Boykin and Schoenhofer on the Theory of Nursing As Caring

Summary

This video discusses the 'Nursing as Caring' theory, developed by Dr. Ann Boykin and Dr. Savina Schoenhofer. The theory emphasizes a holistic, person-centered approach to nursing, focusing on understanding patients as caring individuals by virtue of their humanity. It moves away from a traditional systems-based model, promoting a more personal, empathetic form of care where nurses respond to the unique needs and desires of each patient. The theory highlights the importance of nurturing relationships and the concept of nursing situations, where meaningful, shared experiences enhance the practice of nursing.

Takeaways

• 🌱 The nursing profession is evolving from a systems approach to a more holistic, caring-focused methodology.
• 💡 The Nursing as Caring theory, developed by Dr. Ann Boykin and Dr. Savina Shoenhofer, emphasizes the importance of caring as the central focus of nursing practice.
• 🩺 Traditional nursing education often focused heavily on medical science, with limited emphasis on the person-centered aspect of nursing care.
• 💖 The theory asserts that all individuals are inherently caring by virtue of their humanness, and this forms the basis for nursing relationships.
• 🤝 Nursing situations are seen as shared lived experiences where caring between nurse and patient enhances personhood.
• 🧠 Persons live caring moment to moment, and nurses must recognize and respond to these expressions of caring in unique and individualized ways.
• ✨ The assumption that persons are whole and complete in the moment challenges traditional views of nursing as ‘fixing’ or addressing deficits.
• 🌟 Nurses are called to know the person as a caring individual and respond to their specific needs in a way that supports their growth in caring.
• 🎭 The 'Dance of Caring Persons' concept emphasizes that everyone involved in healthcare contributes to the caring environment, from nurses to support staff.
• 📖 Aesthetic knowing, such as storytelling and sharing experiences, plays a critical role in understanding and practicing the Nursing as Caring theory.

Q & A

What is the primary shift in nursing education discussed in the transcript?

The primary shift discussed is from a traditional systems approach to nursing education to more holistic approaches, such as the nursing as caring theory, which focuses on the person as a whole rather than just medical procedures.

Who are the founders of the Nursing as Caring theory, as mentioned in the transcript?

The founders of the Nursing as Caring theory are Dr. Ann Boykin and Dr. Savina Shoenhofer.

What personal experience led Dr. Ann Boykin to rethink the traditional systems approach to nursing?

Dr. Ann Boykin, after years of teaching nursing from a systems perspective, felt something was missing—she believed that nursing wasn’t fully focused on the person but more on medical science. This realization, coupled with her exposure to a conference on caring, led her to rethink nursing education.

What is the significance of the 'nursing situation' in the Nursing as Caring theory?

In the Nursing as Caring theory, the 'nursing situation' is a shared, lived experience between the nurse and the nursed. It is in this interaction that nursing is created, known, and practiced. It allows nurses to understand and respond to what matters to the person being cared for.

What does the Nursing as Caring theory assume about people?

The theory assumes that people are caring by virtue of their humanness. This inherent capacity for caring is present in every person, and it is the nurse’s role to nurture and support that caring nature.

How does the Nursing as Caring theory suggest nurses should approach situations where they struggle to see a patient as a 'caring person'?

If a nurse struggles to see a patient as a 'caring person' due to their actions (e.g., a rapist), the nurse must acknowledge that they may not be able to provide true nursing care in that moment. The nurse can perform tasks, but without seeing the person as a whole, they cannot fully engage in nursing.

How does the Nursing as Caring theory define personhood?

Personhood is defined as a way of living grounded in caring. It is enhanced through participation in nurturing relationships with caring others, such as in the relationship between the nurse and the patient.

What role does 'aesthetic knowing' play in the theory of Nursing as Caring?

Aesthetic knowing is particularly relevant in the Nursing as Caring theory. It involves understanding nursing situations through artistic or creative expression, helping nurses to deeply understand and reflect on their lived experiences in nursing.

What are 'calls for nursing' according to the Nursing as Caring theory?

Calls for nursing are ways in which patients express their needs for care. These calls help nurses understand what matters most to the patient at that moment and inform the nurse’s nurturing response.

What is the 'dance of caring persons' concept in the Nursing as Caring theory?

The 'dance of caring persons' refers to the collaborative environment where all participants (nurses, patients, doctors, and others) contribute their unique caring to enhance the well-being and personhood of everyone involved.

Outlines

00:00

🩺 Evolution of Nursing Education and the Birth of Nursing as Caring

This paragraph discusses the transition in nursing education from a systems approach to a more holistic view. Dr. Ann Boykin reflects on her dissatisfaction with the traditional method of teaching nursing, which focused more on medical science than on caring for individuals. Her experience at an international caring conference led her to explore nursing as caring, emphasizing the need to study the discipline of nursing itself. Boykin, along with other scholars, sought to redefine nursing education to focus on the person and caring, filling a gap in the traditional curriculum.

05:02

🌱 The Core Assumptions of Nursing as Caring Theory

This section introduces the foundational assumptions of the Nursing as Caring theory, notably the idea that all humans are inherently caring. The example of nursing a rapist is used to demonstrate that a nurse’s role is not to judge but to care for the individual as a human being. The theory emphasizes that nursing is about understanding the unique caring expression of individuals, and nurses must focus on the person rather than the actions or labels associated with them. If a nurse cannot emotionally connect with a person due to their actions, they may not truly be able to nurse them.

10:03

⏳ Living Caring Moment to Moment

This paragraph delves into the idea that caring is expressed moment to moment and that each moment presents a choice to live and express caring. The authors discuss the importance of being intentional in caring and how each interaction helps both the nurse and the person being cared for grow. Another significant idea presented is that persons are whole and complete in every moment, challenging the traditional medical model that sees individuals as broken and needing fixing. Instead, nursing involves affirming and supporting the person’s uniqueness and helping them grow in their own way.

15:03

🤝 Personhood and Nurturing Relationships in Nursing

Here, the concept of personhood as a way of living grounded in caring is explored. Personhood is enhanced through nurturing relationships, and the role of the nurse is to support and enhance this aspect in patients. The authors argue that nursing is both a discipline and a profession, requiring a deep understanding of caring as a domain of knowledge. The Nursing as Caring theory positions caring as the essence of nursing and emphasizes the need for nursing programs to study and incorporate caring into their curriculum.

20:04

👩‍⚕️ The Nursing Situation: A Shared, Lived Experience

This section highlights the central concept of a 'nursing situation,' described as a shared, lived experience where the interaction between nurse and patient enhances personhood. Through these situations, nursing becomes known and practiced. The authors introduce different types of knowledge used in nursing (personal, ethical, empirical, and aesthetic), stressing the importance of aesthetic knowing in understanding and expressing the lived experience of nursing. Through sharing stories of these experiences, nurses grow in their ability to care.

📞 The Call for Nursing and the Nurturing Response

The concept of a 'call for nursing' is introduced, where nurses enter the world of the patient to understand their unique caring needs and what matters most to them. The 'nurturing response' is the nurse's individual response to the call, shaped by the moment and the patient’s needs. The text emphasizes that no two calls or responses are alike, and both must be uniquely created for each situation. This dynamic interaction lies at the heart of the nurse-patient relationship, and understanding it helps nurses provide appropriate care.

🗣️ Direct Invitation and the Dance of Caring Persons

In this paragraph, the concept of 'direct invitation' is discussed, where nurses openly ask patients how they can care for them in ways that matter most. The 'dance of caring persons' describes a holistic environment where everyone involved in the care process, from nurses to support staff, contributes to the person’s well-being. Each person’s unique caring contributes to the overall care environment. This reinforces the importance of teamwork and the collective effort to enhance the personhood of the patient.

💬 Stories of Caring: Growing in Competency

This part presents a touching story of a nurse caring for a dying child, illustrating the uniqueness of how nurses express caring. Through stories like this, nurses share their experiences and grow in their ability to provide compassionate care. The story highlights how individual acts of caring, such as hugging a child and mother, shape the way nurses understand and perform their roles. Sharing these stories helps nurses learn from one another and expand their capacity to express caring in meaningful ways.

💖 Compassionate Nursing: Focusing on the Person

In this concluding paragraph, the importance of compassionate care is emphasized. The speaker reflects on how patients often remember the compassion and empathy shown by nurses more than the technical procedures. A specific example is provided of a woman who felt comforted and supported by a nurse after her husband was taken away for treatment. This scenario underscores the growing shift toward person-centered care, where the emotional and human needs of patients are given priority in nursing practice.

Keywords

💡Nursing as Caring

This is a theoretical approach to nursing that focuses on recognizing and nurturing the inherent caring nature of humans. It contrasts with traditional systems-based approaches by emphasizing the human connection and personhood in nursing. The founders argue that nursing should not just be about medical tasks but about forming caring relationships with patients.

💡Personhood

In the context of nursing as caring, personhood refers to the understanding of individuals as whole, complete beings who are inherently capable of caring. The theory argues that nurses must recognize the personhood of patients, seeing them beyond their medical conditions or bodily parts and nurturing their human essence.

💡Systems Approach

The systems approach is a traditional model in nursing education that focuses on the body as a system to be analyzed and treated. This approach emphasizes medical science and treating physiological issues. The founders of the nursing as caring theory criticize this method for lacking a focus on the person and caring, which they believe should be at the heart of nursing practice.

💡Empirical Knowledge

Empirical knowledge refers to the factual, scientific knowledge gained through observation and experimentation. In the video, empirical knowledge is described as one of the components of traditional nursing education, which is heavily focused on science and medical knowledge. The 'nursing as caring' theory seeks to balance this with caring-focused knowledge.

💡Caring Relationships

Caring relationships are fundamental to the nursing as caring theory. These relationships form the core of nursing practice and are based on mutual respect, understanding, and support between the nurse and patient. In these relationships, nurses are expected to nurture the person's capacity for caring, rather than just treating their medical needs.

💡Nursing Situation

A nursing situation is described as the lived experience of caring between the nurse and the person being nursed. It is through this interaction that nursing is enacted and personhood is enhanced. The theory argues that true nursing happens in these moments of caring, rather than through medical procedures alone.

💡Call for Nursing

This concept refers to the unique needs of a patient that the nurse identifies through their caring relationship. A 'call for nursing' expresses what matters most to the patient in that moment, and it guides the nurse’s actions. It is about understanding the patient’s individual needs rather than applying a one-size-fits-all medical approach.

💡Nurturing Response

A nurturing response is the nurse’s personal and unique response to a patient's call for nursing. It is not predetermined but is created in the moment, depending on what matters to the person being nursed. This response focuses on nurturing the patient’s caring nature and supporting their well-being in a holistic way.

💡Aesthetic Knowing

Aesthetic knowing is one of the patterns of knowing used in nursing, focusing on the nurse's ability to create meaningful and compassionate responses based on their understanding of the patient’s unique situation. In the video, it is highlighted as an important aspect of the nursing situation, where nurses interpret and respond creatively to the needs of those they care for.

💡Authentic Presence

Authentic presence refers to the nurse’s ability to fully engage with the patient as a whole person, being fully present in the moment to understand and respond to the patient’s needs. It is a core principle of the nursing as caring theory, emphasizing that genuine connection between nurse and patient is essential for effective care.

Highlights

The shift from a systems-based approach to a more holistic, caring-based perspective in nursing education.

The development of the Nursing as Caring theory by Dr. Ann Boykin and Dr. Savina Schoenhofer.

Dr. Boykin’s realization that nursing was not focusing enough on the person, but rather on medical science, prompting the shift to a caring-focused approach.

The key influence of attending the International Association for Human Caring conference on Dr. Boykin's perspective.

The idea that caring is fundamental to personhood and that all persons are caring by virtue of their humanness.

The importance of recognizing that nursing is about nurturing and supporting the person in what matters to them.

A nurse’s obligation to look past a patient’s actions, such as criminal acts, and focus on their humanity and capacity for caring.

The assumption that persons are living caring moment to moment and express their caring in unique ways.

Caring is a choice that can be expressed in every moment, and nurses have an obligation to be intentional about living caring.

The challenging assumption that persons are whole and complete in the moment, rejecting the fix-it approach common in medical practice.

Nursing situations are lived experiences that enhance personhood through the caring relationship between nurse and patient.

The use of the ‘call for nursing’ to understand what matters to the person and how to provide care based on those unique needs.

The concept of the ‘nurturing response,’ which is the nurse’s unique response to the patient’s call for nursing in the moment.

The ‘dance of caring persons’ emphasizes that everyone involved in the patient’s care contributes to the overall development of personhood.

The value of sharing nursing stories to enhance competency in expressing caring and to help nurses grow in their practice.

Transcripts

[Music]

nurses have traditionally been schooled

in a systems approach to nursing

but more holistic approaches are being

developed and these influence how

nursing is taught and practiced

the nursing as caring theory is one of

these approaches

in this program nursing as caring is

discussed by its founders dr ann boykin

and dr savina shonifers

well

how did i

come to

think about nursing as caring

um

you know i've been a nurse since the 60s

and have studied nursing

and regular ways studying it from a

systems perspective

teaching it from a systems perspective

just as i was taught and i think that's

very common with faculty that we teach

as we were taught

and all of the different places that i

had taught there was one thing that

always bothered me and that truly was

that i didn't think we were really

studying the discipline of nursing

i knew we were focusing on medical

science and bringing a little bit of

nursing

in at the end called nursing care

but somehow or other i just knew we

never focused on the person

but i really didn't know how to do that

either because i'd never witnessed it

i'd never been taught that so i didn't

know

and

in 1981 when i came to florida atlantic

university

the model for the study of nursing was

systems model pretty much like it was at

a lot of institutions at the time

and in the early 80s i had an

opportunity to attend an international

association for human caring conference

and that really

changed my life

because it was a very small group of

scholars devoted to the study of caring

you know gene watson dolores scott doris

riemann madeleine lininger kathleen

valentine just a small group

so over the years in the very beginning

piece of that what we did is we were

very small faculty

and we came together at a table

and

i said

let's bring our syllabus and let's look

at what are we studying

and we did including myself

and we sorted it all out into little

piles and we had pathophysiology and

pharmacology and

all of the

empirical knowledges

and so i said well where's the nursing

content

and there was a big hole

and how would we fill that hole and over

the course of many years

we

developed the study of caring we did a

little bit of caring we went to the

literature and we studied it a little

and we realized that there was a really

a formal way we could really study

caring and we began then to study mayor

often we can't begin to bring in works

that were really substantively grounded

in caring

and it was the nursing situation that

really filled that void

for the study of nursing

the importance of nursing as caring

is that it is a perspective that is

grounded in the humanness of personhood

that it is grounded in

the phenomena of nursing as person

and that is what it is all about it is

coming to no person

to respond to person to research from

that human perspective and to answer the

questions that matter to those being

nursed

in working with faculty

we recognized that there needed to be a

shared consensus

of an understanding of caring to

undergird the curriculum

however

ann and i wanted to go beyond

that curriculum work and actually

develop a full-fledged theoretical

systematic expression

of nursing as caring we asked ourselves

in our view what's the unique focus of

nursing

where does caring fit as a central part

of the unique focus of nursing

and what we came up with

was the understanding that stated in our

statement of focus

nursing is nurturing persons living

caring and growing and caring

the first and most fundamental

assumption underlying the theory of

nursing is caring

is that persons are caring by virtue of

their humanness

so there's no question

we don't have to evaluate whether a

person is caring or not we start with

that assumption

simone roach who talks about caring says

that although it's innate within us we

have to draw it forward

we have to give the person something to

respond to that matters to them to bring

forth that innate capability

so

from a nursing perspective if i'm in the

emergency department

and i have someone who walks into that

emergency department who's a rapist

how do i live out that assumption that

persons are caring by virtue of their

humanness this person is a caring person

now it's my responsibility as a nurse

to see past the act because i am not

there to judge that act there is a

system that we have to judge that

i am there as nurse to see the person as

caring person

and to nurture and support the person

in what matters to them

now if i'm not able to get past the act

which sometimes happen because we are

human

then i have to acknowledge that i cannot

nurse

that then i may be able to do things to

the patient

really putting that patient in an object

role you know i may be able to start the

iv i may be able to do the things i need

to do but i cannot truly nurse because

i'm not able to get

to know you as person and to come to

know what matters to you

the next assumption

that's uh really important to an

understanding of the practice of this

theory

is that persons are caring moment to

moment

persons live their caring from moment to

moment express their own caring ways

very uniquely

as living caring we do live at moment to

moment

how i live my caring right now

informs me changes me and helps me to

grow in how i live my caring in the next

moment

and each moment

is an opportunity for us to choose

to live caring or not

we always have the choice

to express our caring in the moment or

not

but the obligation

if we believe that caring is the human

mode of being that all persons are

caring by virtue of the humanness the

obligation is

to pay attention to be intentional in

the living of caring moment to moment

another important assumption underlying

this theory

is the idea that persons are whole and

complete in the moment

and this is probably

one of the most difficult or challenging

assumptions

to buy into

in nursing we are used to taking

a medical perspective approach

which appropriately is a fix-it approach

from our perspective of nursing and from

the perspective of this theory

there is nothing to be fixed

there is nothing that's broken

there are no deficits

the function of nursing in the world is

to recognize the person as caring as

living caring uniquely and then to

affirm support and celebrate that person

in their caring

and in that way participate with them

in living their hopes and dreams for

growing and caring

the assumption that persons are whole or

complete in the moment is a precious

assumption to me

i am always with you with the intention

of knowing you as person

you are never part you're never defined

by part you're never an arm you're never

a leg you're never a heart you are

always whole

and it's my responsibility

through authentic presence to be with

you to come to know that wholeness

the next fundamental assumption

underlying the theory of nursing is

caring

is that personhood is a way of living

grounded in caring

and that of course is one of the things

that we attempt to achieve in the caring

between

enhancing personhood

enhancing

our capacity to live

caring in the world moment to moment

living grounded in caring

and associated with that is the next

assumption that says personhood is

enhanced through participation in

nurturing relationships with caring

others and that's where nursing practice

comes in

and then the final assumption which

we believe is important

contextually at least

is the idea that nursing is both a

discipline and a profession

nursing is indeed a very privileged

discipline and profession

and as such

it is incumbent upon us to really be

able to articulate

the specialized unique knowledge of

nursing

and a professional practice so when we

say that a discipline has a domain of

knowledge for example

we have said for many many years that

caring is the essence of nursing

that's something that every nurse would

probably agree to yes caring is the

essence of nursing

so if that is true then i believe that

that caring becomes a domain of

knowledge which we are obligated to

study

that's why we we ought to be studying

caring in every nursing program whether

it is nursing is caring or just studying

caring because caring is a very special

domain of knowledge within our

discipline

so one of the most

important concepts

that we work with in the theory is the

idea of nursing situation

and we understand nursing situation

to be a shared

lived experience in which the caring

between nurse and nurse enhances

personhood

it is in the nursing situation that

nursing is created

it's in the nursing situation that

nursing is known

we believe from our work with practicing

nurses and from our study that all that

is important of nursing is known through

the nursing situation

we use the nursing situation as a medium

for study

nursing situations once they've been

lived

originally creatively

can then be used to study nursing

and as each student enters into that

situation the situation actually lives

and continues to evolve and grow we use

the

harper's patterns of knowing personal

knowing ethical knowing empirical

knowing and aesthetic knowing in working

with our theory but here in particular

in talking about nursing situation i

think it's useful to point out that

aesthetic knowing is particularly

relevant

and when we're working with practicing

nurses or

in our teaching

we like to invite people to render their

understanding

their lived experience of nursing render

it aesthetically

another important concept in the theory

of nursing is caring is the idea of the

call for nursing

what it is that nurses do

nurses enter into the world of another

in order to come to know that person as

caring person and to hear calls for

nursing

to come to understand

what is it that matters to you today

who are you as caring person

what are your hopes and dreams for

growing and caring

and how can i be with you today

in a way that matters it is an idea that

helps direct

our attention

and helps nurses create the kind of

nursing that's appropriate for the

situation

together with the call for nursing is

the nurturing response

the nurturing response is the uniquely

created response of the nurse

to that which matters

to the person

a call for nursing

is always a call that says in one way or

another

know me as caring person and respect me

as caring person

so that a nurturing response then is

always

a response to that general call

but the nursing response is created

specifically

toward that which matters to the person

in the moment

neither calls nor responses

can be canned can be pre-conceptualized

can be predicted ahead of time

because calls are unique in the moment

calls are uniquely heard

in the moment

and thus responses are uniquely created

for this situation

it's not to say that there aren't some

commonalities so that we can study about

calls and prepare ourselves to create

ranges

of appropriate responses but the call

and the response

is something that occurs in the caring

between the caring between nurse and

nurse

related to the idea of call and response

is the idea of direct invitation

indirect invitation we say to the

patient i am here to care with and for

you today

how can i care for you in ways that

matter

how can we together create an

environment of caring that will help you

get to where you want to be

and again this theory doesn't address

brokenness or

needs for fixes

or needs for

replenishing deficits and so

that question that direct invitation is

not about

necessarily how can i fix you today

but how is it that today

you are trying to live caring in this

situation

in ways that are true for you

and how can i help you with that

another concept that's important to the

theory of nursing as caring is the

concept the dance of caring person

each person has something to contribute

to the caring environment

in some

theories it would be said that the

patient was at the center

in the dance of caring persons the

patient is there the nurse is there the

physician may be there the physical

therapist may be there the person that

manages the financial office may be

there

definitely the person who cleans the

room and who brings the food they're all

in this dance of caring persons

they are all contributing their own

unique caring to the full development of

personhood for all who are involved

we have the privilege of being with

someone with the intention of nursing

them

from the nursing is caring perspective

this happens in a nursing situation

which is that lived experience between

nurse and nurse

in which the caring enhances personhood

through this being with the person in

the caring between the nurse and nursed

now when i am with you in your wholeness

and with the intention of hearing your

story with the intention of wanting to

know who you are as caring person

through that i will hear what

i would call calls for nursing

what matters most to you what are your

calls for nursing and it is that

that informs my response so it's that

that directs then my nurturing response

for what i will do with you and for you

because of what i hear

and the way that i do that is through

how i live my unique caring my unique

expressions of caring it's another story

i'll never forget

oh years ago i was at a conference

and we were talking about stories

and this nurse stood up and she told

this beautiful story of a young child

who was dying from leukemia

and

had this story within her for 15 years

and just then shared this story

and she told how

this mother lived many miles away and

she had other children and how she had

to call this mom to come because she had

the sense that this little girl was

going to die

and when the mom got to the hospital

the mother

and the nurse

laid in bed and hugged this child

now the unique expression of caring of

that nurse was to get in bed and hug the

mom and the child together

now i don't know that i would have done

that that that would have been my unique

expression of caring but by hearing that

story

i learned and i think i would be free

to climb in bed and hug a child or hug

someone who needed that hug so it's in

sharing these expressions of caring

through the story that again we grow in

our competency to express our caring

it's it's kind of freeing

[Music]

i find that the caring model works for

me because i think being compassionate

is at the core of this all you know all

of this

people don't

think of the shots that we give or the

ivs that we hang or the compressions on

their chest is what they really care

about what they care about is that

you're caring for them as a person that

you're not forgetting that they're a

person in that bed and who you know who

they are there are situations every day

that happen here that really um

emphasize the fact that we're becoming

more person centered instead of object

centered

this morning for instance i walked in to

the triage room and there was a woman

all by herself in there crying and i

didn't know if she was the patient or

the family member but i asked her

if she was in distress and i said it can

i get your vital sign she goes oh i'm

not the patient that was my husband i

was just having my moment here

so i started talking to her and as i did

the triage nurse came back in the triage

nurse had just wheeled her husband away

and

talked to her a little bit she was

really upset about her husband's

condition

and the triage nurse said to her well

you know life is what happens to us when

we're making other plans and then they

hugged

and you could just see the relief on the

woman's face that she did feel she'd

been heard she'd been supported

and it was a really

caring situation and

it really showed how the nurse and the

nurse are communicating caring

and it was very

very indicative of how some of the

transformation has taken place here

you