COMFORTING PROCESS - A complex process that includes discrete, transmitting actions such as touching, or broad longer interventions such as listening Comfort - Merriam: to hope to, to ease the grief or trouble of - Comes from the Latin word Confortare which means “become strong, comfort or encourage” or meaning to strengthen greater - Implies a renewal, amplification of power or sense of control, a positive mindset and readiness for action. Kolcaba’s Theory of Comfort - Explains comfort as a fundamental need of all human beings for 3 reasons arising from health care situations that are stressful: a. Relief b. Ease c. Transcendence - Comfort can enhance health seeking behaviors for patients, family members, and nurses. - One related concept to comfort is comfort measures a. This may be provided directly or indirectly b. Maintaining a quiet environment c. Coordinating the activities of other health care personnel d. Supporting the client’s family members or SO - Encompasses the client’s 4 elements or Nursing Metaparadigm: a. Psychospiritual – talking in soothing tones, acknowledging and accepting feelings, offering your presence, encouraging decision making b. Social – supporting family and friends, encouraging family and friends to visit c. Environmental – removing clutter and opening windows CARING I. Introduction - Is sharing deep and genuine concern about the welfare of another person. - This is a dimension of human relating - Art of nursing and nursing can’t exist without caring. - Is central to all helping professions, and enable people to create meaning in their lives. II. Professionalization of Caring - Caring practice involves connection, mutual recognition, and involvement between nurse and client. - Just as clients benefit from caring practices, the nurses involved in these situations experience caring through knowing that they have made a difference in their client’s lives. - Cite examples in the book. III. Caring as “Helping the Other Grow” - Milton Mayeroff – to care for another person is to help him grow and actualize himself. - Caring is a process that develops overtime, resulting in a deepening and transformation of the relationship. Recognizing the other as having potential and the need to grow. - Caring process has benefits for the one giving care. By helping the other person grow, the caregiver moves toward self-actualization. By caring and being cared for, each person “finds his place” in the world. By serving others through caring, individuals live the meaning of their own lives. - Major Ingredients: a. Knowing – means understanding the other’s needs and how to respond to these needs b. Alternating rhythms – signifies moving back and forth between the immediate ang long-term meanings of behavior, considering the past c. Patience – enables the other to grow in his own way and time d. Honesty – includes awareness and openness to one’s own feelings and a genuineness in caring for the other. e. Trust – involves letting go, to allow the other to grow in his own way and own time f. Humility – means acknowledging that there is always more to learn, and that learning may come from any source g. Hope – is belief in the possibilities of the other’s growth h. Courage – is the sense of going into the unknown, informed by insight from past experiences IV. Nursing Theories on Caring - These theories and models are grounded in humanism and the idea that caring is the basis of human science. Each theory develops different aspects of caring, describing how caring is unique in nursing. A. Culture Care Diversity and Universality (Leininger) - Emphasizes care as a “distinct, dominant, unifying and central focus of nursing”. Her theory of culture care diversity and universality assumes that nurses must understand different culture in order to function effectively. - Transcultural nursing focuses on both the differences and similarities among individuals in diverse cultures. - 3 decision care approaches: 1. Preservation of the client’s familiar lifeways 2. Accommodations that help clients adapt to or negotiate for satisfying care 3. Repatterning nursing care to help the client move toward wellness - Further defines caring as “assistive, supportive and enabling experiences or ideas towards others with evident or anticipated needs, to ameliorate or improve a human condition or lifeway. B. Theory of Bureaucratic Caring (Ray) - Focuses on caring in organizations as cultures (like hospitals) – caring in nursing is contextual and is influenced by the organizational structure. - Ray’s research – caring varied in the emergency department, ICU, oncology unit and other areas of the hospital. *Cite examples in the book. Furthermore, the meaning of caring was further influenced by the role and position a person held. - Spiritual-ethical caring influences each aspect of the bureaucratic system – each of these aspects is different, but they make up a whole bureaucratic system. C. Caring, the Human Mode of Being (Roach) - Caring as a philosophical concept and proposes that caring is the human mode of being – meaning all individuals are caring, and develop their caring abilities by being true to self, being real, and being who they truly are. - 6 C’s of Caring in Nursing: (read the definition in the book page 425) 1. Compassion 2. Competence 3. Confidence 4. Conscience 5. Commitment 6. Comportment D. Nursing as Caring (Boykin and Schoenhofer) - Respect for people as caring individuals and respect for what matters to them are assumptions underlying the theory of nursing as caring. - Emphasized the importance of the nurse knowing self as a caring person – through this, the nurse can be authentic to self, freeing oneself to truly be with others even though sometimes it is difficult. E. Theory of Human Care (Watson) - Views caring as the essence and the moral ideal of nursing. - Nursing as human care goes beyond the realm of ethics. - Watson emphasizes nursing’s commitment to care of the whole person as well as a concern for the health of individuals and groups. - She also emphasized that the practice of nursing is both transpersonal and metaphysical. F. Theory of Caring (Swanson) - “nurturing way of relating to a valued ‘other’, toward whom one feels a personal sense of commitment and responsibility”. - client’s well-being should be enhanced through the caring of the nurse who understands the common human responses to a specific health problem. The theory focuses on caring processes as nursing interventions. - 5 Caring Processes: (read the definition in the book page 427) 1. Knowing 2. Being with 3. Doing for 4. Enabling 5. Maintaining belief V. Types of Knowledge in Nursing - An understanding of each type of knowledge is important for the student of nursing because only by integrating all ways of knowing can the nurse develop a professional practice. 1. Empirical Knowing – the Science of Nursing - Ranges from factual, observable phenomena to theoretical analysis. 2. Personal Knowing – the Therapeutic Use of Self - Promotes wholeness and integrity in the personal encounter, achieves engagement rather than detachment, and denies the manipulative or impersonal approach. 3. Ethical Knowing – the Moral Component - Focuses on “matters of obligation or what ought to be done” goes beyond simply observing the nursing code of ethics. 4. Aesthetic Knowing – the Art of Nursing - Is the art of nursing and is expressed by the individual nurse through his or her creativity and style in meeting the needs of clients. (read only) *Now, how to develop Ways of Knowing? There are unique methods in developing each type of knowledge but these patterns can’t be used in all methods. Say for example: a. Personal Knowing – is developed through critical reflection on one’s own actions and feelings in practice. b. Empirical Knowing – is gained from studying scientific models and theories and from making objective observations. c. Ethical Knowing – involves confronting and resolving conflicting values and beliefs. d. Aesthetic Knowing – arises from deep appreciation of the uniqueness of each individual and the meanings that individual ascribes to a given situation. VI. Caring Encounters – caring is contextual, meaning there are ways that a nurse can demonstrate caring and this nursing approach used with a client in one situation may be ineffective in another. 1. Knowing the Client - Personal knowledge of the client is a key in the caring relationship between nurse and client. The nurse aims to know who the client is, in his or her uniqueness. This knowledge is gained by observing and talking with the client and family while using effective listening and communication skills. The nurse can’t remain detached, but must be actively engaged with the client. (state the example from the book) 2. Nursing Presence - Watson describes the transpersonal caring relationship in which the nurse enters into the life space of another person. Establishment of a caring relationship depends on a moral commitment by the nurse and the nurse’s ability to assess and realize another person’s state of being. - Swanson’s category being with is by being emotionally present to the client and family, the nurse conveys that they and their experiences matter. - Examples: healing process, answering to a call bell. 3. Empowering the Client - Empowering relationship includes mutual respect, trust and confidence in the other’s abilities and motives. - Enabling is defined as “facilitating the other’s passage through life transitions and unfamiliar events”. This also includes coaching, informing, explaining, supporting, assisting, guiding, focusing, and validating. - Nurses are both advocate for (verb) and are advocates (noun) for clients and families. Through advocacy, nurses are champions for their clients. They empower clients and families through activities that enhance well-being, understanding and self-care. 4. Compassion - Compassion = Caring. The caring nurse is described as warm and empathetic, compassionate and concerned. - Compassion involves participating in the client’s experience, with sensitivity to the person’s pain or discomfort, and a willingness to share in their experience. - Compassion is a gift from the heart, rather than an advances skill or technique. - Attention to spiritual needs is part of compassionate care particularly in the face of death and bereavement. - Comfort is often associated with compassionate care and many nursing interventions are carried out to provide comfort. (read the examples) 5. Competence - The competent nurse employs the necessary knowledge, judgement, skills, and motivation to respond adequately to the client’s needs. - VII. Just as competence without compassion is cold and inhumane, compassion without competence us meaningless and dangerous. Maintaining Caring Practice 1. Caring for Self - Helping oneself grow and actualize one’s possibilities. - Taking the time to nurture oneself – initiating and maintaining behaviors that promote healthy living and well-being – healthy lifestyle (nutrition, activity, exercise and recreation) and mindbody therapies (guided imagery, meditation and yoga). - Opposite of this is self-complacency that often accompanies egocentricity. - AHNA 2012: “the nurse has the responsibility to model health care behaviors. Holistic nurses strive to achieve harmony in their own lives and assist others striving to do the same”. 2. A Healthy Lifestyle: a. Nutrition b. Activity and Exercise c. Recreation d. Avoiding unhealthy patterns 3. Mind-Body Therapies: a. Guided Imagery b. Meditation c. Storytelling d. Music Therapy e. Yoga 4. Reflection on Practice - Thinking from a critical point of view, analyzing why one acted in a certain way, and assessing the results of one’s actions. To develop oneself as a caring practitioner, reflection on practice must be personal and meaningful. - A method of self-examination that involves thinking back over what happened in a nursing situation. - Requires discipline, action, openness and trust. It is a form of self-evaluation.
