MODULE 1

FOCUS ON CARE

Prepared by:
Jose chan r.n.

COMMITMENT TO CARE: A PHILOSOPHICAL

PERSPECTIVE ON NURSING

Caring with, for and about is the essence of humanity

-Anonymous-

Caring is definitive of nursing. It is a moral ideal entailing commitment.

Commitment is present in dedication to others, in personal allegiance, and in
promises kept. With commitment, we respond to peoples lives, lives we are
seeking to sustain, enhance and bring peace of mind to.
Nursing generates healing. It created hoe and seeks to actualize dignity. The
caring practice of nursing is based upon moral commitment, upon belief that
people matter.
REFLECTIONS
1. Care
Care is defined as to have feelings like concern, responsibility or love
for someone or
something.
Care is the process of protecting someone or something and providing
what that person
or thing needs.
2. Commitment
Commitment is a stance towards the world or towards others on the
part of an individual
group which defines what is important and imperative for that
individual or group.
-Val Hooft (1995)
Commitment is a promise or agreement to do something.
3. Commitment to Care
Caring is more than having concern or being concerned for others, it
entails commitment reaching to another intending to care. Care
emerges from a deep moral source within and we are compelled to act,
willingly dedicating self through therapeutic use of self. Care so
understood is our way of being in relation to all people and all things. It
is the call at the heart of nursing.
Important Keys in the Act of Nursing Care

1. Worth The examined life is worth living. Who we are and who
we become, our self hood and good are inextricably intertwined.
2. Authentic Self- It has been said that the important things is that
we live life not in imitation of anyone else, but rather in being true
to ones self
3. Responsibility- It is what is incumbent on us exclusively, and what,
humanly, we cannot refuse. This charge is a supreme dignity of
the unique,
4. Hope- Patients come to us nurses in search of hope wanting to be
taken care of and understood.
5. Faith- we gain confidence by having faith in ourselves and others.
Having faith on both is transformative, it realized possibility. It
requires self awareness.
BECOMING A NURSE: CARING
The nurse is present in moments of healing, in movement to life and
death. Nurses are ordinary people in an extraordinary job. In these moments,
the experiencing of them with the other, which is the love, joy, often the
sorrow and the dignity and beauty of nursing action, the nursing care.
The love and care of nursing are interwoven with responsibility to love
and care for self and others; to discover and extent potential and possibility
with the person, family and community (Fromm 1967).
According to Boykin and Schoenhofer (1990), the presence of caring is
to be the human expression of respect for and response to wholeness, an
active engagement in the person-to-person of being and becoming.
Pearson (1988) deemed it important that nurses bring the ordinariness
of human existence to nursing. His thoughts inspire us to reflect upon the
consequences of denying our ordinary self, donning the mantle of the expert
in so doing separating the unity of personal and professional.
Parse (1989) is confident about who the nurse is and of their vital link
to humanity and healing. She devised what she called as Fundamentals for
the art of nursing as shown in the list below.

Know and use nursing frameworks and theories

Be available to others
Value the other as a human presence
Respect differences in view
Own what you believe and be accountable for your actions
Move on the new and untested
Connect with others
Take pride in yourself

Like what you do

Recognize the moments of joy in the struggles of living
Appreciate mystery and be open for new discoveries
Be competent in your chosen area
Rest and begin anew.

Being a nurse requires a unity of person and professional. Nursing

requires ordinary and extraordinary skills like directedness and
consciousness. The presence of the nurse and the healing power generated
though compassionate caring.
ENCOUNTER: THE DIALOGIC HEART OF RELATION
A dialogical relation, a caring and liberating encounter, can empower
both patient and nurse to actualize potential and, by protecting vulnerability,
foster and enable growth. Care that achieves empowerment, liberation and
growth is essential relation: it is without intention to dominate.
According to Benner and Wrubel (2001), caring practices are capable of
transformation and growth. They said caring is dialogical, according to the
respect for the other, shaped by the capacity to receive or repudiate
helping.
VIRTUES OF CARING
The dialogical virtues integral to caring and essential to informed,
compassionate and committed kind of caring are those of:
Authenticity of being- realizing potential, renewing beginning
Conscience- consciousness and engagement to moral activity
Commitment- advocacy with the other
Presence- being with or into a relationship
Compassion- the interdependence of feeling for and with and concern
of care
Empathy- involvement with, acceptance of, understanding the way of
the other
Empowerment- liberation, freedom to realize potential
SYNERGY: UNITY OF BEING and ENCOUNTERING

We are together in a world of nursing in authentic caring presence.

Within ethical relation and encounter, we come together in dialogue, through
mutual understanding and confirmation; we recognize possibility and realize
human potential. There is synergy, being and encountering, the one caring
with the one cared for understanding diversity and reality, expanding
consciousness and competence through mutual enhancement. Through a

unity of being and relation, the nurse gains wisdom, synthesis knowledge,
skill and compassion within a union of heaths and minds to realize ones
commitment to care.

THE CONTEXT OF CARE

The principle of caring for other is a central characteristic of being

human. This caring concept is active during sickness and health, but is
clearly observed during episodic or long-term illness of a loved one. It is
reciprocal in nature in that in any given illness, situation care is given and is
exchanged when the health need is reversed.
THE CONCEPT OF SELF CARE
At a fundamental level, care begins with the notion of self care in that
each person has the potential to undertake caring activities that will support
their health and social well being.
According to Gormley (1995) , health and illness are a continuous
entity and there is a point where the ability to continue with self care
arrangements becomes unmanageable and professional care is required.
In this sense, Haug (1986) suggests that self care and professional
care are polar opposites, but in reality this is a simplistic interpretation that
does not give a comprehensive explanation. Nonetheless, Banks (1975) said
that individuals transfer the caring responsibility of the professional care
agents when they believe that they are unable to maintain effective self care
and not necessarily at a fixed point in the continuum between health and
illness.
DOROTHEA OREMS SELF CARE MODEL
The Self-Care Deficit Theory developed as a result of Dorothea E.
Orem working toward her goal of improving the quality of nursing in general
hospitals in her state.
The major assumptions of Orem's Self-Care Deficit Theory are:
People should be self-reliant, and responsible for their care, as well as
others in their family who need care.
People are distinct individuals.

 Nursing is a form of action. It is an interaction between two or more

people.
Successfully meeting universal and development self-care requisites is
an important component of primary care prevention and ill health.
A person's knowledge of potential health problems is needed for
promoting self-care behaviors.
Self-care and dependent care are behaviors learned within a sociocultural context.
Orem's theory is comprised of three related parts: theory of self-care;
theory of self-care deficit; and theory of nursing system.
The theory of self-care includes self-care, which is the practice of activities
that an individual initiates and performs on his or her own behalf to maintain
life, health, and well-being; self-care agency, which is a human ability that is
conditioned by age, developmental state, life experience, socio-cultural
orientation, health, and available resources.
INFORMAL CARE
Informal care is determined as care given within the family or kinship
structures, friends, and neighbors. Such care can be physical, emotional,
financial, and social in nature.
Community Care Act of 1990- care in the community by the community
This law has been seen as an instrumental driver for change but
at the same time it drew the attention of the plight of informal
carers and recognized aspect of the work they carried out.
According to Poon et al (2003), the demand for informal care and
support is set to rise given the projected figures for elderly people with
chronic diseases in the forth coming decades. This demonstrates the need or
the voluntary and formal care sectors to work in closer partnership with
informal carers if the perceived health demands are to be met.
VOLUNTARY CARE
Voluntary care has played a pivotal role in the developments of
services that have become mandatory such as district nursing or the home
help service. Voluntary care is viewed as an unselfish act and an expression
of collective responsibility that demonstrates a concern for others. In the
founding of the hospice movement, voluntary workers gave their time and
expertise freely. One example is the Red Cross.

PROFESSIONAL CARE
Professional care has played a crucial role in the development of health
care. Professional care workers have been instrumental in advising policy
and have implemented policy requirements through their practice arenas.
According to Swanson (1991), a caring consciousness guides nurses to
respect value and take responsibility and accountability for their patients
care.
According to Kitson (1987), characteristics of professional care were
commitment, sufficient levels of knowledge, skill and respect for the person
being cared for.

HOLISTIC CARE
Holistic nurses are often described by patients as those nurses that
truly care.
As nurses we can not only use holistic nursing care to enrich the lives
of our patients, but to enrich our own lives as well. The key is not necessarily
about how long you spent interacting with a patient, but how you used the
time you had with them. Nurses should strive to always make the most of the
short time they have with each patient. As nurses we need to promote a
patients psychological and emotional wellbeing in order to facilitate physical
healing. When we do this our relationship with the patient changes and grow
into something more positive than before. This leads to better patient
outcomes and can increase the happiness and purpose in your work as a
nurse.

THE CARING MODEL

In an attempt to provide a model of care that is more sympathetic to
contemporary nursing that the other approaches, Watson (1979) have
identified characteristics of care using a definitional approach that features

the concept of holism. She provided a list of 10 carative factors that reflected
the humanistic and scientific principles:

Humanistic-altruistic system of values

Instilling faith and hope
Sensitivity to self and others
Helping-trusting human relationship
Expressing positive and negative feelings
Creative problem-solving approach
Transpersonal teaching and learning
Supportive and protective environment
Human needs assistance
Existential-spiritual force

COMMUNITY CARE
Community care services are intended to help people who need care
and support to live with dignity and independence in the community and to
avoid social isolation. The services are aimed at the elderly and those who
have mental illness, learning disability and physical disability. The main aim
in providing community care services is to enable people to remain living in
their own homes and to retain as much independence as possible, avoiding
social isolation. Local authority social services provide community care
services or arrange for them to be provided. Care needs can be difficult to
gauge and provision also involves matching client expectation, finances
available and people willing to do the job.
The National Health Service and Community Care Act 1990

Devolved the prime responsibility for means-tested funding from the

central

Department

of

Social

Security

to

local

Social

Services

departments.

Local authorities were given the responsibility to assess people's needs

and to plan and provide care. This includes the allocation of funds for
places in nursing and residential homes as well as other services such as
domiciliary care.

PRIMARY CARE
Primary care is that care provided by physicians specifically trained for
and skilled in comprehensive first contact and continuing care for persons
with any undiagnosed sign, symptom, or health concern not limited by
problem origin, organ system, or diagnosis.
Primary care includes health promotion, disease prevention, health
maintenance, counseling, patient education, diagnosis and treatment of
acute and chronic illnesses in a variety of health care settings (e.g., office,
inpatient, critical care, long-term care, home care, day care, etc.). Primary
care promotes effective communication with patients and encourages the
role of the patient as a partner in health care.
PRIMARY HEALTH CARE NURSING
Primary health care is the first level of contact that individuals, families and
communities have with the health care system. In areas of the world, this:
incorporates personal care with health promotion, the prevention of
illness and community development
includes the interconnecting principles of equity, access,
empowerment, community self-determination and inter-sectoral
collaboration
encompasses an understanding of the social, economic, cultural and
political determinants of health.
Grounded in their scope of practice, nurses provide socially appropriate,
universally accessible, scientifically sound, first level care. They work
independently and interdependently in teams to:
give priority to those most in need and addresses health inequalities
maximise community and individual self-reliance, participation and
control

ensure collaboration and partnership with other sectors to promote

public health.

EVIDENCE BASED CARE

Contemporary nursing care has embraced the notion that professional
caring should be underpinned by relevant evidence of best caring practice
that is supported and underpinned by empirical research. The search for
evidence based care recognizes the changing dynamics of practice, which is
influenced

by

advancements

in

technological

innovations

and

new

paradigms.
According to Stevens et al (1993), there are three reasons why there is
a growing interest in professional practice in the research process:
1. At the macro level- there is an increasing relationship with
professionalism
2. At the collective level- nurses are encouraged to utilize
research in everyday practice and stimulate areas requiring
further investigation
3. At the micro level- professional nurses are accountable for their
actions in terms of knowledge underpinning practice that has
been scientifically verified.

EMPOWERING CARE

Only when health professionals understand

empowerment will it be possible to identify and enhance
empowering practice
WHY IS EMPOWERMENT SO IMPORTANT FOR CARE TODAY?
Health care is not immune to the external changes that have occurred
in the last ten years; changes that have been politically, socially, and
economically drive. Indeed the health care system today has had to adapt to
change,

taking

on

proactive

rather

than

reactive

role.

Hence,

empowerment is needed.
DEFINING EMPOWERMENT
Empowerment for Health is a process in Health Promotion through
which people gain greater control over decisions and actions affecting their
health.
Empowerment may be a social, cultural, psychological or political
process through which individuals and social groups are able to express their
needs, present their concerns, devise strategies for involvement in decisionmaking, and achieve political, social and cultural action to meet those needs.
Through such a process people see a closer correspondence between their
goals in life and a sense of how to achieve them, and a relationship between
their efforts and life outcomes.

MODELS OF CARE
The interactional process observed between professional and client is
central to the application of empowerment in practice. A model of care
describes the characteristics of a practice. The model of are attributed to a
certain practice would offer information concerning the distribution of power
between the players. The following are three major models of care that aim

to describe the distribution of power between the professional and the

individual seeking care.

Traditional

medical

model-

advocates

that

the

professional

manages the power base within the therapeutic relationship. The client
maintains a passive role.

Consumerist model- describes a relationship which is dictated by the

active client who elicit power through the choices their financial status
permit.

Transformed medical model- depicts a relationship in which a

harmonious balance between professional and client has been struck.
The relationship thrives through the expert contributions of each party.
Illustrative Presentation of the Models of Care

HISTORY OF EMPOWERMENT
As shown in the next illustration, the aim of presenting a family tree
was to illustrate how the modern day use of the term empowerment has
evolved, influenced by numerous families (discipline of knowledge). Indeed,
it appears that the concept of empowerment facilitated in health care today
is of a hybrid rather than a pedigree entity. However, as with most families,
the empowerment of family has a degree of linkage across generation lines.
For instance, it can be noted how the philosophical grandfathers contributed
to the contemporary use and understanding of empowerment.
2011 and beyond
Continued collaboration
Predictive levels of
empowerment
Empowering practice
Interdisciplinary
collaboration between
organizational studies and
Philosophy of
health care (Menon 2001)
existentialism
Kierkguard (1813Health psychology
Patient empowerment
1855) Heidegger
Lifestyle and alienation
(Rogers et al 1997)
(1889-1979)
in Moscow
Mental health setttig
Industrial/Political
Sartre (1905-1980)
philosophy
Camus (1939- 1960)
Sociological Theory
Marx
(1818-1883)
Psychodynamic
Organizational
Counseling by Theory
Ivey
studies
Existence
precedes
Durkeheim
(1858Organizational
studies
Alienation
and poverty
Freud
(1856-1939)
Speitzer
(1995)
(1996)
human essence
and is Employee
Education
1917)
(Freire 1994)
for
the disempowered
Self
estrangement and
Psychological
Liberation
a prerequisite
to
Pedogogy
Anomie/
of the alienation as
empowerment
proletatiat)
self
disempowerment
empowerment
psychotherapy
empowerment
oppressed
expression of isolation

EMPOWERMENT AS A PRODUCT
Rogers et al (1997) state that an empowered individual has obtained
self worth, efficacy, and acquired a sense of power. This definition denotes
empowerment as a product that it is an element that the individual has
gained.
EMPOWERMENT AS A PROCESS/ CONTINUUM
Webb and Tossell (1995) assert empowerment should be viewed as a
continuum. This appears to suggest that the current situation and context of
the individual alongside their idiosyncrasies are taken into account and
contrasted against the previous history of the individual.

CHARACTERISTICS OF EMPOWERMENT

Rogers (1997) Characteristics of Empowerment

Having access to information and resources
Having a range of options from which to make choices
Assertiveness
A feeling that one can make a difference
Learning to think critically
Not feeling alone
Understanding that a person has rights
Effecting change in ones life
Learning skills
Changing the perception of others of ones capacity to act
Coming out of the closet
Increasing ones positive self image and overcoming stigma

CHARACTERISTICS OF ORGANIZATIONAL EMPOWERMENT (SPREITZER

1996)
The characteristics identified by Spreitzer (1996) for formal staff
networks should be appreciated in the context of informal carers. For
instance, May (2001) explore how gatekeeping by professional bodies
can hinder the development of successful and effective relations.

There must be a concerted effort to include each member of the

therapeutic alliance.
Role Ambiguity- enforcement of the clear boundaries between
consumers and staff
Span of Control- Parameter determined by the number of workers a
manager has direct control over
Socio-political support- appraisals in the working environment
Access to information
Access to resources
Participative unit climate- professional development programs

MEMBERS OF THE EMPOWERED COMMUNITY

Machin (1998) explored the application of team working strategies
withing community health care groups. Due to the nature of community
health care teams being largely multidisciplinary, the philosophy of
teamwork is an ethos that does not exist naturally. He stated that because of
this overlap, role ambiguity occurs, which is arguably is parallel to the barrier
to empowerment mentioned by Spreitzer.
Kar et al (1999) emphasized how community empowerment is a critical
fact of any programme. Using a process of analogy the authors presented a
stage program with empowerment objectives and practical suggestions to
attain these aims. Their stage programme acknowledges the essential step
by step approach in order to encourage the optimum and nurturing
environmental conditions to maintain any implementation.

Patient

Family/Friends
Informal carers

POINT OF
Professional
COMMUNITY
Carers