Human Caring:
Relationship-Centered Care
for
Case Managers
Coleen Cox-Ballah, DHA, MS, RN, CCM
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)
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.
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)
Caring Science
• Major Principles
– Relational Caring
– Caring core: Ten Carative Factors / Caritas
Processes
– Transpersonal Caring Moment-Caring Field
– Caring as consciousness – energy-intentionalityhuman presence
– Caring-Healing modalities
Caring Core: Caritas Processes™
• Caritas: “…to cherish, to appreciate,
to give special, if not loving attention
to” (Watson, 2008, p. 39).
• Ten Caritas Processes™
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
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
Ten Caritas Processes™
• 7. Authentic teaching-learning within context
of caring relationship; stay within other’s
frame of reference; shift toward a healthhealing-wellness coaching model
• 8. Creating healing environment at all levels;
physical/nonphysical, subtle environment of
energy, consciousness, wholeness, beauty,
dignity, and peace are potentiated
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, unknownsAllowing for miracles
Setting Intentionality: Caring
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Caring in the Beginning
Caring in the Middle
Caring in the End
Caring Continuing
Relationship Centered-Care
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Practitioner’s relationship with self
Practitioner-to-patient relationship
Practitioner-to-community relationship
Practitioner-to-practitioner relationship
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
Practitioner’s Relationship with Self
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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
Practitioner-to-Patient Relationship
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
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
CMSA Day on the Hill
Practitioner-to-Practitioner
Relationship
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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
Practitioner-to-Practitioner
Relationship
Practitioner’s Relationship with Self
• Practice
– Self-reflection
– Self-awareness
– Self-growth
– Self-caring
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
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)
Other Healing Modalities
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Reflective Journaling
Poetry
Art
Music
Exercise
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.
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
Intentionality: Caring In the End
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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
In Loving-Gratitude
Additional Resources
• Mindfullness Apps:
(www.freemindfulness.org/apps)
• Relaxation Techniques for Stress Relief:
(www.helpguide.org)
• Watson Caring Science Institute:
(watsoncaringscience.org)
References
• Institute of HeartMath. (2014). GPS for the soul.
Retrieved from http://www.heartmath.org/freeservices/solutions-for-stress/gps-for-the-soul.html
• 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.