4/30/2013. Human Caring Multiple Ways of Knowing. Holistic Nursing Conference May 3, Mary Rockwood Lane PhD, RN, FAAN

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1 Mary Rockwood Lane PhD RN FAAN Human Caring Multiple Ways of Knowing WCSI. All Rights Reserved. Holistic Nursing Conference May 3, 2013 WCSI. All Rights Reserved. Mary Rockwood Lane PhD, RN, FAAN Associate Professor College of Nursing Shands Arts In Medicine Director Emeritus Center of Spirituality in Healthcare WCSI Faculty 23 1

2 History of Caring Science and Art as Healing Force C A R I T A S C A R I T A S 5 Caritas comes from the Latin word meaning cherish, to appreciate, to give special attention, if not loving, attention to: connotes something that is very fine, that indeed is precious. Eriksson in Finland has used the word caritas in her theory to convey similar meanings. Caritas/Christ Church Oxford University 6 2

3 Watson Caring Science Institute Caritas Ways of Being Becoming 1. Loving Kindness 2. Heart-centered Authentic Presence; Compassionate Forgiveness Gratitude- Appreciation Energetic Caritas Consciousness Giving Receiving Stillness-Silence Connecting with field of Universal Love Manifesting Caritas Field - to sustain caring and our humanity Other Infinite Personal and Professional Practices of Caring Nursing is the most noble profession our work is sacred and precious. Self care is a essential aspect of our work. Remember the promises we are privileged to keep: to honor connections of body and spirit in all relationships, with a sustaining passion, from the present until we are old. Being in right relation with self and others 8 The Core of Caring Theory 1. Heart/Soul Source of Compassion; Philosophy, Ethics, Love, Values & Human Spirit Connection 1. Voice Language & Structure - Caritas Processes 1. Hearth Where Theory Lives In the Caring Moment 1. Mind - Caring as Consciousness, Presence, Intentionality & Informed Moral Action 1. Hands/Praxis Caritas Modalities, Artistry: All Ways of Knowing/Being/ Becoming/Doing 1. Practice Loving Kindness 2. Instill Faith and Hope 3. Nurture Individual Spiritual Beliefs and Practices 4. Develop Helping Trusting Relationships 5. Promote & Accept Expressions of Positive & Negative Feelings 6. Use Creative Scientific Problem- Solving Methods for Decision Making 7. Perform Teaching and Learning that Address Individual Needs and Styles 8. Create a Healing Environment for the Physical and Spiritual Self which Respects Human Dignity 9. Assist with Physical, Emotional and Spiritual Human Needs 10. Allow Space for Miracles to Take Place Caritas: the basis of love for the ultimate meaning and destiny of other humans. WCSI

4 Expanded View of Person: Light Energy Consciousness: MindBodySpirit Connectedness Heart-Connectedness with Source Alex Grey Sacred Mirror 10 Era III Non Local Transcendent Consciousness Connecting with Universal Source Holographic Notions Consciousness Transcends Time and Space, and Physicality Consciousness is Joined Consciousness Omnipresent, Infinite, Immortal and Ultimately One; Unitary Being; Unitary Field Evolving Heart-Centered Human Deepening /Sustaining Our Humanity11 Alex Grey 12 4

5 Nightingale Divine Laws 13 Electromagnetic Field of the Heart Stillness Giving Receiving Caritas Process 8: Becoming the Healing Environment Setting the Tone The heart radiates an electromagnetic field that energetically affects each others moods, attitudes and feelings. 15 5

6 Source: Caring/Compassion Inner Truth; Beauty, Our Very Humanity Watson WCSI Copyright 2010 HM Slide with Permission 16 Contemplative Pause: Reconsidering Nightingale 17 Nightingale Caring-Healing Modalities: Auditory, Visual, Sensory, Consciousness, Tactile, Voice,Environmental, Healing Arts Beauty, aesthetics Light (bed should face outdoors/nature) Water, Clean air Mood quiet, soft voices Human Touch Smell, Taste, Sight, Sound Imagination, (Visualization)Movement, Attitude and Relationships WCSI. All Rights Reserved. 18 6

7 Florence Nightingale Caring Science Ancient wisdom and contemporary science/art/spirituality converge 19 Nightingale: Health for All 20 Caring Science as Sacred Science Ethics of Belonging - Infinite Field of LOVE Sustaining Divinity of Humanity Grace and Dignity Connectedness of All Relational Cosmology Dwelling and Aligning with Infinite Field of Universal Love 21 7

8 Connecting Purposeful emphasis on integrating the wholeness of the patient, patient patterns and patient meaning into the nursing initiatives. 22 BACK TO BASICS OF HUMANKIND jeanwatsoncopyright Energy, Intent and Multiple (All) Ways of Knowing Diane Swengros Caritas Coach InovaHealth WCSI. All 2009 Rights Reserved. WCSI

9 Fundamental Patterns of Knowing -Carper Empirics Scientific Knowing Esthetics Artistic Knowing The component of personal knowledge Ethics Moral knowing in Nursing Carper, B., Advances in Nursing Science (1978) 1 (1) WCSI Aesthetic Ethical Spiritual Personal Creative Empirical Intuitive 26 Ways of Knowing EMPIRICAL Factual, objective, and verifiable by outcome measures Application of theories Body of knowledge that is research based and systematically organized WCSI

10 Ways of Knowing AESTHETIC Holistic expressions and perceptions of creativity, openness, meaning, and empathy Expanding caring healing modalities to include voice, touch, presence, poetry, music, aroma therapy or any other aesthetic medium WCSI Ways of Knowing PERSONAL Knowing, encountering and actualizing of the self Self-actualization through interpersonal processes and interactions Present meaning that are brought into relationship with WCSI Ways of Knowing ETHICAL Make choices within situations involving moral judgments Analysis and clarification of shared values; justice, compassion Examining what is worth being and preserving WCSI

11 Ways of Knowing SOCIOPOLITICAL Changing environments toward highly integrated, continuum-based and multifaceted Engaging issues such as gender, diversity, culture, power Caritas Path to Peace WCSI Ways of Knowing EMANCIPATORY Engaging issues of equity, justice and transformation, attends to social barriers Creates clearing for bringing together art, science, spirituality for new depth for unabashed love for caring & healing ti WCSI Caritas Process 1: Humanistic Altruistic Values Practice of Loving-Kindness and Equanimity with Self and Other 33 11

12 Magnetic Reminders: Pausing - Practicing Presence: Loving Kindness VALUES: Preserving Human Dignity: Magnets on Patientʼs Door INOVA Health, Fairfax, VA 34 Caritas Expression of Loving Kindness Practice from what is in your HeArt With loving expression using voice and touch; - one word from your heart can express profound kindness Value what Jean Watson has taught us, that what we hold in our heart matters 35 Caritas Process 2: Faith and Hope, Being Present Authentically 36 12

13 Art is A Caring Moment Caring Moment A heart centered love-filled, energetic field; a turning point; A call to higher/deeper consciousness, intentionality; An authentic choice of caring/living; Requires presencecentering-search for meaning; New level of authenticity- potentiating self healing and wholeness. 38 Caritas Process 3: Sensitivity to Self & Others, Ongoing Spiritual Development 39 13

14 TS Eliot The Still Point - in midst of chaos. Healthcare: What is Basic health and human caring? 40 Love: Intelligent Heart Centered Human-to-Human Caring Practice Love The Old Unfamiliar Name... Behind the Hands, Not Known Because Not Looked For, But Hidden in the Stillness, Behind the Scenes Where is Our Patient? T.S. Eliot 41 Lifelong skills: Meaning Relaxation Meditation Guided imagery Prayer Creativity Trust 14

15 Caritas Process 4: Developing Authentic Trusting Caring Relationships 43 Caritas Process 5: Allowing Expression of Positive-Negative Feelings: Listening to Another s Story 44 Caritas Process 6: Creative Problem-Solving Caring Process 45 15

16 Creativity and Spirituality In Healthcare Arts In Medicine Programs: Practice Spirituality in Healthcare groups: Practice Shamanism Artist as healer Caritas Process 7: Relational Teaching Learning / Inner Subjective Meaning 47 From Implementation to Partnering From doing to and for the patient to being with the patient- mutual process Giving information to a patient in away they can understand-genuine teaching learning staying within the other s frame of reference. Creating a caring healing relationship How can I best help you learn about your medications? What will life be like for you when you go home on a low sodium diet? 48 16

17 From Evaluation to Reflection Evaluation is often done by the nurse to the patient Reflecting involves open communication- how do you feel? What are you experiencing? 49 Caritas Process 9: Creating a Healing Environment Physical Environment: Privacy/Windows Healing Garden/ Nature Light, color, sounds, flow of movement Nurse as Environment: Voice, touch, eye contact, energy, feelings Family connection Health care team collaboration 50 Healing Arts Program 17

18 Creating a Healing Environment Guided Imagery Music, Dance, Poetry, Art Listening Healing touch Artistic expressions Human interactions Beauty / Nature 52 Healing Environments Gardens Rooms Views Altars Caritas Process 9: Assistance With Basic Needs Sacred Acts Embodied Spirit: Touching Mind Body Spirit Not Just Body Physical 54 18

19 Bea Everyday a patient should have something beautiful to look at... Nightingale blooming in midst of thorns 55 Health Outcomes Patient care humanized Quality of life improved Clinical practice enhanced Environments illuminated Cost effectiveness Caritas Heart Moment:What song does your heart Sing? WCSI. All Rights Reserved

20 Caritas Process 10: Open to Existential - Spiritual Unknowns: Allow for Mystery & Miracle 58 Caritas Nursing Praxis Application of Learning to Practice Study of Practice Informed Passion Caring Practices New Caring Modalities Practice of Knowing and Being and Doing in Caring Relationship Natural Healing Modalities Practice is informed by our world view and our knowledge base 59 Connected to Infinite Love and Grounded to the Earth Healing Touch Meditation by Cynthia Hutchinson Watson Caring Science Institute WCSI. All Rights Reserved

21 Art as a Way of Caring WCSI. All Rights Reserved. Art as A Healing Force 21

22 Call to Artists Everyone is an Artist If you can walk You can Dance If you can talk You can Sing! Call to Healers Human Caring Reclaiming the art Bringing in art Starting a program In your life In your practice Art As a Way of Caring 22

23 Shands Arts in Medicine Artist in residence: Visual artist Musician Dancer Poet Storyteller Theatre The Hospital as a Healing Community Sacred Space For all How does it feel? Its broken, fix it Healing spirit Art as Healing On the walls Content Meaning Story 23

24 Art Heals Yourself Others Neighborhood Earth Enhanced Practice Loving Mindful Present Caring 72 24

25 Art as Advanced Therapeutics Leadership Facilitator Advocate Do it yourself Be Creative Enhanced practice Research Develops a knowledge base Defines art in healing Defines health outcomes Changes practice Research Findings David Speigel, support group patients Diane Tusek, One hospital day shorter, decreased meds Ulrich- art on the walls and a window shortened hospital stay and ½ pain meds Candice Pert Psychoneuroimmunology endorphins and neurotransmitters from relaxation 25

26 Physiology: Symptom Reduction with art Physical Decreased muscle tension Decreased pain Increased oxygenation Increased circulation Improved sleep Improve appetite Psychological Decreased anxiety Increased intuition Improved clarity in thinking Enhanced faith Increased acceptance Caring Science Outcomes The outcomes we have seen since adopting Caring Science, include improved nurse retention, increased satisfaction scores and improved benchmarking on our clinical outcomes. Lance Anastasio, President and CEO Winterhaven Hospital, Winterhaven, FL 78 26

27 Rational for Assessing and Measuring Improvement of Caring Practices; Mindful Intentional Interventions; Benchmarking Settings, Structures for Improvement; Tracking Caring Against Routine-Robotic Practices; (from Bio-cidic to Bio-genic) Evaluating Caring-Non-Caring: Patients/Practitioners WCSI. All Rights Reserved. 79 Rational for Assessing and Measuring Improvement of Caring Practices; Mindful Intentional Interventions; Benchmarking Settings, Structures for Improvement; Tracking Caring Against Routine-Robotic Practices; (from Bio-cidic to Bio-genic) Evaluating Caring-Non-Caring: Patients/Practitioners WCSI. All Rights Reserved. 80 Caring Science Research: Caring assessment instruments Assessing Measuring Caring and Outcomes

28 CPAS Caritas Patient Assessment Score 1. Develop a Quick and Easy Instrument to Administer and Measure Patient Perceptions of Caring An APGAR Score Maintain Integrity of Caritas Processes 2. The 5 Items Selected Account for 78% of the Explained Variance of Caring 3. #1 Providing Care with Loving Kindness Accounts for the Majority of Variance 67.8% 4. Develop Instrument for Use by Facilities Interested in Measuring Patient s Perceptions of Caring Practices WCSI. All Rights Reserved. 82 WCSI International Comparative Caring Research (University of AZ Dr. B. Brewer PI ) To Apply the Watson Caritas Patient Score Instrument in multiple hospitals using Caring Theory as Professional Practice model 1. To Use the Data for Ongoing Performance Improvement and Clinical Investigation unit level comparison; quarterly reports online; 2. To Build an Accurate and Reliable National Comparative Database of Authentic Caritas practices Perceived by Patients; relationship bx caring system, nurse sensitive patient safety and quality indicators; 3. To Improve the Validity and Reliability of the WCPS 83 Empirical Theoretical Measurement of Authentic Caring WCPS Tool Watson Caritas Patient Score - WCPS (Apgar* score of caring) WCPS - Watson Caring Science Institute: Watson, Brewer, & DʼAlfonso, 2009 WCSI. All Rights Reserved

29 New Caring Science Criteria: New Outcome Indicators Leaders/Managers NOW Seek ʻEvidenceʼ of: Human Flourishing: Staff and Patients, Family, Community. Purposive Involvement: Contributing to Something Larger Than Self Inspired Vision. Building Capacity: Inspired Organizational Leadership, Workgroup Cohesion, Workgroup Learning Processes. Honor and Use of Unique Individual Talents for Advancement Progression; Relational Coordination 85 Allowance for Creative Emergence Caritas HeartMath Pilot Baptist Health, Jacksonville, FL Personal Clinical Indicators of Stress (e.g. Outlook, Motivation, Fatigue, Resentful, etc.) 10 or 10 Indicators Improved with Caritas HM Program After 1 Month Organizational Qualities (e.g. Work Attitude, Strategic Understanding of Organizational Goals, Goal Clarity, Value of Contributions, Communication Effectiveness, Productivity, Time Pressure, Morale Issues and Intention To Quit.) 86 Opportunities For Ritual Handwashing An ACT Initiative PROVIDES A PAUSE TO: Quiet Busy Mind Wash Away Old Experience Center in Caring Intention Honor Self and Other Reconnect to Core Values Bless and Release Last Person/Situation Purify Sacred Space for Authentic Presence Open to Ability to Give and Receive Next Person/Situation The Children s Hospital, Denver 87 29

30 Into The Caritas Staff Retreat with a Stone Waterfall Feature From Smoking Area to Caritas Garden Angie Fontaine, RN Caritas Coach, Jacksonville Baptist, FL, Cultivating Consciousness and Listening for Meaning Wyoming Medical Center jeanwatsoncopyright2012 Afternoon Tea Where: Reflective Practice is Cultivated Where Nurse s Own Experiences are Shared Where We Learn to Listen for the Healing Environment Quiet Time The Children s Hospital Denver 90 30

31 CP: 10 Sanctuary Healing Room for Nurses 91 Kaiser - Antioch Medical Center 92 Reflections 93 31

32 Vijali s Three Questions What is your essence? What keeps you from getting there? What can you do to achieve it? No Fear Open heart Total commitment A Sacred Pilgrimage or Vision Quest Go Into peace and silence Listen Remember Return My heart leaps up when I behold a rainbow in the sky! by William Wordsworth (1802) 96 32

33 May beauty be all around you Come join us. Walk on a rainbow trail. Walk on a trail of song and all around you will be beauty. There is a way out of every dark mist. It is over a rainbow trail. Navajo Poem 97 Individual Artistic Renderings Multiple Ways To Express Experience WCSI. All Rights Reserved. Books 33

34 Spirit Body Healing A phenomenological hermeneutic study of the lived experience of art in healing WCSI. All Rights Reserved. Themes in Art and Healing pain and darkness going elsewhere being creative in a turning point slipping through the veil knowing the truth and trusting the process embodying spirit feeling healing energy and compassion

35 Pain Trigger 35

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37 Going Elsewhere Pet Therapy: Something to Care for and Love Marlienne Goldin, RN Caritas Coach & Faculty Watson WCSI Copyright

38 Art as Turning Point 38

39 Slipping Through the Veil 39

40 Healing Energy 40

41 121 Habitat for Healing Influencing the Environmental Field Using Creative Caring-Healing Modalities For Staff, Patients and Families Wyoming Medical Center jeanwatsoncopyright Embodiment of Spirit 41

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43 Transcendence Thank You! Each one of you is the light and beauty of the rainbow of caring. WCSI. All Rights Reserved. 43

44 Reflections