The Art of Caring
• Explore caring theories as they apply to the art
• Acknowledge the potential disruption of
technology to the therapeutic nurse-patient
• Define caring presence and suggest strategies
to enhance caring presence.
• May be less visible than physical interventions
• Include therapeutic communication, active
listening, touch, and mindfulness
• Help patients to maintain, enhance or restore
Technology in Care Environments
• Examples: smart pumps, bar code medication
administration systems, EHRs, smart phones,
• Benefits of technology: increase efficiency,
promote safety and streamline the work of
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
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
• Enumerates 10 Caritas Processes (evolved
from original carative factors)
Watson and Woodward 2010, p. 353
• 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.
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
• Engaging in genuine teaching-learning experience
that attends to unity of being and meaning,
attempting to stay within others’ frames of
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).
Think about a Patient Encounter
• Were you fully present in the moment and
conscious of the individual and his/her
• Did you smile and greet the patient by name and
• 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?
• 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?
Paterson and Zderad’s Humanistic
• 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
• 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
• 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
(Finfgeld-Connett 2008, p. 528).
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
• 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
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
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).
Thought Provoking Questions/
• Examine each of the ten Caritas Processes developed
by Watson. Describe an example of a patient
encounter that demonstrates the use of each Caritas
• 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.
• Finfgeld-Connett, D. (2008). Qualitative convergence of three nursing concepts: art
of nursing, presence and caring. Journal Of Advanced Nursing, 63(5), 527-534.
• 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.