Discussion Theory #10

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Adopts

Kristen Swanson, RN, Ph.D, FAAN

Today’s Goals

  • Understand why the Department of
    Nursing is adopting a Nursing Theorist
  • Learn about Swanson’s Caring Process
  • Discuss how Swanson’s Caring
    Process can be applied to Practice

Purpose of a Nursing Theory

  • Nursing Theory is a body of wisdom that is used to support nursing practice.
  • Nursing theory comes from experiential learning, nursing research and non-nursing sources.
  • It can provide a framework for practice.

For example - what to:

  • ask
  • observe
  • focus on
  • think about

Why Swanson ?

  • 4 Theorist were researched by the CNS group and presented to
    Nursing Leadership Council

  • 2 Theorists (Watson and Swanson) were investigated further
    since both had a caring focus

  • Reasons Swanson was chosen:
    * Definable

* In line with the hospital’s mission and goals
* Supports hospital’s patient experience initiatives
* Applicable to any nurse-patient relationship in any clinical
setting
* Can incorporate with other nursing initiatives

Swanson’s Caring Processes

Swanson’s Key Definitions

Person:

Unique dynamic
beings with thoughts,
feelings

and behaviors

Nursing:

Informed caring

for the

well-being of others

Health:

A complex process
of establishing new
meanings restoring
integration and emerging

into a sense of

renewed wholeness

Environment :

Any context that

influences or is influenced

by the patient.

Defined
situationally

What is Caring ?

Caring is the nurturing way of relating to a
valued other. This “valued other” is one whom you
feel a personal sense of commitment and responsibility

5 Caring Processes

Knowing:

Striving to understand an event as it has meaning in the

life of the other

How to accomplish KNOWING:

  • Avoid assumptions
  • Assessing thoroughly
  • Being observant as to what is said
    and not said
  • Asking probing questions
  • Seeking cues from the patient
  • Being engaged with the patient

Being with:

Being emotionally present to the other

How do we accomplish BEING WITH:

  • Being there when needed
  • Conveying availability
  • Sharing feelings
  • Not burdening the patient with YOUR
    feelings or experiences

Doing For:

Doing for others as they would do for themselves if it were at all

possible

How do we accomplish DOING FOR:

  • Doing for but doing no more than that
  • Anticipating others needs
  • Performing competently and skillfully
  • Preserving dignity

Enabling:

Facilitating the other’s passage through events or transitions

by providing support and validation

How do we accomplish ENABLING:

  • Informing and explaining
  • Generating alternatives
  • Validate and give feedback on progress

  • Empowering others to care for
    themselves

Maintaining Belief:

Sustaining faith in the other’s capacity to come through
events or transitions and face a future with meaning

How do we accomplish MAINTAINING BELIEF:

  • Sustaining faith

  • Hold patients in esteem

  • Be hopeful but realistic

  • Offer optimism

  • Helping one find meaning by creating memories

  • Recognizing the sacredness of someone’s experience

Knowing

Ways to demonstrate KNOWING:

  • Getting to know their past experience and skill set
  • Listening and seeking first to understand

  • Staying open and suspending judgement
  • Observing actions and asking open ended questions
  • Investigating opportunities for learning
  • Providing feedback

Striving to understand talents and skills and assessing their past

and present performance

Being with

Demonstrates availability and conveying that a person’s

experience matters. Diversity is honored and promoted

Ways to demonstrate BEING WITH:

  • Staying focused on the new person
  • Acting with thought, not reacting
  • Conveying emotions and expressing empathy
  • Using words and gestures that suggest understanding
  • Sharing feelings of where they are in their career
  • Sharing feelings after a difficult situation

Doing For

Doing for new nurse as they learn how to do for themselves.
Providing a helping hand while preserving the dignity

of them as a nurse

Ways to demonstrate DOING FOR:

  • Providing resources
  • Responding to emergencies
  • Anticipating when they need further support
  • Providing privacy when giving feedback and maintaining
    confidentiality

Enabling

Serve as a developer, educator, and trainer of new staff

Encourage autonomy.

Ways to demonstrate ENABLING:

  • Provide information proactively and consistently

  • Teach skills and strategies to manage an assignment

  • Developing learning guides and checklists

  • Promoting teamwork and shared problem solving

  • Validate progress through feedback

Maintaining Belief

Maintaining a positive attitude for long term success

as a Mount Auburn nurse

Ways to demonstrate Maintaining Belief:

  • Building upon the strengths of the individual and showing
    faith in their ability to perform

  • Acting with honesty, respect, and regard for each other

  • Respecting and valuing new employee’s worth and offering
    encouragement

  • Creating and regularly communicating a vision for success

Knowing

Striving to understand our patients. What is their literacy level,
language, culture, and age. Be sensitive to their disabilities
and the emotions this hospital encounter may be causing

How to demonstrate KNOWING with patient education:

  • Identify any learning barriers or disabilities

  • Who are they? What is their educational level, age, and
    what language is spoken and read at home

  • What are their learning preferences? Reading, listening,
    video, return demonstration

Being with

Demonstrate your availability and desire for them to ask ?s

Tailor education for this patient as an individual

How to demonstrate BEING WITH for patient education

  • Create a teaching environment that is safe, and responsive
    to the patient’s unique needs: (ie.) Privacy, interpreters

  • Spend time explaining things to the patient. Convey your
    desire to make sure they understand

  • Ask patients to repeat back what they learned to validate
    their understanding

Doing For

Some education may need to be demonstrated and role modeled
before a patient can take the next step of returning the
demonstration.

How to demonstrate DOING FOR for patient education

  • Explaining to patients what we are doing for them while they are
    in the hospital and identifying when they are capable of
    providing that care themselves

  • Skill demonstration

Enabling

How to demonstrate ENABLING:

  • Confirming understanding by asking questions

  • Offer patients resources to learn more about what they need
    to learn

  • Evaluate the patients ability to do for themselves.
    Can they take their medications properly
    Can they change their dressing
    Do they know what to look for when they go home

Giving patients the tools to promote self care

Maintaining Belief

Being reassuring and hopeful that the patient will be able to
acquire the knowledge and skills needed to manage the

change in their health

How to demonstrate MAINTAINING BELIEF:

  • Be the cheerleader

  • Point out the patient’s progress

  • Investigate alternatives to manage the patient care needs
    when needed to promote a safe transition from the hospital

Knowing

How to demonstrate KNOWING with pain management

  • Thoroughly assess the type and level of pain
  • Don’t make assumptions about the patient’s pain
  • What does this pain mean to the patient
  • Seek physiological cues to pain
  • Be aware of cultural differences in the demonstration of
    pain

Being with

How to demonstrate Being with for pain management

  • Convey availability
  • Taking the time to listen to how their
    pain is being managed
  • Make sure they know you are there
    for them to address their pain needs

Doing for

  • Anticipate their pain needs to help them
    help themselves
  • Recognizing the patients pain level
    and identifying what they need
    help with

  • Optimizing their environment to
    maximize what they can do for
    themselves

How to demonstrate Doing for with pain management

Enabling

  • Explaining pain progression
  • Accepting the patient’s pain as described by the patient
  • Generating ideas or thinking through
    alternatives to manage pain
  • Teaching how to take care of their pain.

(take medication before pain escalates, coping strategies)

How to demonstrate enabling with pain management

Maintaining Belief

  • Being optimistic about being able to make them comfortable
  • Maintaining a hopeful attitude that
    they will get through this painful event
  • Helping patients through this painful
    transition in their life
  • Helping them find some meaning for
    this experience

How to demonstrate Maintaining Belief with

pain management