2. Matthew Wayner & Anne Roane James Madison University NSG463 – Professional Role Transition Karen Jagiello, MSN, RNC Oct. 2015 INNATE COMPASSION: A DISCUSSION OF THE NURSING AS CARING MODEL

3. A New Approach to Nursing Nursing as Caring theory developed in the late 20 th century Co-authored by Anne Boykin and Savina Schoenhofer Focuses on intrinsically caring nature of humanity as basis for nursing practice http://bvlh.org/wp-content/uploads/2013/02/iStock_000014371972XSmall.jpg

4. Anne Boykin, BSN, MN, PhD 1 Began nursing in 1966 Retired in 2011; past dean and professor, Christine E. Lynn College of Nursing (Florida Atlantic University) Noticed throughout her education and early career that nursing education focused on the systems model No focus on care of the person In essence, not being taught how to be a nurse Spent many years using formal methods of study to develop theory of caring Statement of focus for study: nursing is nurturing persons—living caring, and growing and caring http://www.nursingascaring.com/#!meet-the- theorists/c1enr

5. Savina Schoenhofer, BA, BSN, M.Ed, MN, PhD 1 Holds degrees in nursing, psychology, counseling, and higher education Has authored numerous articles and made contributions to many books focusing on nursing as caring Served as a visiting professor, Christine E. Lynn College of Nursing (Florida Atlantic University) Created the Theory of Nursing as Caring website Forum for discussion of theory and examples in everyday practice http://www.nursingascaring.com/#!meet-the-theorists/c1enr

6. Overview of Theory Components 2 Persons are caring by virtue of their humanness Persons are caring, moment to moment Persons are whole or complete in the moment Personhood is a process of living grounded in caring Personhood is enhanced through nurturing relationships with caring others Nursing is both a discipline and a profession

7. Persons are Caring by Virtue of Their Humanness 2 The major concept which underlies all other aspects of the theory Not every act of life is a caring act, but this theory does not focus on the uncaring acts Theory involves assumption that all persons are naturally caring of other beings on a fundamental level

8. Persons are Caring, Moment to Moment 2 Theory states that caring is a way of life that is in a constant state of unfolding, ever progressing to the next caring moment Each moment holds potential to grow in caring, growing in caring is an ongoing process, each moment through life https://changeyourenergydotorg.files.wordpress.com/2015/04/3d- abstract_widewallpaper_the-moment_59355.jpg

9. Persons are Whole or Complete in the Moment 2 There is no presumed deficit or dysfunction to be fixed, the presumption is that people are whole in the moment Each moment presents the opportunity to grow as caring person. The goal of nursing care, therefore, is not to make a patient “whole” again, but rather to heal through enhancing and maximizing what is in place

10. Personhood is a Process of Living Grounded in Caring 2 Personhood is being true to oneself in each moment Personhood signifies that each individual has limitless potential to grow in caring Knowing oneself as caring person involves congruence with beliefs and actions http://blog.crisp.se/wp-content/uploads/2012/02/congruent-circles.jpg

11. Personhood is Enhanced Through Nurturing Relationships with Caring Others Every relationship serves as a source for opportunities for caring. Endeavoring in a relationship of nurturing strengthens one’s ability to “live grounded in caring” Nursing presents a plethora of unique opportunities for forging caring relationships with others http://i.huffpost.com/gen/1577382/images/o-HOLDING-HANDS-facebook.jpg

12. Nursing is Both a Discipline and a Profession 2 The nurse draws on their values and beliefs, as well as their nursing knowledge and experiences, with caring as the intention and focus http://www.mchonline.org/nursing-services/nursing-care

13. Putting the Theory into Practice Boykin and Schoenhofer encourage nurses to expand their understanding of caring, and to be constantly looking for new ways to improve how they care for various patients 2 Adapting to different situations Encouraging caring attitudes in other nurses Honoring each new nurse relationship/interaction as an opportunity to make a person-to-person connection and grow as a human When a nurse’s work originates from a mindset of caring, the result is greater compassion

14. Evidence-Based Support of Model For many reasons, many of which are regulatory and financial in nature, the focus of nurses’ interactions with patients seems to drift away from the betterment of the individual patient and more towards metrics Patients become numbers and dollar signs instead of holistic, sentient beings Mounting evidence shows the benefits of compassionate care across healthcare 3 Focus on teaching lessons of compassion to rising doctors and nurses, and in continuing education Healthcare that begins in genuine, patient-focused caring results in better patient outcomes

15. Implications for the Future of Nursing Huge emphasis on reducing readmissions and better chronic disease management 4 Aging population Higher prevalence of chronic diseases Affects reimbursement and other financial incentives http://www.nursingworld.org/ImageLibrary/headline-images/elderly-woman- getting-meds.jpg

16. Implications for the Future of Nursing (cont.) How can institutions apply the lessons of the Nursing is Caring theory to improve healthcare for providers and patients? Nurse-to-patient ratio reduction: increases nurse job satisfaction and compassion 5 Practices that re-focus attention on human, psychological elements of care E.g. “Pause” at the end of unsuccessful resuscitation efforts 6 Use of technology to expedite care to permit more of nurses’ time to be spent interacting with patients http://lawsquirrel.com/wp-content/uploads/2014/06/Resuscitation-300x224.jpg

17. Why This Theory Matters to Us Matthew: Before becoming familiar with this theory, I had the same sense through nursing school that the focus was more on systems than on the person. Caring was learned through clinical experiences, from clinical instructors who made caring their focus. The theory is reflective of part of my nursing philosophy, that everyone has the capacity to the make the world a better place for those around them. http://www.samford.edu/uploadedImages/_Asides/Schools/Health_Sciences/Nursi ng/nursing-students-listening-to-lecture.jpg?n=3457

18. Why This Theory Matters to Us (cont.) Anne: I was drawn to this profession because of a desire to be a purposeful part of the wellness journeys of others This theory emphasizes the uniquely human elements of healthcare from the caregiver side of the equation The most spiritually satisfying moments for me begin with a genuine, natural motivation to improve the lives of others http://www.cpr.org/sites/default/files/styles/full- width/public/images/emergency_room.jpg?itok=GVKw4rGz

19. References 1.Oliphant, E. (2015) “Nursing Theorist: Boykin and Schoenhofer.” Texas Woman’s University Libraries. Retrieved from http://libguides.twu.edu/ 2.Boykin, A., & Schoenhofer, S.O. (2001). Nursing as caring: A model for transforming practice. Sudbury, MA: Jones and Bartlett. 3.Lown, B. A., Rosen, J., & Marttila, J. (2011). An agenda for improving compassionate care: a survey shows about half of patients say such care is missing. Health Affairs, 30(9), 1772-1778. 4.Hendriks, J. M., de Wit, R., Crijns, H. J., Vrijhoef, H. J., Prins, M. H., Pisters, R.,... & Tieleman, R. G. (2012). Nurse-led care vs. usual care for patients with atrial fibrillation: results of a randomized trial of I ntegrated chronic care vs. routine clinical care in ambulatory patients with atrial fibrillation. European Heart Journal, 33(21), 2692- 2699. 5.Khamisa, N., Peltzer, K., & Oldenburg, B. (2013). Burnout in relation to specific contributing factors and health outcomes among nurses: A systematic review. International Journal of Environmental Research and Public Health, 10(6), 2214-2240 6.Bartels, J.B. (2014). The pause. Critical Care Nurse,34(1).