If caring is to be retained as the "essence" of nursing, and if research in this area

is to advance, then the various perspectives of caring must be clarified, the

strengths and the limitations of these conceptualizations examined, and the
applicability of caring as a concept and theory to the practice of nursing
identified. Examination of the concept of caring resulted in the identification of
five epistemological perspectives: caring as a human state, caring as a moral
imperative or ideal, caring as an affect, caring as an interpersonal relationship,
and caring as a nursing intervention. Two outcomes of caring were identified:
caring as the subjective experience and as the physiologic responses in patients.
The authors concluded that knowledge development related to caring in nursing
is limited by the lack of refinement of caring theory, the lack of definitions of
caring attributes, the neglect to examine caring from the dialectic perspective,
and the focus of theorists and researchers on the nurse to the exclusion of the
patient

ABSTRACT: The nurse–patient relationship has traditionally been viewed as the essence of
nursing practice. This paper disputes that the ideals of such a relationship occur effortlessly in
nursing practice. Findings from a phenomenological study of individuals hospitalized with a
depressive illness found that a therapeutic relationship did not come instinctively to the
mental health nurses, and that there was a dichotomy between the close relationship expected
by patients and the distant relationship provided by nurses. It is unclear whether nurses'
distancing behaviour was as a result of the participant's depressive illness, a normal part of
nursing practice, or whether other features such as nurses' workloads were an influencing
factor. Further research is required to explore this issue.
Conceptual Framework of the Nursing Program
The conceptual framework, of CCRI's Nursing Program, is its central focus on the dynamic
process of caring actions within the context of the nurse-patient relationship. This
relationship is defined as a dynamic one, between the nurse and the patient, for the purpose of
helping the patient. The nurse-patient relationship is central to every nursing activity. It
focuses on the patient and is therapeutic, purposeful, and goal directed in nature. The nurse's
unique position in the provision of nursing care allows for the promotion of patient advocacy.
These major components along with supporting concepts provide direction and structure for
developing the program of learning in nursing.
The nurse-patient relationship is the foundation for caring practice. Caring is a force for
protecting and enhancing patient dignity. The nurse affirms patients as persons rather than
objects, and assists them in making choices, and finding meaning in their illness experience.
Caring is a morally responsible action that takes place within the nurse-patient relationship.
This caring action has its basis in the nurse’s responsibility and accountability, to give safe
and competent care when the patient is unable to care for themselves. Nurse caring differs
from other caring professions in that a nurse’s time with patients spans a twenty-four hour
period, involves the use of touch, and includes being in another’s intimate space. Examples
of caring action include but are not limited to, the physical care of the body that promotes
comfort and healing, health and medication teaching, listening, and psychological and
spiritual support.
Caring about others begins with caring about self and other nurses. Caring is learned by
experiencing caring practices among faculty and students, which cultivates sensitivity to self
and others. The student learns the basic constructs of caring including but not limited to
comfort, compassion, concern, empathy, helping behaviors, nurturance, support,
involvement, and sharing. A second dimension of caring involves the actual "caring for".
Caring for refers to providing for or being responsible for another in a competent manner.
The nursing process is a critical thinking tool that provides the structure for caring action.
The patient/family needs are assessed according to Maslow's hierarchy of needs. The
structure of the nursing process, Maslow's hierarchy of needs and Gordon’s Functional
Health Patterns, form the standards by which critical thinking skills are developed by the
student throughout the curriculum.
The assessment phase of the Nursing Process includes the use of multiple sources to collect
pertinent data and is related to Gordon's Functional Health Patterns. This database is next
analyzed for the purpose of identifying patient needs and their hierarchy according to
Maslow. From this analysis, the North American Nursing Diagnosis Association's (NANDA
International) nursing diagnoses are established. Based on each nursing diagnosis, Nursing
Outcomes Classification (NOC) and specific patient outcomes are identified, and an
individualized plan of Nursing Intervention Classification (NIC) is developed to meet patient
needs. The implementation step involves the actual carrying out, or administering of the
nursing orders, or collaborative actions based on priorities of care. Evaluation of patient
outcomes based on identified goals as the criteria for evaluation, help the nurse to judge the
success of nursing care. Based on the evaluative process, the nurse becomes aware of a need
for revision and modification of the plan of care. Thus,0 th0e nursing process is viewed as
dynamic and continuous.
The nursing arts and scientific knowledge, which are consistent threads throughout the
curriculum, serve as a standard for critical thinking throughout course content. Criteria
necessary to promote the nurse-patient relationship include communication and interpersonal
skills, which convey a respect and a professional responsibility for all.
The interplay of man, health, and environment serves as the context in which the nurse-
patient relationship exists. Man is viewed as a human being who is a unique biopsychosocial,
cultural, and spiritual individual, who functions as a whole in response to internal and
external cues in the physical and social environment. The concept of health is considered a
dynamic state that includes all aspects of one's life: physical well-being, social interaction,
emotional capacity, and spiritual well-being. Health promotion is a valued activity within the
nursing role, and includes the related concepts of wellness, primary, secondary and tertiary
prevention. To achieve this end, the student is encouraged to be a role model of healthy
behaviors, and to teach health care strategies.
Health promotion concerns are those activities directed towards maintaining or enhancing the
health and well being of individuals and their families. The student learns the role of patient
advocate as he/she provides information needed to make health care decisions and then
supports the patient in that decision. The student learns and teaches health practices that
promote and enhance optimum functional levels of wellness. Such practices include, but are
not limited to, nutrition, diet, exercise, drug therapy and complementary therapies.
The environment consists of two major components, the practice milieu, and those internal
and external factors that the patient brings to the health care setting. The concept of
environment is viewed as external to the person directly affecting health and well-being.
Other externals include health care environment structures such as inpatient and outpatient
settings, acute, sub-acute, long-term care, home and community care.
The culture of the practice environment, whether inpatient, outpatient or home care, is very
complex. This complexity creates the need for collaboration between health care disciplines
and services. Today's market driven health care system creates tension in the practice
environment between our professional philosophy and the reality of cost containment and
changing health policies. Multidisciplinary approaches are required for the planning and
management of patient's needs within a cost-effective framework. In the process of educating
future nurses, it is essential for the student to grasp how the impact of these external factors
affects health care outcomes.
Together, the nurse with the patient, create a health promoting and healing environment. The
nurse as presence, being there and with another in time of need applies critical thinking skills
to bridge the gap between the technological aspects of care and the human responses to
illness and disease. The nurse’s unique position in relation to the patient and family allows
for facilitation of healing. In addition, the healing environment encompasses self-activity of
the patient that incorporates complementary strategies to promote wellness. Healing practices
are adapted to patients’ needs and particular health care settings. The support of family
members and significant others is critical to the healing environment. Cultural diversity
impacts the healing environment and nursing students learn to appreciate and respect this
diversity.
The profession of nursing has a set of values that act as a standard to guide nursing behavior.
The profession expects its members to know, understand, and internalize these values. The
interaction of personal, professional and patient values enter into the process of decision
making. In an effort to achieve sound ethical and legal decision-making, the faculty directs
the student toward the formulation of professional values. Within this framework, the faculty
emphasizes that students are directly accountable for their behavior.

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