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 behaviours and stress perception among student nurses in different nursing programmes: A cross-sectional study

Caring is central to providing high-quality nursing. Little research exists concerning the relationship between caring behaviours and stress perception among student nurses. This study aimed to explore this relationship among student nurses in different nursing programmes. A sample of 792 student nurses from three nursing education programmes in one academic institution completed Chinese versions of the Caring Behaviors Scale and the Nurse Stress Checklist to assess participants' caring behaviour and psychosocial responses to work-related stress, respectively. We found a statistically significant negative correlation between caring behaviour and stress perception among participants. The three most frequently reported caring behaviours were related to ‘knowing the patient’: (a) recognising that each patient holds unique values, (b) taking a patient's chief complaints seriously, and (c) stating that the family's best interests should be respected regarding health decisions. Completion of work, time limitations, and lack of personal interactions were sources of stress. Nursing education curricula involve the fundamentals of caring and the preparation of nursing students for clinical practice. The study recommends that nursing faculty and administrators should educate students in stress management in order to foster, support, and promote caring behaviours among nursing professionals.     

Dependency in autonomous caring – night nurses’ working conditions for caring in nursing

Scand J Caring Sci; 2010; 24; 312–320
Dependency in autonomous caring – night nurses’ working conditions for caring in nursing Few research studies have focused on nurses’ working conditions for caring provided at night, and these studies have mainly described nurses’ work in hospital settings, not in a municipal, social‐care context. In Swedish municipal care, nurses have responsibility for hundreds of older people in need of care. This working condition compromises caring encounters; instead the nurses’ caring is mainly mediated through care staff (or relatives). In considering that caring based on caring encounters is fundamental to ethical nursing practice questions leads to the aim: to explore Swedish municipal night nurses’ experiences of their working conditions for caring in nursing. All municipal night‐duty nurses (n = 7) in a medium‐sized community in Sweden participated in interviews, while six of them also wrote diaries. Thematic content analysis has been used in analysing the data. The findings revealed that the nurses experienced their working conditions for caring in nursing in the themes of Dependency in the Organisation and Other Staff, Vocational Responsibility, Deficiency in Conditions for Caring and Autonomous Caring. The findings illustrate privileged, as well as, poor working conditions for caring in nursing. The nurses’ role as consultants emerge as their main function. The consultant function implies that nurses do not participate in ordinary bed‐side caring, which makes it easier for them to find time for caring in situations that arise when nurses’ skills, expertise and authority are called upon. Conversely the consultancy function entails short‐term solution of complex caring problems, which can signify deficient caring due to prevailing working conditions. The findings also point to nurses’ possible problems in fulfilling their own and vocational demands for ethics in the practice of caring in nursing related to existing working conditions.     

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.     

护士关怀能力现状及影响因素调查

目的了解护士关怀能力现状及影响因素,为提高护士关怀能力提供依据。方法对某市3所三级医院共310名护士发放关怀能力量表进行调查。结果护士关怀能力得分（175．70±18．74）分,护士关怀能力较低;其影响因素包括年龄、职称、学历、科室。结论应加强护士关怀能力的培养,可以利用高年资护士的榜样作用带教低年资护士,各层次护理人文关怀教育都应当注重关怀实践,根据各科患者的关怀需求施予关怀。     

Affective neutrality and involvement in nurse–patient relationships: perceptions of appropriate behaviour among nurses in acute medical and surgical wards

This paper explores ideas about the appropriate basis for nurse-patient relationships which underwrite the nursing practice of experienced staff nurses on the acute surgical and medical wards of a Scottish general hospital. Three central features of involvement with patients are identified, knowledge, reciprocity and investment, and these are related to three general models of the nurse-patient relationship, characterized as primary, demonstrative and associational. The implications of the nursing practice on which these models are based are discussed in the context of issues of quality of care and orientation to work.     

Strategies in caring for women with postpartum psychosis--an interview study with psychiatric nurses

Aim and objective. The aim of this study was to explore strategies in caring for women with postpartum psychosis used by nurses. Background. The most serious type of psychiatric illness in connection with childbirth is postpartum psychosis. Nearly two in 1000 newly delivered women are stricken by postpartum psychosis. Most of these patients need psychiatric care to recover. While earlier studies point to the need for psychiatric care, knowledge of specific nursing strategies in caring for postpartum psychosis patients remains limited. Methods. Interviews with 10 experienced psychiatric nurses were carried out, transcribed verbatim and an inductive content analysis was made. Result. The main strategies for care found in this study were: (i) To create a patient–nurse relationship and (ii) To apply nursing therapeutic interventions. Presence, continuity and nurse‐patient partnership contributed to create a relationship and incorporate the rest of the care team. To satisfy the patients’ basic needs and feeling of security was the foundation of the nursing therapeutic interventions. Confirmation and giving hope were also used as nursing therapeutics as well as information to the patient and her relatives about her illness. Conclusion. The conclusion of the study is that strategies used by nurses are a combination of general and psychiatric nursing approaches but the specificity in caring knowledge for caring patients with postpartum psychosis requires further development. Relevance to clinical practice. The result of the study indicates that it is important to organize patient care for postpartum psychosis with continuity and consistency and to support the nurse to create a relationship and therapeutic intervention with the patient. The present study shows the importance of further developing specific nursing theories that can be applied when caring for patients with postpartum psychosis. It also shows the need for further pedagogical education for mental health nurses.     

Strategies to facilitate effective caring for patients in primary health care clinics

BackgroundCaring is described as the innermost core of nursing which occurs in a relationship between the patient and the care provider. Although caring in nursing is associated with maintaining and strengthening of the patient’s sense of dignity and being a person, there seems to be a gap between caring theories in nursing, healthcare policies and caring for patients by professional nurses in primary health care clinics. Developing strategies that will facilitate effective caring for patients by professional nurses in primary health care clinics within an ethical and mindful manner became an area of focus in this study.ObjectivesTo develop strategies to facilitate effective caring for patients by professional nurses in primary health care clinics in South Africa.MethodStrategies were developed based on the conceptual framework developed in Phase 2, which was derived from synthesis of the results of Phase 1 of the previously conducted study and supported by literature. The conceptual framework reflects the survey list of Dickoff, James and Wiedenbach’s practice theory.ResultsThree strategies were developed: 1) facilitating maintaining of the empowering experiences; 2) facilitating addressing the disempowering experiences by professional nurses, and 3) facilitating addressing of the disempowering primary health care clinic systems.ConclusionThe developed strategies, being the proposed actions, procedures and behaviours, could facilitate effective caring for patients by professional nurses in primary health care clinics.     

Caring, patient autonomy and the stigma of paternalism

Caring, patient autonomy and the stigma of paternalism ¶This paper utilizes data generated during a qualitative study in palliative and maternity care settings to guide discussion of the current discourse, which emphasizes patient autonomy and derides paternalism. Data are presented which illustrate that this ideology is established in nursing practice. Respect for patient autonomy is identified as an essential element of individualized, patient-centred and ethical care but conversely, it is suggested that over-emphasis may confuse and suppress beneficent intervention. The value of ethical theory to provide an objective means to explore ethical dilemmas in practice is not debated, but exploration of the issues raised by the data suggest, that principle-based ethical theory suffers the following constraints: the predetermined balance of ethical principles in favour of respect for autonomy prevents an unbiased perspective and optimum guidance; in contrast to caring relationship, application of ethical theory does not reveal the particulars necessary to guide ethical decisions aimed at promoting good for the individual; current discourse appears to disregard the inherent inequality in the relationship between the helped and helper and practitioners' need to preserve their own moral integrity. Consequently, this paper argues that beneficence derived through caring should not be superseded uncritically and suggests that mutual nurse-patient relationship, which balances respect for patient autonomy and beneficent guidance based on practitioner's clinical expertise, protects the moral integrity of both patient and practitioner. For conciseness, the term patient will be used to indicate recipients of both nursing and midwifery care and while both nurses and midwives are not always specified, any term referring to nurses, denotes both.     

Caring in palliative nursing: competency or complacency?

Caring is an attribute of palliative nursing that is assumed to be fundamental. However, as the sophistication of palliative care increases, the liberal art of caring has become submerged under the weight of medical and pharmacological sciences. The nursing profession defends caring as the essence of its practice yet caring work in the palliative environment receives relatively little attention in research or in literature generally. Although it is accepted that nurses' caring work sometimes involves intimate and private aspects of patient care, the value and positive outcomes of caring should not remain hidden. Palliative nurses have special but tentative opportunities to prove the value of caring and define the complexity of caring work. This article argues that nurses need to reclaim the caring ethic and demonstrate its worth.     

Acts of caring: nurses caring for nurses

Caring behaviors displayed toward nurses by nurse managers and nurse peers play a significant role in establishing relationships that promote a healthy work environment. A qualitative study was done to identify behaviors perceived to be caring toward nurses. The theoretical background used for the study was Nursing as Caring by Boykin and Schoenhofer. Data were collected from focus groups consisting of registered nurses currently employed in the practice setting. Content analysis was used for the analysis. The overarching category that was identified was tending to a caring environment. The following emergent categories were also found: caring through helping and supporting, caring through appreciating, and acknowledging unappreciated caring. The findings suggest that nurses demonstrate caring behaviors toward their colleagues by coming to know them on both a professional and a personal level. These behaviors form the foundation for an environment that supports a consistent demonstration of caring.     

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.     

Using the caring dimensions inventory as an indicator of person‐centred nursing

Aims. This paper reports findings from a large‐scale quasi‐experimental study that used a measure of caring as a means of evaluating person‐centred nursing and aims to illustrate the synergy between the concepts of caring and person‐centredness. Background. Evidence would suggest that effective person‐centred nursing requires the formation of therapeutic relationships between professionals, patients and others significant to them in their lives and that these relationships are built on mutual trust, understanding and a sharing of collective knowledge. This correlates with the conceptualisation of caring that is underpinned by humanistic nursing theories. Design. A pretest post‐test design was used in this study to evaluate the effect of person‐centred nursing on a range of outcomes, one of which was nurses’ and patients’ perception of caring. Methods. The Person‐Centred Nursing Index was the main data collection tool. The Caring Dimension Inventory and Nursing Dimensions Inventory, were component parts of the Person‐Centred Nursing Index and were used to measure nurses’ and patients’ perceptions of caring. The Person‐Centred Nursing Index was administered at five points in time over a two‐year intervention period. Results. Nurses had a clear idea of what constituted caring in nursing, identifying statements that were reflective of person‐centredness, which was consistent over time. This was in contrast to patients, whose perceptions were more variable, highlighting incongruencies that have important implications for developing person‐centred practice. Conclusion. The findings confirm the Caring Dimension Inventory/Nursing Dimensions Inventory as an instrument that can be used as an indicator of person‐centred practice. Furthermore, the findings highlight the potential of such instruments to generate data on aspects of nursing practice that are traditionally hard to measure. Relevance to clinical practice. The findings would suggest that nurses need to be aware of patients’ perceptions of caring and use this to influence changes in practice, where the prime goal is to promote person‐centredness.     

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.     

What caring means to geriatric nurses

Caring is the major concept in nursing. The purpose of this study was to describe the meaning of caring for nurses caring for elderly patients. Parse' s phenomenology was addressed in the research design, which included four steps: participant selection, dialogical engagement, extraction-synthesis, and heuristic interpretation. By stratified sampling, 30 nurses who worked in medical-surgical wards in a general teaching hospital were selected as participants. Dialogical engagement was completed through in-depth, tape-recorded interviews on the open question, " What is the meaning of caring for you as a provider of care to the elderly? ". Data were interpreted by process of Parse' s phenomenology, which included extracting the essence, synthesizing the essence, formulating a proposition, extracting concepts, and structuring the meaning. The meaning of caring for nurses engaged in caring for the elderly was: " Through the initiative deliberation from sincerity, the nurse is to dedication by the empathy and tolerance". The core concepts of caring were: deliberation, initiative, sincerity, tolerance, empathy, and dedication. It should develop and apply the caring concept and theory actively to geriatric nursing care.     

Exploring a culture of caring

AIM: The delivery of patient-centered care is basic to a large midwestern healthcare institution's mission and highly valued by the department of nursing. Even so, nurses on one medical unit questioned whether caring behaviors were devalued in a technology-oriented environment of providing care. The nursing leadership on the unit responded to the inquiry by conducting a research study. This study explored the state of patient-centered nursing care on a medical unit as perceived by the nursing staff and patients, using Watson's Theory of Human Caring as a framework. SUBJECTS AND METHODS: The study utilized surveys for both nursing staff (n = 31) and patients (n = 62), and included a focus group of nursing staff (n = 8) to explore ideas for innovation. RESULTS AND CONCLUSIONS: Both nurses and patients perceived a high level of caring on the unit. The overall theme from the focus group was that "caring begets caring," with 2 subthemes: "relationships of care" and "the context of caring." Caring for each other was identified as essential to keep staff energized and able to work lovingly with patients. Nursing leadership brought the research findings to all staff on the unit for discussion and implementation of structural support for the unit culture of caring.     

Nurses' experience of caring for inmate patients

AIM: The aim of this paper is to report the findings of a study of the experience of caring for prisoners through examining the everyday experience of nurses' delivering health care to inmate patients in a correctional setting. BACKGROUND: Prisons are most often viewed as places for punishment, while the goals of health and healing, and prevention of diseases in correctional facilities are often neglected. Nurses who deliver health care to prisoners are challenged to do so in a caring relationship that will facilitate their health and healing. The literature on the nature of prison nursing indicates that delivering health care to inmates must be carefully balanced against the need for security, and is affected by factors such as custody staff values, staff education, nursing management, and organizational practices. METHOD: In-depth interviews were carried out with nine Registered Nurses who had been employed in a variety of correctional institutions throughout their careers, and analysed thematically using Colaizzi's phenomenological method. Findings. Nurses' caring was experienced as an attempt to negotiate the boundaries between the cultures of custody and caring. Facing complex challenges and a number of limitations on the nurse-patient relationship, nurses strived to find a way to care for their inmate patients. Environmental risk meant that caution and vigilance were essential and these nurses demonstrated courage and persevered for the sake of their inmate patients. CONCLUSION: The findings make clear the challenging and frustrating experience of nurses' caring for inmate patients in restrictive settings. As a result, there are implications for nursing practice, education, and research to assure the best possible health outcomes for inmate patients, the integrity of caring nursing practice, and the safety of both nurses and patients.