Caring Science / Caring Theory - Wild Apricot Turkel... · PDF fileresearch on caring...

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Transcript of Caring Science / Caring Theory - Wild Apricot Turkel... · PDF fileresearch on caring...



Marian C. Turkel RN PhD NEA-BC

Director Professional Nursing Practice and Research

Einstein Healthcare Network

Faculty Associate Watson Caring Science Institute

President International Association for Human Caring

WCSI. All Rights Reserved.

Moving From the Case to the Face

From Patient to The Spirit Filled Person Behind a Disease

From Medical Diagnosis to The Meaning Given to the


From Performance/Doing to Presence and Being;

From Medical-Clinical Views of Humanity to Unity of

Mindbodyspirit, Oneness - Connectedness

From Industrial Models to Creative, Mature Professional

Models of Caring-Healing Education, Practice & Research

Caring Science Transformation

Watson WCSI Copyright 2010 2



Traditional qualitative or quantitative research on specific caritas process, caritas process serve as a framework for the research

Traditional qualitative or quantitative research on caring healing modalities

Caring co-related to NDNQI data, patient satisfaction, RN satisfaction, or economic data

Relationships: Uncaring to Caring (Halldorsdottir, 1991)

Biocidic or Life Destroying (Toxic, Leading to Anger, Despair, Decreased Well-Being);

Biostatic or Life Restraining (Cold or Treated as Nuisance);

Biopassive or Life Neutral (Apathetic or Detached);

Bioactive or Life Sustaining (Classic Nurse-Patient Relationship as Kind, Concerned and Benevolent);

BIOGENIC or Life Giving/Life Receiving

Transpersonal Caring Manifesting Caritas Field


4 WCSI & Jean Watson, Used by permission Visit



Patient Consequences


Emotional-Spiritual Well-Being (Dignity, Self Control, Personhood)

Physical - Enhanced Healing, Saved Lives, Safety, Energy, Costs, Comfort, Loss

Trust Relationship, Alienation, Family


Humiliation, Frightened, Out of Control, Despair, Helplessness, Alienation, Vulnerability, Lingering Bad Memories

Decreased Healing

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(Swanson, 1999)

Nurse Consequences


Emotional-Spiritual Sense of Accomplishment, Satisfaction, Purpose, Gratitude, Preserved Integrity, Fulfilment, Wholeness, Self-Esteem, Living Own Philosophy, Respect for Life, Death, Reflective Love of Nursing, Knowledge


Hardened, Oblivious, Robot-Like

Depressed, Frightened, Worn Down

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7 Watson WCSI Copyright 2010

Reclaim Nursing ARTS: General Advanced Healing-Caring Modalities

Intentional Touch (Therapeutic Healing)



Music sound

Expressive Journaling



Caritas/HeartMath Method



Pet Therapy


Art-Dance Movement

Etc., Etc., Etc

Caring Science Criteria for Return on Investment

What Can You Anticipate in Doing This Work?


Your Hospital


The Community

Culture of Safety

Human Flourishing

ROI (Key Financial &

Organizational Indicators)

Quality & Clinical Outcomes

Constituent Satisfaction

Recruitment & Retention

Community Health and


Results, Rewards & Recognition

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Quality and Service

Clinical Quality Index

Customer Service Index

Employee Satisfaction

(or Pride in the Organization)

Caring Science Impact

Quality Indicators

Service Indicators

Retention & Recruitment



Caregiver Support

Organizational Excellence

9 Watson WCSI Copyright 2010

Shifting Foci of Health Care and Health Professions

Focus on Disease or Health Problem

Focus on Tasks-Data

Focus on Medical Specialties-technology

Focus on Hospital Unit-Inpatient

Focus on Admin Solving Problems Institutional Data

Authoritarian Industrial External Control


Focus on Individual Person-Inner Meaning Behind Diagnosis/Condition

Focus on Authentic Caring Relationships/Understanding

All Caring is Holistic-Spiritual

Post-hospital Community: Self-Caring; Self-Control; Self-Knowledge, and Self Healing-Renewal

Meaningful Use of Information, Data/Technology

Autonomous: Visionary, Inspired Leadership Creative Transformative Models

Life-Sustaining Systems/Civilizations

Today Near Future

Watson WCSI Copyright 2010 10



Inspiring and Assuring Human Caring: Emerging Authentic Caring Science Criteria

and Indices New Standards

Giving Voice, Language and Action to Values, Ethics, philosophies Economics of caring-healing at individual and system level

Creating a System-Wide Culture of Caring-Healing Ethical-Theory-Value- Guided Professional Practices;

Assuring Personalized Human Caring Relationships in a Healing Environment for Staff and Patients/Family;

Evidence of Caring Processes/ Language and Action for Personalizing Caring-Healing Practices; Caring Healing Modalities;

Organizational Qualities: Meaningful Support/Involvement: Board/ CEO/Executives /Administrators/ Managers /Staff/Patients/Families

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Inspiring & Assuring Human Caring: Responsibilities: (Cont.)

Invite Staff to Rediscover Their Own Practice of Human Caring/ Expand and Deepen Theoretical Models of Personal/Professional Caring:

Utilize Caring Language Document Caring Practices with Language; Informatics Systems:

Promote Research on Caring Patient Outcomes, Nurse Retention, Costs

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Assessing and Measuring Caring in Nursing and Health Sciences

Jean Watson, 2009

Measuring caring? Yes, but intentionally and mindfully, with a consciousness that deep caring cannot be fully measured at this time. At best these measurements serve as quality empirical indicators of caring and point back toward the deeper aspects behind the measurements.

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1. Develop a Quick and Easy Instrument to Administer and Measure Patient Perceptions of Caring An APGAR Score If You Will

Maintain Integrity of Caritas Processes

2. The 5 Items Selected Will Account for 78% of the Explained Variance of Caring

3. #1 Providing Care with Loving Kindness Accounts for the Majority of Variance 67.8%

4. Develop Instrument for Use by Facilities Interested in Measuring Patients Perceptions of Caring Practices

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WCSI, 2010


Two most important practices

Deliver care with loving kindness

Have helping trusting relationships with me



Marian C. Turkel RN PhD NEA-BC

Director Professional Nursing Practice and Research

Einstein Healthcare Network

Faculty Associate Watson Caring Science Institute

President International Association for Human Caring

WCSI. All Rights Reserved.

Intentionality or manifesting intention

Practice of loving kindness to self allows one to enter the caring relationship with others with intention to become the energetic environment that potentiates caring and healing

Watson Caring Science Institute WCSI. All Rights Reserved. 18



Caring for self allows for the emergence of creative, caring energy

Maintaining the balance between our doing and our being

We need to nourish our inner strength and beauty to reach out others from our authentic caring selves

Self care is critical to health and healing

If the nurse does not care for herself it is impossible to compassionately care for others

Inability to care for self shows up as violence in the workplace

Failure to care for self leads to burnout or compassion fatigue- new language of compassion energy



Caring for self is essential to create a caring harmonious work force environment

When organizations are infused with compassionate caring values they reflect a human face which is necessary for the continued existence of humanity.

As self is renewed, personal and professional commitments become balanced and inner energy is replenished

Watson Caring Science Institute WCSI. All Rights Reserved. 21

Having the knowledge, judgment, skills, ENERGY, experience and motivation required to respond adequately to the demands of ones professional responsibilities. (Roach,1987)



Impact of Stress on Patient Safety

Journal of the American Medical Association Sept 23, 2009

- JAMA. 2009;302(12):1294-1300 - stress and fatigue among

medical residents can lead