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

2. 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)

3. 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.

4. 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.

5. 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

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

7. 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

8. 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

9. 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

10. 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

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

12. 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.

13. 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

14. 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

15. Practitioner-to-Patient Relationship

16. 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

17. 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

18. CMSA Day on the Hill

20. 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

21. Practitioner-to-Practitioner Relationship

22. 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.

23. 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

24. 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)

25. Other Healing Modalities
Reflective Journaling
Poetry
Art
Music
Exercise

26. 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.

27. 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

28. 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

29. In Loving-Gratitude

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

31. References
Institute of HeartMath. (2014). GPS for the soul. Retrieved from
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.