Teaching Caring

“The spirit in which the nurse does her work makes all the difference. Invested as she should with the dignity of her profession and the cloak of love for suffering humanity, she can ennoble anything her hand may be called upon to do.”

-Isabel Hampton Robb, Nursing Ethics, 1900
Founder of American Nurses Association

Novice nursing students are task oriented. As a result, most focus on the tasks they need to accomplish: Vital signs, nursing assessment, and meds to pass. They struggle to see the patient.

Some students enter nursing school with a sense of entitlement, that nursing school is all about them and their success as a student.

As I saw this mindset in more and more students, I openly wondered if nursing is at risk of losing its timeless virtue ethic; the centrality of caring and compassion which comprises the essence of the “art” of nursing practice!

Possessing authentic care and compassion is not optional to the professional nurse. It is a unique distinctive and ethos of the nursing profession for almost 2,000 years when the modern era really began with the early Christian church in the first century.

In addition to teaching the science of nursing, students require an enculturation of the values, virtues, and ethics of the profession. Caring, and the “art” of nursing need to be made intentional and taught like anything else that is important in the curriculum.

Caring Disposition Improves Critical Thinking

Did you know that caring is essential to the development of critical nurse thinking? Pai, Eng, and Ko (2013) studied the effect of caring behaviors and disposition toward critical thinking and found that there was a statistically significant correlation (p<.001) between caring behaviors and level of critical thinking demonstrated by the nurse.

They also identified that the right emotions and engagement of the nurse are essential to correctly interpret clinical data. Chris Tanner also validated this observation in her model of clinical judgment (2006).

The authors recommended that nursing education needs to emphasize a curriculum that emphasizes caring behaviors to improve the disposition of critical thinking in nursing students (Pai, Eng, & Ko, 2013). By incorporating the strategies in this article you will be empowered to implement this educational best practice recommendation!

Can Caring Be Taught?

Can caring be taught? I believe it can, but first, caring needs to be properly defined. In the book Primacy of Caring, Patricia Benner and Judith Wrubel presented this beautiful definition of caring as a nurse:

The essence of caring as a nurse is that you recognize the value and worth of those you care for and that the patient and their experience matter to you.” 

This definition captures why a nurse must care; every person has intrinsic value and worth. I made it a priority to share this definition and make it practical with my students.

Two Caring Questions

Using this definition, I developed two questions to apply this definition to practice. Each student was asked these questions consistently each clinical or in post-conference:

  1. What is your patient likely experiencing/feeling right now in this situation?
  2. What can you do to engage yourself with this patient’s experience, and show that he/she matters to you as a person?

By asking these two questions, despite being task-oriented, my students had caring on their patient care radar and were prepared to honestly answer this question when it was asked.

Going Deeper

To help my students further integrate caring into their practice, I used Swanson’s Middle Range Theory of Caring as a theoretical framework to identify specific caring behaviors that can be used to effectively communicate and demonstrate caring.

The strength of Swanson’s caring theory is that it builds on the caring work of Jean Watson and Patricia Benner. It was derived from the maternal/child health practice setting with women who experienced infant death or gave birth to a critically ill infant.

When Swanson asked these mothers about actions the nurses performed that demonstrated that they cared, she identified five qualitative themes that became the following caring processes:

  1. Knowing
  2. Being with
  3. Doing for
  4. Enabling
  5. Maintaining belief (p. 163)

Each theme has several subcategories that serve as caring interventions. For example, under “Knowing,” a caring intervention is “avoiding assumptions” or avoid making a judgment. When the nurse does this in practice it allows the patient to feel genuinely cared for.

As an ED nurse, I can testify to the relevance of this principle. Some patients are labeled as “frequent fliers” because of their frequent visits. But once this judgment is made, I am unable to authentically empathize and care for them as a person.

Another practical example is the caring intervention, “conveying availability” under the “being with” caring process. Practically communicating that you are available to the patient communicates caring. For example, instead of offering the call light and putting it within reach, state to the patient, “Here is the call light. I am available if you need me. Do not hesitate to use it.”

Steps to Implement

In one clinical rotation with fundamental students, the course was only five weeks long. I realized that Swanson has five caring processes. I decided to integrate one caring process each week so all five caring processes would be addressed in the course of this clinical.

I implemented this strategy with fundamental and advanced students in clinical and received the same response: Both groups loved it!

To make it easy to integrate Swanson’s caring framework in your clinical, I created the following resources that you can download and put to good use in your program:

  • Educator guide: Overview of implementation.
  • PowerPoint on importance of caring in nursing
  • Student handout: “Looking Back to Move Profession Forward.” Quotes from nursing leaders that highlight importance of caring/professionalism to nursing practice.
  • Student handout: Summary of Swanson’s caring theory with caring interventions
  • Student handout: Five one-page caring process templates so students can develop a “plan of caring” in addition to a traditional care plan for each clinical.

>>>FREE Download: Caring Can Be Taught Bundle<<<

Practical Next Steps

Integrate the importance of caring in your clinical by taking the following next steps:

  1. Discuss caring and its relevance to nursing practice. Share your own reflections on the importance of caring and what is in the nursing literature. Use the PowerPoint on importance of caring in nursing and handout that has timeless quotes on caring and professional behavior to guide this discussion.
  2. Explain the essence of Swanson’s caring framework. Use the one page summary worksheet of Swanson’s framework and the article, “Caring Made Visible” by Swanson (1998) explains her framework in her own words which was discussed, distributed, then posted online.
  3. Integrate the “Plan of Caring” one-page handout over the next five weeks. Take one process each week as a clinical group, and go through the five processes over five weeks. Students selected two caring interventions to implement each clinical. They would put in their own words how they would apply this intervention.
  4. During clinical, each intervention was implemented then evaluated by the student. This written “plan of caring” was submitted each week for faculty to note and provide feedback. If time allowed, students shared their reflections in post conference.

Closing Thoughts

Caring and compassion ultimately need to come from the heart. But when students are guided to recognize the centrality of caring to the nursing profession actions that communicate caring, unless they are a sociopath, caring behaviors can be cultivated!

Use these tools and make a difference to communicate the centrality of caring to the next generation of professional caregivers!

Next Step

Nursing is both a science and an art. Though empathy is fundamental to holistic nursing practice, this soft skill is not easily taught, nor consistently integrated into the curriculum.

KeithRN Clinical Dilemma case studies emphasize the importance of the art and ethics of the nursing profession. Each study integrates aspects of caring, engagement, and ethical decision-making and its relevance to modern nursing practice.

Use these case studies to engage and help your students care like a nurse and face the most common clinical dilemmas in practice.

Useful Links

Learn more to be empowered to confidently teach caring to the next generation of nurses!

References

  1. Hampton Robb, E. (1900). Nursing ethics. Cleveland, OH: E.C. Koeckert.
  2. Benner, P. & Wrubel, J. (1989). Primacy of caring: Stress and coping in health and illness. Menlo Park, CA: Addison-Wesley Publishing Company.
  3. Pai, H., Eng, C., & Ko, H. (2013). Effect of caring behavior on disposition toward critical thinking of nursing students, Journal of Professional Nursing.
  4. Swanson, K. M. (1991). Empirical development of a middle range theory of caring. Nursing Research, 40(3), 161–166.