WEEK 3-Caring and The Nurse

Relational Inquiry-Doane &Varcoe

Theoretical orientation of Relational Inquiry-
 Uses ideas from Phenomenology and
 Critical social theory.

Relational Inquiry-Nursing obligations

 Nursing values and obligations are found in ethical
codes or principles.
 Ethical Principles-
 Autonomy
 Beneficence
 Nonmaleficence
 Justice- equity in the allocation of scare
resources( who get a bed; who gets funded and
who does not).
In Nursing, Nurses face a number of conflicting
obligations-
- how does a nurse decide which obligation to
use in a particular situation?- pg. 120
Relational Inquiry and Nursing Obligations
Relational Inquiry enables the nurse to take a
proximal-distal view of each situation.
- Proximal view-the nurse ability to discern their
obligations in a given situation
- Distal view- .

Relational Inquiry and Relational capacities

Nurses need to Develop 5 capacities of Ways of
Being(5C’S)
1.Being compassionate
2.Being curios
3.Being committed
4.Being Competent and
5.Being corresponding
Transpersonal Caring: A Nursing Practice Guideline
Gallagher-Lepak & Kubsch (2009)
“Too often we underestimate the power of a touch, a
smile, a kind word, a listening ear, an honest
compliment, or the smallest act of caring, all of
which have the potential to turn a life around."
Jean Watson.
Nursing: Jean Watson
Caring is
An intentional consciousness of caring enacted
between a nurse and another, transcending the
boundaries of time, space and physicality.
(Kozier et al, 2014, p. 65)
Caring is a conscious judgement that manifest
itself in concrete acts, interpersonally, verbally and
nonverbally. ( p 171)
Caring an intersubjective human process is the
Moral ideal in nursing.
The goal of nursing is to help persons increase
harmony within mind-body-soul which leads to self-
knowledge, self-reverence self-healing and self-
care. ( Chinn & Kramer, p.185)

Transpersonal Caring
“ A transpersonal caring intervention (TCI) connects
with and embraces the spirit and soul of the other
through the processes of caring and healing and
being in authentic relation in the moment”
(Gallagher-Lepak & Kubsch, 2009, p, 171) .
Nursing interventions related to caring are known as
Carative factors in Watson’s theory.
Watson’s 10 Carative Factors
Watson’s 10 Carative Factors (Gallagher-Kepak
& Kubsch, 2009)

1. The formation of a humanistic-altruistic

systems of values
2. The instillation of faith-hope
3. The cultivation of sensitivity to one’s self and
to other
4. The development of a helping-trusting
relationship
5. The promotion and acceptance of the expression of
positive and negative feelings
6. The systematic use of a creative problem-solving
process
7. The promotion of interpersonal teaching-learning
8. The provision for supportive, protective and/or
corrective mental, physical, societal, and spiritual
environment
9. Assistance with the gratification of human needs
10. Allowing for existential-phenomenological-spiritual
dimensions of caring
Carative Factor 1- humanistic-altruistic systems
of values
1. The formation of a humanistic-altruistic systems of
values
Values are Grounded in concern, kindness and
empathy
“starting point and an attitude that becomes a will,
an intention, a commitment and conscious judgment
that manifests itself in concrete acts of caring”
(Kozier et al, 2006 as cited in Gallagher-Lepak &
Kubsch, 2009. p 174)
CLINICAL EXEMPLAR = Ex Values Clarification by
the nurse.

Carative Factor 2- hope

2. The instillation of faith-hope
“Hope comes when patients know that others care
and have hope for them” (Gallagher-Lepak &
Kubsch, 2009, p. 174)
Hope provides meaning to life and reason for living.
CLINICAL EXEMPLAR = Cognitive restructuring-pg.
175.
Application of hope-Next slide.

Application of carative feature 2 Hope and

Trajectory framework.
Trajectory is defined as the course of illness over
time and the actions of the client, family and
providers to mange that course.
It includes the unique response of the client. Ex-
Cancer
Kramer-Kile- 9 phases in the Trajectory model-
continuum
Hope and Cognitive Restructuring.
2. trajectory – signs and symptoms appear. Ex
Cancer, MI, ALS etc.
4. unstable phase – symptoms not under control
5. acute – severe and relieved symptoms; disease
complications
8. downward – progressive deterioration
9. dying

Carative Factor 3- sensitivity

3. The cultivation of sensitivity to one’s self and to
other
“By being sensitive to others’ feelings, nurses show
empathy, compassion, and understanding”
(Gallagher-Lepak & Kubsch, 2009, p. 175)
An awareness that what happens to one affects the
other and this awareness transfers into actions.
CLINICAL EXEMPLAR = Bearing Witness .pg....
175.

Carative Factor 4-trusting relationship

• The development of a helping-trusting

relationship
• “To develop a helping-trusting relationship, the
nurse must first know the client
person…”(Gallagher-Lepak & Kubsch, 2009, p.
175)
• CLINICAL EXEMPLAR = therapeutic presence
(both psychological and physical)

Carative Factor 6- problem-solving process

 • 6. The systematic use of a creative problem-
solving process
• “…nurses use knowledge from the affective,
cognitive and psychomotor domains. Creativity
involves generating fresh ideas, originality and
independent thought rather than relaying on
learned ways to solve problems” (Gallagher-
Lepak & Kubsch, 2009, p. 176
• CLINICAL EXEMPLAR = advocacy

Beyond Empathy: Expanding expressions of

Caring (Morse, et al, 2006)
o Empathy-Therapeutic and Emotional empathy.
o Therapeutic empathy-A more cognitive\
behavioral approach that deemphasizes
emotional involvement.
o “we contend that therapeutic empathy (i.e. a
learned communication skill comprised primarily
of cognitive and behavioral components which is
used to convey understanding of the patient’s
reality) is particularly unsuited for use in the
clinical setting” (p. 76)
Empathy and empathetic communication
Provides a communication model that focuses on
the ‘emotive engagement or embodiment’ between
the nurse and client. Emphasis is on engagement
between the nurse and client and not solely on
outcomes.
Emotional Empathy-The caregiver’s intuitive
sensing and response to the other’s plight.
Actions resulting from emotional empathy allows the
nurse to recognize the needs of the client. Ex-Touch.

Morse- Intervention-Empathy Communication

(cont)
 • Morse provides Therapeutic communication
strategies using empathy-includes an emotive,
embodied process of communication with pts.
(pg. 76)
• Communication model focuses on 2 broad
characteristics-Next slide
1. The nurse is focused\engaged on the clients
response-the nurse’s response is engaged
(therapeutic) OR
2. The nurse’s is focused on her\himself (protecting
her\himself from suffering and less therapeutic)-
AND
3.Response of the nurse- spontaneous\Reflexive-
1ST Level OR.
4. Response of nurse- learned- 2nd level.

Beyond Empathy: Expanding expressions of Caring

(Morse, et al, 2006-)
Discusses a communication model. Model
examines on ( pg.... 77)
1.The nurse focuses on the pt. response OR
2.Protecting her\himself by withdrawing.
3. The response by nurse is automatic(First level)
OR 4. Learned(second level)
Beyond Empathy: Expanding expressions of
Caring

Empathy
 Therapeutic empathy-
 Emotional empathy-The nurse response to a
client's suffering.
o The nurse learns through his\her experience
with clients and modelling such behaviours.
o The nurse recognizes the client’s needs and the
nurse expresses their response-Ex therapeutic
touch.