Caring and the Professional Practice of Nursing
-Part 2

by Teresa Vance, RN

Caring in the nursing profession takes place every time a nurse-to-patient contact is made. The nurse enters the world of the patient in order to come to know the patient as a caring person, and that it is from this “epistemology” that the caring of nursing unfolds (Schoenhofer 2002). That caring makes a difference to the patient’s sense of well being. Caring may occur without curing but curing cannot occur without caring (Watson 2003).

It is with that belief that nurses care for patients in the hope that we contribute to the cure or wellbeing of that patient.

Hope and commitment are ingredients of caring. Hope is described as more than mere wishful thinking, but as an awareness of the moment alive with possibilities (Schoenhofer 2002).
Hope may be the only crutch a patient has to keep their optimism. Nurses care enough to honor that hope and support the patient. We view that patient as whole and complete. The second carative factor of Jean Watson’s ten carative factors is faith-hope (see table one).

Hope is guided by our commitment as nurses to our patients. It is also clouded with preconceived beliefs and morals that we are reared with.

I am a field nurse in a for-profit hospice organization. Caring is a central concept to the delivery of hospice care. The patients we encounter are in a variety of settings, such as, own home, nursing home, retirement center, family home, or a friend’s home. They are often frightened with the knowledge of their imminent death and in unfamiliar surroundings. They rely on the nurse and the delivery of care to help them feel physically better.

As a hospice nurse we also view the patient as a spiritual being. That means reaching out to the patient and forming a deeper connection to the spiritual self. It means becoming one.

The one caring and the one being cared for are interconnected (Watson 1997). It’s experiencing human connection at a deeper level than a physical interaction (Watson 2003)

The nurse must have an inner peace with her own mortality. The nurse must be comfortable with death and dying and possess a deep understanding and acceptance of all life cycles and be prepared for their own death (Watson 2002). Caring is directed to a pain free death with dignity and a belief of a spiritual transformation or journey after death.
Caring centers on the person, preserving dignity and humanity. It is a commitment to alleviate another’s vulnerabilities by providing attention and concern for each human life (Watson 2002). Hospice is holistic focused caring. Our goal is to offer the dying patient the opportunity to die in the comfort of their own home surrounded by those who care. The dying patient in the nursing home is offered the opportunity to die with a caring nurse holding their hand. Often the nursing home patient has no family or living relatives that can share in the dying experience. The hospice nurse will be the one to care for the dying patient and ease his journey. This relates to the carative factor number eight of Jean Watson’s ten carative factors, it states; supportive, protective, and/or corrective mental, physical, societal and spiritual environment, and that is what we hope to achieve with the dying patient (see table one).
Hospice also cares for the family. Caring approaches to nursing affect the nurse and the family being cared for. This can be very challenging with dysfunctional families. Our focus is always centered on the patient while dealing with the family. We must be guided by caring, compassion, tenderness, gentleness, loving kindness, and equanimity for self and others.

Caring in hospice goes beyond the actual death. Bereavement contact is done on a routine basis for a year after the death. Nurses often attend services for the deceased to say goodbye and receive closure with that patient and family.

                                                                             Cont'd

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