Anne Boykin & Savina O. Schoenhofer

Presented by:Nelfa Padovano,BSN RN-BC.

Nursing TheoryUniversity of Colorado

DenverSchool of Nursing

Spring 2014

NURSING AS CARING THEORY

Theorists:• Dr. Anne Boykin, Professor and Dean of the College of Nursing at

Florida Atlantic University, where she had a long time commitment

to the International Association for Human Caring.

• Her scholarly work centers on CARING as the grounding for nursing.

• Dr. Boykin serves as an international consultant on caring. Her

works included the ‘Nursing as Caring: A Model for

Transforming Practice’ (1993)a book co authored by Dr. Savina

Schoenhofer, and Living a Caring Based Program (1994). The

Nursing as Caring Theory is presented to nurse scholars in the

various roles of practitioner, researcher, administrator, teacher and

developer. (Parker & Smith p371).

B. Analysis and Evaluation of the theory’s assumptions, values, concepts and propositions:

“Caring is the end rather than the means of nursing, caring is the intention of nursing, rather than an instrument.” (Parker & Smith p 371)

 

Persons are caring by virtue of their humanness.

The three strengths of humanity being love, kindness and social intelligence. Nursing as a profession uniquely focuses on caring as it’s central value, its primary interest and direct intention for practice.

Persons are whole and complete in the moment.

• The foundational values of respect and coming to know grounded the theory and revolves around the theme of responding to what matters. Caring means spiritual commitment and devotion inspired by the love and respect for persons as a whole. (Boykin & Schoenhofer, 2001, p 393)

Persons live caring from moment to moment.

• This is the focus of nursing as a practiced discipline. Nursing knowledge and practice live in the context of person-with-person caring. The theory calls for aesthetic knowing in nursing best demonstrated with storytelling, poetry& music.

Personhood is a way of living grounded in caring.

Personhood is living life grounded in caring

•One’s personhood is enhanced by participating in nurturing relationships with caring others. It is one’s living out of who they are in congruence with their beliefs and behaviors and living the meaning of one’s life.

Nursing is both a discipline and a profession.

• A call for nursing is a call for acknowledgement and affirmation of the person living caring in specific ways in the immediate situation. It is a call for nurturance. Nurses develop sensitivity and expertise in hearing calls through intention, experience, study and reflection in a broad range of human situations. (Parker & Smith 373)

C. The Theory in relation to Practice •Nurturing persons living caring and growing in nursing is the nurses’ commitment to practice nursing as caring. It is often challenged when nurses are presented with someone who is difficult to care and it is in this situation that the nurse uses all available patterns of knowing, grounded in the obligations and intentions inherent in the commitment to caring:

the knowledge of self and others, empirical, aesthetic and ethical knowing.

D. Example of the theory’s application to practice: Nursing as Caring, when caring for someone with an altered state of mind.

In this example, It was required that all my ways of

knowing be brought into action. I made myself available to

the person I was caring for, who was admitted for seizure

and altered mental status from Cocaine abuse. My values

were challenged, but as a nurse I need to put my

knowledge of self and knowledge of others to work. Here I

am presented with a person that needed nurturing and

caring to bring her back to her normal self and support her

in every means while knowing her in the process. She was

screaming and agitated, pulling out her catheter and her

IV access.

Cont.• To keep her safe for that moment we needed to

restrain her. After a few hours, she was calm and

crying, but still confused. I talked to her with ethical

knowing that she was vulnerable and I need to

engage her as a person rather than as a helpless

object of my concern. When I asked her how she

felt, she stated her position is very uncomfortable,

and that she needed to be on her right side,(which

she cannot possibly do with the 4 point restraint)

Cont.

• I told her I am going to help her and release the restraint on the

left side if she promises me she will not start pulling on her IV

again. She promised and she kept her promise, so her restraint

was then only on her right arm and right leg. She also told me

then that she did not like it when her legs were held open and so

many people were there, (that was probably when they put in her

catheter at the ED).I held her hand and told her, I will make sure

that is not going to happen again, but that I will need to put

another catheter in her, but this time it is going to be just I and

her wonderful CNA. I explained the importance of the catheter

being that she is incontinent and we do not want her to soak in

her own urine. She smiled and said, “yeah, because that is gross.”

cont• She agreed, and before we put the indwelling catheter, we

untied her right restraints. After the catheter was placed,

she asked if she can have something to eat. I talked to the

doctor and told her I was going to do the swallow

evaluation and let her know how the patient swallows. I

also recommended that she come see and evaluate the

patient for discontinuing the restraint, as the patient had

been calm and cooperative for the last four hours.

Aesthetic knowing in caring is honoring humility, joining in

hope and demonstrating trustworthiness in the moment.

E. An example of a research study using Theory of Caring as framework.

Dyes, S., Boykin, A., Bulfin, M., Hearing the Voice of

Nurses in Caring-Theory based Practice., Nursing

Science Quarterly. 4/2013. Vol. 26, Issue 2.

Longo, J., Acts of Caring; Nurses Caring

Nurses. Holistic Nursing Practice. 2011

Vol. 25, issue 1.

F. Summary identifying the strengths and limitations of the theory.

• Strengths: As nurses we know there are various ways of

expressing caring. The theory of Nursing as Caring had

been tested in various nursing practice settings and

those nursed had voice the ‘experience of being truly

cared for’. Patient and nurse satisfaction in those units

had reportedly increased, retention increased, and the

environment for care became grounded in the value of

respect for persons.

Cont.• Limitations: As nurses we frequently find that we do not

have enough time to practice caring, given the demands

of our role. The nursing environment, either in clinical

practice, administration, education and research, has

encountered challenges that depersonalizes and

routinizes the care we deliver, like technological

advances, demands for immediate and measurable

outcomes that focus on simple and superficial quick

care, economic focus and profit motive (time is money).

(Parker & Smith p. 380)

G. Research or Practice Application Article Guided by the Theory• Bulfin, S., Nursing as Caring Theory: Living and Caring in Practice.

Nursing Science Quarterly. Oct. 2005, Vol. 18, No. 4, pp 313-319.

Abstract: This article features a report of a research project in a community hospital. Staff members were given opportunities to engage and act on the ideas of Boykin and Schoenhofer in their nursing as caring theory. Feedback from patients, family members, and all staff who touched patients informed the creation of a new model of care that positively transformed the workplace in the hospital setting. Strategies that were implemented to guide the values of nursing as caring theory are described. The result of the project was an environment that nurtures persons in their caring and growing in caring while illuminating the fullness of nursing.

Case Study # 1• Subjective: 54 y.o Female admitted for AMS, seizure and FTT.

Lives alone and unemployed. H/o chronic drug use, i.e. cocaine and methamphetamine• Objective: Incontinent of Bowel and Bladder. All teeth

missing, confused, agitated and combative• Assessment: Oriented to person only, BP 195/88, P78, RR 20 T36.9,

98% on room air, abnormal LFTs and low Albumin.• Plan: Get to know the person, treat her as human

regardless of the choices that she’s made. Providing the language of caring with (Roach’s) five C’s, compassion, competence, commitment, confidence and conscience.

Case Study #2• Subjective: 23 y.o. female recently diagnosed with

Stevens’ Jonson Syndrome. Patient is married and has

a 6 y.o son, works as an EMT personnel.

• Objective: pale appearing, anxious and is tearful and

looks fearful.

• Assessment: anxiety, mucositis and suffering from

mouth and throat pain, difficulty swallowing and has

not had real food for a week. VSS, independent

mobility.

Cont.• Plan: Values of respect and coming to know, grounded

in theory and responding to what matters to the patient

at the moment, showing spiritual commitment and

devotion inspired by the love and respect for the person

as a whole. Aesthetic knowing in nursing and providing

care with storytelling, being present and listening. Make

sure patient is comfortable and has adequate pain relief.

Re-affirming commitment of care and support for

personhood during the moment.

References:• Boykin, A. & Schoenhofer, S. (2001). Nursing as Caring: A Model for Transforming Practice. Boston: Jones and Bartlett.

 • Boykin, A. & Schoenhofer, S. (2000). "Nursing as Caring". In Parker, M., Nursing Theories and Nursing Practice. Pp. 371-385

• http://www.nursingascaring.com/

• Locsin, R., Development of an Instrument to measure Technological Caring in Nursing. Nursing and Health Sciences.(1999) Vol. 1, Issue 1, pp27-34

• Parker, M., Smith, M., Nursing Theories and Nursing Practice 3rd Edition. 2010, Davis, Philadelphia, Pa.