The Integral Aspects of
Nursing
o Caring is a dimension of human relating, and
often referred to as the art of nursing
Carin o Caring is central to all helping professions, and
enables people to create meaning in their lives.
g
o Caring is sharing deep and genuine concern
about the welfare of another person.
o Caring practice involves connection, mutual
recognition, and involvement between nurse
and client.
Compassion - Awareness of one’s relationship to others, sharing their
The Six
joys, sorrow, pain, and accomplishments. Participation in the experience
of another.
Competence - Having the “knowledge, judgment, skills, energy,
experience and motivation required to respond adequately to the
C’s of demands of one’s professional responsibilities”
Confidence - Comfort with self, client, and others that allows one to build
trusting relationships.
Caring in Conscience - Morals, ethics, and an informed sense of right and wrong.
Awareness of personal responsibility
Commitment - The deliberate choice to act in accordance with one’s
Nursing desires as well as obligations, resulting in investment of self in a task or
cause.
Comportment - Appropriate bearing, demeanor, dress, and language
that are in harmony with a caring presence. Presenting oneself as
someone who respects others and demands respect.
o Boykin and Schoenhofer suggest that the purpose of
the discipline and profession of nursing is to know
Nursing
people and nurture them as individuals living and
growing in caring
as o Respect for people as caring individuals and respect
for what matters to them are assumptions underlying
the theory of nursing as caring.
Caring o Caring is a lifetime process, lived moment to moment
by the nurse and constantly unfolding.
o Human care is the basis for nursing’s role in society
Theory o Nursing’s commitment is to care of the whole person as
well as a concern for the health of individuals and
of groups
Human
Care
o The nurse must care for the self in order to care for others.
Social and o Nurses must remain committed to human care ideals.
o Cultivation of a higher/deeper self and a higher
Ethical consciousness leads to caring.
o Human care can only be demonstrated through
Responsibilit interpersonal relationships.
o Honoring the connectedness of all (unitary consciousness)
ies of Nurses leads to transpersonal caring-healing.
in Relation
o Education and practice systems must be based on human
values and concern for the welfare of others.
to Caring
o Swanson defines caring as “a nurturing way of relating to a valued
‘other,’ toward whom one feels a personal sense of commitment and
responsibility”
Theory
o The theory focuses on caring processes as nursing interventions.
o Swanson’s theory was developed through interactions with parents at
the time of pregnancy, miscarriage, and birth.
of
o The five caring processes:
i. Knowing - Striving to understand an event as it has meaning in
the life of the other
ii. Being with - Being emotionally present to the other
Caring iii. Doing For - Doing for the other as he/she would do for the self if
it were at all possible
iv. Enabling - Facilitating the other’s passage through life
transitions and unfamiliar events
v. Maintaining Belief - Sustaining faith in the other’s capacity to get
through an event or transition and face a future with meaning
Caring responses are as varied as clients’ needs,
environmental resources, and nurses’ imaginations. When
clients perceive the encounter to be caring, their sense of
Caring
dignity and self-worth is increased, and feelings of
connectedness are expressed.
i. Knowing the client
Encount
ii. Nursing Presence
iii. Empowering the Client
iv. Compassion
ers v. Competence
Knowin 1. The nurse aims to know who the client is, in his or her
uniqueness.
g the
2. This knowledge is gained by observing and talking with
the client and family while using effective listening and
communication skills;
Client
3. The nurse’s ‘knowing the client’ ultimately increases the
possibilities for therapeutic interventions to be perceived
as relevant.
Nursing 1. . Physical presence is combined with the promise of
availability, especially during a time of need
Presence
2. Being emotionally present to the client and family, the
nurse conveys that they and their experiences matter.
Empower
1. . Through knowing the client and engaging in a mutual
relationship, the nurse is able to identify and build on
client/family strengths
ing the 2. The caring behavior of enabling is defined as “facilitating
the other’s passage through life transitions and unfamiliar
events”
Client 3. As advocates, nurses empower clients and families
through activities that enhance well-being, understanding,
and self-care.
Compass
1. Compassion involves participating in the client’s
experience, with sensitivity to the person’s pain or
discomfort, and a willingness to share in their
ion
experience.
2. Nurses are challenged to be creative and innovative,
basing interventions on knowledge of the client’s
preferences, in order to provide comfort care.
Compete 1. The competent nurse employs the necessary
knowledge, judgment, skills, and motivation to
nce respond adequately to the client’s needs.
• As nurses take on multiple commitments to family,
work, school, and community, they risk exhaustion,
burnout, and stress. Despite these challenges, it is
imperative that nurses attend to their own needs,
Caring because caring for self is central to caring for others
• The nurse has a responsibility to model health care
for Self
behaviors. Holistic nurses strive to achieve harmony in
their own lives and assist others striving to do the
same.
1. A Healthy Lifestyle
a. Nutrition
b. Activity and exercise
c. Recreation
Caring d. Avoiding unhealthy patterns
2. Mind-Body Therapies
for Self a. Positive Affirmations
b. Guided Imagery
c. Meditation
d. Storytelling
e. Music Therapy
f. Yoga
o Communication is a critical skill for nursing.
o It is the process by which humans meet their survival
needs, build relationships, and experience emotions.
In nursing, communication is a dynamic process used
Communica to gather assessment data, to teach and persuade,
and to express caring and comfort.
ting o It is an integral part of the helping relationship
1. The Communication Process
2. Modes of Communication
3. Nonverbal Communication
4. Therapeutic Communication
5. The Helping Relationship
Sender - The sender, a person or group who wishes to
communicate a message to another, can be considered
the source-encoder
The Message - what is actually said or written, the body
language that accompanies the words, and how the
Communica message is transmitted
Receiver - the listener, who must listen, observe, and
tion Process attend
Response - the message that the receiver returns to the
sender. It is also called feedback.
o Verbal Communication - Verbal communication is largely conscious
because people choose the words they use. Nurses need to consider
the following when choosing words to say or write:
i. Pace and Intonation - The manner of speech, as in the rate or rhythm
Modes of
ii. and tone, will modify the feeling and impact of a message
iii. Simplicity - includes the use of commonly understood words, brevity, and
completeness
Communica iv. Clarity and Brevity - saying precisely what is meant, using the fewest
v. words necessary
vi. Timing and Relevance - involves sensitivity to the client’s needs and concerns
tion vii. Adaptability - alter spoken messages in accordance with behavioral cues from
the client
viii. Credibility - worthiness of belief, trustworthiness, and reliability
ix. Humor - The physical act of laughter can be an emotional and physical release,
reducing tension by providing a different perspective and
x. promoting a sense of well-being.
o Nonverbal Communication - Nonverbal communication
often tells others more about what a person is feeling than
what is actually being said, because nonverbal behavior is
Modes of controlled less consciously than verbal behavior
i. Personal Appearance - How a person dresses is often an
indicator of how the person feels.
Communica ii. Posture and Gait - The ways people walk and carry themselves
are often reliable indicators of self-concept, current mood, and
tion health
iii. Facial Expression - Feelings of surprise, fear, anger, disgust,
happiness, and sadness can be conveyed by facial expressions
iv. Gestures -Hand and body gestures may emphasize and clarify
the spoken word, or they may occur without words to indicate a
particular feeling or to give a sign
o Promotes understanding and can help establish a
constructive relationship between the nurse and the client
o The therapeutic helping relationship is client and goal
Therapeutic directed
i. Attentive Listening - listening actively and with mindfulness, using all
the senses, and paying attention to what the client says, does, and
Communica ii.
feels as opposed to listening passively with just the ear
Visibly Tuning In- key nonverbal skills that can be used to visibly tune
tion in to clients, which is an expression of empathy that tells “clients that
you are with them, and it puts you in a position to listen carefully to their
concerns”
1 2 3 4 5
S O L E R
face the other adopt an lean towards the maintain good eye try to be relatively
person squarely open posture person contact relaxed or natural
o Using silence
o Providing general leads
o Being specific and tentative
Therapeutic o
o
Using open-ended questions
Using touch
Communica
o Restating or paraphrasing
o Seeking clarification
tion
o Perception checking or seeking consensual validation
o Offering self
o Giving information
Techniques o
o
Clarifying time or sequence
Presenting reality
o Focusing
o Reflecting
o Summarizing and planning
o Is an intellectual and emotional bond between the
nurse and the client and is focused on the client.
The o Respects the client as an individual, including
maximizing the client’s abilities to participate in
Helping decision, making and treatments, considering ethnic
and cultural aspects, and considering family
relationships and values.
Relations o Respects client confidentiality.
o Focuses on the client’s well-being.
hip o Is based on mutual trust, respect, and acceptance
Pre-interaction Phase - The nurse reviews pertinent assessment data and
knowledge, considers potential areas of concern, and develops plans for
The
interaction.
Introductory Phase - The goal of the nurse in this phase is to develop trust
and security within the nurse–client relationship
Helping
1. Opening the relationship
2. Clarifying the problem
3. Structuring and formulating the contract
Relations
Working Phase - Nurse and client accomplish the tasks outlined in the
introductory phase, enhance trust and rapport, and develop caring.
1. Exploring and understanding thoughts and feelings
hip
2. Facilitating and taking action
Termination Phase - Nurse and client accept feelings of loss. The client
accepts the end of the relationship without feelings of anxiety or
dependence.
o Teaching client education is a major aspect of
nursing practice and an important independent
nursing function
o Client education is multifaceted, involving
promoting, protecting, and maintaining health.
Teaching o It involves teaching about reducing health risk
factors, increasing a person’s level of wellness, and
taking specific protective health measures.
i. Nurse as Educator - Being an educator or teacher
is an important and primary role for the nurse.
Clients and families have the right to health
education in order to make informed decisions
about their health.
o As a part of multidisciplinary teams, the nurse is often in a
leadership position and frequently delegates aspects of care to
others.
Leading, i. Nurse as Leader - nurse leaders participate in and guide teams that
assess the effectiveness of care, implement evidence-based practice, and
Managing construct process improvement strategies.
ii. Nurse as Manager - Nurses are responsible for managing client care. As a
manager, the nurse is responsible for (a) efficiently accomplishing the
and goals of the organization, (b) efficiently using the organization’s resources,
(c) ensuring effective client care, and (d) ensuring compliance with
institutional, professional, regulatory, and governmental standards
Delegating iii. Nurse as Delegator - Registered nurses increasingly delegate
components of nursing care to other health care workers. These “nurse
extenders” may be identified by a variety of titles including certified
nursing aides/assistants, home health aides, medication assistants,
patient care technicians, orderlies, or surgical technicians.