Nursing Situation and Theories of Caring - Research Paper Example

? A Nursing Situation and Theories/Concepts of Caring The Nursing Situation My nursing situation is about a young doctor in the system where I work. He was admitted to an intensive care unit private room for an inguinal hernia repair. The surgery is usually simple. His young wife, however, was overwhelmed with the idea of caring for him for three days given that she has three small children to attend. It was decided to keep him in the hospital intensive care unit where I cared for him for three days. The first two days was uneventful. On the third day I got report that the patient had a horrible night. I went in the room for a quick look I notice the patient was pale, no urine output, and was complaining of abdominal pain. The report was that the intensivist doctor tried everything during the night including giving him laxative and diuretic during the night shift with no success. In assessing his condition, I noticed his abdomen was taut and swollen. I asked the day intensivist to do CT scan for a more accurate picture of what was going on with this patient. He decided against the CT scan but ordered an X-Ray of the abdomen. The result showed that there was a lot of fluid compressing on his bladder, colon, and kidney. I called the intensivist with the result but he wasn’t convinced of the seriousness of the situation and was indecisive. I took it upon myself to call the surgeon and explained what was going on with the patient, what was done, and begged him take a look at the patient. Within an hour he was there. I updated him in all the happening. He decided to take the patient to the Operating Room for an emergency surgery which removed three litres of clots from the surgical site. I transfuse the patient with multiple units of blood. After the surgery the patient recovered quickly. He and his family were very grateful to me and said that I saved his life. Before he left the hospital he gave me a personal thank you card with a gift. He said if it wasn’t for me he might have died. 2. Theoretical Perspectives A relatively popular theory on caring in the nursing profession is that by Jean Watson. As per Watson’s own description, Watson’s theory of caring involves ten aspects (2007, p. 131-132). In the words of Watson (2007, p. 129), the ten are the “core conceptual aspects” of Watson’s theory of caring. The first aspect pertains to humanistic and altruistic values. This dimension involves loving-kindness and equanimity for self and others. The second aspect prescribes instilling and enabling faith and hope. The third aspect requires the cultivation of sensitivity to one’s self and others. The fourth aspect emphasize on the need to develop helping-trusting, human caring relationship. This can apply between the nurse and the patient as well as between the medical professionals and the patients. Although Watson herself has not directly stated the key role of the nurse in bringing this about, the discussion of Watson in several articles can be validly interpreted to mean that nurses have key role in tapping the participation of both patients and relatives in the healing and healthcare process. It is see, for example, that because nurses have more interaction with patients, they are in a better position to educate both patients and relatives and instruct them how the patient can recover faster from an illness or condition. The fifth aspect of Watson’s theory of caring involves the promotion of an environment that encourages expression, both positive and negative feeling s, as a route to establish connections and promote a feeling of being cared for. The sixth aspect of caring involves the systematic or creative use of scientific problem-solving caring processes. The seventh aspect encourages the promotion of transpersonal teaching-learning. This means that nurse contributes to the creation of an environment that promotes a situation of learning from one another. The medical professionals, for example, can learn from the patient the specifics of her illness and the patient can learn from the medical professionals how the specifics of his or her illness can be dealt. This situation is promoted better when patient-healthcare professional relationships go beyond the traditional. The eighth aspect of Watson’s caring theory specifies the “provision for a supportive, protective, and/or corrective mental, social, and spiritual environment” (Watson, 2007, p. 132). I interpret that this aspect has two meanings. On one hand, this aspect of Watson’s theory of caring specifies that health professionals must empathize with their patients. On the other hand, for treatment to work better, I believe that the other meaning of aspect number 8 of Watson’s theory is the nursing professional must work somehow to make patients empathize with their health professionals, such as by promptly revealing to them their situation and difficulties. The ninth aspect of Watson’s theory emphasizes “assistance with gratification of human needs” (Watson, 2007, p. 132). Perhaps, this is the part of Watson’s theory of caring which is the most simple yet one of the most important. I believe that it is quite established that nurses assist or should assist patients in the gratification of their needs. Watson’s (2007, p. 132) elaboration of the point however include the notion of spiritual emergence that can include a religious interpretation, something which can be debated by many in the nursing profession. The tenth aspect may also be debatable for its reference to an “existential-phenomenological spiritual dimensions” (Watson, 2007, p. 132). There may be no problem adopting Watson’s first eight aspects but some portions of Watson’s ninth and tenth aspects may be difficult to generalize considering the various theological and philosophical engagements nurses may have on the matter. According to Watson, the ten aspects are also the ten “original Carative Factors” that remain as the timeless structural core of her theory of caring (2007, p. 132). Again, all ten are discussed in Watson (2007, p. 131-132). In an undated material, the Saint Joseph Hospital pointed out that when utilized by nurses, Watson’s theory of caring can make the patient’s world larger or smaller, brighter or drab, rich or dull, or threatening or secure through the theory’s impact on nurse’s attitude and competence. Watson and Foster (2003, p. 363) articulated an “attending nurse caring model” in which the attending nurse is deemed responsible for several things. What follows is a restatement of what Watson and Foster has emphasized on what an attending nurse should accept as his or her responsibility. First, an attending nurse should establish caring relationships not only with the patients but also with families. Second, the nurse should support a comprehensive assessment of caring needs from the patient’s perspective but in a manner that is based on theory at the same time. Third, the attending nurse must support the assessment of subjective as well as objective concerns. Fourth, during treatment, the attending nurse must co-create with the patient and his/her family a comprehensive caring plan that is coordinated with the medical plan for the patient. Fifth, an attending nurse must be ready for occasions to carry out a therapeutic regime plan. On this, Watson and Foster’s (2003, p. 363) exact words are, “Overseeing and assuring comprehensive care planning and in some instances regime plan related to the caring-healing modalities of nursing.” Finally or sixth, an attending nurse must help ensure good communications among nurses, physicians, and team members to ensure that medical and caring tasks are diligently executed. Watson and Foster’s 2003 articulation is a potent articulation that can empower nurses and improve job performance. Correctly done and implemented in a manner that organizational hierarchies in a hospital, clinic, or other medical settings are recognized and respected, the Watson and Foster 2003 perspective on the roles of an attending nurse can expand the role of nurses to go beyond traditional roles or mind-sets on which some nurses have been used to. For example, in the Watson and Foster 2003 perspective, nurses have an important role in tapping both patients and their relatives for tasks related to healthcare. The traditional notions may have emphasized that nurses should be implementing doctors’ orders. Finch (2008, p. 25) pointed out that Watson’s theory of caring is one of the two theories in nursing “that significantly inform our understanding of nurse-patient communication”. The other of the two theories is the interpersonal relations theory of Peplau (Finch, 2008, p. 25). Peplau’s theory views nursing as a human relationship between the sick and a nurse (Finch, 2008, p. 25). Thus, Watson’s theory of caring strongly complements Peplau’s theory of nursing as a human relationship. For Finch (2008, p. 25), however, “caring is the hallmark of effective nursing practice and is accordingly a desirable characteristic of all nurses.” Duffy (2009, p. 10), on the other hand, emphasized that caring is the foundation of professional nursing. The characteristic of a caring nurse is the foundation why patient injuries and patient satisfaction on nurse care are among the key indicators of the American Nurses Association’s Acute Care Indicators. Watson (2010, p. 15) stressed that “caring is a professional, ethical covenant that nursing has with its public”. Given Watson’s elaborated theory of caring, another option is to adopt McCance’s (1999) theory of caring. According to Theofanidis (2008, p. 19), McCance’s refined theory of caring identified four essential attributes of caring: serious attention, concern, providing for, and regard/respect/liking. Theofanidis (2008, p. 20) argued that McCance’s identification of the essential attributes suffice. Roach (2002, p. 43) considered that the six key concepts of caring are the six Cs or compassion, competence, confidence, conscience, commitment, and comportment. According to Roach (2002, p. 48), comportment refers pertains to being true to the patient and to ourselves. Amante et al. (2007, p. 50) argued an important point: caring can be systematized in healthcare, especially in the intensive care unit. 3. Essence of Caring in the Nursing Situation and Description The essence of caring identified in the nursing situation I have described echoes one of the themes of Milton Mayeroff’s book, On Caring. One of the themes expressed in the Mayeroff’s book is that in order to care, one must know a patient’s needs and properly respond to the patient’s needs. At the same time, through caring, a person acquires a meaning on his or her own life (Mayeroff, 1971, p. 2). Mayeroff statement on this is highly relevant to the nursing situation I have narrated. There are several reasons. First, I saw in my humble nursing situation life’s meaning for me: helping my fellowmen, saving life. Having an opportunity to help one’s fellowman is a privilege that is not available to everyone in their lifetime. In my case, the nursing profession made that privilege always available to me. In my situation as a nurse, I have acquired opportunities to save the lives of others. At the same time, the availability of opportunities for me to help other and to save the life of others enabled me to consider my life more meaningful. The situation enabled me to commit myself to life and my life to my profession. The commitment resulting from the realization of my potential worth probably made others happy as in the nursing situation I have narrated. My patient and his family appreciated my service so much that they have offered gifts. The situation is not one-sided because as I made them happy, their appreciation made me happier. Of course, accepting a gift may or may not be ethical but perhaps accepting the gifts occasionally and refusing the gifts generally may be appropriate so as to strengthen the bonds between the patient and the nurse while discouraging the possible emergence of materialistic values. One important caring concept that is relevant in my nursing situation is Watson’s (2007) concept of sensitivity to one’s self and others. In my case, my sensitivity to the patient’s needs and his anguish motivated me to look deeper into his situation. The motivation appears important because it enabled me to warn my colleagues on the dangers to which our patient has been exposed. The hospital situation can be numbing at times. We see so many sufferings, anguish, and death. Perhaps, the hospital situation numb us so much that sometimes we fail to realize the real pains and sufferings to which our patients are exposed. We hear so many cries in the hospital and in the clinic setting. However, we must continue to overcome the occasionally numbing effects of our work situation and we must continue to be sensitive to the needs of our fellowmen. Sensitivity to others is an important tool in the nursing profession. In my nursing situation, the sensitivity enabled me to save a life. Watson’s concept of gratification of human needs was also useful in my nursing situation. The concept enables me to remind myself that that my profession basically means commitment to assisting others in gratifying their needs. A grasp of the concept enables me to be more inquisitive of the situation of my patients and their needs. The concept reminds me that the motive for the inquisitive must remain at the professional level: that of finding ways to assist my patients gratify their needs. My nursing situation also allowed me to deepen my realization that in the hospital or clinical situation, the nurse encounters a stream of people who are the relatives and friends of the patient. I have felt their love for the patient and I realize that this love can somehow be translated at times into a force that can be instrumental in the patient’s recovery and avoidance of risks. Machines may be good in measuring some of the vital signs of the patients. However, families and friends can be better at taking a look at the patient’s skin color over time (whether it is pale and indicative of risks). Families and friends can psyche the patient to become better, to be more serious in taking his or her medicines, and to pay more attention in eating well and psyching himself or herself to become well. Watson and Foster (2003) concept of comprehensive assessment of caring needs based on theory remind me to deepen my grasp of healthcare science. Caring is not enough because for the caring to save lives and make people really happy by savings lives, it must be based on theory. In my opinion, were it not for my grasp of health science theory, I would not have seen the risks that that my patient was exposed in my nursing situation. In other words, I deeply believe that in my nursing situation, several concepts of caring are available. I merely touched the more important ones and I reminded myself that following Amante et al. (2007) is useful: caring must be institutionalized in healthcare system and in the healthcare protocols of a nurse. 4. Other Personal Relevance Other than a semi-universal value for caring, the American Nursing Association Code of Ethics is a good guide on how my nursing experience can be reviewed. Provision 2.4 of the ANA Code of Ethics (2001) states: “When acting one’s role as a professional, the nurse recognizes and maintains boundaries that establish appropriate limits to relationships. While the nature of nursing work has an inherent personal component, nurse-patient relationships and nurse-colleague relationships have, as their foundation, the purpose of preventing illness, alleviating suffering, and protecting, promoting, and restoring the health of patients. In this way, nurse-patient and nurse-colleague relationships differ from those that are purely personal and unstructured, such as friendship” In other words, while the nursing profession emphasizes caring as a way of life and as primary vehicle for relating with patients and colleagues, the nursing code of ethics prescribes that the relationship that is established in the caring environment should be focused on preventing an illness and on helping patients to recover quickly from their illness. To me implies that caring that in general, while flowing from the heart and human values, caring must be just enough to what is required for the nurse to effectively discharge his or her duties to his or patients, just enough but taking care that it is enough to make patients recover quickly from his or her illness or prevent an illness. While I cannot immediately cite the literature today, various studies have indicated that a human touch can express caring and has the potential to promote recovery. In the past I have seen literature on holistic nursing that appear to advocate the use of human touch to promote recovery or prevent an illness. Identification of what constitutes “just enough” is difficult to pre-determine or anticipate. Yet, at the same time, the nurse must take care to constraint the expression of care within the ambit of his or her professional role. In situations where there may have been excesses, the ANA Code of Ethics (2001) prescribes on Provision 2.4: “….In all encounters, nurse are responsible for retaining their professional boundaries. When those professional boundaries are jeopardized, the nurse should seek assistance form peers or take appropriate steps to remove her/himself from the situation.” In my nursing situation, I believe I may have anticipated the patient’s needs more than what the head doctor or lead in the medical team may have anticipated or assessed. I believe that this situation is many times replicated in various medical settings. In some cases, it is possible that nurses are able to assess or anticipate the needs of their patients better than the medical team leader. In my opinion, this can be a natural result of the situation wherein nurses spend more time with their patients than the head doctor of a medical team. I continually remind myself that although nurses are important in a medical team, individually each nurse is only a member of a team and must subordinate himself or herself to the success of his or her medical team. Each team member has a set of capabilities and inadequacies but the team as a whole compensates each others’ weaknesses and boosts each other’s strength. I continue to remind myself that should I come to believe that I am able to anticipate or assess the needs of a patient better than the rest of the team players, except perhaps for certain emergencies, I must respectfully share my views to the medical team directly responsible to the patient. I continue to remind myself of the hierarchy and responsibilities in the medical profession. As a caring nurse, I will continue to voice out my opinion and perspective, in a caring way and from a caring perspective as well as from a team player’s perspective. 5. Conclusion My nursing situation was informative on several useful concepts of caring in the nursing profession. However, most important, it made me realize the importance of my profession to others and this realization made my life more meaningful. My life has become more meaningful in the nursing profession because caring is essentially the foundation of the profession. References Amante, L., Rossetto, A., and Schneider, D. (2007). Nursing care systemtization at the intensive care unit (ICU) based on Wanda Horta’s theory. Rev Esc Enferm USP, 43 (1), 50-60. ANA (2001). Code of ethics for nurses with interpretative statements. Available in: http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses.aspx (accessed 17 July 2011). Duffy, J. (2009). Quality caring in nursing: Applying theory to clinical practice, education, and leadership. New York: Springer Publishing Company. Finch, L. (2008). Development of a substantive theory of nurse caring. International Journal for Human Caring, 12 (1), 25-32. Mayeroff, M. (1971). On caring. Harper Perennial. McCance, T., McKenna, H, and Boore, J. (1999). Caring: theoretical perspectives of relevance to nursing. Journal of Advanced Nursing, 32, 1388-1395. Roach, S. (2002). Caring, the human mode of being: A blueprint for the health professionals. 2nd ed. Ottawa: CHA Press. Saint Joseph Hospital (Undated). Theory of transpersonal caring. Saint Joseph Hospital. Available 14 July 2011 in: www.saintjosephnurses.org. Theofanidis, D. and Fountouki, A. (2008). Nursing theory: A discussion on an ambiguous concept. International Journal of Caring Sciences, 1 (1), 15- Watson, J. (2007). Watson’s theory of human caring and subjective living experiences: Carative factor/Caritas Processes as a disciplinary guide to the professional nursing practice. Florianopolis, 16 (1), 129-35. Watson, J. (2010). Caring science and the next decade of holistic nursing: Transforming self and system from the inside out. Beginnings (Spring), 14-16. Watson, J. and Foster, R. (2003). The attending nurse caring model. Journal of Clinical Nursing, 12, 360-365. Read More