Nursing as Caring:Nursing as Caring:A Model for Transforming PracticeA Model for Transforming PracticeAnne Boykin, PhD, RNAnne Boykin, PhD, RNSavina O. Schoenhofer, PhD, RNSavina O. Schoenhofer, PhD, RNMarguerite J. Purnell, PhD, RN; AHN-BCMarguerite J. Purnell, PhD, RN; AHN-BCFlorida Atlantic UniversityFlorida Atlantic University
ContentsContents CaringCaring Major assumptionsMajor assumptions Key ConceptsKey Concepts Focus of nursingFocus of nursing The nursing situationThe nursing situation Direct invitationDirect invitation Calls for Nursing and NursingCalls for Nursing and Nursingresponses of caringresponses of caring Dance of Caring PersonsDance of Caring Persons
6 Major Assumptions6 Major AssumptionsMajor assumptions are stated by the theorists to presentMajor assumptions are stated by the theorists to presenttheir values that ground the theory, and to illuminatetheir values that ground the theory, and to illuminatetheirtheirworldviews . This means that you know “where they areworldviews . This means that you know “where they arecoming from”. The theory of Nursing As Caringcoming from”. The theory of Nursing As Caringin grounded in 6 major assumptions which providein grounded in 6 major assumptions which providedistinctive meanings:distinctive meanings: Persons are caring by virtue of their humanness.Persons are caring by virtue of their humanness. Persons are caring moment to moment.Persons are caring moment to moment. Persons are whole or complete in the moment. Personhood is living grounded in caring.Personhood is living grounded in caring. Personhood is enhanced through participating in nurturingPersonhood is enhanced through participating in nurturingrelationships with caring others.relationships with caring others. Nursing is both a discipline and a profession.Nursing is both a discipline and a profession.
CARINGFollowing are excerpts fromthe Theory of Nursing asCaring (2001)
All persons are caring by virtue of their humanness –All persons are caring by virtue of their humanness –caring is an essential feature and expression of beingcaring is an essential feature and expression of beinghuman. The view of person as caring and complete ishuman. The view of person as caring and complete isintentional – prevents segmenting into parts, such asintentional – prevents segmenting into parts, such asmind, body, and spirit.mind, body, and spirit. Fundamentally, potentially, and actually, each person isFundamentally, potentially, and actually, each person iscaring.caring. Each person, throughout life, grows in the capacity toEach person, throughout life, grows in the capacity toexpress caring. Being a person means living caring.express caring. Being a person means living caring. Through knowing self as caring, I am able to be authenticThrough knowing self as caring, I am able to be authenticto self and others.to self and others. Caring is living in context of relational responsibilities.Caring is living in context of relational responsibilities. Caring is responsibility to self and others.Caring is responsibility to self and others. Caring shapes relationships.Caring shapes relationships.About CaringAbout Caring
KEY CONCEPTSKEY CONCEPTSThese are important conceptsThese are important conceptsthat can be operationalized, i.e.that can be operationalized, i.e.they can be put into action andthey can be put into action andstudied, recognized, describedor measured
Caring in NursingCaring in Nursing: The intentional and authentic: The intentional and authenticpresence of the nurse with another who is recognized aspresence of the nurse with another who is recognized asperson living in caring and growing in caring. If you lookperson living in caring and growing in caring. If you lookat the 6at the 6ththbasic assumption listed, it states that nursing isbasic assumption listed, it states that nursing isboth a discipline and a profession. This assumptionboth a discipline and a profession. This assumptionsupports and validates how a nurse approachessupports and validates how a nurse approachesprofessional caring practice, that is, from an informedprofessional caring practice, that is, from an informedstance grounded in disciplinary knowledge. This clearlystance grounded in disciplinary knowledge. This clearlydistinguishes “lay” caring from professional nurse caring.distinguishes “lay” caring from professional nurse caring. Authentic Presence:Authentic Presence:Authentic presence may be understood as one’sAuthentic presence may be understood as one’sintentionally being there with another in the fullness ofintentionally being there with another in the fullness ofone’s personhood.one’s personhood. Caring communicated through authentic presence is theCaring communicated through authentic presence is theinitiating and sustaining medium of nursing within theinitiating and sustaining medium of nursing within thenursing situation.nursing situation.
Key Concepts con’tKey Concepts con’tPerson as Whole and Complete in the MomentPerson as Whole and Complete in the Moment Person as caring centers on valuing and celebratingPerson as caring centers on valuing and celebratinghuman wholeness, that is, the human person ashuman wholeness, that is, the human person asliving caring and growing in caring; valuing andliving caring and growing in caring; valuing andrespecting each person’s beauty, worth, andrespecting each person’s beauty, worth, anduniqueness.uniqueness.The person is at all times whole. To encounter aThe person is at all times whole. To encounter aperson as less than whole fails to encounter person.person as less than whole fails to encounter person.
Personhood isPersonhood isliving grounded in caringliving grounded in caring Personhood implies living out who we are as caringPersonhood implies living out who we are as caringpersons.persons. Personhood implies living the meaning of one’s life.Personhood implies living the meaning of one’s life. Personhood implies demonstrating congruence betweenPersonhood implies demonstrating congruence betweenbeliefs and behavior.beliefs and behavior.
The Focus ofThe Focus ofNursingNursing((What do nurses think about while theyWhat do nurses think about while theyare nursing?)are nursing?) The focus of nursing is nurturingThe focus of nursing is nurturingpersons living caring and growing inpersons living caring and growing incaring.caring.
Nursing SituationNursing Situation The nursing situation is the shared, lived experience inThe nursing situation is the shared, lived experience inwhich thewhich the caring betweencaring between nurse and nursed enhancesnurse and nursed enhancespersonhood.personhood.(What does the nurse(What does the nurse dodo?)?) It is in the nursing situation that theIt is in the nursing situation that the nursenurse attends to callsattends to callsfor caring, creating caring responsesfor caring, creating caring responses that nurturethat nurturepersonhood.personhood.
Calls for NursingCalls for Nursing AA call for nursingcall for nursing is a call from theis a call from theone nursed, perceived in the mind of the nurse.one nursed, perceived in the mind of the nurse.This call for acknowledgement and affirmation ofThis call for acknowledgement and affirmation ofthe person living caring in specific ways in thethe person living caring in specific ways in theimmediate situation.immediate situation. Calls for the nurturance that is Nursing areCalls for the nurturance that is Nursing arepersonal expressions that communicate in somepersonal expressions that communicate in someway - “know me as caring person and affirm me.”way - “know me as caring person and affirm me.”
What the nurse does…What the nurse does… In the nursing situation:In the nursing situation:The nurse enters into the world of the other with theThe nurse enters into the world of the other with theintention of knowing, affirming, supporting, andintention of knowing, affirming, supporting, andcelebrating other as caring person.celebrating other as caring person. Direct invitationDirect invitation isisintegral to this.integral to this. Nurses should offer the direct invitationNurses should offer the direct invitation as part of theiras part of theircoming to know other. The direct invitation raisescoming to know other. The direct invitation raisesawareness of nurse and nursed that nursing IS theawareness of nurse and nursed that nursing IS theservice that nursing offers.service that nursing offers. The Direct InvitationThe Direct Invitation opens the door to explicitopens the door to explicit“caring between.”“caring between.”
Example of Direct invitationExample of Direct invitationInsteadInstead of asking “What can I do for you?” -of asking “What can I do for you?” - turn theturn thefocusfocus away from yourselfaway from yourself to the one you are nursing.to the one you are nursing.Ask, in your own words, sincerely desiring toAsk, in your own words, sincerely desiring toknow:know: WhatWhat matters to you most, right nowmatters to you most, right now??”” This is a very powerful question – wait forThis is a very powerful question – wait forthe answer in stillness, with patiencethe answer in stillness, with patience..The one being nursed willThe one being nursed will respond to the invitationrespond to the invitation ininmany different ways with uniquemany different ways with unique calls for nursingcalls for nursing thatthatarise from what matters.arise from what matters.
Nursing responses of caringNursing responses of caring The nurse responds to these calls for nursingThe nurse responds to these calls for nursingwithwith specific caring resspecific caring responses to sustain andponses to sustain andenhance the other as caring person.enhance the other as caring person. ThisThis caring nurturancecaring nurturance is what we call theis what we call thenursing response.nursing response.
Caring betweenCaring between Presence develops as the nurse is willing to riskPresence develops as the nurse is willing to riskentering the world of the other, and as the otherentering the world of the other, and as the otherinvites the nurse into ainvites the nurse into a special, intimate space.special, intimate space. The encountering of the nurse and the nursedThe encountering of the nurse and the nursedgives rise to the phenomenon ofgives rise to the phenomenon of caring betweencaring between,,within which personhood is nurturedwithin which personhood is nurtured.. The nurse as caring person is fully present andThe nurse as caring person is fully present andgives the other time and space to grow. Throughgives the other time and space to grow. Throughpresencepresence andand intentionalityintentionality, the nurse is able to, the nurse is able toknow the other in his or her living caring andknow the other in his or her living caring andgrowing in caring.growing in caring.
The Caring Between…The Caring Between…ThisThis full engagementfull engagement within the nursingwithin the nursingsituation allows the nursesituation allows the nurse to truly experienceto truly experiencenursing as caring,nursing as caring, and to shareand to share that experiencethat experiencewith the one nursed.with the one nursed.This is theThis is the caring between, the sharedcaring between, the sharedrelation within which nursing is createdrelation within which nursing is createdand experiencedand experienced..
Dance of Caring PersonsDance of Caring Persons(Nursing As Caring: A Model For Transforming Practice(Nursing As Caring: A Model For Transforming Practice, 2001, p. 37), 2001, p. 37)
Dance of Caring PersonsDance of Caring PersonsA Person-Centered, Caring-Focused Relational ModelA Person-Centered, Caring-Focused Relational Model Acknowledgement that all persons have the capacity to care byvirtue of their humanness Commitment to respect for person in all institutional structuresand processes Recognition that each participant in the enterprise has a uniquevaluable contribution to make to the whole and is present in thewhole Appreciation for the dynamic though rhythmic nature of the Danceof Caring Persons, enabling opportunities for human creativity
ReferencesReferencesBoykin, A., & Schoenhofer, S. O. (1991). Story asBoykin, A., & Schoenhofer, S. O. (1991). Story aslink between nursing practice, ontology,link between nursing practice, ontology,epistemology.epistemology. ImageImage,, 2323, 245-248., 245-248.Boykin, A., & Schoenhofer, S. O. (2001).Boykin, A., & Schoenhofer, S. O. (2001). NursingNursingas caring: A model for transforming practice.as caring: A model for transforming practice.Sudbury, MA: Jones and Bartlett.Sudbury, MA: Jones and Bartlett.Mayeroff, M. (1971).Mayeroff, M. (1971). On caringOn caring. NY: Harper and. NY: Harper andRow.Row.