HOW PRACTICAL IS THIS THEORY
IN THE REAL WORLD OF NURSING?
Nurses are frequently heard to say they have no
time for caring, given the demands of the role.
All nursing roles are lived out in the context of a
contemporary environment. At the beginning of
the twenty-first century, the environment for prac-
tice, administration, education, and research is
fraught with many challenges, such as
- technological advancement and proliferation
that can promote routinization and depersonal-
ization on the part of the caregiver as well as the
one seeking care; - demands for immediate and measurable out-
comes that favor a focus on the simplistic and
the superficial; - organizational and occupational configurations
that tend to promote fragmentation and alien-
ation; and - economic focus and profit motive (“time is
money”) as the apparent prime institutional
value.
Nurses express frustration when evaluating their
own caring efforts against an idealized, rule-driven
conception of caring. Practice guided by the theory
of nursing as caring reflects the assumption that
caring is created from moment to moment and
does not demand idealized patterns of caring.
Caring in the moment (and moment to moment)
occurs when the nurse is living a committed inten-
tion to know and nurture the other as caring
person (Boykin & Schoenhofer, 2000). No prede-
termined ideal amount of time or form of dialogue
is prescribed. A simple example of living this inten-
tion to care is the nurse who goes to the IV or the
monitor throughthe person, rather than going
directly to the technology and failing to acknowl-
edge the person. When the nurse goes through
the person, it becomes clear that the use of technol-
ogy is one way the nurse expresses caring for the
person(Schoenhofer, 2001). In proposing his model
of machine technologies and caring in nursing,
Locsin (1995, 2001) distinguishes between mere
technological competence and technological com-
petence as an intentional expression of caring
in nursing. Simply avowing an intention to care is
not sufficient. The committed intention to care is
supported by serious study of caring and ongoing
reflection. As Locsin (1995, p. 203) so aptly states:
[A]s people seriously involved in giving care know,
there are various ways of expressing caring.
Professional nurses will continue to find meaning in
their technological caring competencies, expressed
intentionally and authentically, to know another as a
whole person. Through the harmonious coexistence
of machine technology and caring technology the
practice of nursing is transformed into an experience
of caring.The practicality of the theory of nursing as car-
ing is being tested in various nursing practice set-
tings. Nursing practice models have been developed
in acute and long-term care settings. In 2002, a two-
year demonstration project was completed that fo-
cused on designing, implementing, and evaluating
a theory-based practice model using nursing as car-
ing. This project demonstrated that when nursing
practice is intentionally focused on coming to
know a person as caring and on nurturing and sup-
porting those nursed as they live their caring, trans-
formation of care occurs. Within this new model,
those nursed could articulate the “experience of
being cared for”; patient and nurse satisfaction in-
creased dramatically; retention increased; and the
environment for care became grounded in the val-
ues of and respect for person (Boykin, Schoenhofer,
Smith, St. Jean, & Aleman, 2003).
At the time of this writing, a similar project is
under development in the emergency department
of a community hospital. Caring from the heart—
a model for interdisciplinary practice in a long-
term care facility and based on the theory of
nursing as caring—was designed through collabo-
ration between project personnel and all stakehold-
ers. Foundational values of respect and coming
to know grounded the model, which revolves
around the major themes of: responding to that
which matters; caring as a way of expressing spir-
itual commitment; devotion inspired by love for
others; commitment to creating a home environ-
ment; and coming to know and respect person as
person (Touhy, Strews, & Brown, 2003). The major
building blocks of the nursing models for an acute
care hospital and for a long-term care facility each
reflect central themes of nursing as caring, but
those themes are drawn out in ways unique to the
setting and to the persons involved in each setting.
The differences and similarities in these two practice
models demonstrate the power of nursing as caring
to transform practice in a way that reflects unity
without conformity, uniqueness within oneness.344 SECTION III Nursing Theory in Nursing Practice, Education, Research, and Administration