2. Outline:
Introduction
Duffy’s life, education, position and achievement
Concepts of the revise Quality-Caring Model
Assumptions of the revised Quality-Caring Model
Propositions from the revised Quality-Caring Model
Caring Relationships
The Caring Factors
Application
Critique and analysis
3. Objectives:
By the end of this presentation you’ll be able to:
- Explore the early life of theorist.
- Overview of Joanne R Duffy’s and Quality Caring Model.
- Identify major concepts and assumptions of Quality Caring Model.
- Emphasize the role of professional nurse.
- Apply Quality Caring Model to education and practice.
- Evaluate quality caring model.
4. Education
graduate of St. Joseph’s Hospital School
of Nursing in Providence, RI.
BSN at Salve Regina College in Newport,
RI
MSD and PHD degrees from The Catholic
University of America
5. Carrier development
Critical care nurse
Dr. Duffy has held associate director of
nursing positions at two academic medical
centers
- Georgetown University Medical Center
- George Washington University Medical
Center
6. She developed the Cardiovascular Center for
Outcomes Analysis and administrated the
Transplant Canter at INOVA Fairfax Hospital in
Virginia.
She is at present a
professor at Indiana
University School of
Nursing
7. …
Dr. Duffy is a Fellow of the American Academy of Nursing, a Magnet
Hospital appraiser, and an international consultant.
She was a nursing consultant to the multidisciplinary study team for
the national APACHE study of outcomes
the First Annual Health Care Research Award from the National
Institute of Health Care Management for this work.
8. Quality Caring in Nursing: Applying
Theory to Clinical Practice, Education,
and Leadership (Duffy, Quality Caring
in Nursing)Dec 15, 2008
Winner of an AJN Book of the Year Award for 2009
Professional Practice Models in
Nursing: Successful Health System
Integration
9. the first to link nurse caring to patient outcomes,
Designed and tested multiple versions of the Caring Assessment Tool
developed the Quality-Caring Model.
10. Quality-Caring Model
studying the linkage between nurse caring and selected health care
outcomes (Duffy, 1992, 1993).
to measure caring developing tools to study human interactions during
illness, (Duffy, 2002; Duffy, Hoskins, & Seifert, 2007)
11. Quality-Caring Model
Dr. Duffy found that hospitalized patients who were dissatisfied often
expressed, “nurses just don’t seem to care.”
This concern was corroborated in the literature and represented a
clinical problem that significantly impacted patient quality this consider
as The seeds of the model
12. The Quality-Caring Model was initially developed in 2003 to guide
practice and research (Duffy & Hoskins, 2003).
Drs. Duffy and Hoskins developed and tested the model in a group of
heart failure patients (Duffy, Hoskins, & Dudley-Brown, 2005)
13. Purpose of the Quality-Caring at 2003
1- Guide professional practice
2- Describe the conceptual–theoretical– empirical linkages between
quality of care and human caring
3- Propose a research agenda that would provide evidence of the value
of nursing (Duffy & Hoskins, 2003).
14. Concepts of revise Quality-Caring model
four main concepts:
1- humans in relationship.
2- Relationship-centered
professional encounters.
3- Feeling cared for.
4- Self-caring.
15. humans in relationship
humans are multidimensional beings with various characteristics that
make them unique.
provides an understanding that influences human interactions and
nursing interventions.
Humans are also social beings connected to others and local
communities.
16. Relationship-centered professional encounters
The independent relationship between the nurse and patient/family
and the collaborative relationship that nurses establish with members
of the health care team.
17. Feeling cared for
a positive emotion that signifies to patients and families that they
matter. It allows one to relax and feel secure about health care needs.
18. Self-caring (self advancing system)
It is a human phenomenon that is stimulated by caring relationships.
Self-caring is a capacity that cannot be controlled; it emerges over time
driven by caring connections.
Self-caring represents quality in that it is dynamic and enhances an
individual’s well-being.
19. Assumptions of the revised Quality-Caring Model:
Humans are
multidimensional beings
capable of growth and
change.
20. Humans exist in relationship
to themselves, others,
communities or groups, and
nature.
33. • Independent caring relationships
between patients and nurses influence
feeling “cared for.”
• Collaborative caring relationships among
nurses and members of the health care
team influence feeling “cared for.”
• Feeling “cared for” is an antecedent to
self-advancing systems.
34. • Feeling “cared for” influences the
attainment of intermediate and terminal
health outcomes.
• Self-advancement is a nonlinear, complex
process that emerges over time and in
space.
• Self-advancing systems are naturally self-
caring or self-healing.
• Relationships characterized as caring
contribute to individual, group, and system
self-advancement (Duffy, 2009).
35. “The overall role of the
nurse in this model is to
engage in caring
relationships with self
and others to engender
feeling ‘cared for’”
(Duffy, 2009, p. 199).
36. What The revised Quality-Caring Model
emphasize to professional nurses?
• Attain and continuously
advance knowledge and
expertise in the caring
factors.
37. • Initiate, cultivate, and sustain caring relationships
with patients and families.
with other nurses and all members of the health care team.
38. • Integrate caring
relationships with
specific evidence-
based nursing
interventions to
positively influence
health.
• Maintain an awareness of the
patient/ family point of view.
• Carry on self-caring activities,
including professional
development.
39. • Maintain an open, flexible approach.
• Advance quality health care through
research and continuous improvement.
• Using the expertise of caring
relationships embedded in nursing,
actively participate in community
groups.
• Contribute to the knowledge of caring
and ultimately the profession of nursing,
using varied approaches of inquiry.
41. Caring Relationships
1- relationship with self ( generating
an orientation of the self that
represents a source of understanding
often lost in the business of life )
• In nursing, remaining self aware is a
necessary prerequisite for caring
relationships because in knowing
the self, it is possible to know
others.
42. Caring Relationships (patients and families)
• primary focus of nursing, patients and families who
are ill.
• Initiating, cultivating, and sustaining caring
relationships, is an independent function of
professional nursing that involves intention, choice,
specific knowledge and skills, and time (Duffy,
2009).
• Intending to care depends on one’s attitudes and
beliefs; it shapes a nurse’s choice and resulting
behaviour's, specifically whether “to care” for
another.
43. Caring Relationships (members of the health
care team ).
Collaborative are essential to quality health care
(Knaus, Draper, Wagner, & Zimmerman, 1986) and are
depicted as an important relationship in the Quality-
Caring Model.
• through genuine collaboration contributes to a
healthy work environment that may increase work
satisfaction.
44. Caring Relationships (communities)
caring for the communities is essential to the revised
Quality-Caring Model.
• predicated on the belief that humans interact with
groups beyond the family to connect, share similar
history and customs, and enhance the lives of each
other.
• Engaging in communities provides professional
nurses opportunities to use caring relationships as
the basis for improving health or decreasing
disease.
45. Watson (1979, 1985)
•identified 10 factors
necessary for human
caring in the patient–
nurse relationship.
(Duffy, Hoskins, &
Seifert, 2007).
• Through empirical
testing, eight factors
were identified in a
sample of 557
medical– surgical
patients that
represented caring
• These factors point to
the specific
knowledge and skills
necessary for caring
relationships.
• The following
represent the caring
factors (as defined by
this group of medical-
surgical patients).
The Caring Factors
46. The Caring Factors
1) Mutual problem-solving
2) Attentive reassurance
3) Human respect
4) Encouraging manner
5) Appreciation of unique meaning
6) Healing environment
7) Affiliation needs
8) Basic human needs
(Duffy, Hoskins, & Seifert, 2007)
47. Mutual problem-solving
• Largest factor
• assisting patients and families to learn about, question, and
participate in their health or illness.
• This factor recognizes that patients and families are the decision-
makers.
48. Attentive reassurance
• being available and
offering a positive outlook
to patients and families
that helps them feel
secure.
49. Human respect
• implies valuing the person of the
other by acting in such a way that
demonstrates that value.
Eg.:
calling a patient by his or her
preferred name.
performing tasks in a gentle
manner.
maintaining eye contact.
50. Encouraging manner
• a supportive demeanor during
interactions conveys confidence in
the patient and is expressed
verbally and nonverbally.
• important to maintain uniformity
between messages expressed and
those implied by body language.
51. Appreciation of unique meaning
• nurses aim to see things
from the patient’s point of
view including his or her
sociocultural meanings. In
this way, nurses tailor
interventions in the
patient’s frame of
reference.
52. Healing environment
• including appealing surroundings,
decreasing stressors (noise, lighting).
• ensuring patient privacy and
confidentiality, and practicing in a safe
manner are included in this factor.
53. Basic human needs
• nursing activities such as assessments,
teaching and learning, and emotional
support.
• Providing for basic human needs is an
opportunity to further the
development of caring relationships.
54. Affiliation needs
• making sure that patients are
not only allowed access to
their families, but also that
families are included in care
decisions and keeping them
informed is important to
patients’ well-being.
55. The Caring Factors
• on patient needs and the context of the situation.
• Not all factors are necessarily used at once; rather, the
professional nurse uses his or he "feeling cared for” is
calming to the patient, leaving him or her to concentrate on
the meaning of illness and the requirements for health and
healing. ” (Duffy, 2009).
56. Application
Using the Quality-Caring Model to Organize Patient Care Delivery
Joanne R. Duffy, PhD, RN, FAAN ,Jennifer Baldwin, MPA, RN, BSN, CNAA ,Mary Jane Mastorovich, MS, RN, 2007
57. Critique and analysis
By chin and Kramer(2007)
- How clear is this theory?
- How simple is this theory?
- How general is this theory?
- How accessible is this theory?
- How important is this theory?
58. Critique and analysis
- How clear is this theory?
Semantic clarity and consistency:
Duffy uses specific and general traits to define caring and
relationships.
The quality caring concepts definitions are consistent with the
common meanings of the terms within nursing .
Structural clarity and consistency:
The diagrams are clear and self-explanatory.
Duffys revised quality caring diagram clearly and simply shows the link
between caring relationships and quality care (Parker and Smith, 2010)
59. - How simple is this theory?
There are four concepts of the theory, which keeps it to a minimum but
their interrelationships make it more complex.
- How general is this theory?
Duffys 2009 revised Quality caring theory is a middle range theory as it
draws on others works (Parker and Smith, 2010)
It has parsimony as it is conceptually simple but allows for a broad
range of empiric experiences ( Chinn and Kramer, 2008)
60. - How accessible is this theory?
Duffys concepts ( such as “feeling care for”) are linked to the empiric
indicators (such as attentive reassurance), that can be used to assess
the phenomena ( caring relationship) that the quality caring theory
describes.
61. - How important is this theory?
Quality caring is linked to nursing sensitive patient outcomes,
improving existing care, caring based interventional research,
educational caring, and cost benefit analysis.
The quality caring model benefits patients, nurses the profession and
the health care system.
The quality caring model offers a way to relate to and engage with
other health care providers and the community. Through measurement
of the caring relationships consequences are assessed which provides
an evaluation design for improvement of services.(Parker and
smith,p.405)
Editor's Notes
APACHE is the most widely utilized clinical prediction tool among adult ICUs for evaluating expected outcomes such as: length of stay, mortality, ventilator days and need for active treatment. The APACHE methodology has been cited more than 4,000 times in articles and research published in leading industry trade journals.
AJN The American Journal of Nursing
Dr. Duffy continued to study human interactions during illness, developing tools to measure caring (Duffy, 2002; Duffy, Hoskins, & Seifert, 2007)
