1. Nursing as Caring:Nursing as Caring:
A Model for Transforming PracticeA Model for Transforming Practice
Anne Boykin, PhD, RNAnne Boykin, PhD, RN
Savina O. Schoenhofer, PhD, RNSavina O. Schoenhofer, PhD, RN
Marguerite J. Purnell, PhD, RN; AHN-BCMarguerite J. Purnell, PhD, RN; AHN-BC
Florida Atlantic UniversityFlorida Atlantic University

2. ContentsContents
 CaringCaring
 Major assumptionsMajor assumptions
 Key ConceptsKey Concepts
 Focus of nursingFocus of nursing
 The nursing situationThe nursing situation
 Direct invitationDirect invitation
 Calls for Nursing and NursingCalls for Nursing and Nursing
responses of caringresponses of caring
 Dance of Caring PersonsDance of Caring Persons

3. 6 Major Assumptions6 Major Assumptions
Major assumptions are stated by the theorists to presentMajor assumptions are stated by the theorists to present
their values that ground the theory, and to illuminatetheir values that ground the theory, and to illuminate
theirtheir
worldviews . This means that you know “where they areworldviews . This means that you know “where they are
coming from”. The theory of Nursing As Caringcoming from”. The theory of Nursing As Caring
in grounded in 6 major assumptions which providein grounded in 6 major assumptions which provide
distinctive meanings:distinctive meanings:
 Persons are caring by virtue of their humanness.Persons are caring by virtue of their humanness.
 Persons are caring moment to moment.Persons are caring moment to moment.
 Persons are whole or complete in the moment.
 Personhood is living grounded in caring.Personhood is living grounded in caring.
 Personhood is enhanced through participating in nurturingPersonhood is enhanced through participating in nurturing
relationships with caring others.relationships with caring others.
 Nursing is both a discipline and a profession.Nursing is both a discipline and a profession.

4. CARING
Following are excerpts from
the Theory of Nursing as
Caring (2001)

5.  All persons are caring by virtue of their humanness –All persons are caring by virtue of their humanness –
caring is an essential feature and expression of beingcaring is an essential feature and expression of being
human. The view of person as caring and complete ishuman. The view of person as caring and complete is
intentional – prevents segmenting into parts, such asintentional – prevents segmenting into parts, such as
mind, body, and spirit.mind, body, and spirit.
 Fundamentally, potentially, and actually, each person isFundamentally, potentially, and actually, each person is
caring.caring.
 Each person, throughout life, grows in the capacity toEach person, throughout life, grows in the capacity to
express caring. Being a person means living caring.express caring. Being a person means living caring.
 Through knowing self as caring, I am able to be authenticThrough knowing self as caring, I am able to be authentic
to self and others.to self and others.
 Caring is living in context of relational responsibilities.Caring is living in context of relational responsibilities.
 Caring is responsibility to self and others.Caring is responsibility to self and others.
 Caring shapes relationships.Caring shapes relationships.
About CaringAbout Caring

6. KEY CONCEPTSKEY CONCEPTS
These are important conceptsThese are important concepts
that can be operationalized, i.e.that can be operationalized, i.e.
they can be put into action andthey can be put into action and
studied, recognized, described
or measured

7.  Caring in NursingCaring in Nursing: The intentional and authentic: The intentional and authentic
presence of the nurse with another who is recognized aspresence of the nurse with another who is recognized as
person living in caring and growing in caring. If you lookperson living in caring and growing in caring. If you look
at the 6at the 6thth
basic assumption listed, it states that nursing isbasic assumption listed, it states that nursing is
both a discipline and a profession. This assumptionboth a discipline and a profession. This assumption
supports and validates how a nurse approachessupports and validates how a nurse approaches
professional caring practice, that is, from an informedprofessional caring practice, that is, from an informed
stance grounded in disciplinary knowledge. This clearlystance grounded in disciplinary knowledge. This clearly
distinguishes “lay” caring from professional nurse caring.distinguishes “lay” caring from professional nurse caring.
 Authentic Presence:Authentic Presence:
Authentic presence may be understood as one’sAuthentic presence may be understood as one’s
intentionally being there with another in the fullness ofintentionally being there with another in the fullness of
one’s personhood.one’s personhood.
 Caring communicated through authentic presence is theCaring communicated through authentic presence is the
initiating and sustaining medium of nursing within theinitiating and sustaining medium of nursing within the
nursing situation.nursing situation.

8. Key Concepts con’tKey Concepts con’t
Person as Whole and Complete in the MomentPerson as Whole and Complete in the Moment
 Person as caring centers on valuing and celebratingPerson as caring centers on valuing and celebrating
human wholeness, that is, the human person ashuman wholeness, that is, the human person as
living caring and growing in caring; valuing andliving caring and growing in caring; valuing and
respecting each person’s beauty, worth, andrespecting each person’s beauty, worth, and
uniqueness.uniqueness.

The person is at all times whole. To encounter aThe person is at all times whole. To encounter a
person as less than whole fails to encounter person.person as less than whole fails to encounter person.

9. Personhood isPersonhood is
living grounded in caringliving grounded in caring
 Personhood implies living out who we are as caringPersonhood implies living out who we are as caring
persons.persons.
 Personhood implies living the meaning of one’s life.Personhood implies living the meaning of one’s life.
 Personhood implies demonstrating congruence betweenPersonhood implies demonstrating congruence between
beliefs and behavior.beliefs and behavior.

11. The Focus ofThe Focus of
NursingNursing
((What do nurses think about while theyWhat do nurses think about while they
are nursing?)are nursing?)
 The focus of nursing is nurturingThe focus of nursing is nurturing
persons living caring and growing inpersons living caring and growing in
caring.caring.

12. Nursing SituationNursing Situation
 The nursing situation is the shared, lived experience inThe nursing situation is the shared, lived experience in
which thewhich the caring betweencaring between nurse and nursed enhancesnurse and nursed enhances
personhood.personhood.
(What does the nurse(What does the nurse dodo?)?)
 It is in the nursing situation that theIt is in the nursing situation that the nursenurse attends to callsattends to calls
for caring, creating caring responsesfor caring, creating caring responses that nurturethat nurture
personhood.personhood.

14. Calls for NursingCalls for Nursing
 AA call for nursingcall for nursing is a call from theis a call from the
one nursed, perceived in the mind of the nurse.one nursed, perceived in the mind of the nurse.
This call for acknowledgement and affirmation ofThis call for acknowledgement and affirmation of
the person living caring in specific ways in thethe person living caring in specific ways in the
immediate situation.immediate situation.
 Calls for the nurturance that is Nursing areCalls for the nurturance that is Nursing are
personal expressions that communicate in somepersonal expressions that communicate in some
way - “know me as caring person and affirm me.”way - “know me as caring person and affirm me.”

15. What the nurse does…What the nurse does…
 In the nursing situation:In the nursing situation:
The nurse enters into the world of the other with theThe nurse enters into the world of the other with the
intention of knowing, affirming, supporting, andintention of knowing, affirming, supporting, and
celebrating other as caring person.celebrating other as caring person. Direct invitationDirect invitation isis
integral to this.integral to this.
 Nurses should offer the direct invitationNurses should offer the direct invitation as part of theiras part of their
coming to know other. The direct invitation raisescoming to know other. The direct invitation raises
awareness of nurse and nursed that nursing IS theawareness of nurse and nursed that nursing IS the
service that nursing offers.service that nursing offers.
 The Direct InvitationThe Direct Invitation opens the door to explicitopens the door to explicit
“caring between.”“caring between.”

16. Example of Direct invitationExample of Direct invitation
InsteadInstead of asking “What can I do for you?” -of asking “What can I do for you?” - turn theturn the
focusfocus away from yourselfaway from yourself to the one you are nursing.to the one you are nursing.
Ask, in your own words, sincerely desiring toAsk, in your own words, sincerely desiring to
know:know: WhatWhat matters to you most, right nowmatters to you most, right now??””
 This is a very powerful question – wait forThis is a very powerful question – wait for
the answer in stillness, with patiencethe answer in stillness, with patience..

The one being nursed willThe one being nursed will respond to the invitationrespond to the invitation inin
many different ways with uniquemany different ways with unique calls for nursingcalls for nursing thatthat
arise from what matters.arise from what matters.


17. Nursing responses of caringNursing responses of caring
 The nurse responds to these calls for nursingThe nurse responds to these calls for nursing
withwith specific caring resspecific caring responses to sustain andponses to sustain and
enhance the other as caring person.enhance the other as caring person.
 ThisThis caring nurturancecaring nurturance is what we call theis what we call the
nursing response.nursing response.

18. Caring betweenCaring between
 Presence develops as the nurse is willing to riskPresence develops as the nurse is willing to risk
entering the world of the other, and as the otherentering the world of the other, and as the other
invites the nurse into ainvites the nurse into a special, intimate space.special, intimate space.
 The encountering of the nurse and the nursedThe encountering of the nurse and the nursed
gives rise to the phenomenon ofgives rise to the phenomenon of caring betweencaring between,,
within which personhood is nurturedwithin which personhood is nurtured..
 The nurse as caring person is fully present andThe nurse as caring person is fully present and
gives the other time and space to grow. Throughgives the other time and space to grow. Through
presencepresence andand intentionalityintentionality, the nurse is able to, the nurse is able to
know the other in his or her living caring andknow the other in his or her living caring and
growing in caring.growing in caring.

19. The Caring Between…The Caring Between…
ThisThis full engagementfull engagement within the nursingwithin the nursing
situation allows the nursesituation allows the nurse to truly experienceto truly experience
nursing as caring,nursing as caring, and to shareand to share that experiencethat experience
with the one nursed.with the one nursed.
This is theThis is the caring between, the sharedcaring between, the shared
relation within which nursing is createdrelation within which nursing is created
and experiencedand experienced..

20. Dance of Caring PersonsDance of Caring Persons
(Nursing As Caring: A Model For Transforming Practice(Nursing As Caring: A Model For Transforming Practice, 2001, p. 37), 2001, p. 37)

21. Dance of Caring PersonsDance of Caring Persons
A Person-Centered, Caring-Focused Relational ModelA Person-Centered, Caring-Focused Relational Model
 Acknowledgement that all persons have the capacity to care by
virtue of their humanness
 Commitment to respect for person in all institutional structures
and processes
 Recognition that each participant in the enterprise has a unique
valuable contribution to make to the whole and is present in the
whole
 Appreciation for the dynamic though rhythmic nature of the Dance
of Caring Persons, enabling opportunities for human creativity

22. ReferencesReferences
Boykin, A., & Schoenhofer, S. O. (1991). Story asBoykin, A., & Schoenhofer, S. O. (1991). Story as
link between nursing practice, ontology,link between nursing practice, ontology,
epistemology.epistemology. ImageImage,, 2323, 245-248., 245-248.
Boykin, A., & Schoenhofer, S. O. (2001).Boykin, A., & Schoenhofer, S. O. (2001). NursingNursing
as caring: A model for transforming practice.as caring: A model for transforming practice.
Sudbury, MA: Jones and Bartlett.Sudbury, MA: Jones and Bartlett.
Mayeroff, M. (1971).Mayeroff, M. (1971). On caringOn caring. NY: Harper and. NY: Harper and
Row.Row.