NS112 Caring and Communication in Nursing Caring Theories NS112 Caring and Communication in Nursing

Caring Theories Several caring theories in nursing, which have been established based on the beliefs that caring is a seminal part in nursing. We are going to examine some of these theories in more detail.

Caring, the human mode of being Roach 2004 Roach (1992) defined caring from a theological point of view, related to love, putting an emphasis on involvement in the other individual. Her theory focuses on caring as a philosophical concept and proposes that caring is the human mode of being or the most common authentic criterion of humanness (Roach 2004).

Caring, the human mode of being Roach 2004 Caring is not unique to nursing or even to the caring professions; it is a primary characteristic of being human. All persons are caring and develop their caring abilities by being true to self, being real and being who they truly are.

Caring, the human mode of being Roach 2004 Roach proposed that ” We care, not because we are nurses, physicians, social workers, parents, etc; we care because we are human beings. We differ in how we care, not in that we care.

Six ‘C’ s Roach 2004 Roach suggests that there are 6 attributes to caring. Referred to as the six ‘C’s. The six ‘C’s are used as a broad framework, suggesting categories of behaviour that describe professional caring. Sister Roach asked the question, “What is a nurse doing when he or she is caring?” Because the list became too specific and unmanageable, data were identified within five categories that became known as the “Five C’s” (later “Six C’s”) ─ Compassion, Competence, Confidence, Conscience, Commitment, Comportment (added later.)

The six ‘C’s Originally consisted of 5 elements. The six ‘C’s or attributes to caring include: Compassion Conscience Competence Confidence Commitment Comportment (added later)

Compassion More than just pity or concern Dictionary definition implies that compassion is a shared attribute of caring, for to show compassion involves suffering with another.

Compassion A way of living born out of an awareness of one's relationship to all living creatures; engendering a response of participation in the experience of another; a sensitivity to the pain and brokenness of the other; a quality of presence which allows one to share with and make room for the other

Compassion How do you think, you as a student nurse, could show compassion to a patient?

Compassion A compassionate person acts without thought of reward. A compassionate nurse should be empathetic Empathy - attempts to identify with another understand something as experienced by another. To be able to empathise with a patient may depend on our level of sensitivity and common understanding of life and life's events. As nurses we should be able to be compassionate and empathise with all patients at least to some degree.

Compassion As a newer nurse, I cared for a patient who had undergone a splenectomy with life-threatening complications. While I was not equipped to fully handle her care during the first difficult days, I watched and learned. She was placed in a chemically induced coma, and I was assigned to her care team. I took the approach that my patient was aware of her surroundings even in her current comatose state. I cared for her as I would wish to be cared for if roles were reversed. Because we were close in age, I talked with her about things of interest to my peers, about television shows she liked towatch, interests we might have shared, and played her favorite music. I brushed her hair and also shaved her legs and underarms — things that would have been important to me. After three months in ICU, her trach was removed, and her first words were “thank you, Heather.” In the days ahead, she told me that she heard the music I played, enjoyed and appreciated my conversation, and the personal care I provided. She felt like “a real person and not just a patient.” I had cared for her as a person, beyond the routine patient and caregiver relationship.

Competence The state of having the knowledge, judgement, skills, energy, experience and motivation required to respond adequately to the demands of one's professional responsibility

Competence Knowledge skill and attitude required to be a nurse Demonstrate an ability to practice safely/effectively fulfilling professional responsibility Compassion works most effectively when allied with competent care.

Confidence Rarely thought of as sub construct of caring. Should never be portrayed as opinionated or boisterous A competent practitioner is a confident practitioner Having confidence in own ability instils confidence in the patient Confidence comes through education, repetition and life and work experiences.

Conscience A state of moral awareness It is essential that nurses are aware of the role of conscience in the provision of care and its congruence with professional codes and guidelines.

Conscience When a person exercises conscience they are not involved in some abstract cognitive endeavour, rather they are looking into their inner self and seeking direction from inner conviction. It involves judging moral issues and making informed compassionate decisions.

Conscience All caring responses are guided by a sense of values. Can be a : Driving Force Acts of courage Acts of duty Act of high quality care Restricting Factor Being aware of inadequate care Setting boundaries Being Governed Source of sensitivity Seeing vulnerable human being Heeding one’s intuition Seeking support (Jensen & Lidell, 2009)

Commitment A complex affective response characterized by a convergence between one's desires and one's obligations, and by a deliberative choice to act in accordance with them

Commitment Nurse must show commitment in two areas: To the patient To the profession

Comportment Appropriate demeanour, dress and language that are in harmony with a caring presence. Presenting oneself as someone who respects others and demands respect.

References Roach S. (1987) The Human Act of Caring. Canadian Hospital Association, Ottawa. Roach S. (1984) Caring: The Human Mode of Being. University of Toronto, Toronto. McCance T.V., McKenna H.P. & Boore J.R.P. (1999) Caring: theoretical perspectives of relevance to nursing. Journal of Advanced Nursing, 1999, 30(6), 1388-1395