfare of the suffering patient and the relationship between the nurse leader and nursing staff, based on the motive of caritas derived from the idea of humanistic caring.     

Nursing as caring theory: living caring in practice

This column features a report of a research project in a community hospital. Staff members were given opportunities to engage and act on the ideas of Boykin and Schoenhofer in their nursing as caring theory. Feedback from patients, family members, and all staff who touched patients informed the creation of a new model of care that positively transformed the workplace in the hospital setting. Strategies that were implemented to guide the values of nursing as caring theory are described. The result of the project was an environment that nurtures persons in their caring and growing in caring while illuminating the fullness of nursing.     

Producing a caring environment for staff: forging old paradigms

Modern health care has evolved into technological wizardry that defies the traditional concept of caring by the bedside nurse. Industry constraints have created an environment where caring for the patient and employee has become easily discarded in favor of the rigors of technological care. With an aging and diminished work force, nursing leaders must be prepared to create a caring environment where nurses are empowered to deliver the humanitarian as well as technological aspects of caring. From a concept of work redesign that mirrors traditional nursing paradigms, nurses can enrich not only their professional work environment but also deliver the high touch aspect of care in their daily work.     

护生人文关怀能力现状调查分析

[目的]了解护生人文关怀能力,分析影响护生人文关怀能力的外部因素。[方法]以7所护理院校730名护生为研究对象,采用护理专业大学生人文关怀能力量表进行现场问卷调查。[结果]不同性别护生、城市与农村护生、班干部与非班干部护生以及对外界关怀程度感受不同的护生人文关怀能力比较均有统计学意义（P〈0.05）,而独生子女与非独生子女护生、不同教育层次护生人文关怀能力无统计学意义（P〉0.05）。[结论]护理院校应针对影响护生人文关怀能力的因素,加强专业价值观教育、通识教育、专业实践和社会实践教育,以提升护生人文关怀能力。     

Clinical nursing leaders', team members' and service managers' experiences of implementing evidence at a local level

kitson a., silverston h., wiechula r., zeitz k., marcoionni d. & page t. (2011) Journal of Nursing Management 19 , 542–555
Clinical nursing leaders’, team members’ and service managers’ experiences of implementing evidence at a local level Aim To describe the experiences of 14 clinical nursing leaders introducing a knowledge translation (KT) project into one metropolitan acute care hospital in South Australia. The study also explored team members’ and service managers’ experiences. Background KT strategies assume that local (nursing) clinical leaders have the capacity and capability to champion innovation combining positional leadership roles (ward leader) with a project lead role. There is limited evidence to support these assumptions. Method Semi-structured interviews of clinical nursing leaders and managers were undertaken at month 4 and 12 of the project. Data were also collected from the interdisciplinary team members (n = 28). Results Clinical nursing leaders identified risks and anxieties associated with taking on an additional leadership role, whereas managers acknowledged the multiple pressures on the system and the need for local level innovation. Team members generally reported positive experiences. Conclusions With support, clinical nursing leaders can effectively embrace KT project leadership roles that complement their positional leadership roles. Clinical nursing leaders’ experiences differed from nursing and medical managers’ experiences. Implications for nursing management Managers need to be more attuned to the personal risks local leaders experience, providing support for leaders to experiment and innovate. Managers need to integrate local priorities with broader system wide agendas.     

优质护理服务示范病房护士关爱能力现状及影响因素分析

目的:分析优质护理服务示范病房护士关爱能力的影响因素,为提高护士关爱能力提供依据。方法:抽取山东省6所三级综合性医院的592名优质护理服务示范病房护士为研究对象,对其关爱能力现状及影响因素进行问卷调查。结果:优质护理服务示范病房护士关爱能力得分平均为184.52分;是否结婚、是否独生子女、是否生育、工作年限以及不同职称对优质护理服务示范病房护士的关爱能力影响有统计学意义(P<0.01),它们能解释48.2%的关爱能力变异量,其中是否结婚、是否独生子女、是否生育是主要的预测力,其解释量为41.1%。结论:优质护理服务示范病房护士关爱能力整体偏低,仍待提高,需要家庭、医院和社会的共同参与,建议针对不同职称、学历、聘用形式的护士进行分层次培训,通过为护士提供体验关怀、实践关怀的机会提高护士关爱能力。     

Satisfaction with caring and living conditions in nursing homes: views of elderly persons, next of kin and staff members

The aim was to describe satisfaction with the caring and living conditions of elderly persons in nursing homes, expressed by the elderly persons, next of kin and staff members. Elderly persons were interviewed about their caring and living conditions. Next of kin and staff members completed a questionnaire about satisfaction with caring and living conditions of elderly persons. The main results showed significantly low levels of satisfaction regarding: altered health, influence on care, rehabilitation and meaningful occupation, as expressed by the elderly persons. Next of kin stated low satisfaction with staff contacts, influence on care, rehabilitation from staff and meaningful occupation for their elderly relatives. Staff members expressed low satisfaction with influence on care and meaningful occupation. The results present important evidence to guide the heads of nursing homes and those responsible for elderly care, which will help to improve the caring and living conditions of elderly persons.     

A Heideggerian analysis of good care in an acute hospital setting: Insights from healthcare workers,patients and families

This study articulates the relational constituents of good care beyond techno-rational competence. Neoliberal healthcare means that notions of care are readily commodified and reduced to quantifiable assessments and checklists. This novel research investigated accounts of good care provided by nursing, medical, allied and auxiliary staff. The Heideggerian phenomenological study was undertaken in acute medical-surgical wards, investigating the contextual, communicative nature of care. The study involved interviews with 17 participants: 3 previous patients, 3 family members and 11 staff. Data were analysed iteratively, dwelling with stories and writing and rewriting to surface the phenomenality of good care. The data set highlighted the following essential constituents: authentic care: caring encompassing solicitude (fürsorge); impromptu care: caring beyond role category; sustained care: caring beyond specialist parameters; attuned care: caring encompassing family and culture; and insightful care: caring beyond assessment and diagnosis. The findings are clinically significant because they indicate the importance of nurse leaders and educators harnessing the potential capacity of all healthcare workers to participate in good care. Healthcare workers reported that participating in or witnessing good care was uplifting and added meaning to their work, contributing to a sense of shared humanity.     

Staff perceptions of caring: the importance of a supportive environment

Five themes of caring interventions emerged from the perspective of staff caregivers-valuing personhood and the work, belonging, knowing, acting together, and promoting quality. Three themes of caring organizational conditions identified by participants included communicating, providing resources, and trusting. The research-based Model of Caring in the Organizational Environment can be used to assess and improve the caring environment of nursing homes as well as to develop caring managers and staff. Organizational well-being for nursing homes is everyone's responsibility and requires formal and informal leaders who can create supportive caring organizational conditions, engage in caring interventions with staff, and inspire the synergy of caring.     

Creating a caring practice environment through self-renewal

The soul of nursing is seeking the good of self and others through compassionate caring. Healing and caring for oneself is vital to have the energy to compassionately care for others. Nurse leaders have the moral responsibility to facilitate self-care, renewal, and healing in the organizational culture to foster caring and trusting relationships. Nurses who have a strong sense of self and caring will provide holistic patient care grounded in caring values.     

Holism and caring: nursing in the Chinese health care culture

This article examines the concepts of holism and caring within the historical and cultural context of the development of nursing in China. Data were collected in two research projects on the cultural construction of caring in nursing within different Chinese communities. Grounded in the theory of "systematic correspondence" and in Chinese medical tradition, illness is perceived as a state of disharmony between the individual and the natural and social environment. The interplay of caring and curative processes is seen as pertinent to health maintenance. In Chinese culture, it is the moral duty of family members to take care of their sick. Because of this, questions are posed about ways in which the nurse can relate to patients and their family members. Although lay people view nursing as servant's work, nurses cherish "treating the patient as their own family member." The authors contend that these versions of nursing are inappropriate. It is the intention of this article to stimulate discourse on a third version focusing on the patient and the family as the unit of care within their dynamic, natural, and social environments.     

社区家庭临终关怀现状

临终关怀作为一门对临终病人和家属提供姑息性和支持性医护措施的新兴学科在国内外不断发展。概述了社区家庭病人临终关怀的概念和需求因素,并阐述如何从控制疼痛、做好心理护理、基础护理、尸体料理和对病人家属的关怀5方面进行社区家庭临终关怀。     

Registered Nurses working together with family members of older people

Aim. The aim of the study was to reach a more profound understanding, through looking at nurses’ working situation, of those factors that influence how nurses are able to work together with family members of older people living in nursing homes or similar facilities. Background. Working with the care of older people as a Registered Nurse provides a varied job with many challenges. Nurses have to co‐operate with family members of those in community health care. Co‐operation is important and necessary for all involved. Design. Nurses working in elder care in a geographically defined area received a questionnaire with three open‐ended questions, on the difficulties and/or problems involved with working together with family members, and the positive or negative aspects of this co‐operation. Methods. Analysis was carried out using the latent content analysis method. Results. Three themes, problems within the system, interaction with families and caring in nursing work, are presented with categories and their subcategories. The nurses wanted their superior to be a nurse so that their working situation would be better understood. Appreciation from their superior and family members was also a very important part of their work as nurses in community health care. The frequent changes and the lack of time in the work of elder care often put nurses under considerable psychological pressure. For the most part family members are a resource for the elder, but sometimes they will avoid contact, which will make co‐operating difficult. Conclusion. Registered Nurses and family members are dependent on each other in their care of the elder. Relevance to clinical practice. More attention should be paid to the working situation of Registered Nurses in community health care, and their ability to work together with family members of older people.     

Congruence of perceptions among nursing leaders and staff regarding missed nursing care and teamwork

The objective of this study was to test the congruence of the perceptions of unit-based nurse leaders (managers, advanced practice nurses) and nursing staff members (registered nurses, nursing assistants, unit secretaries) in acute care hospitals as to the extent and type of missed nursing care and nursing teamwork. Based on the leader-member exchange congruence framework (LMX), nursing staff and nursing leaders completed the MISSCARE Survey, and a segment of the participants completed the Nursing Teamwork Survey. The findings of this study show a lack of LMX congruence between leaders and nursing staff members. Nursing staff report less missed care and lower teamwork than do leaders, and nursing staff list more problems with having adequate material and labor resources than do leaders. LMX congruence has been associated with positive organizational outcomes.     

Nursing leaders' and nurses' view of health

This study is part of a scientific project, 'Multidimensional Health', the main goal of which is to introduce a broad view on health into health care and nursing The purpose of this study is to examine the view of health among nursing leaders and members of caring staff and to compare it to that of patients (a previous study in the project) The study is based on K Eriksson's theory of caring and its view of the human being with a body, soul and spirit, and health as a dynamic process concerning all aspects of human life An inquiry form with open questions that brought to the fore various aspects and dimensions of health was filled in by 20 nursing leaders and was used in interviewing 49 nurses According to the results many aspects of life are contained in the concept 'health' Health is above all an experience of well-being Ways of promoting one's health are described in terms of various 'healthy' living habits and preventive measures A supporting and humane attitude is hoped for in others There is unanimity that feelings affect health Belief may have a positive influence on health The meaning of life is connected with health Even suffering is part of health In interpreting the answers we assume three dimensions of health 'Health as behaviour' connects health with living in a healthy way 'Health as being' would mean a state of health and is characterized by a search for some kind of balance in one's inner state 'Health as becoming', growing towards health, means that a person becomes whole on a higher level of integration     

Practices for caring in nursing: Brazilian research groups

ERDMANN A.L., DE ANDRADE S.R., FERREIRA DE MELLO A.L., KLOCK P., DO NASCIMENTO K.C., SANTOS KOERICH M. & STEIN BACKES D. (2011) Practices for caring in nursing: Brazilian research groups. International Nursing Review 58 , 379–385 Background: The present study considers the production of knowledge and the interactions in the environment of research and their relationships in the system of caring in nursing and health. Aim: To elaborate a theoretical model of the organization of the practices used for caring, based on the experiences made by the research groups of administration and management in nursing, in Brazil. Methods: The study is based on grounded theory. Twelve leaders of research groups, working as professors in public universities in the south and the south‐east of Brazil, distributed in sample groups, were interviewed. Findings: The core phenomenon ‘research groups of administration and management in nursing: arrangements and interactions in the system of caring in nursing’ was derived from the categories: conceptual bases and contexts of the research groups; experiencing interactions in the research groups; functionality of the research groups; and outputs of the research groups. The research groups are integrated in the system of caring in nursing. Conclusions: The activities of the Brazilian administration and management in nursing research groups are process oriented and in a process of constant renovation, socially relevant, operate in a complex scenario and contribute to the advancement of the organizations of the system of caring in nursing through strengthening the connection among academia, service and community.     

Patient and situational factors that affect nursing students' like or dislike of caring for patients

The purpose of this study was to identify certain characteristics of the patient or the helping situation that evoke in nursing students positive or negative feelings about caring for patients. Causes nursing students spontaneously gave for their feelings about caring for patients were examined. Results provided some support for the perception that nurses may not be responsive to certain patients. The nursing students liked best caring for patients who were cheerful and communicative. They also liked to care for patients who were in pain, patients they viewed as needing high levels of nursing care, and patients who responded positively to their attempts to minister.