Anne Boykin & Savina O. Schoenhofer Presented by: Nelfa Padovano,BSN RN-BC. Nursing Theory University of Colorado Denver School of Nursing Spring 2014 NURSING AS CARING THEORY

Theorists: Dr. Anne Boykin, Professor and Dean of the College of Nursing at Florida Atlantic University, where she had a long time commitment to the International Association for Human Caring. Her scholarly work centers on CARING as the grounding for nursing. Dr. Boykin serves as an international consultant on caring. Her works included the ‘Nursing as Caring: A Model for Transforming Practice’ (1993)a book co authored by Dr. Savina Schoenhofer, and Living a Caring Based Program (1994). The Nursing as Caring Theory is presented to nurse scholars in the various roles of practitioner, researcher, administrator, teacher and developer. (Parker & Smith p371).

B. Analysis and Evaluation of the theory’s assumptions, values, concepts and propositions: “Caring is the end rather than the means of nursing, caring is the intention of nursing, rather than an instrument.” (Parker & Smith p 371)

Persons are caring by virtue of their humanness. The three strengths of humanity being love, kindness and social intelligence. Nursing as a profession uniquely focuses on caring as it’s central value, its primary interest and direct intention for practice.

Persons are whole and complete in the moment. The foundational values of respect and coming to know grounded the theory and revolves around the theme of responding to what matters. Caring means spiritual commitment and devotion inspired by the love and respect for persons as a whole. (Boykin & Schoenhofer, 2001, p 393)

Persons live caring from moment to moment. This is the focus of nursing as a practiced discipline. Nursing knowledge and practice live in the context of person-with- person caring. The theory calls for aesthetic knowing in nursing best demonstrated with storytelling, poetry& music.

Personhood is a way of living grounded in caring. Personhood is living life grounded in caring One’s personhood is enhanced by participating in nurturing relationships with caring others. It is one’s living out of who they are in congruence with their beliefs and behaviors and living the meaning of one’s life.

Nursing is both a discipline and a profession. A call for nursing is a call for acknowledgement and affirmation of the person living caring in specific ways in the immediate situation. It is a call for nurturance. Nurses develop sensitivity and expertise in hearing calls through intention, experience, study and reflection in a broad range of human situations. (Parker & Smith 373)

C. The Theory in relation to Practice Nurturing persons living caring and growing in nursing is the nurses’ commitment to practice nursing as caring. It is often challenged when nurses are presented with someone who is difficult to care and it is in this situation that the nurse uses all available patterns of knowing, grounded in the obligations and intentions inherent in the commitment to caring: the knowledge of self and others, empirical, aesthetic and ethical knowing.

D. Example of the theory’s application to practice: Nursing as Caring, when caring for someone with an altered state of mind. In this example, It was required that all my ways of knowing be brought into action. I made myself available to the person I was caring for, who was admitted for seizure and altered mental status from Cocaine abuse. My values were challenged, but as a nurse I need to put my knowledge of self and knowledge of others to work. Here I am presented with a person that needed nurturing and caring to bring her back to her normal self and support her in every means while knowing her in the process. She was screaming and agitated, pulling out her catheter and her IV access.

Cont. To keep her safe for that moment we needed to restrain her. After a few hours, she was calm and crying, but still confused. I talked to her with ethical knowing that she was vulnerable and I need to engage her as a person rather than as a helpless object of my concern. When I asked her how she felt, she stated her position is very uncomfortable, and that she needed to be on her right side,(which she cannot possibly do with the 4 point restraint)

Cont. I told her I am going to help her and release the restraint on the left side if she promises me she will not start pulling on her IV again. She promised and she kept her promise, so her restraint was then only on her right arm and right leg. She also told me then that she did not like it when her legs were held open and so many people were there, (that was probably when they put in her catheter at the ED).I held her hand and told her, I will make sure that is not going to happen again, but that I will need to put another catheter in her, but this time it is going to be just I and her wonderful CNA. I explained the importance of the catheter being that she is incontinent and we do not want her to soak in her own urine. She smiled and said, “yeah, because that is gross.”

cont She agreed, and before we put the indwelling catheter, we untied her right restraints. After the catheter was placed, she asked if she can have something to eat. I talked to the doctor and told her I was going to do the swallow evaluation and let her know how the patient swallows. I also recommended that she come see and evaluate the patient for discontinuing the restraint, as the patient had been calm and cooperative for the last four hours. Aesthetic knowing in caring is honoring humility, joining in hope and demonstrating trustworthiness in the moment.

E. An example of a research study using Theory of Caring as framework. Dyes, S., Boykin, A., Bulfin, M., Hearing the Voice of Nurses in Caring-Theory based Practice., Nursing Science Quarterly. 4/2013. Vol. 26, Issue 2. Longo, J., Acts of Caring; Nurses Caring Nurses. Holistic Nursing Practice Vol. 25, issue 1.

F. Summary identifying the strengths and limitations of the theory. Strengths: As nurses we know there are various ways of expressing caring. The theory of Nursing as Caring had been tested in various nursing practice settings and those nursed had voice the ‘experience of being truly cared for’. Patient and nurse satisfaction in those units had reportedly increased, retention increased, and the environment for care became grounded in the value of respect for persons.

Cont. Limitations: As nurses we frequently find that we do not have enough time to practice caring, given the demands of our role. The nursing environment, either in clinical practice, administration, education and research, has encountered challenges that depersonalizes and routinizes the care we deliver, like technological advances, demands for immediate and measurable outcomes that focus on simple and superficial quick care, economic focus and profit motive (time is money). (Parker & Smith p. 380)

G. Research or Practice Application Article Guided by the Theory Bulfin, S., Nursing as Caring Theory: Living and Caring in Practice. Nursing Science Quarterly. Oct. 2005, Vol. 18, No. 4, pp Abstract: This article features a report of a research project in a community hospital. Staff members were given opportunities to engage and act on the ideas of Boykin and Schoenhofer in their nursing as caring theory. Feedback from patients, family members, and all staff who touched patients informed the creation of a new model of care that positively transformed the workplace in the hospital setting. Strategies that were implemented to guide the values of nursing as caring theory are described. The result of the project was an environment that nurtures persons in their caring and growing in caring while illuminating the fullness of nursing.

Case Study # 1 Subjective: 54 y.o Female admitted for AMS, seizure and FTT. Lives alone and unemployed. H/o chronic drug use, i.e. cocaine and methamphetamine Objective: Incontinent of Bowel and Bladder. All teeth missing, confused, agitated and combative Assessment: Oriented to person only, BP 195/88, P78, RR 20 T36.9, 98% on room air, abnormal LFTs and low Albumin. Plan: Get to know the person, treat her as human regardless of the choices that she’s made. Providing the language of caring with (Roach’s) five C’s, compassion, competence, commitment, confidence and conscience.

Case Study #2 Subjective: 23 y.o. female recently diagnosed with Stevens’ Jonson Syndrome. Patient is married and has a 6 y.o son, works as an EMT personnel. Objective: pale appearing, anxious and is tearful and looks fearful. Assessment: anxiety, mucositis and suffering from mouth and throat pain, difficulty swallowing and has not had real food for a week. VSS, independent mobility.

Cont. Plan: Values of respect and coming to know, grounded in theory and responding to what matters to the patient at the moment, showing spiritual commitment and devotion inspired by the love and respect for the person as a whole. Aesthetic knowing in nursing and providing care with storytelling, being present and listening. Make sure patient is comfortable and has adequate pain relief. Re- affirming commitment of care and support for personhood during the moment.

References: Boykin, A. & Schoenhofer, S. (2001). Nursing as Caring: A Model for Transforming Practice. Boston: Jones and Bartlett. Boykin, A. & Schoenhofer, S. (2000). "Nursing as Caring". In Parker, M., Nursing Theories and Nursing Practice. Pp Locsin, R., Development of an Instrument to measure Technological Caring in Nursing. Nursing and Health Sciences.(1999) Vol. 1, Issue 1, pp27-34 Parker, M., Smith, M., Nursing Theories and Nursing Practice 3 rd Edition. 2010, Davis, Philadelphia, Pa.