The Essence Of The Nursing Practice Essay

The Essence Of The Nursing Practice Essay

The Essence Of The Nursing Practice Essay

Caring is viewed as the essence of nursing, discuss…
Lenninger (1984) described caring as the “essence of nursing”. Over the years many nursing theorists and researchers have examined the concept of caring and written extensively on the importance of caring in nursing. Going back to the foundation of modern nursing Nightingale (1859) wrote that nursing’s most important work is caring. Despite the wealth of ground covered in these works the term “care”, is rarely defined as a theoretical concept in its own right and is often used interchangeably with the term nursing (Gaut, 1983). In this article the author will explore the existing theoretical perspectives on caring. The Essence Of The Nursing Practice Essay
Duke & Copp (1992) likened caring to the string in a necklace; it holds all the beads together. However if it can be argued by Paulson (2004) that there is an increase in client dissatisfaction then that begs the question; are caring behaviours and attitudes decreasing amongst the modern workforce of nurses? Paulson (2004) tells us that many nurses are surprised that service users perceive they receive unsatisfactory care. These nurses are sure that they are providing care in the precise manner that they were taught in nursing programs focused on caring for clients. Paulson (2004) has argued that there is a difference between taking care of and caring for service users. Remen (1980) points out that these two different approaches are often indistinct and when they are misunderstood, problems arise. Nettina (2000) informs that nursing care concentrates on objective, physical care concerned with assessment, diagnosis, planning, implementation and evaluation. Paulson (2004) comments that taking care of clients objectively is necessary, but that this mode of care subtly encourages nurses to depersonalise the individuals in question. Bruce, Bowman & Brown (1998) reported that high satisfaction figures recorded by clients were directly linked to a caring and compassionate workforce. Caring attitudes can be taught and should be taught to nurses where a caring deficit exists  The Essence Of The Nursing Practice Essay


In health care today, technological advances grab headlines while clinicians’ documentation duties mount almost daily. Is basic nursing care receding into the background?

Recently, American Nurse Today’s Editorial Advisory Board (EAB) had a spirited discussion on the current state of nursing and patient-care delivery. We concluded we need to shift the focus back to basic nursing care. Hence, the special supplement you’re now reading—The Essence of Nursing: Advancing the Art and Science of Patient Care, Quality, and Safety.

So what is the essence of nursing? It’s what some people call “high-touch” nursing, where the nurse has plenty of face-to-face time and a personal connection with patients and their families.

In a sense, the essence of nursing is the very heart of nursing.

During our discussion, EAB members shared examples of extraordinary nurses who’ve had a significant impact on patient outcomes and the patient-family experience. We also shared anecdotes in which nurses didn’t behave like the compassionate, competent caregivers we all aspire to be. This dichotomy underscored our belief that nurses need to get back to the basics—to living and breathing the essence of nursing in every patient encounter to realize the full potential of our profession.The Essence Of The Nursing Practice Essay

Certain characteristics and competencies set nursing and nurses apart from other professions and practitioners. As EAB members discussed the essence of nursing, we asked each other: What’s distinctive about a nurse’s DNA? How does that distinction manifest when it comes to providing safe, high-quality patient care? How can nurses deliver the essence of nursing to its fullest extent possible—especially when caring for such vulnerable patients as low-birth-weight infants and elderly adults? What factors or circumstances enable or prohibit nurses from doing this? In today’s fast-paced, high-acuity, multidimensional, and penalty-driven healthcare delivery system, it’s crucial that we find answers to these and related questions.

Nursing presence
The nurse is the key to providing safe, effective, and compassionate care at both the individual and organizational levels. Despite the rapidly changing healthcare environment, one constant remains: The nurse, in a collective sense, is the healthcare professional who’s with the patient and family 24/7/365.

This article describes the development of literature-based models for bachelor degree essays in Swedish undergraduate nursing education. Students’ experiences in a course with literature-based models for bachelor degree essays are discussed. The ever-growing body of nursing research and specialized and complex health care practices make great demands on nursing education in terms of preparing students to be both skilled practitioners and users of research. Teaching to help students understand evidence-based practice is a challenge for nursing education. Action research was used to generate knowledge of and practical solutions to problems in everyday locations. Six models were developed: concept analysis, contributing to evidence-based nursing by means of quantitative research, contributing to evidence-based nursing by means of qualitative research, discourse analysis, analysis of narratives, and literature review. Action research was found to be a relevant procedure for changing ways of working with literature-based, bachelor degree essays. The models that were developed increased students’ confidence in writing essays and preparedness for the nursing role.The Essence Of The Nursing Practice Essay

The nurse creates and nurtures an intimate bond with the patient and family through a constant presence and hands-on care. She or he gets to know the patient and family better than any other healthcare provider, learning their wishes, fears, capabilities, and challenges. It’s the nurse in whom the patient confides in the middle of the night and to whom the patient’s loved ones turn for information, support, and solace.

When a patient experiences overt distress or deteriorates suddenly, the nurse is likely to be the first one on the scene, initiating rescue procedures. More often than not, it’s the nurse who detects subtle changes in vital signs or behavior that signal a serious or life-threatening event. The literature tells us that when nurses have the right preparation and are present at the right place and the right time, patient outcomes improve. In collaboration with interdisciplinary colleagues, nurses’ highly skilled, competent, compassionate care can help prevent the patient’s functional decline, eliminate knowledge deficits for the patient and family, and promote their engagement in health care.The Essence Of The Nursing Practice Essay

The dynamic essence of nursing is due to caring. Unfortunately,
many different terms such as care, care-giving, care receiving, nursing
care, etc. are used interchangeably which promotes confusion. Thus,
the concept of care can be considered one of the least understood parts
of nursing. It is important to note that because there are multiple ways
to define caring from different paradigms, the frame of reference is
imperative to understand the definition.
The purpose of this paper is to: analyze three conceptualizations of
caring and discuss the relevance of incorporating theory into practice.

Watson’s Theory of Caring
Watson [1] defines caring as: “the moral ideal of nursing whereby
the end is protection, enhancement, and preservation of human
dignity. Human caring involves values, a will and a commitment
to care, knowledge, caring actions, and consequences. All of
human caring is related to inter subjective human response to
health-illness; environmental-personal interaction; a knowledge
of the nurse caring process; self knowledge, knowledge of one’s
power and transaction limitations” (p. 901). Moreover, Watson
posits that “the essence of the value of human care and caring may
be futile unless it contributes to a philosophy of action. . . The
actual concrete action of caring can transcend the value (and pass
it on). . . The value of caring is grounded in the self-transcending
creative nurse” (p. 32). She further believes that human-to-human
caring interactions of nursing cannot be validated or understood
using a “positivistic, deterministic, materialistic mind set” [1.
Watson [1] acknowledges the differences between traditional
science and human science. They are as follows:The Essence Of The Nursing Practice Essay
Corresponding Author: Dr. Nancy D. Blasdell , Rhode Island College School
of Nursing, 600 Mt. Pleasant Avenue, Providence, RI 02908-1991, USA ; E-mail:
Citation: Blasdell ND (2017) The Meaning of Caring in Nursing Practice. Int J
Nurs Clin Pract 4: 238. doi:
Copyright: © 2017 Blasdell. This is an open-access article distributed under the
terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author
and source are credited.
International Journal of
Nursing & Clinical Practices
Nancy D. Blasdell
Rhode Island College School of Nursing, 600 Mt. Pleasant Avenue, Providence, RI 02908-1991, USA
Int J Nurs Clin Pract IJNCP, an open access journal
ISSN: 2394-4978 Volume 4. 2017. 238
Blasdell, Int J Nurs Clin Pract 2017, 4: 238
A nurse is required to perform certain acts for her patient which
are legally and ethically binding. Watson [1] posits that the value of
human care and caring is more than the mere action of performance.
Caring involves a sense of self identity and spirit of the person. It
involves a pure sense of dedication and commitment to the patient.
A specific action of caring may transcend the value because it is
“grounded in the self-transcending creative nurse” [1].
The following are Watson’s [1] eleven assumptions related to
Human Care Values in Nursing:
1. Care and love are the most universal, the most tremendous,
and the most mysterious of cosmic forces: they comprise the
primal and universal psychic energy.The Essence Of The Nursing Practice Essay
2. Often these needs are overlooked; or we know people need
each other in loving and caring ways, but often we do not
behave well toward each other. If our humaness is to survive,
however, we need to become more caring and loving to nourish
our humanity and evolve as a civilization and live together.
3. Since nursing is a caring profession, its ability to sustain
its caring ideal and ideology in practice will affect the
human development of civilization and determine nursing’s
contribution to society.
Traditional Science
Nursing Human Science for Caring
Normative Ipsative
Reductionistic Transactional
Mechanistic Metaphysical; Humanistic-contextual
Method centered Phenomena centered
Disease centered on Person-experience centered
Pathology-physiology, the
physical body
Human responses to illness and
personal meanings of human condition
Ethics of ‘science’ Human-social ethics- morality
More quantitative More qualitative
Absolutes, givens, laws Relativism, probabilism
Human as object Human as subject
Objective experiences Subjective-intersubjective experiences
Facts Experience, meaning
Nomothetic Idiographic +/ nomethic
Concrete-observable Abstract- may or may not “be seen”
Analytical Dialectical, philosophical,
Science as product Science as creative process of
Human = sum of parts ex.
Human = mind/body/spirit gestalt
of whole being (not only more
than sum of parts, but different)
‘Real’ is that which is
measurable, observable, and
‘Real’ is abstract, largely subjective
as well as objective, but is may
or may not ever be fully known,
observable, fully measured,
what is ‘real’ holds mystery and
unknowns yet to be discovered The Essence Of The Nursing Practice Essay
1. As a beginning we have to impose our own will to care and
love upon our own behavior and not on others. We have
to treat ourselves with gentleness and dignity before we can
respect and care for others with gentleness and dignity.
2. Nursing has always held a human-care and caring stance in
regard to people with health-illness concerns.
3. Caring is the essence of nursing and the most central and
unifying focus for nursing practice.
4. Human care, at the individual and group level, has received
less and less emphasis in the health care delivery system.
5. Caring values of nurses and nursing have been submerged.
Nursing and society are, therefore, in a critical situation
today in sustaining human care ideals and a caring ideology
in practice. The human care role is threatened by increased
medical technology, bureaucratic-managerial institutional
constraints in a nuclear age society. At the same time there
has been a proliferation of curing and radical treatment cure
techniques often without regard to costs.
6. Preservation and advancement of human care as both an
epistemic and clinical endeavor is a significant issue for
nursing today and in the future.
7. Human care can be effectively demonstrated and practiced
only interpersonally. The intersubjective human process
keeps alive a common sense of humanity; it teaches us how to
be human by identifying ourselves with others, whereby the
humanity of one is reflected in the other.
8. Nursing’s social, moral, and scientific contributions to humankind and society lie in its commitment to human care ideals in
theory, practice, and research (p. 32, 33).
The eleven assumptions to Human Care Values in Nursing provide
an understanding of how nursing is connected to caring. The
assumptions give a sense of purpose to the concept of caring from
Watson’s perspective.The Essence Of The Nursing Practice Essay
In order to understand nursing as the science of caring, Watson
derived 10 primary carative factors. The carative factors involve the
interpersonal aspects of caring and function as structural guides to
understand care as a phenomenon in an interpersonal relationship
process. The carative factors and processes are linked to basic human
needs, human relationships, and health maintenance [2]. They are as
1. The formation of a humanistic-altruistic system of values
2. The instillation of faith-hope
3. The cultivation of sensitivity to one’s self and to others
4. The development of a helping-trust relationship
5. The promotion and acceptance of the expression of positive and
negative feelings
6. The systematic use of the scientific problem-solving method for
decision making
7. The promotion of interpersonal teaching-learning
8. The provision for a supportive, protective, and (or) corrective
mental, physical, sociocultural, and spiritual environment
9. Assistance with the gratification of human needs
10. The allowance for existential-phenomenological forces (p. 9, 10).
Int J Nurs Clin Pract IJNCP, an open access journal
ISSN: 2394-4978 Volume 4. 2017. 238
Citation: Blasdell ND (2017) The Meaning of Caring in Nursing Practice. Int J Nurs Clin Pract 4: 238. doi:
Page 2 of 5
Watson [3] explains that the carative factors refer to how interventions
are associated to the human care process. As the nurse has interaction
with the patient, the carative factors become actualized. She further
explains that higher levels of caring can occur between different
nurses and different experiences.
The nurse-patient transpersonal dimension is part of the dynamics
of the human caring process [3]. “An event, such as an actual
occasion of human care, is a focal point in space and time from which
experience and perception are taking place, but the actual occasion
of caring has a field of its own that is greater than the occasion itself ”
(p.59). The actual caring occasion as it is called, includes action
and choice by the patient and the nurse. The experience of coming
together in a caring situation provides the two people the opportunity The Essence Of The Nursing Practice Essay
to formulate a decision of “how to be in the relationship – what to do
in the moment” [3].
Watson’s Theory of Human Care involves three major areas:
1. Nursing within the context of human science and art;
2. Mutuality of person/self of both nurse and patient with mindbody-soul gestalt, within a context of intersubjectivity;
3. the moral ideal of the human care relationship in nursing which
includes concepts such as phenomenal field, actual caring
occasion, and transpersonal caring [3].
The actual goals of the theory are related to the mental and spiritual
growth for oneself and others, discovering meaning in one’s own
existence and experiences, discovering inner power and control, and
enhancing occurrences of transcendence and self-healing [3]. The
actual agent of change is considered the patient. However, the nurse
can be a co-participant in the change through the process of human
care. The agent of change is the “personal, internal mental-spiritual
mechanisms of the person who allows the self to be healed through
various internal or external means, or without external agents, but
through an inter-subjective interdependent process wherein both
persons may transcend self and usual experiences” [3].
The interventions of Watson’s Human Care Theory are associated
to the human care process with complete participation of the nurse/
person in conjunction with the patient/person. These interventions
require an intention, a drive, a relationship, and actions. The process
requires a commitment to caring as a moral obligation directed toward
the preservation of humanity [3]. The carative factor, as mentioned
earlier, is formulated by a knowledge base and clinical competence. It
is only when the nurse is being with the other person can the carative
factors become actualized.
It is important to remember that the perspective of Watson’s
Theory of Human Care is spiritual-existential and phenomenological
in its orientation. However, it has also been influenced by Eastern
Philosophy [3]. The context is humanitarian and metaphysical and
incorporates the art and science of nursing. Science is emphasized in
the context of human science [3].
Leininger Theory of Caring
Madeleine Leininger is known world wide as the founder of
transcultural nursing. She developed her thoughts during the middle
1950’s. When she worked as a psychiatric nurse specialist in a child
guidance home, she was exposed to children from many diverse

Presence and vigilance are key elements of the essence of nursing. But along with the privilege of being “the one who’s there” comes a tremendous responsibility and accountability. Nurses are, and always have been, the patient’s first and last line of defense. Keeping the patient safe from preventable adverse events—such as falls, pressure ulcers, infections, and immobility complications—are high on nurses’ priority list as they manage and coordinate the patient’s care to ensure safe passage through the care-delivery system.The Essence Of The Nursing Practice Essay

Spotlighting basic nursing care
This supplement puts basic nursing care back in the spotlight where it belongs by:

revisiting key elements of patient care, updating them in the context of today’s healthcare environment
emphasizing the nurse as the patient’s sentinel, who protects the patient from injury and acts quickly when potential danger arises
stressing the nurse’s role in marshalling appropriate resources to ensure optimal patient outcomes
highlighting the significance of nursing observation and evaluation of the patient.
Where the topic of technology arises in this supplement, the authors make it clear that its most important role is to support the decision making of nurses and other clinicians. Although technology can help improve patient care, it also can distract us from basic care. If we get caught up in technology, we can lose sight of the higher purpose of health care.

The essence of nursing and the organization
Many of the indicators that drive a healthcare organization’s performance, profitability, and image in the community it serves hinge on how well its nurses practice the essence of nursing, The essential elements of nursing care are crucial in reducing lengths of stay, cost per case, adverse events, and litigation. Nurses have a measurable and significant impact not just on safety, quality, and economic outcomes but also on patient satisfaction and engagement, as shown in scores on Hospital Consumer Assessment of Healthcare Providers and Systems surveys.

Who better than the nurse to coordinate the many disciplines involved in a patient’s care? To consider the multiple facets of the patient-family dynamic when exploring care needs across the care-delivery system? Effective nursing care is critical in preventing readmissions and ensuring that patients successfully navigate the many hand-offs that occur during their stay.The Essence Of The Nursing Practice Essay

With today’s focus on quality and cost and the financial penalties of suboptimal care, validating and quantifying nurses’ impact and recognizing their value to healthcare organizations and communities at large is crucial. As we work to enhance the patient experience and promote care across the continuum, our ability to uphold the essence of nursing will make or break our efforts. The Essence Of The Nursing Practice Essay


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