I believe like that RADICAL transformation is needed and can be realized in nursing education today. I have crafted a document: “A Declaration to Transform Nursing Education” that situates 7 needed practical paradigm shifts for nurse educators to help make this a reality. The FIRST paradigm shift states:
1. I will emphasize and encourage the “art” of nursing that is defined as caring, empathy, and nurse engagement.
Todays blog topic…Is caring still valued and recognized as central to professional practice by our students & educators today?
Where’s the Beef?
It’s hard to believe, but it has been 30 years (1984) since the iconic Wendy’s commercial made the catch phrase “Where’s the Beef?” a larger than life cultural phenomenon with a large fluffy bun and a much smaller hamburger. Though caring is the “beef” that is the essence of nursing practice and most important characteristic of a nurse (1) for over 2,000 years, it seems from my vantage point that it is shrinking in its relevance and emphasis today by both students and nursing academia.
Why is Caring Central to Nursing?
From the first century to the Middle Ages, caring for the sick originated as a ministry of the Christian church performed by both lay deacons and deaconesses and later through nun and monastery orders (2).
Showing compassion and caring for the sick was founded on the teachings and example of Jesus, who demonstrated high regard for human life through His model of service, sacrifice, and teaching that “in everything, do to others what you would have them do to you” (Mathew 7:12).
Patricia Benner also affirms that caring is central and remains relevant to nursing practice today.
“Nursing can never be reduced to mere technique…the nature of the caring relationship is central to most nursing interventions” (3, p.4). “The nurse is both a knowledge worker and one who cares…knowledge is dangerous if it is divorced from caring” (3, p.400).
As nursing has become a well paying career path, this can become a stronger motivating influence for todays students. There is nothing wrong with being paid well for what a nurse does. But if this is the primary motivation for a student to become a nurse, this should be a cause for concern.
Though caring, compassion, and serving humanity could be safely assumed as the primary motivator to enter nursing a generation ago, today this can no longer be assumed.Though the nursing profession and students entering academia have changed over the years, it is imperative to recognize the influence of the current philosophy of postmodernism to our culture and potential impact to nursing education.
Postmodernism is a philosophy that says absolute truth does not exist and that all worldviews and beliefs are equally valid.This has then led to relativism, the idea that all truth is relative.This belief is at the root of challenging the traditional definitions of when life begins (very relevant if you are an unborn baby!) or defining “marriage”.
But are all worldviews equally valid? The Christian worldview that has influenced the nursing profession has a HIGH regard for human life because it recognizes that man is created in the image of God (Genesis 1:27).
Ancient Rome at the time of Christ had a LOW regard for human life. It was cuturally acceptable to kill humans as sport in the Colosseum or leave unwanted infants outside the city walls to be eaten by wild animals.
Which culture would you rather be a part of? The answer should be obvious.
Postmodernism & Caring
The takeaway of this philosophy lesson is to provide you with a lens to see the reason nurse educators need to be concerned but then ACT to be intentional to situate caring in your curriculum. If our current culture sees all viewpoints as equally valid, then to CARE or NOT to CARE is equally valid and its importance is in the eye of the beholder.
This is dangerous to our profession, and as nurse educators we must do all we can to emphasize and situate caring, empathy, and compassion intentionally in our curriculum. If this is not done, I am fearful that caring is in danger of being eroded and may one day be seen as irrelevant.
Caring Made Practical
To practically situate nurse empathy, compassion, and caring, I ask two simple questions in my clinical reasoning case studies as well as with my students in clinical:
1. What is the patient likely experiencing/feeling right now in this situation?
2. What can I do to engage myself with this patient’s experience, and show that they matter to me as a person?
By simply asking and expecting a well thought answer to these questions by your students during their clinicals, they will begin to see the practical value and relevance to engage and empathize in a way that communicates caring as well as its impact on patient care.
I have also successfully used Kristen Swanson’s “Empirical Development of a Middle Range Theory of Caring” helpful to identify themes of what constitutes and defines caring by the nurse. Swanson investigates what patients value and perceive as caring behaviors from their lens and perspective (4).
See my tab, “Teaching Caring” for more information on how students can bring a “plan of caring” in addition to a “care plan” to the clinical setting!
Caring Behaviors Benefit the Nurse!
Caring increases the vigilance and guides the evaluation of nursing interventions by recognizing subtle changes in a patient’s condition. In this context of caring, the nurse is paying close attention to the patient’s body language and interpreting the significance of what is being communicated, so that a change of status can be acted upon (3).
Practicing in a caring manner also benefits the nurse and leads to the nurse’s well-being, both personally and professionally. The nurse feels more connected both to his or her patients and colleagues and is more satisfied with bedside care (5).
Though caring remains the unchallenged virtue ethic of the nursing profession today, let’s do all we can as nurse educators to intentionalize caring in our curriculum, but more importantly MODEL caring by your example in all that you do with students as well as colleagues. Caring is much more effective when “caught” then “taught”!
Question: What do you think? Is caring still valued by most students today? What are you doing in your program to intentionalize caring?
Please comment below and let a conversation begin!
1. Leininger, M. (1988). Leininger’s theory of nursing: Cultural care diversity and university. Nursing Science Quarterly, 1, 152-160.
2. Wilkinson, J.M., & Treas, L.S. (2011). Fundamentals of nursing, (2nd ed.). Philadelphia, PA: F.A. Davis Company.
3. Benner, P., & Wrubel, J. (1989). Primacy of caring: Stress and coping in health and illness. Menlo Park,CA: Addison-Wesley Publishing Company.
4. Swanson, K.M, (1991). Empirical development of a middle range theory of caring. Nursing Research, 40(3), 161-166.
5. Swanson, K.M., (1999). What is known about caring in nursing: A literary meta-analysis. In A.S. Hinshaw, S.L. Feetham, & J.L.F. Shaver eds. Handbook of clinical nursing research, Thousand Oaks, CA: Sage Publications.
Keith Rischer – Ph.D., RN, CCRN, CEN
As a nurse with over 35 years of experience who remained in practice as an educator, I’ve witnessed the gap between how nursing is taught and how it is practiced, and I decided to do something about it! Read more…
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