Discuss how the care in the ‘David’ story can be humanised using the Humanising Framework. You should choose three dimensions from the Humanising Values Framework to support your discussion.
INTRODUCTION
Professional standards of practice and behaviour reflected through the Code, are key values (NMC, 2015), to prioritise people, practise effectively, preserve safety and promote the nursing profession. However, at times the complexity of achieving these principles comes under investigation (Flynn, 2012). Therefore, elements will be discussed throughout this essay relating to ‘David’s Story’ using the humanising framework. It will evaluate the theory of humanised and person-centred care and rationalise the importance of this philosophy.
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‘The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge and to do this in such a way as to help him gain independence as rapidly as possible,’ (Henderson, V, 1960). These were the basic principles of nursing some 50 years ago and although the same values exist today, changes in nursing direction have occurred over the years to include a more holistic approach. The purpose of which centres around the person as a ‘whole’ when delivering care to patients and looking at the best ways to provide and meet their needs through their choices. Ordinarily, the majority of nurse’s express core values such as compassion, care, and commitment, (Kitson et al, 2013). However, reports show that this is not always the case, as are highlighted in the media through various incidents, such as the Francis enquiry (Francis, 2013) into the uncaring culture and neglect that patients suffered whilst in the care of Stafford Hospital. (Galvin and Todres, 2013), set out a theoretical framework to allow person-centred care to become a priority within the healthcare by nurses and other health professions. O’Sullivan and Hocking (2006) agree that experiencing autonomy and involvement in caring for self, contribute to well-being. The framework encompasses eight elements focusing on human values considered to affect interactions with patients and their families/carers in how humanising and dehumanising those interactions can be. Heuristically, each element shows the positivity that it can provide and what it means in value to be human when used in conjunction with other dimensions such as holism and person-centred care. Holistic approaches incorporate the patient’s personality and behaviour, including their social aspects along with the body, mind and self. Although, holism is not a 21st century concept and is shown throughout history, ‘People say the effect is only on the mind, it is no such thing…’ (Nightingale, F. 2007). The 6 c’s, a framework of base values that lead the way for change amongst the nursing profession, providing the ethics to create a culture that places the onus on the patient, their families, carers and service users, strengthening the care they receive to ensure these beliefs are centred around the patient. Papadopoulos (2014) acknowledges, compassion should be at the centre of contemporary healthcare, due to the diverse cultures and societies that require appropriate understanding. Within the humanising framework, the elements describe humanising and dehumanising across a spectrum and consists in the following forms; Insiderness-Objectification, Agency-Passivity, Uniqueness – Homogenization, Togetherness – Isolation, Sense-making – Loss of meaning, Personal Journey – Loss of personal journey, Sense of place – Dislocation, Embodiment – Reductionist body. Each element gives various possibilities that can relate to the care provided to patients, families and carers. Further insight into 3 of the elements will allow a deeper understanding on how humanising values improve relations with patients and service users. In David’s Story, dehumanising took place on several accounts.
One element that comes to the forefront is dislocation. Placed in a side room with no interaction, in a clinical setting does not provide patients with a sense of place. Schutz (1944) describes ‘the stranger’ who has a sense of dislocation when first experiencing a new place. Furthermore, it is widely acknowledged that places can affect people's health both by producing well-being or distress feelings, therefore conveying positive or negative information for people's self-esteem, security and identity, (Evans & McCoy, 1998). Dewar and Nolan (2013) believe compassionate environments can be created using key components of compassionate relationship centred care. The target of “more humane hospital environments”, Nagasawa (2000), refer to spatial, physical and functional design attributes that health-care environments should possess, consequently reducing the stress felt by patients and staff, to promoting and increasing the well-being and the quality of life of hospital users. Simple changes to colour, lighting and use of materials, such as bedding, allow for patient satisfaction, although, this could cause staff to feel disorientated from familiar environments. Considerations must be addressed regarding the various roles within the different hospital environments, whilst allowing for clinical aspects, for example; Infection control, to remain a priority in patient care. Studies between units have shown that a more humanised unit, produced increased positive patient assessments compared to the less humanised unit, (Davidson, 1994). Humanising environments, therefore, are perceived by patients and hospital users as improving quality, however nurses remain affected by variables in their roles, which could account for how they experience these environmental changes in within their roles. Focusing on a second element, Uniqueness, implies having your preferences, priorities, likes and dislikes
associated as an individual, avoiding the categorisation of being assumed the same along with all other patients and labelled into categories. Treated as individual within the health care setting requires communication, nurses need to factor in the importance of the information gained about the patient through this. Widäng, Fridlund and Mårtenson (2008) illustrated that patients feared being associated as the disease and not for who they were as individual people. The importance of identity as a unique person was a necessity to maintaining health. Without discussion on admission from the nursing staff, patients, families and carers were homogenised, therefore acted accordingly to the expectations of the medical professions. Relationships between nurses and patients are unique as each partner contributes providing a combination of valuable points, enhancing the relations between them, (Peplau, 1952). Peplau (1952) also argues that the emphasis on the nurse is as important as the patient, however this contrasts with nursing theories and patient-centred care today (Hemingway, 2012). The final element to discuss here is Agency, the idea of making choices that one is accountable for. When passivity is the frame for relations, patients become passive and no longer have control over their own health. Closely linked to dignity which means to be worthy, which patients find difficult to sustain in passive form, shows the importance of this being recognised and valued in a patient. Johnsson and Ekebergh (2006) study of women patients following myocardial infarction (MI), showed that the women felt their lives had suddenly stopped, allowing them no control over their situation. Blinded by the events, they found it hard to comprehend actions, that prior had very little significance to them. The responsibility for those patients now rested with the healthcare professionals, taking the choices away from them.
For the case study one considered the overall working environment of the organisation, with a particular client situation to apply the case study arguments around. This client was experiencing a catastrophic reaction to an event. One applied an integrated person-centred approach which considered meeting their needs by listening to the issue, and working with the person, and their family, as well as care staff, Registered Nurses (RN’s) and the Director of Nursing (DON). In order to find a resolution and meet the client’s needs. As well as, adding to their care plan strategies to assist with future behavioural and psychological symptoms of dementia (BPSD). This particular situation fit perfectly within the two questions of; does the organisation prevent me from providing person-centred care, and do we have formal team meetings to discuss residents’ care.
The second concept, the environment, is the setting that can be controlled by the nurse or an individual to augment comfort. (Masters, 2017). In a hospital setting this could include dimming the lights, providing a low stimulation environment, or limiting visitors. Another example may be removing an individual from a situation that is not conducive to healing. Health is the third concept and refers to the orchestration and collaboration of those involved in assisting the patient to a state of well-being. Lastly, the concept of nursing describes the utilization of the nursing process of assessment, planning, intervention to meet the comfort needs of the individual and evaluating the effectiveness of those
Watson conceived her Theory of Human Caring while she was teaching at the University of Colorado in 1975 to 1979 (Conway et al, 2011). It evolved from her personal views on nursing and merged with her learning and experience from her doctoral studies in education, clinical and social psychology. With the publication of her first book, Jean Watson developed the initial ideas of her theory and came up with 10 “carative” factors. Her actual theory was published in 1985, after which she further developed the corresponding nursing curriculum. In those years, Watson also extensively traveled in Asia and Australia while practiced. The prevailing influences in the nursing field at the time were those of Carl Rogers, Florence Nightingale and Leininger. Main psy...
Ethical issues arise daily in the healthcare world. The manor in which issues are addressed vary. “There are, it might be said, as many histories of nursing ethics as there are individual ethicists and professional or cultural contexts” (Guildford 2010, p.1). “A code of ethics is a fundamental document for any profession. It provides a social contract with the society served, as well as ethical and legal guidance to all members of the profession” (Lachman 2009, p.55). According to Lachman, since the original ANA Code from 1950, the significance of service to others has been consistent. Two changes in the code have occurred since the original. First, not only the patient is being treated, but the family and community where they live are also considered.
Vincent nurses, provides a framework for professional nursing practice guided this research. As the business of healthcare is about taking care of people, the model starts with the patient, and their family, as the central focus. Surrounding the patient, are the concepts of mind, body and spirit, which cause us to think holistically regarding the care provided. Finally, the core values/ faith based practices, guide us in managing our patients in a way that is consist with our culture/ values, supportive of our professional growth, encourages the use of best practices, that result in better outcomes, and makes us productive in a way the encourages giving back outside the hospital as well (Stone, 2011).
The concept of person refers to the recipient of nursing care, such that no person is the object of care and no aspect of wellbeing is left out (Arnold & Boggs, 2001; Thorne, Canam, Dahinten, Hall, Henderson, & Kirkham, 1998). This not only includes disease and illness states, but also psychological, social and spiritual dimensions. Therefore, factors such as gender, lifestyle, behaviors, beliefs, values, coping skills, habits, perceptions and lived experiences are considered (Arnold & Boggs, 2011). This holistic and multi-centered approach also extends to families, communities, and populations (Schim et al., 2007). The concept of person is central to nursing theory and research, and is fundamental to the, “Code of Ethics for Registered Nurses,” as outlined by the Canadian Nurses Association (2008). In practice, ‘person’ is used to guide client teaching and nursing interventions (Kozier, Berman, Snyder, Buck, Yiu, & Stamler, 2014).
Jean Watson is a well-respected American nursing theorist who created the Theory on Human Caring. Watson’s concept on caring for a human being is simple, yet has much depth and meaning, and holds strong for nurses to work with compassion, wisdom, love, and caring. The Theory on Human Caring is necessary for every nurse, as it is our job to care for others in a genuine and sensitive way. The theory is extensive; its core foundation is based on nine concepts all interrelated and primarily focused on a nurse giving a patient care with compassion, wisdom, love, and caring (Watson, J., 1999). The nine essential aspects consist of: values, faith-hope, sensitivity, trust, feelings, decision-making, teaching-learning, environment, and human needs. Watson also created the Caritas Process consists of ten different ways of giving care:
The purpose of this paper is to provide an overview of Jean Watson’s Theory of Caring. This theory can be taken into account as one of the most philosophically complicated of existing nursing theories. The Theory of Human Caring, which has also been referred to as the Theory of Transpersonal Caring, is a middle – range explanatory theory. (Fawcett, 2000) The central point of which is on the human component of caring and actual encounter between the client and the caregiver.
Poor care does not only result in bad press and public perception but also break the trust between the patient and nurse. Utilising the theoretical framework developed by Todres et all (2009) which explores eight central aspects of what it is to be human. Todres et al (2009). This model can be used to improve nursing care. Referring to the term ‘being treated as human beings’ not being treated as a number or object.
Watson, J. (2012). Human caring science: A theory of nursing (2nd ed.). Sudbury: Jones and Bartlett Learning.
The provision of patient/family-centered care, which assure safety and quality in the service, would have a team work approach as a foundation and underpinning. In a healing process or in the preservation of health intervene several factors, some of them are closely related with the environment. Healthcare providers constitute an important part of that environment, and definitely, communication with patients, families, and among themselves, have a significant impact on it. The environment would influence the patient’s perception of care, and the staff’s level of
Introduction Person centred care is important as it ensures that the patient is involved in their care and is treated holistically, with respect, is empowered and given realistic choices about their treatment and care. (Royal college of nursing, 2015). I will be developing a personal development plan to reflect on my strengths, weaknesses, concerns and expectations in relation to my personal and professional development as a Student Nurse relating this to the professional values of nursing. I will be performing a literature review of texts relating to points raised in my SWEC analysis. Using a SWEC analysis I will pick 3 points for each area and then discuss 3 of these points in more detail.
This provision is strongly connected with nursing as a human science because one has to treat every patient in a unique matter with respect, compassion and empathy to their particular situation they are experiencing. The third provision interrelates with the fundamental nursing responsibilities of optimizing the health by advocating for the patient and protecting the patient. In sixth provision, it explains how nursing is group work that is constantly being evaluated, and improving to provide a safe but quality environment for everyone. (Morrisard, n.d.) Each of code of ethics are essential in providing care for the patient as well as protecting the patient’s safety, rights, and
Working in health care is an important job. People put their trust in us to do our very best to provide them with the absolute best care. Being entrusted with such responsibility requires nurses to conduct themselves both professionally and ethically. Nurses must adhere to the professional values of human dignity, integrity, autonomy, altruism, and social justice. It is these five values that guide us in our practice and as nurses we must promote and emulate these values. They play an important role in the quality of treatment and success of an organization and help us determine right from wrong.
The purpose of this paper is to define my professional nursing philosophy. I will utilize the nursing metaparadigm as a framework for integrating the concepts of person, environment, health, and nursing into my nursing practice. Secondly, I will discuss Jean Watson’s theory of human care and how this has personally impacted my profession as a nurse and guided my nursing philosophy.