Chapter 27


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Chapter 27

  1. 1. The Art of Caring in Technology Laden Environments Chapter 27
  2. 2. Objectives • Explore caring theories as they apply to the art of nursing. • Acknowledge the potential disruption of technology to the therapeutic nurse-patient relationship. • Define caring presence and suggest strategies to enhance caring presence.
  3. 3. Caring Functions • May be less visible than physical interventions • Include therapeutic communication, active listening, touch, and mindfulness • Help patients to maintain, enhance or restore their health
  4. 4. Technology in Care Environments • Examples: smart pumps, bar code medication administration systems, EHRs, smart phones, smart rooms • Benefits of technology: increase efficiency, promote safety and streamline the work of nursing
  5. 5. We Need to Ask • To what extent does these technology disrupt the nurse-patient caring encounter? • How can we continue to care effectively for our patients and promote a healing environment while incorporating the advantages and efficiencies that technologies provide?
  6. 6. Watson’s Theory of Human Caring • Caring is “healing consciousness and intentionality to care and promote healing.” • Caring consciousness is “energy within the human-environmental field of a caring moment.” • Enumerates 10 Caritas Processes (evolved from original carative factors) Watson and Woodward 2010, p. 353
  7. 7. Caritas Processes • The practice of loving kindness and equanimity within the context of caring consciousness. • Being authentically present and enabling and sustaining the deep belief system and subjective life world of self and one being cared for. • Cultivation of one’s own spiritual practices and transpersonal self, going beyond ego self, opening to others with sensitivity and compassion. • Developing and sustaining a helping-trusting, authentic caring relationship.
  8. 8. Caritas Processes cont. • Being present to, and supportive of, the expression of positive and negative feelings as a connection with deeper spirit of self and the one being cared for. • Creative use of self and all ways of knowing as part of the caring process; to engage in artistry of caring-healing practices. • Engaging in genuine teaching-learning experience that attends to unity of being and meaning, attempting to stay within others’ frames of reference.
  9. 9. Caritas Processes cont. • Creating a healing environment at all levels (a physical and nonphysical, subtle environment of energy and consciousness, whereby wholeness, beauty, comfort, dignity, and peace are potentiated). • Assisting with basic needs, with an intentional caring consciousness, administering “human care essentials,” which potentiate alignment of mind-body-spirit, wholeness, and unity of being in all aspects of care, tending to both embodied spirit and evolving spiritual emergence. • Opening and attending to spiritual-mysterious and existential dimensions of one’s own life-death; soul care for self and the one being cared for (Watson & Woodward, 2010, p. 355).
  10. 10. Think about a Patient Encounter • Were you fully present in the moment and conscious of the individual and his/her uniqueness? • Did you smile and greet the patient by name and acknowledge visitors? • Did you attentively listen to the concerns of the patient and family and offer them the opportunity to ask questions? • Did you explain what you were doing with and for the patient and why?
  11. 11. Technology Disrupts • Do you push the workstation into the room, focus your attention on the computer screen and talk at the screen as you clicked on the drop down menus to document the patient encounter? • Does the workstation create a barrier between you, the patient, and the patient’s family? • Is your assessment of the patient’s current situation colored by the objective representation of the person created by the monitoring technologies present in the room?
  12. 12. Paterson and Zderad’s Humanistic Nursing Theory • Basis of nursing is the response to the call for help in solving a health related concern. • Nurses hear the call and respond with their entire being, their knowledge, experiences, ethics and competencies shape the interaction with the patient as they respond. • Nursing care requires conscious awareness of self, and the uniqueness of our patients. – requires emotional energy expenditure by nurses – avoid the potential for inadvertently dehumanizing the patient experience in our technology laden practice environments. (Kleiman 2010)
  13. 13. Presence • The act of being there and being with our patients—fully focusing on their needs. • “Presence is an interpersonal process that is characterized by sensitivity, holism, intimacy, vulnerability and adaptation to unique circumstances. ” (Finfgeld-Connett 2008, p. 528).
  14. 14. Types of Presence • Physical presence--competent in carrying out care, efficient with interventions, but inattentive to communication and non-verbal cues projected by the patient and family. • Full presence--greet the patient by name, communicate appropriately with the patient and pay attention to what is being said and not said during the encounter. • Transcendent presence– uses centering to clear the mind of distractions, uses the patient’s name and gentle touch to convey interest and responsiveness while carrying out the necessary physical interventions. Penque and Snyder 2010
  15. 15. Strategies to Enhance Caring Presence • Attention to Self-Care • Centering—focus on this patient only • Bracketing—let go of preconceived expectations about patient experience • Active listening – At level of patient for eye contact – Nod and encourage communication – Clarify, restate and ask questions – Use Silence
  16. 16. Art of Nursing • “The art of nursing is the expert use and adaptation of empirical and meta-physical knowledge and values. It is relationship-centered and involves sensitively adapting care to meet the needs of individual patients. In the face of uncertainty, creativity is employed in a discretionary manner. Artful nursing promotes beneficent practice and results in enhanced mental and physical well-being among patients. It also results in professional satisfaction and personal growth among nurses” Finfgeld-Connett (2008, p. 528).
  17. 17. Thought Provoking Questions/ Exercises • Examine each of the ten Caritas Processes developed by Watson. Describe an example of a patient encounter that demonstrates the use of each Caritas Process. • Reflect on your personal health. Are you a role model for your patients? What aspects of your personal health do you need to improve? What strategies will you adopt to improve your health? • Chose a caring presence strategy to implement in your practice and use the reflective journal template provided in the chapter to reflect on your practice.
  18. 18. References • Finfgeld-Connett, D. (2008). Qualitative convergence of three nursing concepts: art of nursing, presence and caring. Journal Of Advanced Nursing, 63(5), 527-534. doi:10.1111/j.1365-2648.2008.04622.x • Kleiman, S. (2010). Josephine Paterson and Loretta Zderad’s Humanistic Nursing Theory. In Nursing Theories and Nursing Practice, 3e. M. Parker and M. Smith, eds. Philadelphia: F. A. Davis Company. p. 337-350 • Penque, S. and Snyder, M. 2010. Presence. In In Complementary and Alternative Therapies in Nursing, 6e. M. Snyder and R. Lindquist, eds. New York: Springer Publishing Company. p. 35-46. • Watson, J. and Woodward, T. (2010). Jean Watson’s Theory of Human Caring. In Nursing Theories and Nursing Practice, 3e. M. Parker and M. Smith, eds. Philadelphia: F. A. Davis Company. p. 351-368.