services on new technologies and pharmacological
interventions. Offered on the unit at varying hours
to accommodate all work shifts, clock hours pro-
vide a way for staff members to fulfill continuing
educational requirements without impinging on
their days off.
Customer Service
Caring Theory has provided depth to an institu-
tional initiative to use FISH philosophy to enhance
customer service (Lundin, Paul, & Christensen,
2000). Imported from Pike’s Fish Market in Seattle,
FISH advocates four premises to improve employee
and customer satisfaction: presence, make their day,
play, and choose your attitude. Briefly summarized,
FISH advocates that when employees bring their
full awareness through presence, focus on cus-
tomers to make their day, invoke fun into the day
through appropriate play, and through conscious
awareness choose their attitude, work environments
improve for all. When the four FISH premises
are viewed from the perspective of transpersonal
caring, they become opportunities for authentic
human-to-human connectedness through I-Thou
relationships. The merger of Caring Theory with
FISH philosophy has inspired the following activi-
ties. A parade composed of patients, their families,
nurses, and volunteers—complete with marching
music, hats, streamers, flags, and noise makers—
is celebrated two to three times a week right before
the playroom closes for lunch. This flamboyant
display lasts less than five minutes but invigorates
participants and bystanders alike. In addition to
being vital for children and especially appropriate
in a pediatric setting, play unites us all in the life
and joy of each moment. When our parade
marches, visitors, rounding doctors, all present on
the unit pause to watch, wave, and cheer us on.
A weekly bedtime story is read in our healing room.
Patients are invited to bring their pillows and fa-
vorite stuffed animal or doll and come dressed in
pajamas. Night- and day-shift staff have honored
one another with surprise beginning-of-the-shift
meals, staying late to care for patients and families,
and refusing to give off-going report until their on-
coming coworkers had eaten. Colorful caring stick-
ers are awarded when one staff member catches
another in the ACT of caring, being present, mak-
ing another’s day, playing, and choosing a positive
attitude.
ACT Guidelines
Placing Caring Theory at the core of our praxis
supports practicing caring-healing arts to promote
wholeness, comfort, harmony, and inner healing.
The intentional conscious presence of our authen-
tic being to provide a caring-healing environment
is the most essential of these arts. Presence as the
foundation for cocreating caring relationships has
led to writing ACT guidelines. Written in the doc-
tor order section of the chart, ACT guidelines pro-
vide a formal way to honor unique families’ values
and beliefs. Preferred ways of having dressing
changes performed, most helpful comfort meas-
ures, home schedules, and special needs or requests
are examples of what these guidelines might ad-
dress. ACT members purposely selected the word
guidelineas opposed to orderas more congruent
with cocreative collaborate praxis and to encourage
critical thinking and flexibility. Building practice on
caring relationships has led to an increase in both
the type and volume of care conferences held on
our unit. Previously, care conferences were called as
a way to disseminate information to families when
complicated issues arose or when communication
between multiple teams faltered and families were
receiving conflicting reports, plans, and instruc-
tions. Now, these conferences are offered proac-
tively as a way to coordinate team efforts and to
ensure we are working toward the families’ goals.
Transitional conferences provide an opportunity to
coordinate continuity of care, share insight into the
unique personality and preferences of the child, co-
ordinate team effort, meet families, provide them
tours of our unit, and collaborate with families.
Other caring-healing arts offered on our unit are
therapeutic touch, guided imagery, relaxation, visu-
alization, aromatherapy, and massage. As ACT par-
ticipants, our challenge is to express our caring
values through every activity and interaction.
Caring Theory guides us and manifests in innu-
merable ways. Our interview process, meeting for-
mat, and a CNS role have been transfigured
through Caring Theory. Our interview process has
transformed from an interrogative threestep proce-
dure into more of a sharing dialogue. Unit meet-
ings have been conducted in a routine fashion with
the committee chair in a lead position to open, run,
and close the meeting, delegating tasks and respon-
sibilities to committee members as the chair saw fit.
The mutuality, transpersonal relationship, and car-CHAPTER 19 Application of Jean Watson’s Theory of Human Caring 305