Caring science and nursing presence

By Carrie A. Roberts | 08/24/2018

She found the theory, and then she found healing.

Caring science and nursing presence

The author struggled with compassion fatigue until she discovered caring science, which focuses more on the suffering patient than the caring nurse.

Carrie A. RobertsMy personal challenge to attain presence in nursing practice, needed for compassionate care, made me aware of barriers that prevent presence. In my opinion, nursing’s historical values of love and charity—core concepts of nursing ethics—are diminished by the increasing technological, societal, and administrative demands placed on bedside nurses.

Today’s nurse must be able to lead a code, answer the call light for a turkey sandwich, and monitor a confused elderly patient—all at the same time. The demands of this multitasking become even more daunting when the nurse-to-patient ratio is higher than normal, which is often the case. Reducing emphasis on nursing’s primary focus—the patient—compromises the nurse-patient relationship.

The disconnect
Empirically and ontologically, the science of nursing and caring science often fail to communicate, and there is a great divide between what is taught in the classroom and the lived experience of the professional bedside nurse. For me, this incongruence led to what I have come to know as compassion fatigue. 

Compassion satisfaction is a self-protective measure some nurses employ to alleviate their negative emotions in the face of repeated exposure to suffering patients. For other nurses, constant exposure to suffering prevents them from forming the necessary nurse-patient relationship, and these nurses often develop compassion fatigue.

Early in my career, I was one of them. Although I was taught that true caring is not realized and nursing presence is not attained without formation of a nurse-patient relationship, I found it almost impossible to achieve that objective in my professional practice. Instead, I was frustrated, angry, and anxious and was unable to balance these emotions in the face of patient suffering and organizational demands.

I was not alone. An estimated 80 percent of acute care nurses experience high levels of compassion fatigue, a phenomenon that negatively affects patient safety and satisfaction, employee engagement, and healthcare organizations’ strategic plans.

Painful memories
My nursing journey was a second career, the fulfillment of a childhood aspiration. As with many nurses, I had a passion to give back to others and needed to feel I was making a difference in someone’s life. Upon graduating with an associate degree, I began working on a progressive care unit of a large, inner-city academic medical center. Although many support modalities were available, including nurse residency, clubs, and professional councils, I was plagued with anxiety, fear, and exposure to suffering and death.

The term compassion fatigue never was used, but in retrospect, I realized I was suffering from it. I will always remember walking to the unit, roaming the halls before my shift, and gathering courage for what awaited me. My fatigue was related not to lack of nursing knowledge or skills but to my “becoming,” my state of being. The reasons were multifaceted: my inexperience, both empirically and ontologically; patient acuity; administrative demands; and schedule rotation.

Today’s healthcare environment has changed greatly from the 1960s, when values and ethics were instilled through what we know as standard nursing education. Also, most nurse caring theories were developed during that decade. Since then, healthcare professions have entered a biotech era in which the nursing profession is viewed as the stakeholder for humanity, the voice of reason, and the patient advocate.

The lesser-known theory
As my educational journey continued into graduate school, I discovered not only different nursing theories that focused on patient-focused nursing practice but also a lesser known academic discipline known as caring science. In the United States, few nursing schools base their curriculum on caring science. For me, prior to my discovery of caring science, the concept of suffering—its underpinning—was not developed in a way that could motivate change or action. In my undergraduate program, the focus was caring, caring realities, and the impact caring has on others. While these are important to nursing, it was not until my graduate program that I was introduced to an alternative approach to caring theory.

From the caring science perspective, the focus is not the caring nurse but the suffering patient. Because my call to the nursing profession centered on the lived experience of suffering—both my suffering and my family’s­—this approach allowed me to tie pieces of my life together, to make sense of lived experiences, and to heal my wounds, personally and professionally.

Two-sided coin
The nursing profession is at a crossroads in its history. Traditional education practices do not fully incorporate the ontological skills needed to produce effective caring nurses. In theory, professional nursing is a two-sided coin. The two sides of caring—the empirical and the ontological—are distinct from one another but need to be connected. The skills and knowledge to perform, together with wisdom and understanding of caring and suffering, are prerequisites for positive growth. Today’s nursing professionals need both skillsets to be successful. Our educational and healthcare institutions need to connect and bring forth change that provides for professional growth. This paradigm shift will take time.

In the interim, nurse leaders should focus on recognizing compassion fatigue and finding ways to reduce its impact on nursing staff. This mandates more research on compassion fatigue and creation of screening tools to identify it.

As I have grown as a nurse, my passion has shifted. I now want to focus my energy on preserving and protecting nursing’s caring identity—individually and as a profession. There is much to learn, but with continued scholarship, the profession can move to proactively reduce compassion fatigue and, thereby, promote better outcomes for patients and their caring nurses. RNL

Carrie A. Roberts, MN, RN, a student at Notre Dame of Maryland University School of Nursing, Baltimore, Maryland, USA, is a Rising Star of Research and Scholarship.

Editor’s note:
Carrie Roberts will present Compassion Fatigue in the Presence of Employee Engagement” on Monday, 17 September 2018, at Sigma’s Leadership Connection in Indianapolis, Indiana, USA.

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