Principal Role of Caring in Nursing in Patients Restoring - Literature review Example

What is caring? Introduction Caring is considered as one of the basic characteristics of expressing humanity. In the context of healthcare, caring is as important as the process adopted for curing a specific ailment. It is the philosophy on which nursing aspect of the healthcare service is based upon. As Foyle (2009) and others put it, in nursing, caring is considered as the most valuable aspect of treatment, and the essence of nursing. However, the contemporary healthcare services regard caring as meeting patients’ expectations and government targets; although the intentions differ, policies, procedures and practices render nursing care in this manner. As Deutschendorf (2006; p.315) asserts, ‘the goals of successful patient care deliver include high-quality and low-cost care and the achievement of patient outcomes and satisfaction levels.’ These objectives can be achieved by adopting an appropriate organizational approach that matches human and material resources with patient characteristics and health care needs. Further, she puts forward that nursing care staff is assigned to clients (patients) in order to achieve these objectives. Many nursing professionals like Leininger (1992) and Barnum (1992) regard that the philosophy of caring has given a framework to nursing profession through unmatchable works of Florence Nightingale (Nightingale, 1992). Many theories of nursing, nursing care modalities and caring approaches have been proposed based on an integrated framework of Nightingale’s nursing care philosophy and organizational (healthcare) objectives. Much research has been conducted to evaluate the impact of ‘caring’ on patients’ overall health and its significance in, especially, nursing profession. Caring concept has been construed in various ways that matter to an individual receiving particular service. Through caring, individuals are made to feel comfortable and confident about the service/treatment; and they are made to feel important in settings surrounded by strangers. Caring has been defined in various ways by different researchers and practitioners all over the world, and its dynamic nature has been proven by Morse et al’s (1990) analysis of nursing theories. Caring is multidimensional and cannot be assigned a concrete definition. Yet, different people have defined ‘caring’ based on what they perceive as caring in the nursing profession. Like, Watson (1985) refers to caring as a nursing term representing the factors nurses use to deliver health care to patients. Nurses respond to others (patients) as unique individuals and perceive the feelings of others and recognize their uniqueness (cited by Neil & Tomey, 2006) This multidimensional philosophy as defined by a middle-range theorist, Swanson (1991; p.162), can be regarded as a comprehensive one that states, ‘caring is a nurturing way of relating to a valued other toward whom one feels a personal sense of commitment and responsibility.’ Its five processes include knowing, being with, doing for, enabling, and maintaining belief (cited by Huber, 2006; p.231). Likewise, many meanings and perceptions of caring have been stated in the literature through various theories and models. Heath (1995) has emphasized that the nursing profession in the UK focuses on holistic care giving covering mind-body-spirit aspects of wellbeing. Many nursing theories have been developed based on the principle that the contemporary management of care should include both patient/client and the nurse’s overall wellbeing. Literature traces this concept to Florence Nightingale’s understanding of holistic caring based on comprehensive patient observation and autonomous decision making by the caregiver (Dossey & Keegan; 2008). Jean Watson’s humanistic model of nursing covers multiple dimensions of caring based on assumptions and practices of nursing. It is based on the philosophy that ‘caring calls for a philosophy of moral commitment toward protecting human dignity and preserving humanity’ (1985; p.31). Watson’s model reinforces the moral commitment and will to care in the nursing profession. Commonly referred to as transpersonal human caring, this model stresses on the relationship between the nurse and the patient that can have a significant impact on the patient’s vulnerability. Therefore, this perspective views patient-nurse relationship deeper than a mere body-mind association. Caregivers with this perspective believe in adoption of a holistic approach to caring and acknowledge the impact of relationship between body, mind and soul on patient’s overall recovery and sustained wellbeing. Morse et al.’s (1990) analysis of caring based on the three important nursing theorists’ views, Orem, Watson and Leininger, has identified five different perspectives of caring namely, caring as human trait that can be measured and defined specific to instances and people; caring as moral imperative considering health with respect to the characteristics that are considered as healthy and/or unhealthy; caring as an affect on the patient’s physical, mental and emotional recovery, caring as an interpersonal relationship between the patient and the nurse, and caring as a therapeutic intervention affecting patient’s health in terms of measurable responses. From a cultural perspective, the transcultural aspects of caring has received much attention in nursing care theories. Many studies in this field revealed that care values and behaviours differ within and between cultures. However, expectations of care and providing care are hidden qualities of human services that make people satisfied or unsatisfied. According to Nightingale, nursing knowledge is different from medical knowledge. Her view of nurse’s role conceived that the nurse should be able to restore the patient to the state that nature (God) would prefer. In her opinion, caring for patients required knowledge of persons and their surroundings, and not that of what physicians used in treatment process. Most of the theories that evolved in the nursing domain are based on this philosophy (Alligood, 2006). Caring is the essence of nursing; in fact, the primary focus in nursing profession is to give care to patients and also manage caring process. Caring process involves providing care and coordinating for caring process. Kelly (1990) has asserted that respect and caring are the fundamental requirements of nursing, in the absence of which nursing does not happen. Leininger’s (1988) study focuses on the importance of caring in nursing practice against various cultural, social, political and professional factors influencing the healthcare process. She also provides a distinct view of care, caring and essence in healthcare terminology. According to her, ‘essence’ refers to a necessary constituent or an essential attribute which makes a thing or act what it is’ (1988; p.4). Further, several factors tend to influence caring; the extent to which nurses value care as an essential part of nursing determine its impact and outcome; secondly, understanding the concept of care is different for different individuals within and between different cultures; thirdly, the way care is provided also differs in different cultural settings; fourth is the nurses’ ability to distinguish between therapeutic and non-therapeutic care practices; fifth issue deals with nurses’ perception of caring and curing concepts impacted by the technological advances in health care system, associated lucrative earnings and also patient recovery chances; lastly, nursing profession’s stand towards caring as a central, unifying, unique and dominant feature and discipline-based knowledge of nursing would determine the extent of caring in nursing profession. Besides these factors impacting caring aspect in nursing, practitioners and philosophers advocate caring as the essence of nursing without which successful nursing cannot be accomplished. According to Orem (2001) self care is of utmost importance in nursing care practice. Orem (2001) advocates the necessity of self care in order to provide nursing care by explaining the situations that demand nursing care, and to reinstate patients’ abilities to self care. Nurses need to care for themselves in order to continually provide care for others and practice safe nursing. This would require adoption of healthy life styles through physical activity, healthy nutrition, maintenance of healthy interpersonal relationships, spiritual growth and stress management. It is imperative that the nurses perform a holistic assessment of their own mental and physical status to identify any problems that may impact their profession. In such cases, a change in life style or appropriate treatment will help in restoring their state of wellbeing, referred to as the integral world view by Dossey and Keegan (2008; p.17-18). In addition to the physical and mental wellbeing, nurses have to be extremely strong psychologically. Very often, care givers mistaken compassion and empathy for patients with ‘feeling their pain,’ and this feeling can psychologically disturb the care givers. While it is important for nurses to be compassionate and empathize with patients in order to understand their state, they should be consciously aware of the function of care giving and its process; nurses should not get emotionally depressed or burnt out in this process. Sherman (2004b; 2005) suggests that nurses can enhance their physical health by inculcating healthy living habits; emotional health by meditating and consciously practicing releasing of bad thoughts; mental health by making choices, setting priorities, letting go of conflicts, learning to say no, and keeping open to new opportunities and possibilities; intuitional health by developing spiritual wisdom. Very important is interpersonal stressors that in turn have an impact on overall health, which needs to be consciously rejuvenated by developing a positive approach, recollecting memories of good experiences and rewards, opening up to colleagues about issues bothering them etc. Caring for psychological needs of the nursing staff by leaders and hospital managers can help them in maintaining a balanced state of being. This can be done through constant interaction between the nursing staff and their managers; conducting reviews of their performance and general issues bothering the nursing staff; appreciating for good and hard work done; and being open to their suggestions. Overall, the managers and leaders will have to be caring towards the main caregivers in the health care setting. The ethical and moral aspects of caring emphasize on the relationship-building process between the care givers and the patients. In general, the ethical and moral aspects of caring are understood from the principles and policies laid out by the healthcare institution in terms of patient rights and hospital/institutional governing policies. However, practitioners and researchers have argued that these aspects are distinct from the intended ‘caring’ process. Pellegrino and Thomasma (1997; p.28) have explained that providing therapeutic cure is a form of caring for the patient, and is a form of moral art in the healthcare practice. On the other hand, others also refer to caring as a biological phenomenon rooted in people’s emotions and feelings of compassion as a conscious part of these emotions. They have identified four senses associated with caring in the healthcare profession. Firstly, caring through feelings of compassion causes the practitioners understand and feel the state of patient’s physical and mental status. This feeling puts the patient at the key position rather than the treatment or caring process, as such. Kindness and humility are the characteristics that practitioners have to possess to care for the patients. Secondly, activity replacement process by the practitioners helps patients not only in performing their daily activities but also in reinstating their dwindling confidence caused due to the illness and their inability to perform daily activities. Nurses and/or their assistants play a major role in activity replacement, without which patient’s illness may get further compounded. This process is one of the most crucial activities in helping the patient recover from illness. Thirdly, giving assurance to the patient that the illness will be taken care of and the patient will be cured by appropriate treatment. This process requires owing the responsibility of curing the patient, and making the patient transfer this responsibility to the physicians and nurses. This aims at reducing the anxiety of the patient by assuring a solution to his/her problem. The fourth sense includes competence, i.e. to take care of all necessary personal and technical procedures of the treatment in detail and with perfection. This process requires specialized skills and training that make the practitioners efficient. Pellegrino and Thomasma (1997) have argued that, although the four senses of caring are essential for optimal care to the patient, they cannot be exercised together. Often, these senses are separate and in opposition to each other. Philosophically, whatever is the approach, it should be able to achieve patient good and satisfactorily resolve the conflicts through appropriate decision making in the caring, curing and coping aspects of treatment for health and illness states. Various models proposed by different practitioners and philosophers emphasize the significance of ‘human’ factors such as morality, ethics, commitment and love, obligation and professional aptitude. These models help in understanding the implications of humanistic approaches to caring. Considering the two outcomes of caring, based on Morse et al.’s (1990) analysis, i.e. subjective experience of patient and their physiologic responses to caring process, the questions that arose from their analysis conclude with a concrete base to relate the process of caring with different dimensions of patient health. Firstly, caring has a significant impact on the emotional state of the patient; secondly, caring cannot be constant and uniform in nature and can be present in various degrees within individuals; caring devoid of therapeutic intervention cannot yield similar and intended results; patient cure without caring cannot be holistic; and finally, caring has a significant impact on patients’ overall health. Shelly and Miller have quoted the experiences of two hospice nurses on caring as, ‘Caring requires commitment and a willingness to do the unlovely. Neither education nor experience quite prepare you for doing the unlovely. Caring demands listening and observing with your whole persons. To care means to be trustworthy. Caring is costly. It takes a great amount of physical, emotional, and spiritual energy’ (2006; p.254). Shelly and Miller (2006) have put forward their views from a spiritual and religious teachings perspective that contradicts the views of others. Although caring for others is a humanistic expectation, it does not form an intrinsic part of human nature. For instance, outside the healthcare setting, people hardly realize or recognize strangers that belong to the health care system because of the potential risks associated with getting involved in caring for strangers. Secondly, if caring were a moral imperative, it should also be defined in terms of the culture and society because moral obligations differ with societal beliefs and customs. Also, people tend to care for strangers, not out of moral obligation but with the feeling of pity at the state of the person. Besides this, caring has different meanings for different people. Shelly and Miller (2006) argue that caring is more of an act of faith as it involves the risk of opening one to another who may not want to be cared for or may not want to be cared in the manner he/she is being cared for. Conclusions In conclusion, caring in nursing has a principal role in restoring and promoting wellbeing of the patients. However, the concept of caring is distinct from technical aspects and practice of nursing. Caring is a concept based on character, attitude and commitment of the nurses towards people suffering from all kinds of illnesses. Many theories and models have explained caring from different perspectives such as humanistic, feministic, transcultural and scientific. Other perspectives include the nurses’, patients’, moral and ethical philosophies’ perspectives. The essential senses of caring include feelings of compassion, ability to serve/help patients in performing daily activities, providing assurance and competence to provide care. Research and evidences have proven otherwise compared to the humanistic, feministic and cultural theories. Exceptions and situations, not complying with these theories, under the influence of external factors and human characteristics and behaviours have been experienced thereby making theorists and researchers believe that the present work on caring is not sufficient, and requires different opportunities to be explored in order to provide a concrete conceptualization of this philosophy. References Alligood, M.R. (2006). Introduction to Nursing Theory: Its History, Significance, and Analysis. In Tomey, A M and Alligood, M.R’s (ed) Nursing theorists and their work. 6th ed. Missouri: Elsevier Health Sciences. (Ch: 1; pp: 3-15) Deutschendorf, A.L. (2006). Models of Care Delivery. 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(Ch:6; pp:67-80) Levitt-Jones, T, Bourgeois, S and Luke, L. (2009). The Clinical Placement: A Nursing Survival Guide. 2nd ed. U.K: Elsevier Health Sciences. Leininger, M. (1988). Care, the essence of nursing and health. Michigan: Wayne State University Press. Morse J M, Solberg S M, Neader W L, Bottorff J L, Johnson J L (1990) Concepts of Caring and Caring as a concept. Advances in Nursing Sciences 13(1) 1-14. Nightingale, F. (1992). Carroll, D.P. (Ed.) Notes on nursing: what it is, and what it is not. Philadelphia: Lippincott Williams & Wilkins Neil, R.M and Tomey, A.M. (2006) Jean Watson: Philosophy and Science of Caring. In Tomey, A M and Alligood, M.R’s (ed) Nursing theorists and their work. 6th ed. Missouri: Elsevier Health Sciences. (Ch: 7; pp: 91-115) Pellegrino, E.D. and Thomasma, D.C. (1997). Helping and healing: religious commitment in health care. Washington D.C.: Georgetown University Press. Shelly, J.A and Miller, A.B. (2006). Called to Care: A Christian Worldview for Nursing. 2nd Ed. U.S.A: InterVarsity Press. Sherman, D.W. (2005). Spirituality and Culture as Domains of Quality Palliative Care. In Matzo, M.L and Sherman, D.W’s Palliative Care Nursing: Quality Care To The End Of Life. New York: Springer Publishing Company. Watson J (1985) Human sciences and human care. Norwalk: Appleton-century-crofts. Read More