Human Caring: Relationship-Centered Care for Case Managers Coleen Cox-Ballah, DHA, MS, RN, CCM

Jean Watson’s Caritas Quote “Humanistic, altruistic value system … comes to life when one cultivates the ongoing practice of Loving-Kindness and Equanimity, a form of cultivated mindfulness awareness / meditation, a practice that opens and awakens the compassionate, forgiving love of the heart center” (Watson, 2008, p. 35)

Objectives Case Managers will understand Human Caring Theory Case Managers will Describe the Caring Core: Ten Caritas Processes™. Case Managers will Describe how Relationship-Centered Care is applied to case management practice Case managers will demonstrate centering exercises useful for maintaining balance in their practice.

Theory of Human Caring Science An evolving field of study grounded in the discipline of nursing and informed by related fields Framework for all caring-healing professions, moving beyond nursing Caring is a sacred art Caring is an act of Love (Watson, 2005) According to Watson (2005), love is the highest level of our evolving consciousness. Love is the motivation for compassionate human service and authentic Caring. The roles of love and the conscious heart demonstrate a shift from head-centered orientation to evolving heart-centered living. We shift from being driven by our egos (head) and the paradigm of fear, adversarial, competitive approach to caring (heart), teaching, helping, loving approach personally and professionally. The heart is an energetic field that transcends our perception that the brain is in control. At the personal level, we must open our hearts and surrender re-patterning ourselves for Caring-Healing work.

Caring Science Major Principles Relational Caring Caring core: Ten Carative Factors / Caritas Processes Transpersonal Caring Moment-Caring Field Caring as consciousness – energy-intentionality-human presence Caring-Healing modalities

Caring Core: Caritas Processes™ Caritas: “…to cherish, to appreciate, to give special, if not loving attention to” (Watson, 2008, p. 39). Ten Caritas Processes™

Ten Caritas Processes™ 1. Practice of loving-kindness/compassion and equanimity with self/other 2. Being authentically present; enabling belief system and subjective world of self/other 3. Cultivating own spiritual practices; beyond ego-self to authentic transpersonal presence 4. Developing and sustaining a loving, trusting, and caring relationship Equanimity: calm temperament: evenness of temper even under stress synonyms: composure · calmness · level-headedness

Ten Caritas Processes™ 5. Allowing for expression of feelings; authentically listening and “holding another person’s story for them” 6. Creative problem-solving-solution-seeking through caring process, full use of self; all ways of knowing/doing/being; engage in artistry of human caring-healing practices and modalities

Ten Caritas Processes™ 7. Authentic teaching-learning within context of caring relationship; stay within other’s frame of reference; shift toward a health-healing-wellness coaching model 8. Creating healing environment at all levels; physical/nonphysical, subtle environment of energy, consciousness, wholeness, beauty, dignity, and peace are potentiated

Ten Caritas Processes™ 9. Reverentially and respectfully assisting with basic needs, holding an intentional, caring consciousness of touching the embodied spirit of another as sacred practice, working with life force/life energy/life mystery of other 10. Opening to spiritual, mystery, unknowns-Allowing for miracles

Setting Intentionality: Caring Caring in the Beginning Caring in the Middle Caring in the End Caring Continuing

Relationship Centered-Care Practitioner’s relationship with self Practitioner-to-patient relationship Practitioner-to-community relationship Practitioner-to-practitioner relationship Jean Watson identified the following levels of relationship-centered care: Practitioner’s relationship with self: Developing a helping-caring relationships with self-and other, Practitioner-to-patient relationship: Cultivate and preserve caring relationships, Practitioner-to-community relationship: Create and sustain community relationships; from Caritas to Communitas, Practitioner-to-practitioner relationship: Nurture self-awareness and engage in building inter-professional learning environments and interdisciplinary teams models of caring.

Practitioner’s Relationship with Self Understand self as a source of healing of self and others Understand the role of family, culture, and community that influences health Understand situations that may be harmful to the underpinning of relationships Understand the essentials of effective communication

Practitioner’s Relationship with Self Practice self-reflection Give full self and presence Active listening Accept patients’ emotions and understanding Significance of self, awareness, caring, and growth Honor the spiritual aspects of caring processes Acknowledge one’s insights, value non-judgmental and compassionate relationships

Practitioner-to-Patient Relationship

Practitioner-to-Patient Relationship Patient: Mind, Body, Spirit: Holistic Identify the meaning in patients’ life stories Give full self and presence to patients Acknowledge and act on the pain/suffering of patients Acknowledge and act on moral/ethical dilemmas Encourage hope, trust, and faith Attentively listen and enable learning

Practitioner-to-Community Relationship Understand the physical/social/economical/occupational influence on health Engage in community assessments, public policy, organization activities, and facilitate change Share expertise Assist in creating caring-healing communities

CMSA Day on the Hill

Practitioner-to-Practitioner Relationship Understand self in relation to others Understand the healing approaches of others Interdisciplinary teamwork Communicate effectively and collaborate with others Advocate mutual trust, empathy, and grace

Practitioner-to-Practitioner Relationship

Practitioner’s Relationship with Self Practice Self-reflection Self-awareness Self-growth Self-caring The relationship with self is the foundation of all other relationships. Understand that self is a source of healing of self and others. Understand the role of family, culture, and community that influences health (positively and negatively). Understand situations that may be harmful to the underpinning of relationships. Understand the essentials of effective communication.

Centering Exercises Basic quieting, centering exercise Sitting or lying position Close eyes and become aware of your body Breathe deeply, relaxed and easily Go to a quiet place within yourself (Watson, 2010) Practice Daily

Centering Exercise GPS for the Soul App We all have a centered place of harmony and balance Life’s challenges and complications may take us from that place iPhone camera lens measure stress level Start guide if out of sync (Institute of HeartMath, 2014)

Other Healing Modalities Reflective Journaling Poetry Art Music Exercise

Desiderata …. Be yourself. Especially, do not feign affection. Neither be critical about love; for in the face of all aridity and disenchantment it is as perennial as the grass. Take kindly the counsel of the years, gracefully surrendering the things of youth. Nurture strength of spirit to shield you in sudden misfortune. But do not distress yourself with imaginings.

Desiderata Many fears are born of fatigue and loneliness. Beyond a wholesome discipline, be gentle with yourself. You are a child of the universe, no less than the trees and the stars; you have a right to be here. And whether or not it is clear to you, no doubt the universe is unfolding as it should … Max Ehrmann, 1927

Intentionality: Caring In the End Cultivate loving-caring practice for self Use the events of the day as lessons learned Offer gratitude for the sacred circle of your life Bless, release, and dedicate the day Create your own intentions

In Loving-Gratitude

Additional Resources Mindfullness Apps: (www.freemindfulness.org/apps) Relaxation Techniques for Stress Relief: (www.helpguide.org) Watson Caring Science Institute: (watsoncaringscience.org)

References Institute of HeartMath. (2014). GPS for the soul. Retrieved from http://www.heartmath.org/free-services/solutions-for-stress/gps-for-the-soul.html Watson, J. (2005). Caring science as sacred science. Philadelphia, PA: F. A. Davis Company. Watson, J. (2008). Nursing: The philosophy and science of caring. Boulder, CO: University Press of Colorado. Watson, J. (2010). Post modern nursing and beyond. Boulder, CO: Watson Caring Science Institute.