caring science / caring theory - wild apricot turkel... · research on caring healing modalities...

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11/21/2013 1 Marian C. Turkel RN PhD NEA-BC Director Professional Nursing Practice and Research Einstein Healthcare Network Faculty Associate Watson Caring Science Institute President International Association for Human Caring © WCSI. All Rights Reserved. Moving From the “Case” to the “Face” From Patient to The Spirit Filled Person Behind a Disease From Medical Diagnosis to The “Meaning” Given to the Illness; From Performance/Doing to Presence and Being; From Medical-Clinical Views of Humanity to Unity of Mindbodyspirit, Oneness - Connectedness From Industrial Models to Creative, Mature Professional Models of Caring-Healing Education, Practice & Research Caring Science Transformation Watson WCSI Copyright 2010 2

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Page 1: Caring Science / Caring Theory - Wild Apricot Turkel... · research on caring healing modalities •Caring co-related to NDNQI data, patient satisfaction, RN satisfaction, or economic

11/21/2013

1

Marian C. Turkel RN PhD NEA-BC

Director Professional Nursing Practice and Research

Einstein Healthcare Network

Faculty Associate Watson Caring Science Institute

President International Association for Human Caring

© WCSI. All Rights Reserved.

Moving From the “Case” to the “Face”

From Patient to The Spirit Filled Person Behind a Disease

From Medical Diagnosis to The “Meaning” Given to the

Illness;

From Performance/Doing – to Presence and Being;

From Medical-Clinical Views of Humanity to Unity of

Mindbodyspirit, Oneness - Connectedness

From Industrial Models to Creative, Mature Professional

Models of Caring-Healing Education, Practice & Research

Caring Science Transformation

Watson – WCSI Copyright 2010 2

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• Traditional qualitative or quantitative research on specific caritas process, caritas process serve as a framework for the research

• Traditional qualitative or quantitative research on caring healing modalities

• Caring co-related to NDNQI data, patient satisfaction, RN satisfaction, or economic data

Relationships: Uncaring to Caring (Halldorsdottir, 1991)

Biocidic or Life Destroying (Toxic, Leading to Anger, Despair, Decreased Well-Being);

Biostatic or Life Restraining (Cold or Treated as Nuisance);

Biopassive or Life Neutral (Apathetic or Detached);

Bioactive or Life Sustaining (Classic Nurse-Patient Relationship as Kind, Concerned and Benevolent);

BIOGENIC or Life Giving/Life Receiving

Transpersonal Caring – Manifesting Caritas Field

ULTIMATE GOAL of CARITAS HEALING MODEL

4 © WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org

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Patient Consequences

Caring

Emotional-Spiritual Well-Being (Dignity, Self Control, Personhood)

Physical - Enhanced Healing, Saved Lives, Safety, Energy, Costs, Comfort, Loss

Trust Relationship, Alienation, Family

Non-Caring

Humiliation, Frightened, Out of Control, Despair, Helplessness, Alienation, Vulnerability, Lingering Bad Memories

Decreased Healing

5 Watson – WCSI Copyright 2010

(Swanson, 1999)

Nurse Consequences

Caring

Emotional-Spiritual Sense of Accomplishment, Satisfaction, Purpose, Gratitude, Preserved Integrity, Fulfilment, Wholeness, Self-Esteem, Living Own Philosophy, Respect for Life, Death, Reflective… Love of Nursing, Knowledge

Non-Caring

Hardened, Oblivious, Robot-Like

Depressed, Frightened, Worn Down

6 Watson – WCSI Copyright 2010

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7 Watson – WCSI Copyright 2010

Reclaim Nursing ARTS: General –Advanced Healing-Caring Modalities

Intentional Touch (Therapeutic – Healing)

Visualization

Imagery

Music –sound

Expressive Journaling

Massage

Centering

‘Caritas/HeartMath Method’

Humor

Prayer

Pet Therapy

Meditation-Silence

Art-Dance –Movement

Etc., Etc., Etc…

Caring Science Criteria for Return on Investment

What Can You Anticipate in Doing This Work?

You

Your Hospital

Patients

The Community

Culture of Safety

Human Flourishing

ROI (Key Financial &

Organizational Indicators)

Quality & Clinical Outcomes

Constituent Satisfaction

Recruitment & Retention

Community Health and

Relationships

Results, Rewards & Recognition

8 Watson – WCSI Copyright 2010

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Quality and Service

Clinical Quality Index

Customer Service Index

Employee Satisfaction

(or Pride in the Organization)

Caring Science Impact

Quality Indicators

Service Indicators

Retention & Recruitment

Measures

Teamwork

Caregiver Support

Organizational Excellence

9 Watson – WCSI Copyright 2010

Shifting Foci of Health Care and Health Professions

Focus on Disease or Health Problem

Focus on Tasks-Data

Focus on Medical Specialties-technology

Focus on Hospital Unit-Inpatient

Focus on Admin Solving Problems – Institutional Data

Authoritarian Industrial – External Control

Consumerism/Profits

Focus on Individual Person-Inner Meaning Behind Diagnosis/Condition

Focus on Authentic Caring Relationships/Understanding

All Caring is Holistic-Spiritual

Post-hospital Community: Self-Caring; Self-Control; Self-Knowledge, and Self Healing-Renewal

“Meaningful Use” of Information, Data/Technology

Autonomous: Visionary, Inspired Leadership – Creative Transformative Models

Life-Sustaining Systems/Civilizations

Today Near Future

Watson – WCSI Copyright 2010 10

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Inspiring and Assuring Human Caring: Emerging Authentic Caring Science Criteria

and Indices –New Standards

Giving Voice, Language and Action to Values, Ethics, philosophies Economics of caring-healing at individual and system level

Creating a System-Wide Culture of Caring-Healing – Ethical-Theory-Value- Guided Professional Practices;

Assuring Personalized Human Caring Relationships in a Healing Environment for Staff and Patients/Family;

Evidence of Caring Processes/ Language and Action for Personalizing Caring-Healing Practices; Caring –Healing Modalities;

Organizational Qualities: Meaningful Support/Involvement: Board/ CEO/Executives /Administrators/ Managers /Staff/Patients/Families

11 Watson – WCSI Copyright 2010

Inspiring & Assuring Human Caring: Responsibilities: (Cont.)

Invite Staff to Rediscover Their Own Practice of Human Caring/ Expand and Deepen Theoretical Models of Personal/Professional Caring:

Utilize Caring Language – Document Caring Practices with Language; Informatics Systems:

Promote Research on Caring –Patient Outcomes, Nurse Retention, Costs

12 Watson – WCSI Copyright 2010

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Assessing and Measuring Caring in Nursing and Health Sciences

Jean Watson, 2009

“Measuring caring? Yes, but intentionally and mindfully, with a consciousness that deep caring cannot be fully measured at this time. At best these measurements serve as quality empirical indicators of caring and point back toward the deeper aspects behind the measurements.”

13 Watson – WCSI Copyright 2010

1. Develop a Quick and Easy Instrument to Administer and Measure Patient Perceptions of Caring – An “APGAR Score” If You Will

Maintain Integrity of Caritas Processes

2. The 5 Items Selected Will Account for 78% of the Explained Variance of Caring

3. #1 – “Providing Care with Loving Kindness” Accounts for the Majority of Variance – 67.8%

4. Develop Instrument for Use by Facilities Interested in Measuring Patient’s Perceptions of Caring Practices

14 Watson – WCSI Copyright 2010

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©WCSI, 2010

WCPAS

Two most important practices

Deliver care with loving kindness

Have helping trusting relationships with me

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11/21/2013

9

Marian C. Turkel RN PhD NEA-BC

Director Professional Nursing Practice and Research

Einstein Healthcare Network

Faculty Associate Watson Caring Science Institute

President International Association for Human Caring

© WCSI. All Rights Reserved.

• Intentionality or manifesting intention

– Practice of loving kindness to self allows one to enter the caring relationship with others with intention to become the energetic environment that potentiates caring and healing

Watson Caring Science Institute © WCSI. All Rights Reserved. 18

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• Caring for self allows for the emergence of creative, caring energy

• Maintaining the balance between our doing and our being

• We need to nourish our inner strength and beauty to reach out others from our authentic caring selves

• Self care is critical to health and healing

• If the nurse does not care for herself it is impossible to compassionately care for others

• Inability to care for self shows up as violence in the workplace

• Failure to care for self leads to burnout or compassion fatigue- new language of “compassion energy”

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• Caring for self is essential to create a caring harmonious work force environment

• When organizations are infused with compassionate caring values they reflect a human face which is necessary for the continued existence of humanity.

• As self is renewed, personal and professional commitments become balanced and inner energy is replenished

Watson Caring Science Institute © WCSI. All Rights Reserved. 21

• Having the knowledge, judgment, skills, ENERGY, experience and motivation required to respond adequately to the demands of one’s professional responsibilities. (Roach,1987)

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Impact of Stress on Patient Safety

Journal of the American Medical Association – Sept 23, 2009

- JAMA. 2009;302(12):1294-1300 - stress and fatigue among

medical residents can lead to medical mistakes and potentially

cause devastating injuries for patients. Mayo Clinic researchers

surveyed 430 internal medicine residents from 2003 through

2008. They found as symptoms of fatigue, depression and stress

increased, so did the number of major medical mistakes doctors

reported.

Watson – WCSI Copyright 2010 – HM Slide with Permission 23

Impact of Stress on Patient Safety

Journal of the American Medical Association – Sept 23, 2009

- JAMA. 2009;302(12):1294-1300 - stress and fatigue among

medical residents can lead to medical mistakes and potentially

cause devastating injuries for patients. Mayo Clinic researchers

surveyed 430 internal medicine residents from 2003 through

2008. They found as symptoms of fatigue, depression and stress

increased, so did the number of major medical mistakes doctors

reported.

Watson – WCSI Copyright 2010 – HM Slide with Permission 24

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Health Results – Heart Centering

• Blood Pressure in Hypertensive Employees (HP) 20% reduction in diastolic and systolic blood pressure

• Diabetes (LifeScan Division of J & J) 1.1% reduction in HbA1c in Type 2 diabetes (1% HbA1c reduction = 35% reduction in microvascular damage)

• Congestive Heart Failure (Stanford Hospital) 14% improvement in functional capacity (6 min. walk)

• Heart Arrhythmias (Kaiser Permanente) 75% of patients had significantly fewer episodes of atrial fibrillation, and 20% were able to stop medication all together

Watson – WCSI Copyright 2010 – HM Slide with Permission

• Focused thoughts in the present

• Set boundaries at home and in the workplace

• Maintained a calmer state

• Felt more focused in the workplace

• Shared positive energy with coworkers

• Did not allow others to affect their mood

• Had better interactions with others

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27 © WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org

27 Jean Watson Copyright 2011

PROVIDES A PAUSE TO:

Wash away old experience

Start clean and fresh

Center in CARING INTENTION

Honor Self and Other

Reconnect to core values

Purify sacred space for

authentic presence

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Caritas Process 8: Creating Healing Environment – Being/Becoming the

Caritas Field

29 © WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org

29 Jean Watson Copyright 2011

• Intentionality or manifesting intention

– Practice of loving kindness to self allows one to enter the caring relationship with others with intention to become the energetic environment that potentiates caring and healing

Watson Caring Science Institute © WCSI. All Rights Reserved. 30

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An existential, energetic field; a turning point; A call to higher/deeper consciousness, intentionality; An

authentic choice of caring/living; Requires presence-centering-search for meaning; New level

of authenticity- potentiating self healing and wholeness.

31 © WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org

31 Jean Watson Copyright 2011

Caritas/Heart Field: Subtle Healing Environment

Watson – WCSI Copyright 2010 – HeartMath Slide with Permission

32 © WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org 32 Jean Watson Copyright 2011

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Watson Caring Science Institute © WCSI. All Rights Reserved. 33

Watson Caring Science Institute © WCSI. All Rights Reserved. 34

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• Centering

• Breathing

• Movement

• Self hand massage

• Aromatherapy

Watson Caring Science Institute © WCSI. All Rights Reserved. 35

• What self care do you already do?

• What self care will you begin to do at work or on days off?

Watson Caring Science Institute © WCSI. All Rights Reserved. 36

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• Caring for self-leadership meetings start with a centering tea ritual

Watson Caring Science Institute © WCSI. All Rights Reserved. 37

• Marian C. Turkel PhD RN NEA-BC FAAN • Faculty Associate Watson Caring Science Institute

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CariingLeaders

• Caring leaders are the change agents in the organization.

– We are the ones we have been waiting for Hopi Quote

– Changing healthcare, one nurse, one practitioner, one system at a time; One HEART at a time .

What We Carry in Our Hearts Matters Most

– What energy are you vibrating to others?

– Caring leaders are Creating Caring Environments for Self- Renewal

– Caring for self is important to have the energy to lead others

Watson Caring Science Institute

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Reframing the Language of Leadership

Traditional

• FTEs

• Discipline

• Management by walking around

• The budget data

• Making decisions out of fear

• LOVE MONEY and use people

• Compliance

Caring • Registered nurses

• Performance accountability

• Honoring caring moments through authentic presence

• A caring story

• Making decisions out of LOVE

• LOVE PEOPLE and use money

• Participation

Being With Others As a Caring Leader

Always the most important hour is the present.

Always the most important person is the one you are facing.

Always the most important act is Love ** Meister Eckehart

Always LOVE "Never believe that a few caring people can't change the

world. For, indeed, that's all who ever have."

**Margaret Mead

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Closing Ritual

Moving Forward by Letting Go

Ritual Touchstones