Chapter 7
Caring in Nursing Practice
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
AONE Guiding Principles for
Future Care Delivery
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Theoretical Views on Caring
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A universal phenomenon that influences the
way we think, feel, and behave
Florence Nightingale studied caring.
In the 1980s, Patricia Benner and Benner
with Judith Wrubel offered another definition
of caring.
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The Essence of Nursing and
Health
Madeleine Leininger studied caring
from a transcultural perspective.
Caring is an essential human need.
Caring helps an individual or group
improve a human condition.
Caring helps to protect, develop,
nurture, and sustain people.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Cultural Aspects of Care
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Implications for nursing practice:
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Know the patient’s cultural norms for caring
practices.
Know the patient’s cultural practices regarding
end-of-life care. In some cultures, it is considered
insensitive to tell the patient that he or she is
dying.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Cultural Aspects of Care (cont’d)
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Implications for nursing practice:
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Determine whether a member of the patient’s
family or cultural group is the best resource to use
for caring practices such as providing presence or
touching.
Know the patient’s cultural practices regarding
removal of life support.
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Case Study
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Mrs. Levine is an 82-year-old patient
diagnosed 2 months ago with lymphoma, a
cancer of the lymph tissue. She has been
experiencing weakness and fatigue. Over the
past 4 weeks, she has lost 8 pounds.
Mrs. Levine had been relatively independent
before her diagnosis, playing bridge each
week with friends and going to lunch with
fellow church members. But now, she has
much less energy to do the things she enjoys.
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Transpersonal Caring
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Jean Watson’s theory of caring (1988, 1979)
Promotes healing and wholeness
Rejects the disease orientation to health care
Places care before cure
Emphasizes the nurse-patient relationship
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Swanson’s Theory of Caring
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Kristen Swanson (1991)
A composite of three studies in a perinatal
unit
Defines caring as a nurturing way of relating
to a valued other, toward whom one feels a
personal sense of commitment and
responsibility
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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Mrs. Levine’s son, Jim, lives only a few miles
away and is a consistent resource when she
needs transportation to the physician or trips
to the grocery store.
She will begin a research protocol for
chemotherapy treatments this week at the
oncology clinic.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Patient’s Perspective of Caring
Patients value the affective
dimension of nursing care.
Reassuring presence
Recognizing an individual as unique
Keeping a close and attentive eye
on the situation
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Ethic of Care
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Concerned with the relationship between the
patient and the nurse and the attitude of each
toward the other
Places the nurse as the patient’s advocate
who solves ethical dilemmas by creating a
relationship
Gives priority to each patient as a unique
being
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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Sue is a nurse who has worked in the oncology clinic
for over 10 years. She enters the examination room
where Mrs. Levine is waiting, introduces herself, and
sits down next to her patient.
Sue states, “Mrs. Levine, I am here to understand
your story. I want to listen and learn how I can best
help you.” Sue uses eye contact while talking and
leans toward Mrs. Levine to establish a physical
presence. Mrs. Levine nods, smiles, and begins her
story.
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Providing Presence
Being with
Eye contact
Body language
Tone of voice
Listening
Positive and
encouraging attitude
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Caring in Nursing Practice
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Behaviors include being present, providing a
caring touch, and listening.
Caring is a product of culture, values,
experiences, and relationships with others.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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Mrs. Levine explains, “I have had a good
life. I just don't know what is going to happen.
The doctor tells me the cancer is serious. I
worry about what is going to happen to me
and how it will affect my son, Jim. I do not
want to become a burden to him.”
Sue responds in a calm, soothing tone, “Mrs.
Levine, your concerns are very normal. It is
important for you to remain as independent
as possible. Let’s talk about how we can do
that.”
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Touch
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Provides comfort
Creates a connection
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Contact touch
Noncontact touch
Protective touch
Task-oriented touch
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Quick Quiz!
1. A female patient has just found a large lump
in her breast. The physician needs to
perform a breast biopsy. The nurse helps
the patient into the proper position and offers
support during the biopsy. The nurse is
demonstrating
A. Enabling.
B. Comforting.
C. A sense of presence.
D. Maintaining belief.
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Case Study (cont’d)
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Mrs. Levine has consistently relied on her
son, Jim, to provide caregiving support by
assisting with transportation and being a dayto-day resource. Jim brings his mother to the
outpatient oncology clinic for her first
chemotherapy infusion.
The total treatment will last for approximately
5 hours. Sue invites Jim to sit in the treatment
area with his mother.
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Listening
Creates trust
Opens lines of communication
Creates a mutual relationship
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Knowing the Patient
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Develops over time
The core process of clinical decision making
Aspects of knowing include:
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Responses to therapy, routines, and habits
Coping resources
Physical capacities and endurance
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Case Study (cont’d)
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Outside of the treatment room, Jim asks,
“How will my mother respond to this
chemotherapy? What should we be
expecting?”
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Based on Swanson's theory of caring, what might
be an appropriate response on Sue's part in
“maintaining belief”?
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Spiritual Care
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Spiritual health is achieved when a person
can find a balance between his life values,
goals, and belief symptoms and those of
others.
Spirituality offers a sense of interpersonal and
transpersonal connectedness.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Family Care
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A nurse discusses a patient’s health care needs with
his family.
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Case Study (cont’d)
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Three hours into the infusion, Mrs. Levine
asks Sue for a glass of water and begins to
talk about her pet cat and her desire to return
home and be able to visit with one of her
bridge partners tomorrow. Sue has another
patient down the hall who has an infusion that
has been under way for about an hour.
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What should Sue do to show her caring for Mrs.
Levine?
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Quick Quiz!
2. When a nurse enters a patient’s room and
says “Good morning” before starting care, the
nurse combines nursing tasks and
conversation. An important aspect of care for
the nurse to remember is the need to
A. Establish a relationship.
B. Gather assessment data.
C. Treat discomforts quickly.
D. Assess the patient’s emotional needs.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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The Challenge of Caring
TaskOriented
Care
Technology
Improved
Nurse-toPatient Ratios
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