2009 o cuidado_-_watson

artigo originaL / research report / artícuLo

Caring as the essence and science of Nursing and health care
O cuidar como essência e ciência da enfermaria e dos cuidados médicos
El cuidar como la esencia y la ciencia de la enfermería y de los cuidados médicos

Jean Watson*

AbStrACt: Human Caring is part of the human condition and a way of Being Human. Caring is found throughout time. Moreover, the
notion of ‘caring’ in nursing has been a given throughout its history. In the past 3 decades or so, professional human caring has been
increasingly acknowledged as the essence and core of professional nursing. This focus is evident in nursing practice, nursing theories,
nursing curricula, and nursing’s philosophical and ethical perspective toward humanity and patient caring relationships. In this paper,
I present the main tenets of works by means of which I have posited Caring as the disciplinary foundation for nursing and have put
forward Caring Science as an evolved view of nursing and human sciences (WATSON,1979, 1985, 1999, 2005, 2008).
KEywOrdS: Human Caring. Nursing. Health care.
rESumO: O cuidar humano é parte da condição humana e uma maneira de Ser Humano. Cuidar é algo que se faz presente ao longo do
tempo. Além disso, a noção de “cuidar” em enfermagem tem sido tida por certa durante toda a sua história. Nas três últimas décadas,
o cuidar humano profissional foi reconhecido cada vez mais como a essência e o núcleo da enfermagem profissional. O foco no cuidar
é evidente na prática da enfermagem, nas teorias da enfermagem, nos currículos da enfermagem e na perspectiva filosófica e ética da
enfermagem como relação à humanidade e aos relacionamentos de cuidado com os pacientes. Neste artigo, apresento os princípios dos
trabalhos mais importantes nos quais postulei o Cuidar como o fundamento disciplinar da enfermagem e para propor a ciência do Cuidar
como uma concepção avançada da enfermagem e das ciências humanas (WATSON, 1979, 1985, 1999, 2005, 2008).
PAlAvrAS-ChAvE: Cuidar Humano. Enfermagem. Cuidados médicos.
rESumEN: El cuidar humano es parte de la condición humana y una manera de Ser Humano. El cuidar se presenta a través de la historia
humana. Por otra parte, la noción de “cuidar” en el oficio de enfermería ha sido considerada su esencia a través de su historia. En las
últimas 3 décadas, se ha reconocido cada vez más el cuidar humano profesional como la esencia y la base de la enfermería profesional.
Este foco es evidente en la práctica de enfermería, las teorías de la enfermería, currículos de enfermería y la perspectiva filosófica y ética
de la enfermería hacia la humanidad y las relaciones de cuidados con los pacientes. En este artículo, presento las principales bases de los
trabajos por medio de los cuales he postulado el cuidar como la fundación disciplinaria para la enfermería y he propuesto la ciencia del
cuidar como una concepción más avanzada del cuidado y de las ciencias humanas (WATSON, 1979, 1985, 1999, 2005, 2008).
PAlAbrAS llAvE: Cuidar humano. Enfermería. Cuidados médicos.

Human Caring is part of the hu- tive toward humanity and patient an Honoring of the following: infinity
man condition and a way of Being caring relationships. Watson has of the human spirit and the evolv-
Human. Caring is found through- posited Caring as the disciplinary ing universe; ancient and emerging
out time. Moreover, the notion of foundation for nursing and put for- cosmology of a unity consciousness
‘caring’ in nursing has been a given ward Caring Science as an evolved of related of All; the world view
throughout its history. view of nursing and human sciences (ontology) as ethic related to an
In the past 3 decades or so, pro- (1979, 1985, 1999, 2005, 2008). Ethic of Belonging (acknowledg-
fessional human caring has been ing our connectedness with infinity
increasingly acknowledged as the Caring Science field of spirit, before our separate
essence and core of professional physical being1; the moral position
nursing. This focus is evident in Within a framework of Caring of sustaining the infinity and mys-
nursing practice, nursing theories, Science there are basic assump- tery of the human condition and
nursing curricula, and nursing’s tions that differ from medical sci- keeping alive the evolving human
philosophical and ethical perspec- ence1. These assumptions include spirit across time, in order to face

* PhD, RN, AHN-bc, FAAN. Distinguished Professor Nursing. University of Colorado Denver. College of Nursing. Founder/Director Watson Caring Science Institute.
www.nursing.ucdenver.edu/caring. www.watsoncaringscience.org

O MundO da Saúde São Paulo: 2009;33(2):143-149. 143

caring as the essence and science of nursing and heaLth care

and deepen our humanity; an ethical related ness, and unitary conscious- cal observable level, and also
awareness that we hold another per- ness. It involves an intentionality at non-physical, subtle energy
son’s life in our hands; this sovereign and caring consciousness, which level; whereby energetic con-
expression of life is given to us, be- has to be cultivated and lived out sciousness of Caritas radiates
fore and beyond our control with in daily personal/professional life. the field, wholeness, beauty,
expressions of trust, love, caring, These 10 processes include the fol- comfort, dignity, peace, calm
honesty, forgiveness, gratitude and lowing: are communicated.
so on; transpersonal perspective 1. Practice of Loving-kindness and 9. Administrating human care
that goes beyond ego fixations and equanimity within the context essentials, helping another with
obsessive feelings that are negative of caring consciousness (a car-
basic human needs, with an in-
expressions of life; the relationship ing consciousness carries high-
tentional caring consciousness
between our consciousness, words, er energy vibrations from our
that honors unity of mindbody-
and thoughts and how they posi- heart-center, the Source of our
spirit and wholeness in all as-
tively or negatively affect our ener- humanity, connecting human-
pects of care.
getic –transpersonal field of Being/ to- human; heart- to- heart;
spirit –to- spirit from one to an- 10. Opening and attending to the
Becoming and Belonging; thus our
other). spiritual mysterious and exis-
consciousness affects our ability to
tential unknowns in life/death,
connect, to ‘be-in-right-relation’ 2. Being authentically present in
the moment, acknowledging health, illness - ‘allowing for
with Source; the infinite universal
and allowing for the deep belief miracles’.
Cosmic field of Love.
In this evolved view of science system and subjective life-world These Caritas Processes
and a starting point of Caring and of self and other (instilling faith acknowledge the unitary energetic
Humanity as ethic, we can appre- and hope). nature of all of life and life journey.
ciate, honor and face the reality 3. Cultivating one’s own spiritual These processes can be considered
that life is given to us as a gift. We practices with comprehension holographically in that the whole
are invited to sustain and deepen of interconnectedness that is in any part and any part is in the
our own and other’s humanity as goes beyond the individual and whole.
our moral and ethical starting point opens one to Source and evol-
for professional caring-healing. ving consciousness. Caritas Nurse: Caritas
These views of Caring Science 4. Developing and sustaining Nursing
are not unlike Nightingale’s no- authentic heart-centered,
tion of natural healing processes, authentic caring relationship What is emerging throughout
which draw upon spiritual dimen- with self and other. the shift to Caritas process is an
sions that are the greatest source of acknowledgement of a deeper
5. Being present to and supporti-
healing (1969). During the last 3 ve of the expression of positive more evolved form of nursing:
decades there is an increasing at- and negative feelings, arising in Caritas Nursing and the Caritas Nurse.
tention to Caring in nursing as the self and other (with an under- As each nurse evolves and nursing
ethical core and stable essence of standing that all of these feel- evolves we learn that the more
professional nursing, in contrast to ings come and go and need to evolved practitioner works from
changing dimensions Watson re- be recognized and honored). the higher/deeper dimensions
ferred to as trim. of humanity and one’s evolving
6. Creatively using all ways of
consciousness. An evolved nurse
knowing, Being and doing as
10 Caritas Processes as core cultivates the practices of Caritas
integral to caring process in
Nursing. Another view of a Caritas
of Caring solving problems/ seeking so-
nurse is one who is working from
lutions for patients/families/
The most recent work on an open, intelligent heart-center,
community.
Caring by Watson (2008)2 builds rather than from a less conscious-
upon the original 10 Carative fac- 7. Engaging in genuine teaching- ness, head-center. The heart-cen-
tors and extends them as 10 Caritas learning experiences that arise tered evolved Caritas Nursing opens
Processes (bringing together caring from an understanding of inter- to transpersonal experiences in the
and Love) as the fully mature prac- connectedness. caring moment. The Caritas Nurse is
tices of caring. These processes are 8. Creating and sustaining a working more and more in awake-
based upon worldview and ethic of healing environment at physi- ning the heart-center to bring one’s

144 O MundO da Saúde São Paulo: 2009;33(2):143-149.


full and open spirit-filled self to any 2. Heart-centered Authentic Pres- three decades. This has occurred
caring occasion. ence largely in the academic world of
This model of Caritas thinking 3. Compassionate Forgiveness nursing science, which often has
invites a total transformation of self disconnected nursing theory from
4. Gratitude- Appreciation
and systems from within, the deep nursing practices. However, dur-
inner place within the creativity of 5. Energetic Caritas Consciousness ing the past decade there has been
the human heart, which connects evolution –personal spiritual special attention to theory-guided
us with Source to sustaining the practice practice models and caring and
human spirit. It is here in this form 6. Opening - Giving –Receiving healing relationships as the core of
of evolved nursing that nurses find 7. Being Still- Silence – Holding professional nursing. Concurrently,
heart-centered caring as the source the Still Point practitioners are seeking more
for compassion, wisdom, truth and authentic practices, giving mean-
8. Connecting with infinite cosmic
authentic transpersonal caring. ing and purpose to their profes-
field of Universal Love
sional lives and work. Much of this
transpersonal Caring 9. Manifesting Caritas Field (to changing consciousness has been
sustain caring and our huma-
relationship nity)
triggered by the nursing short-
age, nursing despair over system
Transpersonal Caring embodies 10. Other - infinite demands, as well as an awareness
a spirit to spirit, heart-to-heart con- It is in understanding and con- of a lack of human caring in our
nection through the full presence necting with the deeply human personal/professional lives, and in
of the nurse with Caritas Loving dimensions of life/death that we both systems and society.
consciousness and intentional- open our hearts to human experi- Nurses are torn between the
ity in the moment. Transpersonal human caring values and the
ences of suffering, loss, search for
caring radiates a field of caring be- ‘calling’ that attracted them to the
meaning, which nurses face and
yond the two people, but a process profession, and the technologically,
witness daily, if not moment- by-
that becomes part of the life jour- high paced, task-oriented biomedi-
moment. These deeply human
ney and greater complexity of life. cal practices and institutional de-
conditions and experiences cannot
A transpersonal caring transcends
be dealt with by technical compe- mands, heavy patient load, along
time, space and physicality and af-
tent and conventional evidence- with outdated industrial practice
fects both nurse and patient which
based practice models of Western patterns4. It has been reported in
both carry into their life processes
medical-nursing science. Thus, some comprehensive summary
as long as they live.
a model of Caring Science allows research that nurses who are not
It is this human caring mo-
for the emergence of an evolved able to practice caring can become
ment which informs the next mo-
Caritas Nurse, it invites nurses into hardened, brittle, worn down, and
ment and potentiates healing and
a deeper appreciation of the com- robot-like5.
wholeness. In this model of caring/
plexity of the human experiences, Both practitioners and health
Caritas nursing is not just doing, but
involves informed, consciousness inner life journey and meaning of systems now realize radical change
intentional way of Being. inter-subjective responses to car- from within is an essential and nec-
ing, healing, illness, despair, dis- essary requirement to reverse the
ease, and death. It is this model non-caring trend many experience
Caritas ways of being- which truly honors and opens to or witness in hospitals and health
becoming the unity of mindbodyspirit and care today. In other words all the
The following Caritas Ways our human –to-human connection change approaches to date, at-
of Being have been identified as with Source which unites All. tempt to solve the health care crisis
another dimension of cultivating in the USA and other Westernized
Caritas Processes in Professional Current focus in human countries by focusing on external
Nursing Practices: Caringa issues and forces. These include
such system solutions as econom-
Caritas –Ways of Being- Philosophies, ethics, and theo- ics, technology, management -
Becoming: ries of nursing science have contin- organization, access control, and
1. Loving Kindness ued to evolve over the past two or environmental hospitality models.

a. This section draws upon previous manuscript (Watson, 2009)3



Other proposed solutions focus on national crises in hospitals today. ing Magnet criteria through trans-
nursing recruitment and retention, Increase demand for efficiency forming nursing, but also have
better compensation packages, and quantity, for production and sought to realize deeper levels of
signing bonuses, relocation fees, outcomes, set within an outdated caring and helping practices for
and hiring increased numbers of industrial mindset, has led to more their nursing staff. Watson’s Theory
minimally-educated laypersons or and more distancing between of Human Caring is one prominent
assistants. These tactics comprise patients and practitioners, and theoretical, ethical, philosophical
superficial and short-term ap- between and among practitioners. framework in which nurses and
proaches, when what is needed is a The result is a culture which has administrators are engaged to
deeper, philosophical, value-based lost its way, void of humanity and inspire and transform nursing and
approach relevant to sustaining the authentic human caring relation- health care for this work.
integrity and dignity of the profes- ships, important communication, Some shifts of consciousness
sion of nursing, which has the larg- and connections, paving the way which underpins this movement
est number of practitioners in the for even more increase in medical and system attempts to resolve the
healthcare system and in society. errors, safety violations and numb- moral/professional conflicts for
The contrast is attending to the ness among the practitioners. nursing, include acknowledging6:
most fundamental resource and the Ultimately, the ability to resolve • human caring is not a commod-
most precious and powerful source conflicts between what nursing is ity to be bought and sold;
for authentic reform/transforma- (viz., the theories, philosophies, • caring and economics are not
tion of hospitals and clinical agen- ethics and knowledge that guide mutuality exclusive, and can
cies: competent, compassionate, their professional/disciplinary prac- co-exist to achieve cost-benefit/
knowledgeable, and caring nurses tices) and what nurses supposedly do, cost-effectiveness ;
and health practitioners. Nurses may be the most critical challenge
• caring is a professional ethical
and practitioners who are literate for the discipline and for the pro-
covenant that nursing has with
with caring relationships are capa- fession’s survival into this millen-
the public to sustain human
ble of having loving, caring, kind, nium, and thus may well impact all
caring in instances where it
and sensitively meaningful, per- of health care, both nationally and
may be threatened; it necessari-
sonal connections with an increas- internationally4. A values-based,
ly involves something deeper
ingly enlightened public: a public theory guided approach to human
and more substantial than a
seeking wholeness and spiritual caring and health care change helps
‘customer’ model orientation;
connections for their wellbeing, not to make visible a major shift that
just sterile, depersonalized medical is required for authentic changes, • practitioners and patients alike
technological interventions, void of in order for nursing and human require caring relationships
human-to-human caring relation- caring to survive into this era. and healing environments, if
ships. Recently a number of hospitals caring-healing practices are to
The underlying dissatisfaction in the United States have shifted be sustained within any health
with healthcare continues to in- toward explicit implementation of care setting.
clude system cultures and routines Human Caring theory as a guide • true transformation of health
which inhibit the ability of nurses toward professional nursing prac- care ultimately has to come
to practice their own profession; tice changes, as well as culture in- from a shift in consciousness
the dominance of medical –insti- stitutional changes. Some of this and intentional actions of
tutional foci, and the quantity of momentum is triggered by the the practitioners themselves,
time demands over the quality of American Nurses Credentialing changing health care from the
direct-care person-centered re- Center, Magnet Hospital Program. inside out.
lationships, and also caring and Magnet hospitals must demons- The evolving caring-healing
healing processes and practices. trate criteria that recognize quality practice environments are in-
This tension continues in spite of patient care, nursing excellence, creasingly dependent on relation-
marketing logos and slogans about and innovations in professional ships, partnerships, negotiation,
“caring institutions”6. practice and also assure quality of coordination, new forms of com-
Recent crises related to safety care to consumers. munication patterns and authen-
concerns have brought renewed In recent years, many nursing tic connections. This awakening
attention to nursing and physician leaders and administrators have includes a shift toward a spiritual-
practices and how to address the been committed not only to meet- izing of health, in contrast to the



more conventional medical-clin- Caring and Nursing patient satisfaction outcomes
ical, techno-cure orientation to Administrative leadership related to the introduction of
health and illness. These shifts in a theory-guided professional
how health and healthcare is per- Nursing administrators as well practice model.
ceived, have arisen from the public, as hospital managers and Chief Ad- • Resurrection Health, Chicago, Il-
and demand of nursing and health ministrative Officers have a signifi- linois. Providing leadership in
care administrators to develop cant role to play in transforming the system wide implementation
creative solutions, that transcend dominant medical system, which of caring theory. Also exploring
the ubiquitous and ineffective fix-it has been framed in some classic re- computerized documentation
models. search as being biocidic (unhealthy, system, which incorporates
toxic) in contrast to biogenic (life language and nursing interven-
giving and life receiving for patient tions based upon caring theory
Emerging models of Caring and practitioners alike). in contrast to conventional
– healing medical-nursing tasks and pro-
In the past decade or so, in- watson Caring Science cedures7.
creasing number of hospitals and Institute: International • Inova Fairfax Hospital, Fairfax,
academic programs in the United Caritas Consortium Virginia. A comprehensive sys-
States and other parts of the world, tem formally researching car-
have begun to use Watson’s Theory Because of these national ing theory through a federally
of Human Caring in very specific and international developments funded project whereby out-
ways, as a guide to changing nurs- and sincere desire for authentic comes of caring theory practic-
ing practice – and ultimately chang- change, new projects using Caring es are examined in relation to
ing the culture of hospital nursing Science Theory and Philosophy of patient and nurse satisfaction,
and academic nursing. (For more Human Caring are now underway retention rates and other varia-
information, see websites: www. in many systems. The Watson Car- bles.
watsoncaringscience.org; www. ing Science Institute and The In-
• Central Baptist Health, Lexing-
nursing.ucdenver.edu/caring ternational Caritas Consortium2
ton, Kentucky. Magnet hospital
are one example where individu-
“This theory/philosophy involves using caring theory as profes-
als and representatives of systems sional practice model.
making explicit human caring
convene twice a year to deepen
and relationship-centered car- • Scripps HealthCare, La Jolla,
and sustain what is referred to as
ing is a foundational ethic for California. This organization is
Caritas Nursing – that is, bringing
healing practices; it honors the exploring caring theory in rela-
caring and love and heart-centered
unity of the whole human being, tion to complementary, holistic
human to human practices back
while also attending to creating medical programs.
into our personal life and work
a healing environment. Caring – • Bon Secours St. Mary’s Hospi-
world2. These gatherings are hosted
healing modalities and nursing tal, Richmond, Virginia. Saint
by different clinical – educational
arts are reintegrated as essentials to Mary’s Hospital is providing
systems using Caring Theory as
ensure attention to quality of life, exemplary programs in caring
forum for transforming education
inner healing experiences, subjec- and practice from the inside out. theory-guided practice models,
tive meaning, and caring practices, For example, the following health and exploring pilot program
which affect patient outcomes and care systems have sponsored the with CaritasHeartMath™, a
system successes alike. International Caritas Consortium program that integrates Caritas
This work places human-to – and the Watson Caring Science Ins- nursing and Science of Human
human – caring as central to pro- titute in recent past and into the Caring with the Science of the
fessional nursing responsibilities, near future as this work expands Heart, as researched and de-
the role and moral foundation for and radiates outward: veloped by HeartMath. (www.
the profession. Preserving human • Baptist Hospital of Miami, Florida HeartMath.com).
dignity, relationships and inte- – three times National Magnet • Scottsdale Health Care, Scottsdale,
grity through human caring are designation recognition (Ame- Arizona. This Magnet hospital
ultimately the measures by which rican Nurses Credentia ling demonstrating caring theory-
patient’s evaluate their often ‘cure Center, ANCC); This organi- guided practices and research.
dominated experiences1.” zation has analyzed health and The host for the April, 2008 ICC



and host of the inauguration of systems guided by Caring Science • centering exercises and mind-
the Watson Caring Science Ins- and caring theory as a guide. The fulness practices, individually
titute. following are examples of such and collectively;
• Baptist Health Jacksonville of caring-in-action indicators: • placing magnets on patient’s
Northeast Florida, Jacksonville, • making human caring integral door with positive affirmations,
Florida. Baptist Health achieved to the organizational vision and and reminders of caring prac-
Magnet recognition for the culture – through new language tices;
healthcare system, using caring and documentation of caring, • exploring documentation of
theory as professional practice such as posters; caring language and integration
model throughout their insti- • introducing and naming new in computerized documenta-
tutions. Participants in a multi- professional caring practice tion systems;
site research project assessing models, leading to new pat- • participation in multi-site re-
caring across their system. The terns of delivery of caring/care. search assessing caring among
sponsor for the October, 2008 Some examples are: ‘Attending staff and patients;
International Caritas Consor- Caring Nursing Project’, ‘Pa-
tium. • creating healing environments
tient Care Facilitator Role’, the
– attending to the subtle environ-
• Wyoming Medical Center, Casper, ’12-Bed Hospital’;
ment or Caritas field;
Wyoming. This hospital is the • conscious intentional meaning-
projected host in October, 2009 • displaying healing objects,
ful rituals, .For example, hand
for the Caritas Consortium and stones, blessing basket;
washing is for infection control,
is incorporating caring theory, but also may be a meaningful • creating Caritas Circles to share
including indigenous, Native ritual of self-caring- energeti- caring moments;
American population, cultural cally cleansing, blessing, and • caring Rounds at bedside with
dimensions for the local people; releasing last situation or en- patients;
also exploring research out- counter, and being open to the • interviewing and selecting staff
comes through identified assess- next situation; on basis of ‘caring” orientation.
ment measures8. Asking candidates to describe
• selected use of caring-healing
• Bon Secours St. Francis Hospital, modalities for self and patients, “Caring Moment”;
Charleston, South Carolina. e.g. massage, therapeutic touch, • development of ‘caring com-
Sponsor of spring, 2009 gather- reflexology, aromatherapy, petencies’ – ‘ caritas literacy as
ing of the International Caritas calmative oil of essences; sound, guide to assess and promote
Consortium and introducing music, arts, variety of energetic staff development and assure
innovative caring practices, modalities; caring.
guided by theory, philosophy
• diming the unit lights and hav- These and other practices are
and ethics of Caring Science.
ing designated ‘quiet time’ for occurring in a variety of hospitals
patients/families/staff alike, to across the United States, often in
Caring Indicators and soften, slow down, and calm Magnet hospitals or those seeking
Programs the environment; Magnet recognition, where caring
• creating healing spaces for theory and models of human ca-
While these above named sys- ring are used to transform nursing
nurses; sanctuaries for their
tems are identified as sponsors of and health care for staff and pa-
own time out; May include me-
the growing International Caritas tients alike.
diation or relaxation rooms for
Consortium, examples of how The names of other health care
quiet time;
these systems are implementing inter/national clinical and educa-
the theory are captured through • cultivation of own spiritual tional systems incorporating Caring
identified acts and processes depic- heart-centered practices of Theory into professional nursing
ting such transformative changes. loving kindness and equanimi- practice models (many hospitals
Caring theory-in-action reflects ty to self and others; are Magnet hospitals or preparing
transformative processes which • intentionally pausing and to become Magnet hospitals) can be
are representative of actions taking breathing, preparing self to be found on following websites: www.
place in many of the systems in present before entering patients watsoncaringscience.org; www.
the Caritas Consortium and other room; nursing.ucdenver.edu/caring



These identified system exam- human caring and healing and inside out. The dedicated leaders
ples are exemplars of the changing health in a system that has gone who are ushering in these changes
momentum today, and are guided astray – educationally, economi- serve as an inspiration for sustain-
by a shift toward an evolved con- cally, clinically, and socially. This ing nursing and human caring for
sciousness. They rely on moral, shift is in a hopeful direction, and is practitioners and patients alike.
ethical, philosophical, and theo- based on a grass roots transforma-
retical foundations to restore tion of nursing, one that is from the

references

1. Watson J. Caring Science as Sacred Science. Philadelphia: FA Davis; 2005.
2. Watson J. Nursing. The Philosophy and Science of Caring. Boulder: University Press of Colorado; 2008.
3. Watson J. Caring Science and Human Caring Theory: Transforming personal/professional practices in nursing and healthcare. J
Health Human Servic. 2009; Symposium issue. [in press]
4. Watson J, Foster R. The Attending Nurse Caring Model: Integrating theory, evidence and advanced caring-healing therapeutics
for transforming professional practice. Journal of Clinical Nursing. 2003;12:360-5.
5. Swanson KM. The effects of caring, measurement, and time on miscarriage impact and women’s well-being in the first year
subsequent to loss. Nursing Research. 1999;48(6):288-98.
6. Watson J. Caring theory as ethical guide to administrative and clinical practices. Nursing Administrative Quarterly. 2006;30(1):48-55.
7. Rosenberg S. CIN: Computers, Informatics. Nursing. 2006;24(1):53-6. B Lippincott Williams & Wilkins, Inc.
8. Persky G, Nelson JW, Watson J, Bent K. Profile of a nurse effective in caring. Nursing Administration Quarterly. 2008;32(1):15-20.

Recebido em 21 de janeiro de 2009
Aprovado em 6 de março de 2009


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