Nursing Care Theory

Nurse educators who use a care paradigm are concerned with affective literacy and all aspects of a caring nursing framework. Traditional models of nursing
focus on a nurse's ability to provide care versus being caring. The newer paradigm is characterized by the application of being and presence and not the application of doing things for someone. The process of being caring is an internal developmental awakening. It opens the affective domains of awareness and is described in many ways by nursing and nonnursing educators (Duffy, 1990; Gaut, 1992; Koerner, 2007; Leininger, 1984; Leininger & Watson, 1990; Mayerhoff, 1970; Nodding, 2005; and Watson, 1979, 1981, 1985, 1988, 1989, 2008). One can see this theoretical idea emerging in the 1970s and growing extensively into practice domains from 1979 to 1992. It has again been captured by leading books and lectures presented by Watson and is called Caritas Processes (Watson, 2008). Alternatively, Koerner calls it the Essence of Nursing (Koerner, 2007).

Watson's model of care includes the need to learn more about one's ethics, personal self-awareness, intersubjectivity, aesthetics, and spiritual–metaphysical understanding. The Watson model is comprehensive for all the domains of knowing and even moves into a domain not articulated very often—the spiritual–metaphysical domain. Koerner (2007) also presents a highly integrated self-exploration of presence and what it takes to provide this to others. She presents a powerful blend of quantum mechanics to the practices of a nurse to include one's inner sense of who one is and why one is there. Koerner asks nurses to wake up and become conscious to what they are doing and what is around them. “It is important to understand that the science and logic we call reality is a manifestation of the world our mind creates, a reflection of our beliefs and our intentions” (p. 175). She describes the path to integration as having seven stages:

1. Embracing our suffering

2. Transcending our polarities

3. Moving toward authenticity

4. Enhancing capacity

5. Moving toward integration

6. Shifting the focal point

7. Returning to community (pp. 100–113)

These inner developmental understandings set us up to be a healing presence— but remember, you will need to consciously choose this role.

The care paradigm, as it is being developed in nursing theory and practice, has significant implications for affective educators who are also engaged in a helping relationship. The most potent interactions are likely to involve attention to knowing across domains—empirical, ethical, aesthetic, personal, and intersubjective. If teaching is understood to be a relationship and students as complete human beings with both cognitive and affective needs, educators must attempt to know them and help them come to know themselves holistically as a part of becoming affectively literate. In doing so, we strive to establish and maintain a classroom culture that fosters interaction,
inquiry, and understanding of self and others as suggested by theories on emotional intelligence discussed in Chapter 11.

Harrison's (1995) meta-analysis of nursing using caring revealed that educators believe caring is evident in:

1. Good listening and teaching skills

2. Having the ability to assess

3. Showing interest and providing moral support

4. Putting students first

These characteristics are closely related to affective teaching methods described in discussions of immediacy theory, which is found in communication literature. Hughes (1995) provided an analysis of care curriculum strategies and concluded that listening, communication, and comfort are central themes. She argued that faculty must help students learn to reduce the focus on technological interaction and to direct clinical energy toward the patient as a human being. Educators must teach in the affective and physical domains for caring to be integrated.

More recently, Benner, Sutphen, Leonard, and Day (2010) continue to support the need for faculty development and training as teachers. “The combination of lack of basic teacher preparation in graduate nursing schools and limited faculty development conspires to thwart effective teaching and learning” (pp. 222–223). They suggest teachers need to be able to teach in ways that “foster lifelong learning and clinical inquiry skills in student nurses” (p. 223). These authors do not speak to affective pedagogy specifically, but they are concerned whenever the teaching generates only knowledge without a context or a place to integrate such knowledge in a case study, a narrative, or simulation experience. They want to see knowledge acquisition move to knowledge in action, and affective methods support this outcome.

Educators can examine classroom culture through an analysis of instructional pedagogy, or the general form of presentation by the instructor to convey knowledge to the student. Specific strategies can be categorized based on the five ways of knowing discussed earlier, which include empirical, personal, aesthetic, ethical, and intersubjective ways of knowing. For example, a professor who is trying to create an aesthetic learning experience for the student might increase the likelihood of success if he or she used an instructional method congruent with the desired outcome. One instructional method would be to use groups and teams in developing ways to support each other in a clinical situation by role playing different scenarios. This is a natural outcome in nursing education when we teach a concept in the didactic setting and then have students practice the nursing care in either the laboratory or clinical setting. What is typical, however, is conducting the class in solely a traditional lecturing and explaining format, which is most compatible with a traditional teaching paradigm discussed earlier.

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