Due in 6 hours 2.5/3pages due ch.18

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,Gffir,o*ilrsrrro*d Wffiffi fi *'e Ifmm 0riu

juan Wnr"sox

I*lr*dlting thc Tkrarl* 0vorvlc* o{ tlrt trfrttr;

tppliraftorr aI thx lhaorY Prertira Ixtnplur by lorri Woodwurd

Suamlry Rtlcrentar

Introducing tle'trheorist L)r. Jea-n Watson is distinguished prolessor e::rerim and detn oinursing emerita at the Unl-

versiq* of Colorado Der:rer, where she sen'ed

for mo:e than J0 ;*ears a-'ld held an endoB'ed Ch*u in Carlng Science f'or n:ort than 16,vears'

She is ibunder cf the originel Center for I luman C,rrung at the Universitv oi Coiorado

liealth Scitnct:, ls * Liring Legend !r the Amcrican Academv of Nursing, and sened as presldent of the N*rional Leagut f+r lu:sing' br. t\tatsot iounded and dgccts the nonprofit \tratson Carlng Srience Institute, dedicated to

furtherinq the rvork of caring, stience, and hcan-ccntercd L,rr:74. -\u:sing, :estorlnq csring

rnd lore ibr nurses's-ad health-carc cllnicilns'

healng practicts fcr stlt a-nd others. Watson earned undergraduate and grad-

uate degrees in r.ursing and p+cluatric-n-:ental health nursins and holds a doctrirate ia edu-

cational psycholoql and counseling iionr t-tre Universit,v of Cclorado at Boulder. She is a widelr p,:blished author ar:d is the recipient of several awards and honors, including ar. intcrnatio.,al Ktllogg bel-cwship in Australia; a Iulbrighr Reser'rch i\ward in Swedeni and 10 honolan'doct*ral degrees' lnciuding ser,*n liom inttrnation al universi- tie s in S1r,eden, the [Jnited Kiledcm' Spain,

Japan. ant! Brilish Colombia and }tottreal, ftrebec, Catada.

L)r. lAlatsfln's orlginal b+ok on cring rva: published ir 1!79. Ilcr :tcond book, .\'r'rrinB' Htnm S;ittttt and Htnatt C*rr, u'as wliftel whi.ie on sabbatical in Australi* and reflects tht mataplir.'sicaL and spirituatr ertoiuticn of her thinking. ,'1 th.rd bcoh Pcslmadtrn Nunitg ard Bryand. rnoles be1'+nd thtory to refuct the

321

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322 5rc' r -.::r 1: ' Craqd 'ltesrics ebt* Cate or Cttiry

ontological ibundatian of nu:sing as 2rI overlJ-

ching liameu'ork tbr transibrming cacng a-nd

heai-ig o:actices in educadon *ild dinica! {a!s

{Wamon, i9?9). Additiona! cmpi-ricaland *n-

ical carlng research iixr developments indude rhe tirst and setond edidons oithe book oc car-

ing insmrments,li stxing a*l ilIeaswir''g C*irtg iai&,ar--irg and He*lrh Srrtars (2002, 2008b),

rshich oflcr: a critique eld collation "rf ruore rha-r).?0 irsruments i'or assesslnq and meas''rlrg

r-ring. Iler Cariag Snenrc,ar Sraryr# Si#lre makes

^ ."t" ib. a d*ep, moral--ethicai, spirir-liiled

ibundarior ibr cerng ssience lld healinq based on infinitt Isve and a-t expanding cosmolag" trV.rtson's 2008ia) eheoretleal rv*rlq i1'furure3" ?Ie

lahilo:opk'; antl Stient: a,l Cwiry, Er1rerd "Hr1 Edittan, rcirsils and retrvorks her lirst

'uook,

!\;-urring.' Tfu Pltilosaphy cnd iiilrttt aj Canag. {1979, reprinted 19i-{), bringing the original

ptbl-ication up ta date trr include all the ch:nges

rnade riuring tle past 30 ltats''Ihis latest update

inrtoduces Llr:tt,l,:r nursing as rhe cuimlnr:ion oi a caring scieace foundation for proi'essional nurcing. ;\ coaurl"rored educauonal bqoh Lrr+i irg a Caing Stitnrc Curitwl'tirl: Emawipatory Ptriatttits bv Jlarcia I li.Lis and \\'rrson, uas prUfiti."a ir. 2011 fullos'ed bv tu'o additional ccauthoreri rtseatch and taeasultment bools,

fuIe*turirig Carilas. Ittemdliatal fusrcrrh an Ca*as u Heatingilielson fr \'Ya*on. 2fi11') and C*tirg Sticnc, Mindful h*ttttt: Impl:menting lllzlrctii Hu*ttn Cxing'{hetr; (Sirzma'r & \\irtson,2014),

'fhe lVatscn Cadng Sclente lnrtir':te is der.elc,Fing educarional, tLlnica1, and admin-

isrratlrie-leadership rnd research models that

seckto sustain and dcepen authenaic caring- healing practices for self and other, trans- forminu pracridcners acd patlents ailke' The

tari*g xie.*'l ni.odel, inttgratifi?, Carilar rtjth tl:e science oilhe hean in lollabo:ation rvith the lnstifute of lieart.}Iath {'*ryw .heartMath.tom), deeroens intelliqent heart-

ccntertd ca:ing, All of\tr'atson's latcst pub)ica-

tion: ar.d innovative educar:onal pxtncrshps, artivities, n{rv pl'cgrainsl speaking calendar,

and directions rnd derelopments, includlnq informadon about a rr*ntra&tionai doctomte

in culng scis:tcc as sacre,i scicnce can be ibund

on the rvebsire: q+tq'.rt ltsoncarhgsclcr-ce.or3'

#versiep'ofthe TheorY 'Ihe rler4' 9{humat c{rrif,3 Eas dcvelopcd be-

nvten 1975 and i979 .1'\ils I rtas teaching at

the Universitr of Llolorado. It ernerged iicm mv o1l'n viefts of nursing, rc'mbined and in- I'orme,l bI m1r dacrrrrai studies ln educadonrl'

rlint"'al, a;rd so;is1 ps1'choiory, -trr lvas m-v initial

attempt io bring r,reaning a-td ibcue to nur-ting

,u ar emerging distipline and distir:ct }:ealth professlon that had lts o*'n uniouc values, Lncrt'iedge, ind prsciices, and its oq-n tthic and rnissicn ro socleq-. "lhe'*'ork w'as also in-

lluenced bv rny invoh'ement witl an integraed arademic nursing curriculum and e$orts ro

fild ccmmr:n nreaning and arder to nursing that tran:cended sertingt, populatians, spe-

r:iakr*, and subspecia-1tv aleas

l'rom my emelgin;5 perspectire, I make ex- plicit that nursicg's values, ethic, pl:ilas+pl1 Lnorvlcdge. ard practices ofhum'rr' caring rc-

quke l*ngu*gt order, s*':cru-re, and clariry ol .oncepts and worldview underlfing nursing *s

r distinct discipline ard rrof'ession 'Ihe theory

qoes ber-ord tht dorni*ant phrsiral wurldvieu"

"r,.i op*nt to sub.iectite, intersubjecrive, and

ir:ner meaninq, unde.rlling he*ling processes

rnd the life world oi'the experianc.in.g rerson' '1his original i\'tatson, 1979) ianguage iiamed

this orienlatior: tirat required uaique crrlng- healing arts. 'lLe humsn caring Processes wErt

named the ''10 caratrve factors," lvhlch com-

plemenred .onventiona.l fl:reditine tut :tood i'n imrk conuast to "lurative faciors " ;!t the sam* tLme, ilis emergiag philosophrv ar:rd theory oi hurnan caring sotght to bala,r:ce ths ture ori-

cntatior cf mcdicinc, giring nu:s:ng its un-lque

disrlplinary, scientilic, and proiessional star:d-

ing w'ith itsel-f mJ its Public 'Ihe euly work has conti:rued to evolve dr'-

nar:ricall1' &nnr the criginal lvritings oi i'S79, 1981, 198-i, rnd the 19?0s tD a nroie updrted

tierv of 10 cariirs proccsses, to carirg scltnce as sacred science, and to a urutan'global con-

sciousness for lcadersirip, My rl'ork now nrkes

roneeclions betrveen human carirg' hcaling, and even peate in our rvorld.' *ith nurses as i6niar Pealrmitktr: ul:en rhey rrr praiticing i:uman caring lor stlf and others. '1his shllt Bioa'es tG more *cplicit metaphysir:sl spuitual

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fticus or uanspersonrl caring trioment, PoEt- mndun critiques, ro n:etaphrrsical-from the-

on'to ortolagiial paradigrn tbr carir'g scicncc'

r\ hroad, cvch'ing unita*' caring sr:icnce rvorldl-iep'urrderlie.s thc iluid evolution of the

theory and the philcsophical-ethical ibunda-

tion for tiris w'crk.

Mni ar Con cePt$al Ele mefi ts 'ihe major conceptuai elemrnts oi rhe criginal

{and emcrgent) theotl are rs }ollows:

. 1'en trrative ia*ors (uanspased to ten

caritas processesJ

' 'I'ransperscnal cuing rnoment ' Caring tonscicusnesslintentionalir,r' and

etrerfled{ Fresente ' Caring-heaiing modallries

Other drryramic aspects of the theor- that

hwe ernerged or are emerging as rnore explicit

ccmponents iacludel

' Iixpmdcd vim's of seif and person (unitnl' cnenessi t r.rbodied sPirit)

. Cariag-healins ronsci,:usne,-cs and energetic

hcart-tentered Ftesence ' l luman-envi:onme ntal fitld of a cuing

mcrnent

' Ucitary $Eeness s'o:ldvieu': unbroken wholenass and connertedless ofatrl

. r\drtnced caring-heaiing morialitiesr' nur:sing 'lrts as a future rnodei lor advanced

piaciic; ofnursing qua nursirg iccnscicusiv guiderl by one's nursing ctirical-thcorctical- philosophical orientation)

C*rtng Sciencs as Safftd Stiente 'lhe eniergence of f,e work is a more erylicir de-

vehprnent rsi *rlng srie*:r as a deep moral_ ethical contcrr ofiniaite a-ad cosrnic lore' rts soon as cne is nrore explitt aboui platlng the hurnan and taring t"itFjn thek science n:odel, it automatical$ forces a relational uniu4' utrrld-

vi.ew and makes uxplirir carlng as a rnoral idrrl to sustiln h,.:-.1*.nity ac.ross rirne tnd spacq one

oithe grlrs a.rd &e raison d'8trc cilu.rsinq ln tht rvorld, but 1-et to be recognized '*'ithin and u'ith-

cut. I*'ertheless, a caring-science orlentation is

I]cceisa$' for the srrnva] ot nursing as g'ell as

hurnaritr' at rlis crossroads in iruman el'olution'

'1his vierv ta.ker nu:sing and healing work

berond convcctional thinl*ng. the iatest rrl- enltion is lorated *'irhin rhe ageless wisdonl uaiiitions a*d perennial ilgredirnts ofthe dis-

crplinc of rursing, rvl'iie uan;ierdtng nursing'

C.rrirg science as a nodel ibr nursirq allows

nu:s:ng's caring-herling core to becorne both

discialir.c-spccihc a::d uarsdisc:rllna-'1" Ihut,

nur.i.g'r'Jneless, ancient, en'Juring, alrJ mo:t

nchieiontributions r;me ofage throngh a crriag-stience orientadon-scientifi cal1y,'tes-

theticalll', ethicalln anti precticalll''

Ten Carative Fa$ors the orlginal rvork {Wttson, 1979J rvas crgan- izecl around 10 carstive ta.-tors as a frsmelvork

for providing a ibrrnat and focus ior nursrng

ohenomena. ;Urhough roralizrrrla'l'rj is stili

ihs current termincLogt for the "core" of nurs-

ing, pror"iding a suurture ibr the initial lvor\ tha t*mrli:r'irr is ton sugnant ibr m1'se*sibr'l- itirs toda;-. I har"e extended carative ro rzrirrrr *td tarilas pra.l:rlt as coneistent s.ith a rncre fluid and tor"lten:Porafl' n]r1a'enlelLr cf the-te ideas rnd rtith m-v expanding direcrioas'

C'an/ar comes iiom the Latin rvorJ mcan- inq "to cherish and appreciate, giring special

attefition tt, or lol'ing," lt connotes sornetiritg that is r.ezu iine; ir:deed, it is pre.ious' 'Ihe

lvord inrilsr is also closelv related rc the origi-

nal rvord rrrrslite ftor.yl m,v tr9?9 booL rk thls rirne, I nou'm.lkc aew clrilt.:ections betlvetn c,lrstil'e al]d caritas and t'ithout hesitaaion'Jse :hen: ro invokt lovc. whttl'. caritrs ionvcls' 'Ihis usage allot's love anC cariag to cofile to- gerher tbr r aell' tbrn oi'deep, transpersonal cari-ng.

.lhis rti:tionslup benveen love and car-

ing ronnotes lnner healing tbr selfand others,

extending to nature tnd thc largtl universe, unfnlding and *r'olving rvithin a cosmolog" thai rs brr* nretaph-vsica-l and transcendent r+'ith thr roelr:h'inE hur:-ran in the uniterse' -Ihis emerging madel oftranspersonrl caring

n:oves from carative to rarilar. 'Ihis integntive

expand*r1 pelspective is postmodero in rhat it traascends convtntional indusrial, static models of nursing *'hile simultaneouslv er'*k- ing both the pasl ar'!d dre rurure. !'r:r examplc,

ih, *,"t" cl nursing is tied ro .\lghtingal:': sense oi'calJing," Suided by a deep seaie ol

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314 5r i r :;rr \ ' Crmd lhurie s tbt*! Care or Ctriug

romfliimetrt and a coven*ltai ethic of hu::ran

sen'ire, cherishing our phtnomerra, our subjecr

r:rafier, and ihcse we sen'e.

lr ls rvhen we intlude cering and ior''e in our

ri.r:rk and ln our life that rve di:cover and a{firrn lhat nursing, like reaching, is more t}tan

i,r.t a iobl it is also a ]il'e-givir'g and Lfc- icrci"ing rareer tbr a htttimc ol gro*"ttr e-rd learning. Such maturity and inteqration ot past

w'ith present and futule no$'requite trans-

froming seil and &ose s'e sen'e, including our

i*sti;uriols and our protisslon' i\s *'e mcr* puhiich ald proi'e;sianalh' ass'rt th*se Fosi- tionu fot our theories, ou: ethics, and cur pr3.rri.'es----el'cn for our ,clence-rte also locate

oursrlvts and our pro:e'sicr and distiplr'c x.ithin a new. crnergiog cosmologr'" Such thinking ca1-1s for a sensa of reverenie and ,ocr"dt"rs *'ith regard to lili and ali living things. It intorporates both art and science, as thel: arc alro being redeined, ackrorvledgi'ng

, ooru*rg.n.. among artl science, and spi*t':- aliql As; enter iato the transpersonal caring theory and *hilosophy, *'e sirnuitaaeously ar* ch^1len6ed to reiccatc ourselves in thesc

enlerging iJeas and to question ibr ourselves ho*'ihe theor.r speaks to us. 'lhis in'vites us into a nelr relationship *'lth ourselves r'nd our ideas ;rbout life, nursinq, and tF'eoqy'

llrt.:-.'i : :::r:, l l," l'

'ihc o:igrnai c:rattvt iactorc :cntd as a guide to n'hat was :ei'erred to as the "iore ci ar':rsinH'

in cnnffrs! to r':.ursing's "trin:." Cbre pointed tr:

those aspects ol nursing that potentiate ther-

apeutlc healir,g Frocesses and relationships-

ther''aifeci the one ca-ring a;rd the one being

cared for. Further, the brsic co'e was srou:dad i:r what I rcicrrtJ to es rhc pl'jl"'rs- oph.'. scicr:ce, ar:d art of carinq Carative is

,hri d""p., and la:ge: dimen'ion oi rursil:g that goes belond the "trir::" ofchrrging times,

settinq, procedures, functiooal tasks, special-

ized focus a-round disease, aad trf,alrxent xnd

,..!es1og.r. ;Urhough the "uim" is irnport:int ald not e,xpend*ble. the point is that nursing ianflot be dtfined around its trim and rvhat it does in a given setting and at a given point in

time. Ior can numirg's trire define and tlarih'

rts 1a:gc: :loic;sion:l cthi; arrd r:ission ro ,o.iclr"-its raison d'Eirc for thc public lhat is *,here nu.rsipe th,eory cornes into p1av, and

transpersonal caring rheow ofers anolhet lYnt

thrat Loth dilt'ers from and eornplements that

rvhich has {orne io be knorl'n as "modtrn" rursirg and comlenlioflal medital-nursing tir:rrerrorks.

'lhe 10 calativc lactors iniiuded in the nrig-

inrl work are the ibllo$'lng:

t, Fcrn:.ltion of r humrnistic-aluuistic srsten: ofvaluet.

?. Instillarl+n olirith-hoPe. 3. Llu.ltivation of sensitiuty to cne's selfand

to 0thers, 4. i)erelopncnt of a Lelp:ng-trustinq'

humall cxirr,q reJadonship.

5. P.romotion and accepunce cf the e-xpres-

sion oipositive and negatilr fetl!ngs'

6. Slstemaric use ofr. creatil'e problern-

solving caring !rccess. l. Pronror!on olranspersona.l teachlng-

lerrnlng. E. P:ovis:on ibr a s':cporivt'. protcctive,

an#or corrective :renral, phl"sical,

societal, and spiritlal cm'irunment' 9. :!ssistanrc *'lth gratificatron of hurnan

n*eds.

I 0. :tllowance ior erisential-Thenommologrcal- spiriturl ibrces. (Watson, 1979' 1985)

Although scme of tht basit ttners of the c,righal ,;aiath'e factors sd11 hcld snd indeed

"r" ur"d as the baris ibr some theory-guided

practice models *nd research, wirat I am pro- pc.inq here. ar part oi mv n'olution and ;he

.toluiion ot these ideas and lre thcorv itseLi, is to tanspcse the caratil't tictcre into "cliaical

caritas processes."

Frarn Csr*tiws Carrfas -Prof,sr'.r'r't .a1.s ':aratlre

tactors evolved s'ithin arr trpand- ing penpectirc and as my ideas and values havc

*'t i't=a, I lor'- ofe: the follcwing translation of ti-.e origi:ial caratil'e i'actors into carires processest ruggtsring n]ore cpen 1'-a15 1n $'hlch

the;- can be tcnsidered.

1. l'ormarion cf a hurnanisrlc-al"mirtic sys-

tem of r';rl.ucs 6crvme-r lhe pracrice oi lorir:g

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Llr r,r, r :rrt 18' Jtat: Wi:o*'t'Ibeory {- I I w*an Ccrirg 335

kindners and equa:rir:rit1' within rhe

contert of caring cotisciousness' ?, lnstilhdon oflaith-hope *r"rx*; being

authentically present and enabling and zus-

tainir:g the de*p belief*xtem and subiectil'e

tif.."nrld oiseHand one being cared ior'

3. Cultivzticr: oi sensitilttr to one's self and

tc otltrs }rieates cultivation of ole's olm spiritual practites and tan:persona-1 scltl

going bevond cgo sei! opening to othtrs

ri'-lth scnsi tlvitr and compastior'' 4. I)*'clopmcnt oi a hclping-trustinq'

hun:an caring relationship /esrrr det'el- opi:-rg and sustaining a he$ing-ttrsting, authentic ca-rlng rek tionshP'

5. Prcrnotjon and accrPtsnce oftLc elprts-

sion oipositive and negaiive t'eelings

ierarn*r belng Present tor and suppor'ive

ot, the *pression ofpositivrt and negatiue

i'eclings as a connecdon lvith deeper spirt Lfselfand the one being cared for

.

(aurhentically listenir:g tc ancther's storyJ'

6, Systematic use cf a creative problem-

solting ca;rng proccss acozrr crtativt ust oi selitand d1 *'a1's oi knorving as part of tl-re caring procflssi to engage in the a'rtistry

of caringlhealing practicer {creative solu-

tion s*eLng trecomes ca:itas coach rolt)' 7. Promotion oitrtnspersona) teaching-

leun:ng ix:cmts er-qa'4ittg in ge nuine tcachir:g-le*rning *'<perience thai amends

to uniry olbeing and meanirrg, rffelnFting to stay w!th:.n othcrs' trames of reErence'

8. Prosision :br a iupportiut, protet:ivc'

andlor torrcctil'e tnental, ph.Ysit:a1, so{ietal,

aad splrltuai enr-ironmeni lrrrono rreatilS

a h.ealing enrironmeftt ar all levcls {a p}r1=-

icai r-nci nc,nphl'sica1, subtle envi:onmcnt

ai energ,' and con:ciousntss, rvhcrrbY

rrholentss. beaurl, conofort, dign:4', and

Peace are potertiated). 9. .\ssistante ntth grntilitaticn ol'1:uman

Lreeds 6erom,u assistlng rl'ith basie needs,

wirh an intcf, tiDr.aI :arirq .'onrciousncss' adrninistering "hu$ar cale essenti31s," rrhich potcntiate u'hcleness and urutv of-

beicg ir B.1l aspects ofcarei sacrcd acts ot basiicsr"l touchir:g ernbodied spirir and

eyoh'rng spiritud emesgence'

I 0, Allort:ance ior e-xlstential-phtnon'iesolog- icai-piritual force s Jerruer cpenir:g and

rttending to spirirual-r+sterious and

edster::tid dirn*nsic[s oi 0ne's owr'

liii-deathl soul care fcr seU anrj the one

btlng cared for.'-AJlowing for nriracles'"

\Yhat d:tlers ir t]'.e tarita: proccss frauc- r,,'trrk is that r decidedh'soiritud dimension and

afl ovcrt e1'ccation r:i lcve and caring arc n'lerged ibr a flew utriaarv ccsmologv for this

mi.l1ennium. Such a pcr:ptctiue iroaica'llv place:

nursing *'ithie its rnost mitur€ iraaelvork a-':d

i, .or,.irt.tt i,r'ith the lightingale madel of Ilursing-1€t to be rctualized but alvaiting its

.rolutlot. 'lhis direcri*n' rryIi-le embedded in theory g*es b*1ucd theor,r and beeomes a

csnvergieg pradigm ior nursing's fi'rt';le' 'ihus, I consider my t'ork orore a philo-

sopl'.icr.l, ethiiil, :ntellrcrual blucplnr lor nursirg's evolving drscipLnll/proiessional niatrix, rather than a sgr*cific theory per se'

Nevertheless, otheis interatt with t1'"e original

lvork at lerels <if concretrness ot abstracrness'

if the t}:eory i: "read" at ihc cara;ive ftctr:r iel'el, it can be inrerprcted as a rniddle-rrngt rheory. lfthe theory is 'read" at ihs transper- sonal u:rltart' caring sci.ence/ffanspersonal carinq ccnsciousncss 1e1'e1, the theory can be

ir:terpreted as a grand theorv located within

dle unitary'-transt'ormatire context' 'Ihe caiing theory has been and inteasingly

is beir:g uscd naiic,nalll. ar:d iniernationall-v as

a g.ride i'or educaiional c':rricul,l, clinieal prar-

tice model:, methods ibr researcF' and inqur,v,

and adlr:inisratite directions for nursing and

health-care deLvery-

Readingthe Theary 'Ihe "theorv" tan be ''read'' as a philosophr'', xn ethic, a paradig:n, an expantitd 'science model, cr a throl'. ll'rtad as a theon, it can be "read' as a qrand theon'withi.n tlie unitary-

transt'otnlatlw paradigm l*'hen understaod at

&e rransperonrl, energetic-fieid 1e"'*1 r:f ca'riras-

unl'ersal lovc anJ cuolving .onsclousflcss' It can be 'read" as mitidie-range thcolv

rvhcn rtad at th': iuar:vc fac;ors/tarlla; process lerel, rt'luch provides the strutnire a-ad

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326 !i.r. t':i:r l.: ' 6vanl ft':cries ebrd Care r Ccrln's

Ianguage of the th*o1r', as both middle rang*

and speci5c. \\rhen used in elinical seftinqs" tLe theory helps nurses ic frame thelr e.<Feri- rr:rcs around thr caitas Frocesses to sus:ain the caring-science ibcus, as ll'ell as derciopinq

L*ngr*qe slisrems, including computcrized docuilentation srsteffis, to document rnd srud). cxting $'itF,ln a designrtcd lantroagc s)'s-

rem (Rosenber.g, 1006, p. 55)' the n-riddle- range ibcu: is also congruent rvith rlioical raring research projects, utilizing the caring language oi camtj.ve,/cr.ritas- Indeed, manv cf the nore icrmriized c*ring assessment tcols are bascd trn the lang';age of this struct':re' Ser"eral rnultisit* research plojects are l:owuA-

dcm.av using consisrrnt cariJrg assrssniafll roo1s, such as Duf's Cariag r\ssesslnea!'lool and the Nelson, Watson, and Ino*-a Ilealth lnstnlment Carlng !-actor Sunev {ferskv. \clson, Watson, Ei Bent, 20S8). 'i.he latest Wafioti Carilt: Pili*tl Store !s being used il multisite clinicrl smdics as an internadon*Ire- search pro-]ecl. (l.or more iaf*rmation, go tc \inu,l,,rratsoncaringsciencc'org'i ln addition, r':rost of the current caring-s{ien{e assessrnertt

tools r::ay be se.en in,{r.rgring ani Mmruring Carirgin *lursingand Ht*kh "\risilrs.2nd

ed,

iWarson,200Bbl.

H ea rt -C en t cre d Tr ansP trr ana I Caring Moment: Caritas field \\.hether the ''theord' is read at dfierent ler-e1s,

used as a }anq.:age rystem for dcrurnentation, ured as a guide for professional rrursinq pra;- tice n:odels, o; used rs the focus of rnultisite or individual clinical caring relearh sitdie!, the essence olfhe liltd rneorv ls in iqe trafisPei- rca*.1 caring ,noBent''Ihf, caring rnoment can be locrtcd rtithin anv cuing occasior., 'rs a conccBt Nirllir: middlc-rargc ar cvcn presclip-

tite o; practice-1evel theory. llou'*'s, the raring fi1ofi(nt is rnost cvl-

dent ll'ithin the ua-nspersond caritas enerqetLc field mode\ in Clat one's coi-rscioutness, interr-

tiorxLt'', f;nergetic heart-cenrcred presencc is radiatir:g a fie]d bei'ond the wn pecple or rhe situadon, allbrting the larxer field. 'Ihus, nurse.s

can berorae nore awtre! I-,!Dre awake. trore consciour of mac&stinglra&rting a cadtas ficld oi iove and heuling for self'and others, helphg

to tansform s-l:if and s}'stere, l+r rnore to:npre- hensire undestanding of this lvoriq see h'ursi*g.'

Zfu ?hilosop\; ttdd Sr,.t,u af Caitzg (:er:ged 2nd

ed.; \\rauon, 2008a). lndrcd, tle latest reseaffh b.lsed on the science of the hean has demon-

strated that the loving hean-centered person is

rirdiatng lole that can be measuled selcral felt

brt cnd themselvcs. ait'eting the subdc cr-rilo:-

marr ofall. llcreorer, this r*srt.rt'h .lifirms thrt rhe hearr is actually sending more mtjssages to

the brain, rather than the otherwy around. !'or mrre inibm:ation, clease I'isit xtrv.heur\'lath .com ; rnr*'.irea:tllarh.org

'lhis rvork pcsits a ur:itao' oneness rvorlC- vierr of connccledness of alll ir emhraces a vr)';e's crplicit noral foundati+a and takes a specilic pos:'jcn rvirh resrcct to thc ccr-tralitv

of huma,'r caring, .c*riras,' acd universa-l lore

as an ethic and ontologr'. It is also a criticsl srilting point for nutsir:g's ex-i.sttnce, broad societal missicn, snd rht basis ibr tlnler advancemer-t i'or ca:rng-hcaLnq practraes Nevertheless, irs use a-nd evolution ale depenJ-

ent on "criti.cal, reiiectivc Fracilces tha; must

be cantinuoush' questi.ned lnd tritiqri'::C !n order to reraain dynamir, flcxible, and end- lessi-v sellrevising and emergent" (Watson,

1996, p. 143J.

Transprrs annl Caring R.e lationsbip

the terms lr*asp ersonal a:ad lt*atferso'lrtl wing; rdetionsiip art foundaticnal t* thc *lrk. Trun:F$lrfi#! totlveYs a co$tcln lbr the ir.tcr life rvorkl and sr:biecive n:eaning of ancther r+.ho is ful1v en:.bodied. ISut the transpersonai alsc energeticallv goes be1'ond the ego self and

bey'old the giren n:romer':t, ruaching to the deeper connections to spirit and rvlth the broader uniyersr. 'lhus, a transpersonal caring rclationship m+vet bevond ego seli ar:d radi- Rtes to sciriaual, even ccsmic, concerns anC ronnectiors ihat raP into healhg pcssibllities md potentials. Transpersonal caring is both imr:*.ne rt. ftrlir- physical and embodled phvs- icalh', rvh,.le rlso paradoxically transcendent, brl.ond physical sel,i.

Transpersona-l t.r.rlng seek to conner:t $lth and embrace the spirit or soul ai the otl:er th:r:ugh thc processes oicaring and htaiing and being in autlientic relation in lhe m,:ment,

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Such a uanspersonaJ rclationship is inBuented

bv the crir.g corsiiousne:s 3nd il:tclltionaliw and rnerget:c prcsencc oithe nurse as she or hc enters into the liiL space or phcnoalenal firld olancitrrer perscn and is abie to detecr the

othe.r person's iondition afbeing {at the soul

or spirit level). It implies a tbtus on the uoi.qutness cf seii and other and the nniqrle- ness of the rnctnenrl wherein the coming to-

eetl-.r: rs n:rurua.l and rcciprocal, each r'rliv in'.bo,li.d ln ihe momenr. rvhjle puadoxic:llr capatrle of uanscerding tht rusnient. open io ngrv p65sibibdes.

'lhc t;ar,sptrsona-l crritas .DnsL-icuqncss r,ucse seek to''see" the splrit-Ii1ltd person be-

hind the satient, behifld the toileague, lieirind

the diseasc or the diagmsis or the bchal'ror or

personalitv one m.lv not like and lonncct rvirh

thar spirit-riilcd -ndir:dua-l rvro exsrs behind

rhe illusion, lhis is healt-centered ca-ritas prac- tice prided b-v the vefl'- firsr caritas process: cul-

tivation nf lovi:rq kindness rnd equanirnin rritl'r seli ar:d other, allou'ing frr development oi-n:ore caring, lote, c*mpassii:n, rnd ,quthes-

ric caring flloments. Transpersonal taring cails for an authentic-

ir,; of being and becoming, an abili*' tc be present to selt and others in a reilectire framc' 'Ihe ranspersanal nulse has &e abJitv tn ctn- ter consciousaess and intentlonaliq' on caling,

healing, and rvholeness, radner than crl disease,

illriesE, and patnolog'. 'I'ranspclsonrl callnq comPeren:ics are tc'

lated tr: ortological developnten: oftht nurse's hurnan caring literac,v tad rva-us of belng and becomiug. 'Ihus, 'ontolcgical cariag con:ne-

tencies" become es cridcal in rhis madel as 'technologlcal curing co*:petencies" t+ the conr.entional alodem, \'Vcstern ftlhfio-cure r:urs:ng-mcdicir.c nrodel, rvhirL is f,c'\+' com- ing to an end.

\\tithin the rnodel *i' transpersonal c arin.g, clinical caritas consciousness is engaged at a

Iburidrrional ethical i*'el for eltry ieto this Iiancrvork '.Lhc nursc aft€3IPis to cnler int+ and stay u'ithin ths other's lrar'c of refcrenc* fbr connetting rtith the inner lii'e rvorld cf rnelnlng and spirit oi the orhcr, 'logr'ther' they ioin in a rnutual searth i"or n:ranillg ald x,hnleres: oibeirg and beco:ning, tl Fottrrtif,ie

con:lbrt measufes, paie colrtrol, a senre *i lvell-bei.rg, r+'holeuess, or eren a spiritual ir*'r- scenden., olsu*^ering. 'lhe pelson is':iewed as

'rvhnie and cc:nplete, regardiess cl il-laese or disease {Wrison, 1996, P. 153).

'. lr "; '

.':t '

'lhe nur:e's moral com:nitrcc[t, intetriiorL]iry',

urd caritas eonsciousness e:<is; tc prottct, en- halce, promote, and potentiale hurnar digniqv, .w'holen*ss, a--rd heali.'rg,"*terein a Persafl crextes

or coitef,i*s his cr her own meaning ibr exis-

tence, heaLing, rl'hc,leness, and lil'ing and dfing'

iLhe nursi's rvill and conscipusnesr a:{irm rhe su$tcdve-sptltual sign,lic*nre of th: per-

sor', u'hi1* s""kt"g to sr:stairr caring in the mrdst

ol ti"rreat and despair-bioiogical, instrzutl+n41,

or otherwise. 'l'his ironors the ]-''fhcu rela- tionship vffsus ar I-lt reiationihip iBtrber, 1rJ311996J.

llhe nurse serks to recognize, accurately de-

tect, and ccnnect t'ifi the inner tonditiol nf spir:r of lnoth.cr th"tough- authcnrlt caritas

iloving) prerencing and being centered in thr caring momeni, Actior.s, words, brhaviors, cognition, bodv language, ftalings' intuition,

ti*ught, scnses, the energ'iie1d, and sc on-411 contribute to lhe transpersonal raring to:rnec-

tion, 'lhe nurse's abiliry io coflnect lvith an- other at tlris rranspersonal spirir-ro-spirit ievel

is transiated !'ia mol'enlents' gestures, licial exlressi:ons, procedures, ini"olmatron, touch,

sound, r'erba.l txcrtssions. ani olhcr scicntfic, technical, csrhetic, *nd human means ofcorn-

n:unj.crtion intD au-rsing human ildscts or intendonal caring-healing modalities,

'Ihe caring-healing mo<lalities r+'iehin the context oi transpersonal trring,/csritas con- sciousness potentiate harr6on)', ri'holeness, a-nd

un!n'ofbeiag bI releasing scn:t ofrhe dishar- monr., the blocked energr lhat interleres wlih the narural healing processes. -l\s a result, the

nurse helps anothel lhrouqh this Process to ac{ess ths heEler rcitldr, in rhe fu]lest sense oi Nightingale s vi.eu-of nu:sing.

Ongoing personal-protissicnal develop- ment rnd spirirual grorvth and personal spiri- tual p:ar-tice a*sist the nurst in entering into this deepe: level of proltssional heajing

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328 :r.,: Li;: 1f ' CruntJ 7h:-crits ab'ili C!'r' 6r CarlrI

practice, rllorvir:g rhe nurse to ax'aken to dre

r."ns:r.rrun;,1 tordition oi ihe rvol]d anJ to rc-

.rrlizc nlorc fullv'on:oiogical co mpetcnctcs" necessary *br tlts ievel of advanced practice oi'

nursing. Valuable teathers for rhis rl'ork include

the nuise's oivt liib history rnd prerious expe-

riences. rvhictr provlde opparron'ities ibr i'c'-

cuse,l ;tr:dies, aithe nurse has livcd through or

ex?erirnced various humgr conditions ald has

knagincd othcrs' tiellags tn vsrious circ'lm-

stances. l'o some degree, the necessary knoll'l- clsc and ccnsciousntss car bl gahcd 'Srough ,toik.orth other cuirures :rJ -Jrt smJl' oi r}'e humaniries {trr, drama, }iterarure, personal story, nar-ratives of illness iourne,vsJ along with

an emlorarior, of onc's orv:: valuts decp bclets'

rclrtionshio t'ith seli and otircrs, ard one's rrorld. OtLr iacrlitators include personal- grovlth &{Periences such as ps1'chotherapl', ir*.p"rronrl p*.hologv' n'reditation, bioener- getics ll'ork, and othtr modek ibr spirlrual arvakeninS4, Coadnuous growth is ongoing for

delclcping and rnao:ring withir' a fiansFcr- son*l car:ng rnodel''lhe notion ofheal'$ pro-

fcssio:rals as lvoulCed hea.lers is acknorriedgeJ

as part oithe nccessaq'grclrth an'l corrlpassioa

ralled finh wirhin this theo4lphilosopht'

C *ing lll ameatl{ a ring A r cw i a rt -A caring octasion occurs rthenever the r'urse

and another ccme mgedler with th€ir unique

ilfe historits and phencnenal lields in a huma:r-t*r-hurnan fransacdon.'lhe conring to-

gethcr in l given momcnt becon:es a lbcal point in space arrd dme' lt becomes trans'en- ient, uherebv experience and prrception take

place. but t}:e aciual caring occasion h*s a

greater field of its own' in a given monrent' tih* pr*.*rt goes b*1'c,nd itseifvet arlser-iiorn aspcits of itselrthrt bccor'lc aart oirhe Ilic h:l-

ton'oieach person, a! u"cll a" pan ci r large:' morc complc< panern ollii'e iWttsor, i985' p, 59; 1996, p. 157).

:\ carinq r:roment invohes an action and a choice bv both the nulse and the othel''Ihe mument of com.ing togethe! Fresetrt: thE twa

rvith the oppomrniry' to decldt horv to be in

thr mor:reni in *re reiatiortship-rvhat to do with arrd ir: tLe molrltnt. If thc caring mc'ment is tr,r.nspersotal, each leels a connection wlth

tlre cther at rhe sFiril le!'el; thus, the flcrnent

:ranscends tin:c anJ spacc. opcring no ncrr

:ossibiliues for hcaling r.d hurnar' connecdon

"t , d...l.t lcvcl rhan that o: phtsirrl intcrac

tion. !'or examPle:

ir't,e iel,- :i.-1r" ir:4 i-tll * 'l"r I L'ci '-ir:' ii

lie'-1,,,,1; u-,:ti'-El * il- ';"er: l -dir"-l I -' r cllilrr

ra! - :,!1r31'rEe ll't 'r'= r]li g;rrr 1'lrr I :s l-

l. :,.r'::!= '-::clrr: \:,:,' ;:'-- ! tsJ:'"

l*eil. I : ,rri',c':ul-11'e l',. I cr, ,e t '''nl+ l;';rrr t'-'

:!L-:J -".J- ):'jc) !i' : r '++)1 'a q

tur aDr:i-rtr_ !r_l' 1" a:r't ili;ill r*'i_Lil:l i+ i f '

oh='"-r"ir*'rcrai tlt!l ,1 ,1r;3;' it'r'r65;-. 1i3'!

;rJ. )Ii-l-lLll

C artng {H ealingJ Consnarmen

the tlynaraie oi ranspersnnal carirg {heating) *'irhin a cating morccnt is nanifest in a 6e1d

nf consciousness''1he ua:.lsperst:nal dirnen- sions of a caring rnonreni are affetted bv the

nuise's consciousness in the carir.g 3lomentr s.hich in turn afects the held of the rvhole' 'Ihe role of consciousness with respect to a holographic vieu' of science has been discussed

ir earlier r.rLtings (Watson, i99?, p. 148) and irciudes the follo*'h:g Points:

. lhe wholc cring-hcaling-loving con- sciousness is tontailed lrithin a single {:arinA molntnt.

. the one crrirrg and the ont: being cared ior s're lnterconnected; tht caring-healinq orocess is r'onnected w'i!h fre orher irumanis) and *'ith the higher energv of rhe u nir.erse.

' 1he cuiag-healiag-loviag constiousness ri the nurs* is communicated to the snt bel"rg r'ared f'or.

' Cadng-hezlir:g'-1ovil:g conscioustress exisis throufh and transcends tlme and space and can tre domitant oxr phlsical dimensions'

Within this contexr, it is ach:orvledgeJ tlut the process is relational and connected- lt tranicends t!me, sFate, and phlsicalig'' Ihe process i.s ittersribiective with trsnscendtnt oossibrlities rhar go belund the glrret caring momen!.

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Crrrt,rr-t 1E',Iear Hra!;arli 7h**tJ'Iltmtn Ccrrrry 3?9

beilgs tral'rng * hurnan experietrcei' Such

thitkirg in regard to ths philcsophical. question .* g.rid* cne's rrorlduieu' and helo to clarili'u'here one maf iocate self'

lvirhin the taring frarnervork. . r\re thost lnteracting and engaging in the

mcdel lnterested in the jr cwn pcrsonal

evcludoni.{re they cor.lfiified to sceking

authentic tonnectiotre rnd carir:g-irealr'rg

relationships with self and otirers? . ;\re those Lq1'olved "conscious" oftlieir

cari:q rrrr;tru o: noncar:ng consciousncst

and intentionally.n a gllen mofllent at an

individual and a systeraic leveli :\-re they

interested and commifted to e-xprndir:g

tleir iaring consc,lousness and acdons to self, otler. envircntnenr, nature, and *'ider u niverse?

' r\re those working *{thin t}re rnodel inter- rsted ic shiftinq their ioms from a moderr' :nedlcal. scic r.ci' -tcchncc':rc o ;ie nmrion

!o a ttuc heart-centered authcnric tr'ring- heal!ng-loving nodeli

'I'his i,r'ork, in both its crigiaal and eqolv-

i::g ibrn-.s, serks ro devtlop;aring as rn *ntological-epistemological l'oundadon for a

ti"re oreical-philoscp hicai-ethic*l frun"ework for tht professic'n and discipline nf nursiag and to ciarii, its marure rciationshlp and dis-

tinct intersection lyith other health sciencer' Nursing caring thclrl'-based activities r: guides to Prxctice, eCucation, and research ilave do'eloptd ihroughour the L'nited States

and other parts oi the *'orld. 'fhe crringl caritas rnodel is consistentl.v* one ol thc nuls- lng caring theories used as a guide in '!l*gnet Ilospitals in the Llnited States and foucd to bc cuiturr.[t'e onsisrent rtith nuning in manv other cultures, nitlons, atrd counttes Nu:se's' reilective-c;ltica1 practice models are incrcas-

inglr adhering tc, a taring ethic aad ethos as the moral rnd scientt iic foundation for r pro-

fession rhat is comlng of age fbr * neru globai

era rn htman histcry.

Latest DeweloPmends 'lhe Watson Caring Scicnce -hsrrtute iWCSI) rvas established:n 20C7 as a nonprofit ibunda-

ticn. 'Ihe tbllo*'ir,e sif,tements deiine and

Inplitatiorts of the Cart*g *fadel 'lhe caring mcdel or theory can be considered a

pi:ilcsop*ca1 aqd n:oraVethicd fou:datior: lbr

rrcfessinnaL nursing and :s part of tire central

ib.., f*, nursing at the dis':iplinalv lerel' -A' model ol'cariag inclu,Jes a ca-11Icr both aft and

science, 1t oferi; a trarnework that es.ibrates and

interiiects n'ith art, sciencs' hucranities, spirit":-

aJ.iq, urd r:e*' dinens.i.ots af mind-bodr'-splnt medicine and nusing erok'ing cpedy as central

to human phenor,eaa olnursing practice'

1 empharize thar it is possihle to read, srudl',

learn about, ald el'en teath and research' the L-aring rlieo{/, I.iolreler' to rruh''get ii," oEe 1r", ro e*p..i*n.e i: personalll''. 'lhe modtl is troth an inrstation and an opporti:*ilr to iattr- act *ith the idtas, to exPcriment lvith and qroru rvirhir- thc philosoohl', ,md to Lil'e ir our

ir rn.', p.,,or.l md professional lirts'

Appfication$ of tfir Theory 'Ihe ideas as originallv develcped, as l.lell as in

rhe current evolvirig phase iWatson, 1979,

1985, 1t99, 2003, 3005, 2008, 101 1), p;otidt us *'ith a chance to tssess, cr|tiqre, end see lvhere or holv, or ei'en i.i rr-e may locatc our-

selves w.ithin a fi-r.rnervcrrk of caring sciencer'

caritas as a basis ibr thrt emerging ideas in re-

lstior to our own tlreories and philosophies of pr,riessional nursing an#or caring cractice' Ii L)nr:h,oo!es ro usc tht caring-sc:encc PrrsPC'- tive as theory. rnodel' philosophy, ethic, ar

Bthos ibr trafl;forming selfand oractice' tr seli and s-vsten:, the followi-ng quesdons may help

{Watson, 1996, p. 161):

. 1.r t-,rere conqruence irettten the values and rnajor conteFts and belicfs in the modcl and

r::t givcn nujse. group, svsrern, orgarlzation,

.*ri.ulr*, popularion needs, clinicel ad- mir{srratrve sertlEg, or other r:rtiw thlt i5 considerinq interacting lrith the raring r:rodcl to uanslbrm and/or inrprole pracrir*?

" \\Ihat is lne's t-iel'; of "hunan"] llnd what does it mean to be hln:an, caring, hea1lng, becorning, growing, tra.nsforming, and so

rni !'or emmpie, in the rvords oi"I'ei1h*rd Ce Chrdin ii'959): ",Le rve humans havinq a :piritual ex*erience, or are lve spirirual

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330 S,L r.. :i' C:pni'll;t+s abiui CtvorCt'in;

dcscribe the go*ls, n:issions, and purposes oi rhe Intern'ltional Carrtas Consortium (ICC)

and the WCSI as in'o interreiated entities' 'Ihe general gcals and objectirts olthe \VCSI

are to ster,,'ard ald sen-e the ICC !n ix actrvi- ties rnd mort sPccilical\- tc:

' 'lranslbrm the domi.::rant rnodel of medical siience iD a rnsdel afcarl'1g scienre bv

reiniroducing tht cthic oi carinq and lovt, necessary icr healing.

. tr)eepen the authenri.c caring-healirrg rela-

tionships berucen practitiener and patieat

to restore lcve aRd heart-renaerfld hlman cornpas;ion as the ethical lbundation of hedth care.

''l'ranslatt the nlodel of tarinS-healingr cariias into niore s1.stenlatic pnrgrams and

sen,ices to help ranslb,rm health rare nne

nurse, one Pra$ltioner' one edutator, and

ane sl*tem at a ti-'ne.

' [rsure catng and healing lor the public, reduce aurse turnover, and decrease costs

to the sYst€ll'l.

Intsrnation al C aritas Coru a rtium Chart* "Ihe main purposes ofthe uotblding and emerg-

ing iCC i\\ratson.200Ba, cp.278-28il) are rs tbllorvs:

L 'lo explore d.ilerse'ways to bring the caring theary tn lit'e in academic aoC c1h-ca} prac-

tice sefiings by supporting and learning

i'rcrn each other

?. 1'cr share know'Iedge and experiences so that rve might heip glide stlf and others in

the journev to live the carlng philosophv

and theorr in oul personrl and prci'essiona) liles.

The consortium gat:,erings, spnnsored b1'

slstems lmplementing ctting theorl i::: praedce:

' Provide arl intimate lbrum to rens*', re- slore, rnd deepen each persnn's and e*cl: g1:te m's comrrllment and autirer'.tlc prac-

tices ofhurnal cui*g in thek personaU proiissional life and rvork.

' Learn lrom each other thtough shared v'ark ol original scholarship, diverse forn:s cf car-

ing inquiry, and modeling of caring-healing ^ -- ^ri --"Pr4L(iLLr.

No part of this book may be reproduced or transmitted

. Ilentc,r :elf and others in using and exterrrl-

ing the theor,r ofhurtan caring to rrrns- ibr:n edulailon and cLnrcal practices'

. Derclop and d.issen:inate caring science

madels of clioicrl scholarship and prc'tis-

sionaL extel.lence il the various serdngs in the $'ocid,

. Frovide a safe {orunr to explore, create, a"nd

renet'sek- and systen'r through reflecrbc

dme out, . Shre idea.s, Lnspire eacl other, and learn

together. . Prticipate in use of aopreriadr"e inqr-rir.r' in

*'hich carh member is itri-litative of earh other's +r'arlg each participant lcarning irom

others.

' Create opporruaie.e'c t'or orlginal scholar- sh:p and nc+ m<;dels oicanng scitnce-

brsetl ciinica1 and educrtional Pra€ti'es . Ccner.qte and shue multisite projects in

carinq theony'taring s,:ienre schol irrsl-'ip . r*err,l,ork tbr educationa,l and ptofessi*nal

nlrdrls oi advancing raring-healing practices and tran*ibrmative rnodels sf nursing.

' Share unique experiecces ibr authenti': self- grcwth ruitl'jn rhc caring slience cor.tsti'

' Iiducate, implen':ent, and disseminate rxemplr;r'expriences and findlnqs tc broader proiessional audiences thraugh

scholarly publications, research, and

formaL presentatioos. . Iinvision nerv possibiiities for transforming

nursitg rnd healtit care.

Because ofthe nrfln1'national and interna- ticnal de'e1+pn'rents ald sinctre desire i'or anthenti{ change. ntrr *roiects using caring science, car.ita* theorr', ard the phllosophr' of hunrm caring ue now undem-av in many slntems.

-ihe WCSI and the lCC are examples

of indiliduals and representatives of svsterns comening (in these cases' once a year) to drrepen and sustaln rvhat is reierred ta as caritas

nuriing-that is, bringing cr.ring and iovt a:-rd ireart-centereql hun',an-to-human pracdces

back l:iro our personal lili and rrork rvorid ftVetsou.2008a)'

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Curing ktdir ttars anel Frograms

Although these earliel-named sYstems are

i<lentified as sPonsors of the elowiog ICC, ex-

ampies olir*r rhese sl'stems sre irnplementing th" th"ory *te capmred tluoueh identified acts

and prrrcsses depicurg suL-h t''n\ibrmatllt rhanges.

Caring theon-in-action reflects transi'or-

nra-it'e oroccsscs ti',at re reoresentatil'c of r'c- tions taking plare in many oi the svstems in the ,lCC and othe: systems guided by caring

sricnce afld caring thcow. thc lbllowing are extmples of such caxng-in-artion inditaisrs:

. Makc human caring integral ta the organi-

s.atiolral visi.on and culture through neu'

Ianguage md Corumentatitn oi' caring, such as posters'

. lntroduie and name new proiessional c*;-

:ne pra!riac modeis. lcading to neu'Pafierns

ortd.lit.-'of lamglcrrc le 'g" trttcnding Caring iusing Project, Paient Care !acilitator Ro1e, the i2-Bed liospital)'

' Create conscicus intentional meaningiirl riruals-for ex*rnple. hand rrashinq ls ibr lI1iictlon cDntrol but iniT also be a rnean- ingfr:1 ritual oi seJf-caring<nergetlcall,v cleansing, blessi.ng' a,qd reltrasing the last

siruation o, encounter' and being open to

the fiext siruation' . Selectircly u:e olcriag-heiling modalides

r'or seliacd patients (e,q.. rnass&ge' theta-

peutic touch, re$.etoiop', alom.tth'erapv,

calmative esser:tial oils' sound. r:rusic, arts,

r r:rit.,"* tf energetit rn+dalities)' ' lJim the unir lights and have designated

"quier dme" tor paticnts, f'ar.iilies, snd stafi'

,Iik" ro ,ott"n, sJow dolvn' and calm the envkonment'

. Crertc hcaling spaces for nu:stc<ancr:aries ibr thsir o$'n time out; this may inrlude

meditadon or relaxation rooms ibr quiet

time. t Cukivate oee's otvn spiritual heaft-centered

plartices,:f lol'r.rg klndness and equar{ntity ro seli and c;hers,

. lntentlonally pause aad brerrire' creparing the seL to be presen: bcfore cntering paient's rocm.

' Use.entetng exettises and :lindialless pracikes, individuallv ald collect*e1,v.

'Place rnagnets +:n patieat's door wlth

posial'e iifirmations ald reminders nf

caring proctices"

' I-xplcre documciltati$n of caring lang'rage and inregraticn in cornputerized documen-

tation slstems"

' Participate in mriltisite rcsearch assessing raring are*ng staf;'an'i P{tients'

' C.eaL h*aling *nvironmtnts, arrending tc the subtlc enritonrntrt cr caritas lieid'

. 1)isolay healing ot{ects, stones, or a blessing

basket. . Crcatc Caritas Crclci to 'hare

caring

ItrOmenI5,

" PeCorm Carine Rouads at bttlside rvith

natirats. . interries' a.'rd sehct staff on lhe brsir of a

"crring" oritnt*lion, ,{sking tandidares to

describe a "ca:ing monent." . l)evelop of "caring cornpetencies" usrng

caritas literacy as 6l:ide to assess and pro-

more stdfdeveloprnent and ensure cuing'

'lhcse and o?hcl oraiticcs are otcr.trr:ng ir a ','a:iery ofhospital: across tLe Lir:ired Statts,

sften in I'lagnet hospitals or those seekinE i\{.agnet rttognition, where ca-ring theory aad rnoJels ofhutrr"n caring are uecd to ransi'*rrn

nr-rsing and heaith care icr slal1 and patients *like,

'Ilte nme: of oth* health-cm clinicai and educational s,vstems iniorporatitg caring rhrory inro professional nursing practice mad-

els {rnanr. are }{agncr hospitils or preparlng to become :{agnet hospitals) can be ibund f,.t rl$rl,.watsorrrringscie nce'org.

These idenrilied s1'stem examples are ex- enplars of the changing momentum today anj are guided by a shiti torvard an n'olvtd ronsciousness. 1'hey rei,v on rnorrl, ethital, pkiiosrphicrl, ar:d theortdtai ibundation: to

,*rrorc Lrurr,t"r: caririg and healinq and irealtt in a ltttm tlat has Eone ffitra1-:ducationallt', ecocomical]r, clinicallv' and sociallt" This shiii is in a hopeful di-rtcri,:n and is based Dft a grassroois rransfornratlon of rrursing,

ane that e$lerging iiom the inside out' The ded.itzted lcaders who are usherilg in these cha:rgcs sen e as m lnspiraricn ror sustaining nursing and human caring ior pract.itionerr and patients aiike.

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33: !,r ( r,irr]. \I ' Cratti Th:griet ab;rl Cem or Cartrg

Candasion Consrstent s'ith the uisdom and l'ision of !'to-

renre Nightingale , nursine ).s a lii'edme journe)"

ri caring and healing, seeking to undersrrnd ard prt,erve ihe u'holcncss of l:ur:ran aisftnce

across time and space anti naticnaVgelgraphic

boundaries, to ,r#er heart-cettereC compas-

sionate., inibrmed kn*vlcdgcable Lurnrn car-

lng to societv and hunankind' 'Ihis ;tmeless vie*' of nursing transcends conventionsl minds

and mindsets of illness, pathologi', and &sease

thrl rre io;rtcd ir thc nhlsrcri body rriih clr- i;:g as en<i goat, oiien at qll cost!, In nursing's tineless nodel, caring, liadness, love, and hean-ce:itercd compa:slonate sen'ice to hu- rna:rkind are restortd.'1hc unin'ing iocus and

process is on connertedness *'ith selI, other, nature, and God.lthe l-ii'e Forcer'the ;\bsolute'

lhis vision and rvisdom is being reignited tod.rr throu8h a blend ofcld and nerv values. ethics, and theories and practices of hurnaa calng and healing.

-Ihese caritas consciou:ncss

prf,rtices Fresen/s hurnanirr, human dignirl*,

and t'holeness and are tl',e I'erv i'oundailan oi truns:brn':ed rhinking and actjor-s,

Such a values-6uided .relational ontologY

and expa-tded epistemologr and ethic is em-

bod.ied in rar.ing science as the dlsciplina4' gror:nd for nursing, nox'and in the future.

'Ihe

adr.ancement of nursing theory, u'hich in- cludes both ideals and Practital guidarct, :.s

w*ffffi&ffifrffiffif Pra*irc Exrrnplar bY Ttry l{ oa d vs a rd, fti4 r}f SiJ. October 2002 presented the opporn:ni4 lor i 7 interdisriplinalv healrh-tare professionils ar tht Children': Ilospltal in llenver, Cci- ,:rado, ro parriciFate in a pilot srudy designed to {il up}ore r}re eflect of iategrating rariog theory into cornprshensive pediaric pain marigemeni and [2) exrminc the Atending Surse Cuing Mcdel' (-'\SCn't) u a cue de- lire1u nodel t'or hospitalized cir.ildren in paia. t\ 3-dry retrear laurched the pilot srudr-, Par- dcipmts rttrc rnvited to cxplorc transpersonal hume-n caring thrsry icaring theory) as taught

increasing$- evident as r:ursi-ng makcs its m*jor

conrributisn to heal'.h tart and matures as a di:tinct cadng- hcalir-g proicssion<ne '.hrt

balances anti complenrcnts cr:nventional, nledical-instlrutional pmctices and processes'

Ner-ertheless, much lvork.rema-ins to be done'

i\ew transformative, human-sFirit-inspircd approacb.es are requ:red to rel'erse i*stitutional

,uti svstern Ltrhargl' .lr':d dalkless. 'l"o treat* *rc necessar! cultural change, the human spirlt

has to be invited back into our health-care slt- terns. Professional and pelsonai models are re-

quired that open t're heans of nuses and oihcr

iracritioners. Ne*' horizons of possibilltits ir"r., to b" explored to (reate spice luhereb.r.- rompassionatt, iflt*nliunal' hexri-ccfltered human raring cen be practicrd, Such autiren-ic

persor*J/proilssional practice modelr of caring

i.i"n.* ,iu capable of leading us, locallv and gioLaJlrl', torva;d a moral commudt! of caririg'

this commumtvwill re:tore herll,'rg and health ai a 1e.v*1 that honors and sust*ins the digniq'

and hummiq'of prectltiotre$ md padents:11ke' the \Vatsan Lla:inE Scrence lartit'':te is

dedicated to create, contluct, arrd sponsor C arinq Scic rcci C aritas r:du.' rtion, trai r.ing, and support m sefl'e tire current and futurs

Eenerations of hcalth-care prciessionals giob-

,1iy {rr*'.rt*.toocaringscience'org; \UC S1' 4405 ;\rapahoe .'\venue, Suite 100" lloulder,

co 80303).

ald modeled bv Dr. Jean Watsan, tiuough ex- periential inieraclions x'ith caring-healing r:rioda"lities. fhe end clithe retreat opened op- poltunirics i'or Particltants ro nrergt :arir'g thcon' *r.d peit theorv into an crncrging caring-healine prrtis.

Rerurning frorn the rrtreat ts the preexist- ing schedules, custon:s, and hahits ol hospitd routine nas both daunting and exciting. We

hrd lived carlng theory'. ald nor rs a ren:ote arrd r.bstract philosophical ideal; rather, *'e h,ad experienced caring as the '.'e.ry core ofr:ur true srlver, rnd it was th.qt call that had led us into the health-carc professions, -lnrigorated

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F?ffE{iBE lg&'l #k r'.s{lt. by thc rercat, we returned to our 37-bed acute

care inparient pediatric unit' tager to apph' crrinq :htoq' to :TFllovc ;:edretric :ain n::n- rFen1ent, Oar experiences thrcughout the rt- i."t h"d acccnruaed taring as our core qalue- fiaring the*rt'could not be restr;cted to a singl.e rrea of Practice.

Whecler and CHnn {1991) deEne pn-xls as

"valu*s nrarle risibie rhrough deliberate actiol'1"

(p, 2). lhs definition unitcs the ontologu, or the essenre, of nulsing to nursiiS xc:iofls,

to s,har nurses do" Nursing r','itlut.r a[ute cxff

u:padcnt hospital settiflgs is practiced depend-

enth-, c*ilaboratirelv, and ildependenth' itscinardo, 1998). Bsnardc destribed dcrrer.id-

ert plxcd.ce as energl'directed by md requiring

physicis-n ordtrs, collaborarire practice as in- terd*pen*lentenerg;'.'-.dircctedto*'ardactil'ities wi* Lther health-care proiessiorrais, and inde- prndcnr practicc as "thtre thr nea'ringi'.t1 role and impicr olnursing rnal'euolre" (P. a3)' Our

l'isica of nursing practice r+'as based in rht '-ar- lng pa:adi.grn of decp resPeci tbr hums*nirv a.'ld

a11liii, olwonder and ag'e oiiife's m1ttery, end

the interconnectedness liorn mind-body-<oirit uniq-- into ccrmlc oneness (Wrtson, 1996)' Crdorv {1995} described nursing as a lived worid ol interdependencr and shared knc*'}- edge, rathe: than as a s*rvice prorided. Caring

praxis lvithin this lived x'ollC is a pra-ris rhat Lttb.r *, combinaticn of actian and refiection . , . pra,trs is about a rel*tionship r+'ith seLt, *-r:d

e relationship q'ith the *'ider cornmuniq" (Fennv tk Wareiorv, 1999, p. i60]. Caring pr&uri, thcrct-ore, is collaborarive praxis.

ColLaboration and cocreation are kev ele-

ments in o,r endeavors to uanslatc caring the- on' lnto practice. 'Iher rereal thc lonline*i process and relaticnal aspect ofcaring praris. Eoth require cpenness to unk-'rou'n pcssibih-

tjes, both honor the unique rontribudons of seli r..rd othtr{s), and borh acknou'1cdge grn$,th and tansfumation as inhertnt to lje r:perience. 'lh.ese key elen:ents suPPort ahe

*r,olutioli oi pra-xis away irom predr:iermtoed

private use only. No part ofthis book ma1'be reproduced or transmitted

Cr rri't:r-r 18 'Jtati [I'*l:tt's T-tcry ty'illutxan C'arir'4 333

a.nd set outcomes ton'a-rd aufrentic *r.ing- expres:ions.'Ihrough collab+ration and

cDcrearion, rre can build +r: existing f'ounda-

tioos ro fluriure el'olutio:r fron: what is tct what

cm be. Our rnission-ta translate carlnx theorr

into prms-had strong ibundational support' JJur1Jine on r:i; supporthl base. rve comr'it' ted or:r iltendons anC energics torsard creat- ing a caring culture. 'l'hc fo1loq'ir:s is cot intended as ir algaritnm to guide one threugh raried steps untiJ caring is achieved t'ut is rather a dcscription oi our ongoing Froccsses rr:d grollth tcilrard an ever-evc'lving caring pr*tis. 'Ihese pfocesscs are cccref,rions that

emcrgeci liom collaboration rvith oir:er :L\ CI'l participimts, fel}ow health profes:iora1s, pr-

ii*ntr "rrd

i'ami1lei, o'.:r envkonnteea, a"nd our

.arinE intefltions.

First Steps (Jnr of our first challenges *'as to rnake the ,\NCi\{ vrsible. SLx tangible e-xhil'ia uere dis- play'eC or thr urit as cvidence o[ou] conrir- ment ro crr|lg value s, First' a lalge, colorirl posrer titled' C,'\RlN G" rras positianed at rhe

eflrrarce to cur unit. Depicting picr'ires of di-

vesse fa:rri.Les at the rentel, the Poster rlates our

three in:tial qoals for thear-guided practice:

{1) *eare canng-healing envircnrner:rs, (2) op-

dmize pain rnrnsgernent through oharmacc- logical and caring-healinq neasures, and

{3f prepa:e ciildrer and iimilies l-or procedures nnd intc*'entions' Watson's clnica1 caritas

Frocess€s \vere Listed, as well as ur rbbrevisted tersion olher gu-ideLnes ib: culrivating caring-

heriing tluoughout the da.v (\Vatson, 20ff2)'

this poster. rrtirten in taring thtory lang';age, expresscd our intention to all and reminded us

tl',at cring is thc corc oiour pruir' 5econd, a shallorv boul oismcotn, .roundeC

river stones uns located in a pron:.inent pori- tion at each nursing desk. A sign postcd by'the stor:es idenrlfied ;hem a:

*Caring-lleaiing

'l'ouch Stones,'' lnviling cae to selelt a stDne as "everr'' human heing has the abiliry to share

their increditrie grft of loving-healing'lhese srones sea-t as a rcminJcr oi o'':; io.parin' -o

love and heal, Pick up a stane, ieel its srnooth

Ctt:!r*t'!

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134 !r.c.i -rr: \: ' Cranti 'ILetries sActi Ctrt or Caritg

f r?}$i{:E gxffi !si&# c$r.sl

cool sudrace, let irs rverght rem.rnd lou cl,votx orvn gitts of love *-qd heallng, Share in '&e love

and healing ofali who hare louchcd rhi: ston*

beibre,vou and pass on 1'ou.r lore and hta-ling

io all who l*'rl1 hold d:is stone after -v61.' "ihird, latched wicker blcssing liasksts ltere

placed a,lriacent to the catlng-healing touch .ton"r. Wrimen instructj.ons irvited ihmilles, l'isitors. and smft- to oft+r names for a blessing

by lvriting the person's initials on a slip oi paper and placing the paper in the basket' Iivery,\Icnda-r through !'ridav, the unit chap-

lain, hoiistic clinical nurse sPecialist (CXS),

and interested stafi devoted 30 minutes of n:editrdrz slenr:e lltthin a healing space to ask ibr peacc and hope lbr all narnes containtd within the baskets,

fourth, signs prcnrring 3 'nJDzing caitoon- snled tiger were posted on erch padenCs door

announcing "Qriet'fin:e." C[iiet time x'as a rniCday, hali:hour p.ruse from hospital hustie-

bustle, Lights in the hall wers dimmed, r'oices

hushed, and stets softened to allow a pau:e tbr

reil-ec;ion. St.rfi' ruen:bers tried not tG cntar padent toorns unless summoned.

l'ilth, a baoklet was written a-qd published to lvel.corne iirniiies and padenrs to o',rr unit, to introduce health tea.m n'Iernbarsl unit rou-

tines, arxilable actlfities, aad deiine iiequently used medical terms. 'Ihis book ernphasized rhat patients, patrnts, ard iamiliel are men:- bers ofthe health team. A descr:pti+r oia"r carirq afiending teafii was also included.

Sixrh and mosi recettlt, the unit chaplain, ch,ld-iife speciallst, and sociai worker or;1an-

iad a *eekly support sessinn called "Coo*es and Ca:hering,' oliered et'ery Lhurs,lay morn-

ing. It *'as held in our hea-ling room-a con- iirence room paintcd to resemble a c*ry ro':m ltirh a herutiful outdoor vierv acd re<iecorated rtth romfortable armchaks, soft Lighting, and phnts. Goodies and Gathering urtended a sa-t'e

retrert laiihin the hospital scr.ing. O{lering ! rour to pa:e*ts lrnd another to staif, these proiessionals prolided snacia to ieed the bod,v,

a sacred space to nourish tsmodonst and theu ruing prcsence to nuttJte the spkit.

A* ending C a in g'f *m (,iI CT) "fc honor the collabcratil'e p*rtnership ol our ANC;\{ FarticiFants, to inr-iude Paticnts a$d t'arnilies as equal patnert in the health-trre team, a:rd to oprn participation to all' se ad*pted the namc r\*cndinq Caring'feam (;\C'I).'lhc acromrc AC'tr'reinforces that our actions are opForrunities to make caring I'isi-

ble. Cue as the cort tf pruis difers iiom the cenraiitv of cure Lt the medical mcdel. llb de- scribe our i:rttndons tc ofhers, we cotrpiled the ibllorving "elerator" dtscription of ,'lC'l',

a terse, 30-second summa4'that rendered fre meanr.rg oIACT in the tinre:imre .:f a shared ele.l'ator ridc:

The are oJ t fu A t t endhg Caing Tun ltl CT) k caiag-$ealing far fetients, families, and oal;,ei'les. ACT toreales relationthips aad col-

la&orativ e prat tit es bet't:xet paliettts, families aad he*lth mn pmvid*s. ACT pratrtrc enables health eart fraaid*t ta redefnc themseltxs at caregiten rather !llaf, larkfirasters. l$'e /mt'idc Health Care not Hslth Tasfts.

Lrrge signs r,rele professionalll' produced ar-J hurg at rzr'trus lccations on ortr unit. 'Ihese signs se*ed a dual purpose.'Ihe largest,

posted conspicuouslr- at ou-r threshold, identl-

fied our unit as the hoa-re *{ the Attending Caring'1'eanr. Smaller signs, posted at eacli

nume's italiDn, spelltd out tht ablve -rtC'1' definirion, inl'iting eler,r'one ente-ring our un.it

to participate in the tollaboratire cccrtation of rring-heali.ng.

Giving ourseives a name and mrking our caring intendoas risible contritruted tq estab-

Lishi-ng a.n rdendlv, 1r:i n:ay be perceived as pe-

rlphtral arrivities. l'or these expressions tc be d*lib*rat. act:ons of praliis, the centlalin' of crring as out cort v,Llue tras ciearlv artirulated, Caring theory is the flexible iiame.*r:rk guid- ing our unit goals and unit education and has lree ri in*gratcd into our impltrnentation ci 3l'! institudoral custttrner- se*'ice initiative.

Unit goals are rtritten 1'ead1'. Htflective of the broadcr instirutional mission statemcni. eacL unlt is encou-raged tn develop a n:ission

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C r rrr.t'-rr 18' Je*r W*t:sn\ 7hrcry t{ I lunat Cariag 335

Pmlstir"r g1{*I31i# ffi l$. statement and outline go*! derigncd ta schicve that n:ission. ln 2003, our rnilsion statcrr.ent 1vi.r ff1srlfltn to tbcu" or provision

cl'qualrr,r ,'ir:ril1 cmtettd rcr4 defined as 'rn envlrofiment ol caring-healing recognizing farnilie: as equrl panncrs !n collaboratitn v"'ith

all hea1th care providers.t' One of rhe goals to

achieve this mission literally spelled out rariaS'

We promote a taring-healing em'ironment lor

pat!ents, iaariLes, and staff thrcugh:

' Conrpassion, conrPetcncer comnirment 'Adrocaq' . Respect, research 'Individualiry . lri urturing . Generosirt

Edueafian Llnit cducational ofrbrings rvere also r*'ised to

reilecr cr.ring thear-v, Phase classes, a !-Yerr curriculum olserlal seminars dcsigned to sup-

pofi nerv hires iri their c1inica1, etiucational, and proiessional gronth, norr isclude a unit or', ,*lt'-"*r" to Prosote personal healing and supporr scif-gro*th.'lhe unit on pain man-- .g**.nt r+'as er<panded tc, include use of cari ng'-healing modalities. i nelv interactiue session on the crritas processes 'a'as added that

;Lsla paniripants to lefl.ect on how these Frocessc,s are airead.Y evidcnt in &eu pra-li: and t,: explore 1!'tys they cen deepen caling

praris both indiuidually and collectircl;., as a

u:rit. the traclcing rooi used to assess a fltle cmplo-ver's : rogrcss thrcugh orien tation ntnv

lncludcs ln arta ior rele.tion on growing -n caring competencies. In addidon to changes in phase classes, intbrmal 'clock hours" r,t'ere of-

fered r:ranthlv. Clock hours are des|qned to re-

spond to the immeCiate needs ol rhe unit and

encompass a diretse rilnge of topics, irorn con-

flict resolution, delriefing riter spec.ilic *-ents,

aed proiessional development, to heahh ue'1t-

ment plans, phrsiolaglr of medical diagnosis, and ln-sen'ices on nerv rechnoir:gies and pltar-

macclog.cal intervendons. Oilired on tLe unit at r.ar-r'ing hows to accon:modate all rvork

shitts. clock hours provide a rvay tbr stafl' mestbers to iuEill rontinuing educa;ional requireme nts during u'orkdavs.

Castamer Srr.rtirc to Covmantal

ln the pr*ctice oihur:ran ca:ing as a ibrm*l theory anC prartire model, there i: a philo- sophlrcal shrfr frofi-: f, customer-sen'ice mindset

to vlen'ir.q nursing and humar, tarjng, as a (ovenant *'ith humanity to sustain human caring in the uor"ld.

Within this exemplar, carlog tlecrv has provi.ded depth to an institutional i-'Iitiarive to

use FISII phrloscpht to cnhance :ultorcr sentce (Lundin, Paul, 8c Chrlstensen, 200!).

L:rported lrom the Pike Place l'!sh trfarket in

Scanle, l lSI l aduccaie s tbur prenrists to im- proue emoloree and cuslomer Barisi&ction: presen.e, make their da1', play, and choose your attirude. Briefly summarized, I'lSIl ad- vocrtes that t'hen employees bring their irl1 a$,areness through presence, i'ccus on cus- toftrers to mtke their day, invoke iun into rie da1'thro'rgh appropriate piay, and througl'.

conscious awrreress chr:cse their attirude. work rnvironmeott improl'e lor all' \{hen the lbur F 1SI I premises are viewed iion: rie per- spectil'e cl transpersonal carilg, the,v became oppr:rnrnities fo.r authenuc human-to-h.uman

connectedness th-rough l-Thou relationsl,ips. the n:erger ot' carir:g t}:.i:or1' rrith flSll pi*losoph-v has lnspired the lbllcri-ing acrivi-

ties. r\ paradc cornpo:ed oi parients, their iir,:i.iies, nurses, and solunteers-complere rvith marchrng music, hats, streafi]ers' 3ags, and noisemakers-ir celebrartd t*'o to tt'^ree times a week just before the pLat'room closes

for Iunc]-.. 'lhis fla:nbotant d:spiav iasts less then -i ninutes trut itvigorates Fa-rticiPa:itl and bvstanders rlke. ln addition to being vital ibr children aad especiallv appropriate in a pediatric sening, glav unites us ail il the lite and joy ol each montent, When oul parrde marches, r'isitors, rounding doctors, and ail

others sn lhe urir pause to watch' rvave, and rheer us on. A *'eekly bedtinre story is read in

our healilg rootr:, Patients ale im'ited to bring

t-:,! ti nilri

PRINTEDBY:[email protected],privateuseonly *iif-,out prUfitf t.r's prior permission Violators will be

prosecuted'

336 Sr.u' r :irs \r ' Oratd lhctnet abrrii Core or Car rrig

&g{itx, t{ffitrrffi *${fl thek pillorvs and lavorite stuflbd anir'ral or do1l

an,l come ilressed in pajamas. )iighr and day- shift stalf membcrs hale honorcd cne another

s1tl,. lurpris e beginnin g-ctl the-*hiii rneals, staying lare ro care :br patienrs and i'amilies,

.*j ,"furl"g to givc otl-going report uniii their oe-coming coworkers had eaten' Color-

rul rarlng sacke-rs are arvarded whcn one st;-f member catthes anothe! in t]le ;\CT of car- ing, being present, making anorhtrs da;', plav-

ing, and--"hnosing a positlve atrilude' 'Ihese

acis ar" a,rthentic and not performed as hos-

p!tr1ir-v acts aad rrithia the cuslorfler mindseg

r&rher, thcy are a prol'essional r:otenant nurs-

ing has rviih humanir-v- around thc world'

ACTGuidelines Plath.g caring theorv rt thc --ore ofour p:atis susP(1rts prr,cricirrq canng-hciling a:ts t(\ Pro' n oie *hol"nett, cor:rfort, harmony, and inner

healing. 'lhe intentional conscious presence of

r:ur autheatic being to plovide a raring-htaling

environn:eni is tl"re rnost esstntial ofthese arts'

Presence xs tht fotndatioo ibr cocreating car-

ing relationships h.as led to rtrili:g '\C'[- guidslines. \V:incn in thc do':tor ordcr secilon .l th" chrn, AClf guidelincs providc a lbrmal way to hcnor unique farnilies'values and be-

lieis. Pref'erred rva.ls ofhaving dresring changes

performed, nost helFftl corrrlbrt mtasures, irame sched'.:Ies, and sperial netds or rsfiuests

are exarnplts of rvhat these gui"delines migirt

add-ress. AC'I' members pu:pcsefully use the word ,qtidiline as opposed to ordrr'f,s Inore

cDn-

gr.reni utrJr cocreadlr collcboraie praxil and to

*n.o.,r*g" cridcal thinking and flexlblliti' l3uilding Practice on caring lelationships ha:

led to a-q intreasc in both the tlpe antl volume

oi cart cont'erences held cn our unit' Prer-!- ousi,v, care coni'erences rvsc called as a B'xl'to dissemitlate inforn:aiion to Is-rnilies u'hen ronrplicated issues atcse or n'hen cnmmun'ica-

donteht'een n:uitiple tearns fnltercd and lim- ilies rvere receiting conflicting repors, plans,

rnd instruct.ions. Nolv these ronferen':es aie

r:ftbred proactil'ely as a *av to coordinate team eii'orts ind to ensur( we are wo:king toward

No part of this book may' be reproduced or transmitted

the iln:ilies' goals.'Iransiticna-1 conferences provide ae opporttniry to €oordinate conli-

nul:l, ol cuc, shrrc rnsight inro thc uniq':c pcrsonalir and preferentes ofthe ch-id, coor-

dlnrte team efibrt, mect tamilres, protide them

rvith tours oi'our unit, and coLlaborate rvith ian:!]ies. Other caring-he*ilng anr oftered on

our unit are therapcutic touch, guided :rnagery',

relaxatian, l'isualj.zation, e.romatherapl', and

massage. :\s ;\C'f suticiprnts, our challenge is to express orx caring valucs through svelY ac-

tiritl'and interaction. Caring thecry guides us and maniltsts in innurnerablt u'r1n' Our inter-

viev,' pr+cess, meeiiflg format, and clinical

nursc specialisr {CN S) role h*'e been transfig-

ured through taring theory, Our inten'ie*r' prorss has tra:rsformed irom an inttrrogativc

thr*a-.t,*p procedure into mors of a sharing dialoque. We are ,ldoFrlng another n:eet.hg

stt'le that expresses caring values.

Our unit dircctor had the foresight tc budger a posrtiorr tbr a CNS to ;upporl the

eocrestion of caring praxis, 'lhe rraditional CNS roles-rescarcher, ciinical expcrt, coLlab-

orator, educator, and change egent-hate allorved the inlegradon oftaringl theory devel-

opment Into all aspecrs oi our unli progracl' 'Ihe CllS role advocates seli'-care and facili- tates sfa-iimembers t(] Ltcorporate caring-healmg

arts into their practice rhrough modelinq and

h-ands-cn suF.Port. .l'r. addrticn to crovrding

assistance, searching fbr rcsou:ccs, Jatrng as

liaison rrith other health-tare tea'ms, and prornotlng staflln their e*brts, the l'ery Fres- ence olthe CSS on the unii reinlnrces cur comrnitment to caring Pruis'

Canclusion

We crntinue to *'ork toward inrcrporating caring iderls la evert'action, Currentll', x'e arc

modi-fring our coraFetencY-based guidehnes

to emphaslte caring competenry rvithin tlsk and skills. tsuilding relationsh"ips for supoart-

ire cotrlsboraill'B pracrice is the rnost exciting and most challenging endeavor s'e are no1!'

ihcing as old rales are reevaluated in iigl"t oi cocreating caring-heelilrg relati*nships"