Boykin & Schoenhofer on Nursing As Caring

Summary

The video discusses the shift in nursing education from a systems-based approach to a more holistic, caring-based perspective. Founders of the Nursing as Caring theory, Dr. Anne Boykin and Dr. Savina Schoenhofer, explain how this approach focuses on understanding patients as whole individuals and emphasizes nurturing personhood through caring relationships. The theory challenges traditional medical approaches by promoting the idea that nursing is not about fixing patients but about supporting their unique expressions of caring. Nurses are encouraged to respond authentically to the needs of patients, fostering a compassionate, person-centered practice.

Takeaways

• 💡 The traditional systems approach to nursing is being complemented by more holistic, person-centered theories like the Nursing as Caring theory.
• 🌱 The Nursing as Caring theory emphasizes focusing on the person, moving beyond just medical science and nursing care to studying the discipline of nursing.
• 👥 Dr. Anne Boyin and Dr. Savina Schifer highlight that caring is central to nursing and essential for human connection in healthcare.
• 📚 Faculty at Florida Atlantic University began to incorporate caring theories into nursing education, challenging the traditional systems model approach.
• 🤝 Nursing as Caring views all persons as inherently caring by virtue of their humanness, which is an important assumption in this theory.
• 🧠 Nurses must acknowledge their own limitations in judgment to truly care for individuals, focusing on the person rather than their actions.
• ⏳ Caring is seen as a moment-to-moment expression, where each interaction shapes how both the nurse and patient grow in caring.
• 🛠 The theory challenges the medical model’s fix-it approach, instead seeing patients as whole and complete individuals in each moment.
• 🌟 Personhood is enhanced through nurturing relationships between the nurse and patient, highlighting the importance of connection in care.
• 🎭 The 'dance of caring persons' emphasizes the collective effort of all healthcare workers in supporting personhood, with each playing a unique role in the caring environment.

Q & A

What is the central idea behind the 'nursing as caring' theory?

The central idea of the 'nursing as caring' theory is that nursing is rooted in human caring, emphasizing that nurses should focus on the person as a whole and nurture their capacity for caring. It views persons as caring by nature and seeks to foster and support their growth in caring through nurturing relationships.

How did Dr. Anne Boykin come to develop the 'nursing as caring' theory?

Dr. Anne Boykin developed the 'nursing as caring' theory after feeling dissatisfied with traditional nursing models that were system-based and focused mainly on medical science. Her perspective shifted when she attended a conference on caring, where she realized that nursing needed to focus on the person and the discipline of caring itself.

Why did Dr. Boykin feel that traditional nursing education was lacking?

Dr. Boykin felt traditional nursing education was lacking because it focused too much on medical science and technical skills, while neglecting the core of nursing: caring for the person. She noticed that there was a void in focusing on the human aspect of nursing and sought to fill that gap through the study of caring.

What are the main assumptions underlying the 'nursing as caring' theory?

The main assumptions are: (1) All persons are caring by virtue of their humanness, (2) Persons live caring from moment to moment, (3) Persons are whole and complete in the moment, (4) Personhood is grounded in caring and enhanced through nurturing relationships, and (5) Nursing is both a discipline and a profession.

What does it mean that persons are whole and complete in the moment?

The assumption that persons are whole and complete in the moment means that, from the 'nursing as caring' perspective, individuals are not seen as broken or in need of fixing. Instead, nursing is about recognizing the person's wholeness and supporting their unique caring nature, rather than focusing on deficits.

How does the 'nursing situation' concept enhance the understanding of caring in nursing?

The 'nursing situation' refers to the shared, lived experience between the nurse and the person being cared for, where caring enhances personhood. It is in this interaction that nursing is created and known, making it a crucial concept for studying and understanding nursing as caring.

What is the significance of 'calls for nursing' in this theory?

'Calls for nursing' represent the needs or desires of the person being cared for, which the nurse hears and responds to in a nurturing way. These calls are unique to each situation and cannot be pre-defined, requiring the nurse to be fully present and responsive to the person's caring needs in the moment.

How does 'nursing as caring' differ from traditional medical approaches?

'Nursing as caring' differs from traditional medical approaches by focusing on nurturing the person's caring nature rather than fixing medical problems. It emphasizes the person's wholeness and the human relationship between nurse and patient, rather than seeing the person as an object to be treated.

What role does 'aesthetic knowing' play in the 'nursing as caring' theory?

Aesthetic knowing is essential in the 'nursing as caring' theory because it allows nurses to creatively express their understanding of caring through their lived experiences. By sharing stories and unique expressions of caring, nurses enhance their capacity to care in diverse and meaningful ways.

What is the 'dance of caring persons,' and why is it important?

The 'dance of caring persons' refers to the collaborative environment where all individuals involved in the care process (nurses, patients, doctors, and even support staff) contribute their unique caring. This concept highlights the collective effort in creating a nurturing environment for everyone involved.

Outlines

00:00

🎶 Introduction to Nursing as Caring Theory

This paragraph introduces the shift from a systems-based approach in nursing education to more holistic methods. The founders of the 'Nursing as Caring' theory, Dr. Anne Boykin and Dr. Savina Schoenhofer, discuss the evolution of the field and their focus on nursing as an expression of care. The idea of nurturing personhood and the humanistic aspect of nursing are introduced as central to this approach.

05:03

🧠 Shifting Focus to the Person in Nursing

Dr. Anne Boykin reflects on her journey in nursing, revealing her dissatisfaction with the traditional systems-based model, which often neglected the person in care. After attending a conference on human caring, she recognized the gap in focusing on the person as a whole. She and her faculty began developing a curriculum that centered on caring and studying the person, rather than medical science alone.

10:03

🤔 Assumptions in Nursing as Caring

This paragraph explores the foundational assumption that every person is inherently caring due to their humanness. Dr. Boykin discusses the challenge of nursing individuals like criminals, where judgment could hinder the ability to see the person as caring. The theory emphasizes that nursing is not just about performing tasks but genuinely knowing and supporting the person in their unique needs and expressions of caring.

15:06

⏳ Living Caring Moment-to-Moment

The theory asserts that caring is expressed moment-to-moment, evolving continuously. Each moment provides a choice to live in caring or not. Nurses are encouraged to be mindful and intentional about living caring, recognizing that the person they are caring for is whole and complete in every moment, despite the common medical focus on fixing or treating deficits.

20:07

🔄 The Wholeness of a Person in Nursing

This section emphasizes the belief that individuals are whole and complete in every moment, a concept that may challenge traditional medical views that focus on fixing deficits. Nurses are encouraged to recognize, affirm, and support the uniqueness of each person’s journey and engage in caring relationships that enhance their personhood.

💼 Nursing as Both a Discipline and a Profession

Nursing is described as both a profession and a discipline, with a unique domain of knowledge centered around caring. Since caring is seen as the essence of nursing, it is essential that nursing programs focus on the study of caring. The idea of the 'nursing situation' is introduced, where caring is experienced between the nurse and the person, enhancing personhood through their interaction.

🎨 Aesthetic Knowing in Nursing

Aesthetic knowing is highlighted as an important element in understanding and practicing nursing. Through artistic expressions, nurses can deepen their comprehension of their lived experiences in caring. The paragraph introduces the concept of the 'call for nursing,' where nurses enter the world of another person to understand what matters to them and respond in a way that nurtures and respects them.

🤝 Direct Invitation in Nursing

The concept of 'direct invitation' is introduced, where the nurse invites the person to express how they can be cared for in a way that aligns with their values and current situation. The theory emphasizes partnership, focusing not on fixing deficits but on supporting individuals in living their unique expressions of caring.

💃 The Dance of Caring Persons

This paragraph introduces the 'dance of caring persons,' where multiple individuals involved in care (nurse, patient, physician, and others) contribute their unique caring perspectives. Every person in the care environment plays a role in enhancing personhood. The nurse, through authentic presence, listens to the person’s calls for nursing and responds with a nurturing approach based on their unique expressions of caring.

🌟 Learning from Expressions of Caring

A touching story shared at a conference illustrates the freedom and growth that come from hearing others' unique expressions of caring. The story of a nurse who comforted a mother and child demonstrates how personal experiences can shape and expand a nurse’s capacity to care. The narrative underscores the importance of compassion and person-centered care, showing how even simple, human gestures have a lasting impact.

💬 Person-Centered Care in Everyday Situations

This paragraph highlights the importance of becoming more person-centered in care practices. A real-life example is provided, where a nurse comforts a crying woman in the triage room, leading to a moment of connection and relief. This encounter reflects the transformation toward recognizing and supporting the person in their emotional experience, emphasizing communication and empathy in the nurse-patient relationship.

Keywords

💡Systems approach

The systems approach in nursing refers to a traditional way of organizing nursing education and practice, focusing on a structured, science-based method of care. In the video, this approach is contrasted with more holistic models of care, such as the nursing-as-caring theory. The speaker mentions how nursing was historically taught from a systems perspective, concentrating on medical science rather than the person receiving care.

💡Holistic approach

A holistic approach in nursing involves treating the patient as a whole person, addressing their physical, emotional, and psychological needs rather than focusing solely on their medical condition. This method emphasizes the importance of caring in nursing. The shift from a systems-based to a holistic perspective is central to the video's theme, as the nursing-as-caring theory exemplifies this change.

💡Nursing as caring theory

The 'nursing as caring' theory, developed by Dr. Anne Boykin and Dr. Savina Schoenhofer, positions caring as the fundamental essence of nursing practice. This theory emphasizes the relationship between nurse and patient as a partnership grounded in caring, where the nurse helps the patient live and grow in caring. The theory contrasts with the more technical and medical models traditionally used in nursing.

💡Personhood

In the context of the video, personhood refers to the intrinsic worth and individuality of each patient, which must be recognized and nurtured by the nurse. Nursing practice, according to the 'nursing as caring' theory, is about understanding and supporting the person’s humanity, not just treating their illness. It emphasizes knowing the patient as a whole and complete individual, not just their medical symptoms.

💡Caring between

The 'caring between' concept refers to the relational space shared by the nurse and patient during a nursing situation. It is in this space where the nurse and patient connect, and the nurse comes to understand what truly matters to the patient. This dynamic interaction allows for personalized care and is foundational to the practice of nursing as caring.

💡Nursing situation

A 'nursing situation' is described as a shared, lived experience between a nurse and a patient where the nurse supports the personhood of the patient through caring. It is within this context that nursing as a practice is realized and understood. The video discusses how these situations provide nurses the opportunity to know their patients and respond to their unique needs.

💡Call for nursing

The 'call for nursing' refers to the nurse's ability to recognize and respond to what matters most to the patient. It is a central concept in the 'nursing as caring' theory, where the nurse listens for and responds to the patient's expressed or unspoken needs, facilitating their growth in caring. The video illustrates this through examples where nurses attend to emotional and relational needs beyond physical care.

💡Nurturing response

A nurturing response is the unique, personalized way a nurse addresses the specific needs or 'calls' of the patient. It is an act of caring tailored to what the nurse learns about the patient through their shared relationship. The video emphasizes that this response cannot be pre-determined, as it must arise naturally in the moment based on the patient’s needs.

💡Wholeness

Wholeness in this theory refers to viewing patients as complete individuals, not broken or deficient because of their illness. The nurse’s role is not to 'fix' patients but to acknowledge their integrity as persons. In the video, this idea challenges the more common medical model of treating patients as a set of symptoms, promoting a more person-centered care philosophy.

💡Aesthetic knowing

Aesthetic knowing involves understanding nursing through the expression of stories, art, or personal experiences. It is one of the patterns of knowing used in nursing education to enhance the understanding of caring. The video describes how nurses are encouraged to render their lived experiences in artistic or expressive ways to deepen their understanding of nursing practice and personhood.

Highlights

Nursing has evolved from a traditional systems approach to a more holistic model, emphasizing the 'Nursing as Caring' theory.

The 'Nursing as Caring' theory was co-developed by Dr. Anne Boykin and Dr. Savina Schoenhofer, promoting a view of nursing that centers on the humanness of the person.

Dr. Boykin realized that traditional systems models focused more on medical science and less on the person, leading her to develop a new approach that emphasizes caring.

The breakthrough for 'Nursing as Caring' came in 1981 when Dr. Boykin attended an International Association for Human Caring conference, inspiring her to focus on caring as a core nursing principle.

The theory is based on the premise that all persons are caring by virtue of their humanness and that caring is a fundamental human trait.

Simone Roach’s idea is integrated into the theory, suggesting that caring is innate but must be drawn out by creating meaningful interactions.

The theory emphasizes the importance of recognizing patients as whole and complete individuals in the present moment, not merely defined by their medical conditions.

Nursing is framed as a discipline and profession that focuses on nurturing persons, living caring, and growing in caring.

The 'Nursing as Caring' theory underlines that nursing situations are shared lived experiences where the caring between nurse and nursed enhances personhood.

Caring is expressed uniquely in every interaction, and nurses should be intentional in choosing to live caring moment to moment.

Calls for nursing are unique to each individual and situation; responses cannot be pre-determined but must be created to reflect what matters most to the person.

The dance of caring persons involves all stakeholders in the healthcare environment, recognizing each person's contribution to a caring environment.

A key aspect of the theory is direct invitation, where nurses ask, 'How can I care for you in ways that matter?' to create a nurturing environment that aligns with patients’ values.

The concept of aesthetic knowing is emphasized, encouraging nurses to express and study caring through creative means like storytelling and art.

Nursing situations, once lived and understood, serve as a rich medium for studying nursing and enhancing the theory's practical application.

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 Anne boyin and Dr Savina

[Music]

shifer 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 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 um

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 jeene Watson Dolores

Scott Doris Freeman meline linger

Kathleen Valentine just a small group so

over the years in the very beginning

piece of that what we did is we were a

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 though that there

was a really a formal way we could

really study caring and we began then to

study mayor off and we can't began 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

know 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 of an understanding of caring to

undergird the curriculum however um an

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 in caring let

me go 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 have

to evaluate whether a person is caring

or not we start with that

assumption Simone roach who talks about

carrying 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's 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 it

moment to

moment um 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 motive being that all persons

are caring by virtue of their 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 uh

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 uh 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

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 carrying

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 um

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 um 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 as

caring or just studying caring because

caring is a very special domain of

knowledge within our discipline so so

one of the most um 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 nurs enhances

personhood it is in the nursing

situation that nursing is created it's

in the nursing situation that nursing is

known pretty strong 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 each student enters

into that situation the situation

actually

lives and continues to evolve and grow

we use the um 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 and 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 in 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 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

preconceptual lied 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

nurs related to the idea of call and

response is the idea of direct

invitation in direct 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 um replenishing deficits and so that

question that direct invitation is not

about um 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 is 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 ention of nursing

them from the nursing is caring

perspective this happens in a nursing

situation which is that lived experience

between nurse and nursed 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 uh

years ago I was at a 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 um 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 I find that the caring model

works for me because I think being

compassionate is at the core of this 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 um

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 um if

she was in distress and I said 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 um the

triage nurse came back in the triage

nurse had just wheeled her husband away

and um talked to her a little bit she

was really upset about her husband's

condition and the triager 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 um caring

situation and uh it really showed how

the nurse and the nursed are

communicating caring and it was very

very indicative of how some of the

transformation has taken place place

here