The Concept of Caring in Nursing - Essay Example

Caring Introduction: In the days of Florence Nightingale caring to the nursing profession essentially meant providing comfort to the patients. Tens of decades have elapsed since the days of Florence Nightingale and the nursing profession has evolved into a much more complex profession thanks to the developments in society and medical science. This evolution of the nursing profession has also led to a more complex understanding of the caring in the nursing profession. The nursing profession has remained embedded in caring and this means that understanding caring becomes essential to the nursing professional. Overview of Caring and it’s Meaning: The question does arise as to the importance of caring to the nursing professional. The answer to that lies in the accepted fact that caring is an essential facilitator for curing and healing and with the nursing profession steeped in trying to bring about curing and healing the importance of caring in this role becomes clear (Ott, Al-Khaduri & Al-Junaibi, 2003). So what does that caring to a nursing professional mean? There are several theories to caring in the nursing profession. A lot of literature has been written on caring and the nursing profession. However there are three theories that bring about clarity to the issue of caring in the nursing profession. These three theories are: Leiningers Caring: A Central Focus of Nursing and Health Care Services. Orems Self-Care Deficit. Watsons Philosophy and Science of Caring. (Sumner, 2005). Care consists of the assistive, supportive, or facilitative actions that are taken for or towards another individual or group of individuals that have clear or anticipated requirements to reduce or improve a human condition or way of life. As a result Leninger,(1984, p. 4) defines caring as “the direct (or indirect) nurturant and skilful activities, processes and decisions related to assisting people in such a manner that reflects behavioural attitudes, which are empathetic, supportive, compassionate, protective, succorant, educational and others dependant on the needs, problems, values, and goals of the individual or group being assisted”. The general nursing theory of Orem essentially consists of three parts. The first part of the theory consists of the Self-Care element, in which an adult through deliberate means learns and perform actions directed towards survival, improved quality of life and well being. The second element is the Self-Deficit part, according to which, nursing is an essential factor towards the learning of the Self-Care element, as the adults are not in a position to perform self-care because of the limitations of their situation. The third element is the nursing element in the nursing system. Caring thus becomes the nursing processes through which nurses assist individuals to meet their self-care requisite and build their self-care or dependent-care capabilities. (Orem, 1985). Watson, 1999, expands caring as grounded in a relational ontology of being-in-relation, and a world view if unity and connectedness of all human beings. Thus she introduces transpersonal caring as an acknowledgement of the unity of life and connections that make caring an extension from the individuals, to others, to the concerned community, and from there to the world and beyond to the universe. Transpersonal caring extends beyond the ego of self and even beyond the current moment to explore deeper connections to the spirit and the broader universe. Transpersonal caring should attempt to connect with and embrace the other individual in need through the processes of caring and healing that are in authentic relation in the given circumstances or the caring moment. Such caring calls for it to be influenced by consciousness and intentionality of the nursing professional as entry into the life space of the other individual. This consciousness and intentionality should be capable of detecting the person’s condition right down to the soul of the individual. This implies that caring focus on the uniqueness of self and the individual and the uniqueness of the moment, wherein the coming together of the patient and the nursing professional is mutual and reciprocal, with each totally embodied in the present time frame, while at the same time being retaining the capacity to transcend the moment and look for new possibilities (Watson, 1999). Discussion and Analysis on Caring: No single nursing theory by itself provides full understanding of caring from a nursing perspective and it is for this reason that it is necessary combine the Leininger’s, Orem’s and Watson’s perspectives of caring from their respective theories of nursing. Taken collectively these three concepts of caring from their respective theories of nursing it is possible to have comprehensive perspective of caring in the nursing profession. From Orem comes the understanding of the individual requirements of the patients under nursing care. Their willingness to learn and perform activities oriented towards survival or improved quality of life and well being and the limitations that they find themselves in being to perform these activities and that nursing care should be focused on providing the necessary assistance towards these ends. From Leininger comes the perspective of the behaviour and manner through which this assistance needs to be provided as an element of caring. The behavioural patterns essential to caring include being empathetic, supportive, compassionate, protective, succorant, and educational, through activities that call for knowledge and skill applied in a nurturing manner. Watson expands these concepts to the uniqueness of the moment of interaction of between the patient and the nursing professional in keeping with uniqueness of the individual and calls for the nursing to try and seek out the depths of the individual and the yearnings within to create an understanding of the unique situation, understand it, act on it and expand it both in time and application. In clarifying the perspective of caring in the nursing profession comes with it the understanding of the complex nature of caring to the nursing profession in keeping with the complex situations that they deal with (McSherry, 2000). This complex perspective of caring to the nursing profession starts with acquiring knowledge and skills in understanding the nature of the limitations that individuals find themselves and the nature of the assistance that would be required in self-care or dependent care requisites. Advances in medical science and the growing development of medical tools have brought with it demands in the greater and continuing acquisition of knowledge and skills in improving the care provided to patients. These demands become even greater when we examine the case of critical care. The responsibilities in care of the critically ill for the nursing professional have been increasing and with this the need for greater knowledge and skills. Knowledge in cardioversion or defibrillation, pacemakers, intraspinal analgesia, pulmonary artery catheters and intracranial pressure monitoring are required of nursing professionals in critical care situations. Lack of this knowledge makes the care provided deficient in these dependent care situations and has a negative impact on the ability of the individual to survive (Telfor & Mondor, 2001). Yet knowledge and skills alone don’t constitute nursing care. Nor is the strict application of procedures and care pathways in the care of a patient. Such an approach removes both the individual element of the patient as well as the nursing care professional. Faulkner, 1996, points out that such an approach forgets the individual and makes the focus of nursing care the disease and leads to dehumanization of the individual. From the perspective of healthcare management systems these activities may constitute doing the needful for the patient, but from a nursing care perspective it does not, for the situation in each individual case is different and so are the aspirations and belief of the individual in the objectives of the outcome of nursing. This cannot be learnt, nor does it come from the duty manual of a nursing professional. It comes from being empathetic and communicating with the individual (Ferreira, 2006). In situations where individuals have communication skills due to either deficiencies in communicating or due to language issues there will be difficulty in communicating. So how does the nursing professional overcome it? It is here that non-verbal skills are useful become useful and development of these skills in a nursing professional become an added part of the caring aspect of the nursing professional. In short being competent in communication through both the verbal and the non-verbal means becomes integral to the nursing professional in her role in caring (Chambers, 2003). Communication provides the means to know the individual requirements, but there is also the demand from caring that it is not enough to just know, but to understand and empathise with the individual. Watson, 1999, goes further in requiring this understanding to go to the depths of the individual so that there is a soul to soul understanding of the unique situation that the individual and the nursing professional are in. This can only happen when within the nursing professional there are the characteristics of compassion and the understanding that even more important than the self is the situation that the individual is in and the contribution of the nursing professional to make a world of difference in the direction that the individual would like the situation to develop. For this to happen, the nursing professional needs to be happy in her profession and career. Once happiness is there it is possible to develop the other self-development factors needed in the nursing professional to make it possible for attempting oneness with the individuals as a part of the demands of nursing care (Faulkner, 1996). Nursing care is focused on the individual or a group of individuals. Tuning in with their requirements is an essential feature of caring. How is this achieved? It is only through listening to individual needs from the individual or from the family members and respecting their wishes that care can be provided, as can be seen from this example. A lady and her husband were first met by a nurse in a pain clinical. There were non-verbal signs of distress in the face of the woman, but she was totally non-communicative and only cried. The nurse was perturbed. She used the only alternative available to her and that was to talk to communicate with the husband. From the husband she gathered that the lady suffered acute pain in her hand, but the doctor refused to treat her till she got rid of the smoking habit. She was finding it difficult to give it up and hence though in discomfort was not willing to discuss her suffering. The nurse then took on the challenge of changing the smoking habit in the woman. Without discussing the pain and the cause of the pain in the hand she explained the difficulties in smoking and the means to overcome it. Gradually the lady became more amenable to the nurse and over a period of time the nurse through her empathy with the lady and her needs got her to stop smoking, which made it possible for them to approach the doctor for managing the pain in the hand. (Walker, Payne, Smith & Jarrett, 2004). Failing to respect individual wishes can have a negative impact on the individual and the outcome of the situation between the individual and the nursing professional, as can be seen from this case. A young adult was admitted in a medical ward for a condition that required the cessation of smoking. The young adult agreed to try provided the nursing professional assisted in the attempt. The nursing professional refused and instead banned the individual from smoking. Smoking stopped in the ward, but continued secretly in the lavatories. The end result was that the management of the condition failed and the treatment outcome for the individual was negative. Thus the outcomes are dependent on the caring provided to individuals in healthcare situations (McSherry, 2000). The individuals perspective of caring varies as the individual is unique, Attuning the care provided is essential for a positive viewing of the care provided. When the caring in the perspective of the individual is deficient, it is quite likely that the individual views it as an intrusion into the situation, which is not warranted and as such may not be cooperative leading to unsuccessful out comes for both the individual as well as the nursing professional. The importance of this attitude can be seen in Table 1 and Table 2 provided below. Table 1. Consequences of Caring and Non-caring for Patients Consequences of Caring Consequences of Non-caring • Emotional-spiritual well-being, dignity, self control, personhood • Humiliation, fear, out of control, despair, helplessness, alienation, vulnerability, lingering bad memories • Physical enhanced healing, saved lives, safety, energy, fewer costs, more comfort, less loss • Decreased healing • Trust relationships, decrease in alienation, closer family relations   Adapted from Watson J. Caring science as sacred science: caritas/love and caring-healing. Program and abstracts of the American Holistic Nurses Association 25th Annual Conference; June 16-19, 2005; King of Prussia, Pennsylvania. (Caring Science and the Caritas Field: Lighting Our Path) Table 2. Consequences of Caring and Non-caring for Nurses Consequences of Caring Consequences of Non-caring • Emotional-spiritual sense of accomplishment, satisfaction, purpose, gratitude • Hardened • Preserved integrity, fulfilment, wholeness, self-esteem • Oblivious • Living own philosophy • Robot-like • Respect for life and death • Depressed • Reflective • Frightened • Love of nursing, increased knowledge • Worn down Adapted from Watson J. Caring science as sacred science: caritas/love and caring-healing. Program and abstracts of the American Holistic Nurses Association 25th Annual Conference; June 16-19, 2005; King of Prussia, Pennsylvania. (Caring Science and the Caritas Field: Lighting Our Path) Watson, 1999, calls for the unique experience in caring to be acted upon and expanded in both time and application. How is this realized? Reflection on the unique experience, understanding it and expanding it to other unique encounters is the manner in which this call of Watson is answered. Recording the experience, studying it or reliving it and learning from are the basis of reflection. Through such reflection a nursing professional can identify the strengths and weakness with the self of the nursing professional and enhance the strengths and overcome the weaknesses in future unique experiences to provide a more caring experience for the individual (Sommerville & Keeling, 2004). From our earlier example the nursing professional when reflecting on the experience with the young adult would find that she was deficient in understanding the individual needs of the young adult and demonstrated lack of compassion by refusing to assist the young adult to try and stop smoking. In her future experiences she would then remove this deficiency by changing herself from within and display greater empathy. Ethical issues for caring and the nursing profession are steeped in the autonomy of the individual and the need for interaction with the individual, providing adequate information and making an informed decision in the direction of the care provided. The essence of caring is the unique individual and the needs of the individual. The empathy with the individual provides the means of understanding the individualistic needs of the situation and guiding the care provided towards meeting these individual needs, rather than pushing the individual towards the care plans charted out as per the guidance in the management of a disease or condition . That gives the disease or condition the importance not the individual (Sutherland, 2000). For a Muslim the consumption of alcohol is taboo. Yet the base for many a medication is alcohol. Understanding the practice of non-consumption of alcohol by a Muslim individual in the care of nursing professional, caring calls for the nursing professional to either change the medication or advocate a change in medication to the physician (Ott, Al-Khaduri & Al-Junaibi, 2003). Conclusion: The combination of Leninger’s Caring: A Central Focus of Nursing and Health Care Services, Orem’s Self-Care Deficit and Watson’s Philosophy and Science of Caring an understanding of the complexity of caring from a nursing perspective becomes clear. It provides not just the means to understanding, but also the ways in which caring can be achieved. Caring remains embedded in the nursing professional because it has an impact on the curing and healing outcomes, which are important to nursing. Through a concentrated effort the nursing professional can acquire all that is necessary and make the necessary amendments in self and the manner of actions to ensure that caring becomes a an essential component of the nursing professional. Literary References Caring Science and the Caritas Field: Lighting Our Path. Retrieved May 12, 2007, from Medscape Today, Web site: http://www.medscape.com/viewarticle/513614 Chambers, S. (2003). Use of non-verbal skills to improve nursing care. British journal of nursing, 12(14), 874-878. Faulkner, A. 1996. NURSING: The reflective approach to nursing practice. Second Edition. London: CHAPMAN & HALL. Ferreira, M. A. (2006). Communication in care: a fundamental task of nursing. Revista brasileira de enfermagem, 59(3), 327-330. Leninger, M. M. (1984). Care the Essence of Nursing and Health. New Jersey: Slack. Inc. Orem, D. E. (1985). Nursing Concepts of Practice. Third Edition. New York: Mcgraw-Hill. Ott, B. B., Al-Khaduri, J & Al-Junaibi, S. (2003). Preventing Ethical Dilemmas: Understanding Islamic Health Care Practices. Pediatric Nursing, 29(3), 227-230. McSherry, R. (2000). Supporting the Patient and their family. In (Eds) Christopher Basset & Lesley Makin, Caring for the Seriously Ill Patient, London: Arnold, pp. 196-215. Sommerville, D. & Keeling, J. (2004). A practical approach to promote reflective practice within nursing. Nursing times, 100(12), 42-45. Sumner, J. (2005). Caring -- The Foundation of Advanced Practice Nursing. Retrieved May 12, 2007, from Medscape Today, Web site: http://www.medscape.com/viewarticle/496360_1 Sutherland, P. (2000). Ethical Issues. In (Eds) Christopher Basset & Lesley Makin, Caring for the Seriously Ill Patient, London: Arnold, pp. 236-252. Telfor & Mondor. (2001). Advanced nursing skill certification in critical care. Dynamics, 12(3), 36-9. Watson, J. (1999). Nursing: A theory of nursing. Massachussetts: John and Barlett Publishers. Walker, J., Payne, S., Smith, P. & Jarrett, N. (2004). PSYCHOLGY for NURSES and the CARING PROFESSIONS. Second Edition. Berkshire, United Kingdom: Open University Press. Read More