I. NURSING IS AN ART
The Development of Nursing as an Art
- deeply rooted in it’s History
- evolution of nursing roles and functions
- emergence and effects of technology and digitalization
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CARE AND COMPASSION - innate of nursing
NURSING IS AN ART because
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It is composed of SKILLS that is perfected thru time and
actual practice until one reaches Proficiency and
Expertise.
MODELS of NURSING PRACTICE
Benner - (include work with Wrubel 1989 and other in 2010)
 -Caring is primary because it determines what matters
to people
- It involves a lot of interactions
- It determines what is stressful to people and how
to cope
- creates a lot of POSSIBILITIES (benner and
wrubel, 1989)
- Connecting with people
- Concern for others
- Allows giving and receiving Health
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Nursing - is a process of helping people cope with the
stress of illness.
- Not blindly following sets of prescribed rules
- each patients is unique
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Illness - is not reducible to disease (cellular pathology)
- Caring depends on discerning problems, solutions
and helping patients implement, and live, a solution.
- Nursing is a moral act that goes beyond mere
application of scientific knowledge
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It requires Creative use of knowledge in his or her
encounter with patients. With creativity the nurse
applies the concepts and acts according to the context
of the situation
Example: Giving medication to adults and children.
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Nursing is an art because of the skills and knowledge
are Improved by constant practice. Frequent application
of once knowledge and practice of skills will lead to
mastery, efficiency and finest until it reaches
automaticity. When we say automaticity it is not only a
habit but it becomes a part of the nurses system or
person hood.
Experts nurses are known as good clinical eye so that
just merely looking at the patient or at a situation would
enable them to predict the next scenario and the
consequences, and therefore their put in a good
position prudently or sensitivity act, so that the patient
wellfare and the desired outcomes will be maintained
It involves Therapeutic use of one’s self
It is an expression of Care and Compassion
NURSING CONTRUCTS considered ARTS
 CARING - is the essence of nursing “Jean Watson”
 COMPASSION
 EMPATHY
 ENGAGEMENT
 EFFECTIVE COMMUNICATION
 HOLISTIC APPROACH -Physical, Spiritual, Psychological,
Social
II. NURSING ACTIVITES CONSIDERED ARTS with Caring,
Communication and Teaching.
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Leininger - TRANSCULTURAL CARING
CARE- is the essence, central unifying and dominant
domain that distinguishes nursing from all other health
disciplines
- is an essential Human Need ( necessary for the
health and survival)
- Care versus Cure
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ACTS of CARING - refer to those “nurturing” and skillful
activities
- Empathetic
- Compassionate
- Supportive
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CARING - is very personal (although universal)
- differ in expression, processes and patterns
- “culturally” based and rooted
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NURSES - must understand “cultural caring” behaviors
- need to get to know the context of the person
cared for:
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Culture - social norms, values and behaviors, laws,
Social rules
Subculture - Religion, Social class, Special needs,
Sexuality
Individual Culture - Gender, Education, Experience, Age
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THE ART OF CARING
 Caring is the essence of Nursing
 There is no cure when there is no Care
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Nursing is the pivotal health profession highly valued for
its specialized knowledge skill, and CARING in improving
the health status of the individual, family and
community. -Nursing Agenda for the Future (ANA, 2002)
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CARING and knowledge are the core of nursing... with
CARING being a key component of what a nurse brings
to a patient experience. - American Organization of
Nurse Executives (AONE, 2015)
Watson’s Model
CARING - Is the “ central” focus of nursing
- Integral to maintain the ethical and philosophical roots
of the profession (2008)
- Demands “ highly quality interaction” from nurses
- Holistic approach - a conscious intention to care
promotes healing and wellness (2008;2010)
- rejects the disease orientation to health care
- Care before cure
- It becomes almost spiritual (raises questions on what it
means to be human and humane)
- It involves the use of “10 carative factors, Caritas processes”
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The model is TRANSFORMATIVE - it influences both the
patient and the nurse (better or worse)
Caring consciousness (on the part of the nurse
promotes Healing)
Swanson’s Model (Theory of Caring and Healing)
Caring - is nurturing way of relating to valued other
towards whom one feels a personal sense of
commitment ans responsibility
- It is growth and health-producing (nurturing)
- occurs in relationships (relating) to the one cared for (a
valued other)
-individualized and intimate (personal), with a sense of
commitment (passion), accountability and duty
(responsibility)
Nurturing is a set of interrelated process that evolve
from the nurse’s own concivtions, knowledge, and
interaction with a patient.
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CARING - is an expression of TECHNOLOGICAL
COMPETENCY
- Co-existence of technology and caring provides a
framework for practice.
FOCUS of NURSING:
- to know human beings fully as a whole person
- affirm, appreciate, and celebrate person hood through
expert and competent use of nursing technologies.
COMMON THEMES ACROSS the CARING MODELS
 Human interaction or communication
 Mutuality
 Appreciating the uniqueness of individuals
 Improving the welfare of individuals and families
THE 6’S of CARING CARE
 Keep the safe
 Prevent harm
 Ensure high quality care
 Get to know them
 Make them feel valued
COMPASSION
 Be with them in times of loneliness
 Maintain “human contact”
 Attitude “ show the 6 C’s
 Maintain and affirm dignity
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Boykin & Schoenhofer’ Model
Caring - an innate human characteristic
- All persons are caring by virtue of their humanness
- is an essential feature and expression of being human
-being a person means “living” caring
- Caring is living in context of Relational responsibilities
-Caring is responsibility to self and others.
- Caring shapes relationships.
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6 MAJOR ASSUMPTIONS:
Persons are caring by virtue of their humanness.
Persons are whole or complete in the moment
Persons are whole or complete in the moment
Person hood is living grounded in caring.
Person hood is enhanced through participating in
nurturing relationships with others.
Nursing is both a discipline and profession.
Locsin’s Model
Assumptions:
 Person are whole or complete in the moment
 Knowing persons is a process of nursing that allows for
continuous appreciation of persons moment to moment
 Nursing is a discipline and professional practice
 Technology is used to know persons as whole moment
to moment.
COMPETENCE
 Regular observations
 Thorough assessments
 Prevent: risk, falls infections
COMMUNICATION
 Regular interaction
 Enchancing comfort
 Decreasing anxiety
 Make the feel valued
 Verbal and non-verbal
COURAGE
 Challenging “poor” practice
 Proper reporting or “whistle-blowing”
 Admission of one’s limitations. Apology
 Patient advocate
COMMITMENT
 Professionalism
 Patient at the center of care
 Perseverance
 Active “presence” and listening
MANEFESTATION OF CARING IN PRACTICE
 Provide PRESENCE
 Use appropriate
 TOUCH
 Active Listening
 Knowing the patient
 Spiritual care
 Relieving symptoms and suffering
 Family Care
III. THE ART OF COMMUNCATION
COMMUNICATON establishes caring healing relationships.
 ALL behavior communicates…
 ALL communication influences behavior.
Nurses with expertise in COMMUNICATION…
➢become sensitive to self and others
➢promote and accept the expressions of positive and
negative feelings
➢develop caring relationships
➢instill faith and hope
➢provide a supportive environment
➢assist in the gratification of human needs
➢allow spiritual expression
(Ryan, 2005; Watson,1985)
The PROCESS of COMMUNICATION:
Circular Transactional Model (Review)
LEVELS of COMMUNICATION
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Intrapersonal (self-talk)
Interpersonal (one on one interaction)
Small group (with a number of people)
Public (with an audience)
Electronic (use of technology)
THERAPEUTIC COMMUNICATION
 Use of “therapeutic communication” techniques
 AVOID forms of non-therapeutic techniques
THERAPEUTIC COMMUNICATION
➢refers to those specific “responses” from the nurse that
encourage the expression of feelings and ideas
➢makes the patient or other person feel accepted and
respected
➢it is an ART to use these techniques or skills in different
situations and with different clienteles
➢the face-to-face process of interacting that focuses on
advancing the physical and emotional well-being of a patient
THERAPEUTIC COMMUNICATION TECHNIQUES
➢active listening
✓providing information
➢sharing observations
✓clarifying
➢sharing empathy
✓focusing
➢sharing hope
✓paraphrasing
➢sharing humor
✓validation
➢sharing feelings
✓asking relevant questions
➢using touch
✓summarizing
➢using silence
✓self-disclosure
✓confrontation
FORMS of COMMUNICATION
 Verbal
 Non-Verbal
CONSIDERATIONS in COMUNICATION
VERBAL
o Vocabulary
o Meaning (denotative and
connotative)
o Pacing
o Intonation
o Clarity and brevity
o Timing and relevance
NON-VERBAL
o Personal appearance
o Posture and gait
o Facial expression
o Eye contact
o Gestures
o Sounds
o Teritoriality and personal space
o Metacommunication
NON-THERAPEUTIC COMMUNICATION TECHNIQUES
X asking personal questions
X giving personal opinions
X changing the subject
X automatic responses
X false reassurance
X sympathy
X asking for explanation (why?)
X using (excessive) silence
X approval or disapproval
X defensive responses
X passive or aggressive responses
X arguing
COMMUNICATION as a HELPING PROCESS
➢Professional – avoid over familiarity
➢Objective
➢Goal-oriented
➢“Therapeutic use of the self”
PHASES of the HELPING PROCESS
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CHED memorandum Order (CMO) 15 series of 2017 NCM102 as a major professional Subject
PURPOSES OF PATIENT EDUCATION
1. Achieve Optimum Level of Health (EDELMAN et al, 2014)
2. Provision of Safe and Patient- Centered Care
(QSEN,2014)
3. Reduce Health Care Cost (CANIVEL et al, 2016; HAINES
et al, 2013)
COMMUNICATION and the NURSING PROCESS
For SUPPLEMENTAL SELF-DIRECTED READINGS:
➢Zones of Personal Space
➢Use and examples of THERAPEUTIC COMMUNICATION
TECHNIQUES
➢Integration of communication in the Phases of the Helping
Relationship
IV. THE ART OF TEACHING and PATIENT EDUCATION
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Patient education (teaching is one of most important
interventions and functions of the nurse.
Patients have the RIGHT to know and be informed of
their diagnosis and conditions, To help them make
decisions about their health and wellness.
THE ROLE OF THE NURSE IN TEACHING AND LEARNING
 Nurses have an Ethical Responsibility to each their
patients (HEISKELL, 2010)
 Nurses assess the learning needs, provide education
(teach) a variety of topics as parts of the patient’s plan
of care
 Nurses need to Collaborate with the patient, his/her
family and other health care team members.
 Nurses need to Document the teaching, adjunct
interventions and patients responses.
THE LEGAL BESES OF PATIENT EDUCATION
 Nursing Practice Acts - state that patient education falls
under the scope of nursing practice (BASTABLE, 2014)
 The joint Commission (TJC, 2015) - sets standards for
patient and family education
 American Nurses Association (ANA) - includes patient
education as standards of Practice (integrated under
standards 1,2,3,4,5,6,7,8,9,10)
 Republic Act 9173 (Philippines) - teaching functions is
specified in Section 28
AREAS FOR PATIENT EDUCATION
 Maintenance and Promotion of Health
 This teaching affirm and to support the patients
presence state of good health.
Examples: Good Nutrition, Exercise and
Engaging in a Relaxation Activity
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PREVENTION OF ILLNESS
 Activities or Health Topics that are involved in this
particular aspect of health would be teaching
clients to avoid diseases and stop unhealthy habits.
Examples: Just like Drinking alcohol or Smoking
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RESTORATION OF HEALTH
 Teaching patients and guiding them back to
previous level of functioning.
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COPING WITH IMPAIRED FUNCTIONS
 This is related ti rehabilitation
 This would mean teaching the person to accept his
condition and the possible consequences of such in
his activities of daily living.
 They can be still functioning in the certain
optimum level because we are going to enhance
their mini capacities, so that they can still
functioning on their own.
PATIENT EDUCATION AS COMMUNICATION
- Involves the goal of teaching which is to chance the
mindsets, the feelings, and actions of the people towards to
better health.
- Effective teaching depends on effective INTERPERSONAL
interactions, so that when we teach we do not only fit the
mind or cognitive but let us strive to feel the heart or
affective and activate the hands and the feet
(PSYCHOMOTOR). So that our learning will be true send we
can address all domains of learning.
Integrate the patients teaching and education is therefore
and art because of the vast uniqueness of clients pills and the
contexual applications on an strategies to address patient
learning needs.
“TELL ME AND I FORGET TEACH ME AND I REMEMBER
INVOLVE ME AND I LEARN”
- BENJAMIN FRANKLIN