Kaiser Permanente, Northern California - Patient Care Services developed a Caritas in Action campaign to encourage caregivers to reflect authentic expressions of Jean Watson's Caring Science in their daily practice and within their medical center.

1. CARITAS in ACTION
How Caring Science informs and inspires the nursing process
and affirms the commitments of Kaiser Permanente Nurses to
provide our patients and their families exceptional care
Copyright 2012 Kaiser Permanente, NCAL Patient Care Services

2. Jean Watson’s Caring Science Theory
 Caring Science is an inter-personal framework that was chosen to guide
the professional practice of Kaiser Permanente nurses in Northern
California in May 2010
 Caring Science assumes competency and the use of evidence based tools/techniques
as the foundation to practice
 While the initial focus was on nursing; other disciplines have begun to adopt the
framework, including others affiliated with patient care services and the continuum
 Theories provide a framework that*:
 Assists in selecting and organizing information
─ What to ask…to observe…to focus on…to think about
 Guides research, practice and communication
 Influences our behavior
 Encourages different thinking about problems and/or situations
 Assists in the description, explanation and prediction of everyday experiences
 Serves as a guide to the assessment, intervention and evaluation of nursing care
 Helps to build a common nursing terminology
 Enhances the autonomy of nursing by defining it’s own independent functions
*http://currentnursing.com/nursing_theory/understanding_works_nursing_theorists.html
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3. As Kaiser Permanente Nurses, we are committed to fostering
four key relationships:
When these relationships are informed and
inspired by Caring Science, we are able to:
 revitalize our identity as caregivers
Communities we Serve
 create a foundation for collaborative, patient-
centric caring and healing
 honor the unique perspectives of our patients and
their families
 advocate and promote Total Health within the
communities that we serve
Patients & their Family
Self
KP leaders encourage and support our
nurses as they explore the inter-dependent
nature of these four relationships in creating
caring-healing environments
Caregiver Team
Copyright 2012 Kaiser Permanente, NCAL Patient Care Services
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4. As Kaiser Permanente Nurses, we are committed to being:
 Compassionate:
we recognize and offer comfort to ease pain and
suffering
 Authentic:
we act genuine and maintain a calm presence
 Responsible:
we take accountability for our actions and honor our
commitments
 Intentional:
we act with integrity and respond with respect
 Nurturing:
we demonstrate the capacity for understanding and
kindness
 Growth-oriented:
we pursue self development and lifelong learning
Copyright 2012 Kaiser Permanente, NCAL Patient Care Services
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5. As Kaiser Permanente Nurses, we are committed to keeping
our patients:
 Safe:
we take precautions and we are reliable in our adherence to
safety standards, including those that protect ourselves
 Comfortable:
we create caring-healing environments and proactively
manage our patient’s comfort
 Informed:
we engage in respectful dialogue and take the time to check
for understanding
 Engaged:
we involve our patients in the course of their care
 Nurtured:
we cultivate a teaching and learning relationship to enhance
total health
 Connected:
we connect with our patients as individuals and serve as
their voice when they are unable to speak for themselves
 Empowered:
we encourage our patients to make decisions throughout
their care journey that strengthen their mind, body and spirit
Copyright 2012 Kaiser Permanente, NCAL Patient Care Services
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6. Caring Science informs and inspires the Nursing Process
Phase
Assessment
Desired Outcome as Guided by Caring Science
Establish a helping-trusting relationship
Take every opportunity with the patient as a chance to connect
and affirm assessment
Diagnosis
Balance the art and science of clinical judgment
Be cognizant of the patient’s response to treatments and go
beyond the medical diagnosis
Planning
Consider the needs of the “whole” person
Develop a comprehensive Plan of Care inclusive of personal and
patient safety
Implementation
Link patient-centered goals and “Total Health”
Walk with the patient and family, continuing to revise and reinforce
the Plan of Care along the way
Evaluation
Honor the patient’s perception of Healing
Value the voice of each patient as the most meaningful barometer
of the quality of care we provide
Copyright 2012 Kaiser Permanente, NCAL Patient Care Services
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7. Caring Science informs and inspires the Nursing Process
Assessment: Establish a helping-trusting relationship
Take every opportunity with the patient as a chance to connect and affirm assessment
Caritas in Action
Evidence / Outcomes

Pause to center

Touch the patient

Smile, make eye contact and use the patient’s name

Understand the patient’s story

Respond to non-verbal cues

Determine the patient’s readiness to change

Listen Authentically

Engage with the patient face-to-face

Be calm and focused

Keep the patient informed

Engage in respectful dialogue and check for understanding

Circle back with the patient to assure needs are being met

Centering practices, including focusing on
breathing, causes a shift from the sympathetic to
the parasympathetic nervous system
 This shift opens the higher centers of the cortex for
information processing, resulting in the ability to
pick up subtle cues, preventing errors and injury

Human touch conveys a sense of concern and
authenticity allowing the development of a
trusting relationship
I've been a nurse since 1981, and knew since age four that's what I wanted to be because I liked taking care of people. Most
of what was presented is what I feel I put into practice every day. An operating room environment can be very intimidating to
patients and although it may be "routine" for me, I make sure that I treat each patient with care and compassion. I also am
observant for potential underlying reasons for their anxiety. As a patient advocate, I try to treat each person as I would want to
be treated or would want my family member to be treated.
Sheila Singletary, RN
ASU, Operating Room Nurse, San Jose Medical Center
Copyright 2012 Kaiser Permanente, NCAL Patient Care Services
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8. Caring Science informs and inspires the Nursing Process
Diagnosis: Balance the art and science of clinical judgment
Be cognizant of the patient’s response to treatments and go beyond the medical diagnosis
Caritas in Action
Evidence / Outcomes

Integrate subjective and objective data

Consider psychosocial, emotional and spiritual needs


Acknowledges the patients expertise in caring
for their own health
Understand what the disease or illness means to the
patient and family

Builds upon patient’s strengths and competency
to manage their illness

See the person behind the diagnosis


Respect and validate the patient's feelings
Allows the patient to express both positive and
negative concerns

Offer emotional and spiritual support

Elicits anxieties, fears and concerns creating an
opening for learning
One special patient was a middle-aged woman paralyzed from the chest down in a skiing accident when she was just 16 years
old. As I took care of her, I learned how independent she was and quickly threw my old assumptions out the door. One
morning during hospital rounds, the doctor asked Ms. J. if he could meet with her caregiver or her parents to explain the
treatment plan after discharge. I knew immediately that he had not reviewed the patient personal history, but chose not to say
anything. Ms. J. candidly explained to the doctor that she; lived alone in her own home, worked full time as high school
teacher, drove her car by herself, was able to get around via electric wheelchair, with the exception of showering and
dressing, (friends helped with this) she was completely independent.
Sandra S Salman, RN
Rehabilitation Nurse, Roseville Medical center
Copyright 2012 Kaiser Permanente, NCAL Patient Care Services
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9. Caring Science informs and inspires the Nursing Process
Planning: Consider the needs of the “whole” person
Develop a comprehensive Plan of Care inclusive of personal and patient safety
Caritas in Action
Evidence / Outcomes

Recognize the role of the patient

Convey a sense of Hope

Offer the patient options

Be open to ideas offered by the patient

Use caring-healing modalities

Advocate for the patient’s comfort

Rely upon scientific problem solving for caring decision
making

Engage in individualized teaching and learning

Ensure a safe environment

Accept the patient’s traditions and beliefs

Facilitate a warm hand-off with colleagues

New care planning process leverages current
evidence based interventions that are ranked
according to the quantity and quality of research
supporting the intervention


The mutuality questions solicit how much the
patient wants to be involved in their care as well
as their perception of their families role
Establishes a healing environment consistent
with model developed by The Samueli Institute

non-profit research organization supporting the
scientific exploration of healing processes and
their role in medicine, with the mission of
transforming health (from www.samueliinstitute.org)
He was kind of your typical old man – a little stubborn - who wanted to live life the way he wanted to live it. So when there was an option
to try chemo therapy which might give him a few more months instead of a few more weeks, even against the wishes of his wife, he
wanted to “go for it.” This was a high risk procedure because our fisherman was 78 years old and had very poor kidney function.
Everyone knew that the first day would be the scariest since there’s really no way to know how the body will react to the strong cocktail of
drugs he would be given. I was with him for five hours, sitting right at the head of his bed on a stool and telling him step by step what was
happening and why.
I remember he kept asking his wife for a chocolate milkshake but she wanted to wait until the following day which would be his birthday.
But I used to work at Baskin Robbins so when I could, I slipped into the nutrition room, took two little chocolate ice cream cups, added a
little milk, mixed them together and made a chocolate shake. I’m so glad I did that.
Amy Lenz, RN
1 North, Roseville Medical center
Copyright 2012 Kaiser Permanente, NCAL Patient Care Services
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10. Caring Science informs and inspires the Nursing Process
Implementation: Link patient-centered goals and “Total Health”
Walk with the patient and family, continuing to revise and reinforce the Plan of Care along the way
Caritas in Action
Evidence / Outcomes

Partner with the patient to achieve goals

Realize new goals will emerge

Serve in the role of health coach

Clearly communicate the goal of the day

Ensure the Care Board is reflective of patient’s needs

Touch base across disciplines to assure coordinated care

Narrate your care

Do with the patient

Respect the patient’s personal space

Cluster your care / time at computer and with the patient

Create a healing environment

Provide care with loving-kindness

Aligns with and reinforces Patient and Family
Centered Care principles

Increases efficiency while decreasing cost
through personalized care

Leverages our integration to meet the needs

Provides the right level of care at the tight time

Honors the wishes of the patient and family
through advance care/ Life Care planning

Promotes communication, planning and actions
that support Total Health
“His elderly mother was dying. There had been no catastrophic event but, she was slipping a little further away each day. She had
prepared, declining interventions. In spite of her wishes, he just couldn’t let go and struggled to keep her alive. He kept insisting we try
to make her better. I spent a lot of time explaining what we were doing and why. When the time came to transfer her to a SNF, he
actually put himself between the ambulance driver and her to keep them from taking her away. As I looked at him, he looked so sad and
helpless. It dawned on me that this wasn’t about him wanting to save her life. It was about him wanting to be a good son standing up for
his mother as best he could. Once I understood this, the right words came easily.
“You have been the best son your mother could have had. You loved her through all of this. There was nothing more that could have
done.” Suddenly he stopped resisting. It was almost as if he had been given permission to let go. He had done enough and someone
had recognized this and acknowledged him for it.
Genevieve Wright, RN
ICU nurse manager, Hayward Medical center
Copyright 2012 Kaiser Permanente, NCAL Patient Care Services
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11. Caring Science informs and inspires the Nursing Process
Evaluation: Honor the patient’s perception of Healing
Value the voice of each patient as the most meaningful barometer of the quality of care we provide
Caritas in Action
Evidence / Outcomes

Acknowledge that the perception of our patients equates
to their reality

Check-in frequently to assess whether the plan of care is
still effective

Pause to validate patient’s understanding though reflective
teach-back

Celebrate positive outcomes and recognize the patient for
their role

Seek to understand the patient’s concerns

Empathize with the patient and family


Supports a learning organization

Is evidenced in Verbatim comments and
HCAPHS results

Allows for conversations for success, moving us
from a fear based culture to one of open honest
dialogue

Aligns with and reinforces Kaiser Permanente’s
Vision 20/20 guiding principles for
transformational change
Invite the patient to co-create solutions
“'Unfortunately, I don't have the names of any of the nurses who cared for me while @ Kaiser. However, I do want it known that every
nurse, without exception, who cared for me was so very professional, friendly, caring & compassionate. The interaction I enjoyed with all
of them on all shifts made my brief stay so comfortable. I was very frightened knowing the uncertainty I faced & they relieved my fear &
comforted me continuously. I tell everyone about my wonderful experience @ Kaiser! Thank you! (from the bottom of my mended heart!)'”
"I felt and still feel very safe. All of the staff (Nurses, Dr's, Surgeons, Administration) made me feel physically safe and emotionally safe.
This has been a scary journey for me, finding out that I had breast cancer, but I was handled like a person and not just a number. Kaiser
has been a blessing to me and my family. Thank you all!“
“The staff was phenomenal. Particularly impressive were: * The sincere, caring and attentiveness shown by all. * The professionalism
displayed. Each display a thorough knowledge of his or her profession and excercised it with a sincere concern and caring. I thoroughly
enjoyed being with the staff.”
HCAPHS Verbatim Comments
Copyright 2012 Kaiser Permanente, NCAL Patient Care Services
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12. Caritas In Action
“It is not always the successful performance of a procedure that gives patients the impression a nurse is skilled, but often the caring practices that a nurse shows while
performing the technical task”‡
Assessment:
Diagnosis:
Planning:
Implementation:
Evaluation:
Ongoing & Continuous
Patient’s Response
Personal & Patient Safety
Walk with Patient
Patient’s Voice
 Pause to center before
entering the patient’s room
 Touch the patient to promote
trust and convey empathy
 Smile, make eye contact
and use the patient’s name
to establish an inter-personal
connection
 Understand the patient’s
story, gaining a sense of who
they are and what they value
 Be aware of and respond to
non-verbal cues
 Determine the patient’s
readiness to change
 Listen Authentically, without
judgment or expectation
 Engage with the patient
face-to-face (heart-to-heart)
 Be calm and focused rather
than rushed or multitasking
 Keep the patient informed
so that they know what to
expect (including when
 Integrate subjective and
objective data
 Consider psychosocial,
emotional and spiritual
needs that impact the
clinical (medical) diagnosis
and translate to overall
well being
 Understand what the
disease or illness means
to the patient and family
 See the person behind
the diagnosis
 Respect and validate the
patient's feelings, positive
and negative
 Offer emotional and
spiritual support (referrals
 Recognize the role of the
patient in determining the
outcomes and success of the
interventions
 Believe in recovery and
convey a sense of Hope
 Offer the patient options
whenever possible
 Be open to alternative ideas
offered by the patient and
their family
 Use caring-healing
modalities that affect mind,
body, spirit, environment
 Advocate for the patient’s
comfort and proactively
manage their pain, personal
care needs and positioning
 Rely upon scientific problem
solving for caring decision
making (staying current with
 Partner with the patient and
family to achieve the mutually
agreed upon goals
 Realize new goals will
emerge as healing journey
unfolds
 Serve in the role of health
coach, encourage and
reinforce the patient’s effort
 Clearly communicate –
through the NKE process –
the goal of the day and what
the patient can expect
 Ensure Care Board is up-todate and reflective of
patient’s needs/requests
 Touch base across
disciplines to assure
cohesive and coordinated
care
 Narrate your care to reassure
the patient
 Do with the patient (and not
“to” the patient)
 Respect the patient’s
personal space and treat
their room as “home”
 Cluster your care / time at
the computer and with the
patient
 Create a healing
environment, being attentive
to the sensory experience
 Provide care with lovingkindness
 Acknowledge that the
perception of our
patients equates to their
reality
 Check-in frequently to
assess whether the plan
of care is still effective
 Pause to validate
patient’s understanding
through reflective teachback
 Celebrate positive
outcomes and recognize
the patient for their role
in achieving them
 Seek to understand the
patient’s concerns or
areas of confusion
 Empathize with the
patient and family when
concerns are shared
 Invite the patient to cocreate solutions to
resolve their concerns or to
empower them to follow
their plan of care
activities/procedures will occur)
and feel reassured
 Engage in respectful
dialogue and take the time to
check for understanding
 Circle-back with the patient
to assure that their needs
are being met (Authentic
Hourly Visitation)
‡Wysong,
to MSW and chaplain as
appropriate)
Evidence-based Practices)
 Engage in individualized
teaching and learning
 Ensure a safe environment,
keeping room clean and
uncluttered
 Accept and support the
patient’s cultural traditions
and spiritual beliefs
 Facilitate a warm and
succinct hand-off with
colleagues to assure
continuity of trust
P. and Driver, E. “Patients’ Perceptions of Nurses’ Skills.” Critical Care Nurse. 29.4 (2009): 24-36.
Copyright 2012 Kaiser Permanente, NCAL Patient Care Services
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