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Running head: THE ART OF CARING AND ITS POSSIBLE EXTINCTION 1

The Art of Caring and Its Possible Extinction

Crystal Bendele

Ferris State University

THE ART OF CARING AND ITS POSSIBLE EXTINCTION 2

Abstract

Nursing’s unique nature relies on the caring aspect of its profession. The importance of this art

of caring is supported by theoretical frameworks such as Jean Watson’s Theory of Human

Caring and Immanuel Kant’s notion of the Categorical Imperative. An assessment of the current

healthcare system, however, suggests that this art of caring is on the verge of being lost, which

implies a bleak outlook for both patient care and the nursing profession itself. To ensure quality

care and protect the nursing profession changes must take place which recognize and support the

values behind the art of caring.


The Art of Caring and Its Possible Extinction

The nursing profession has undergone dramatic changes since its early beginnings. What

began as an art dedicated to caring has now become a science devoted to curing. To some

extent, this shift is due to changes in the modern healthcare system. Within this system, a

number of factors exist that undermine a nurse’s ability to practice her art. Moreover, because

caring is central to a nurse’s duties, anything that threatens the ability to care for patients

threatens the profession of nursing itself. Therefore, to ensure quality care and protect the

nursing profession, changes need to be made to the current healthcare system, changes which

will promote those notions that form the basis for the art of caring.

For many healthcare professionals and even some patients, the nursing practice involves

the performance of clinical tasks that work to cure the body. Indeed, curing a patient’s body is a

part of a nurse’s duties. This is evident in such nursing tasks as assessments, the passing of

medication, IV starts, dressing changes, and catheter insertions. This is the science behind

nursing. Caring, on the other hand, involves a nurse’s attention to a patient’s mind and soul. It

pertains to all those elements of nursing that speak to the human interaction between the nurse

and the patient. Activities that reflect caring might include a nurse’s body language, her use of

the patient’s name, her touch, active listening, patience, and sensitivity toward the patient.

Essentially, the art of caring involves administering the curative aspects of the science, but doing

so in a way that acknowledges the holistic needs of the patient.

This art sets nurses apart from other healthcare professionals. According to the American

Nurses Association (2010), “the essence of nursing practice is caring.” The practice of this art

and its recognition of the holistic needs of patients forces nurses to acknowledge the humanity of

those for whom they care. With such an acknowledgement, patients are no longer merely objects


in search of a cure. Instead, these patients are recognized as unique individuals with diverse

healthcare needs and concerns. Essentially, the art of caring rescues patients from a standardized

healthcare experience and allows them to experience care individualized to their needs.

To further this discussion of the art of caring and uncover the basis for this notion,

relevant theories should be explored. The importance of such exploration resides in the fact that

theories provide an overlying framework in which decisions are made and actions are taken.

Consequently, they provide a foundation for the practice of the art of caring. The two theories of

relevance are Jean Watson’s Theory of Human Caring and Immanuel Kant’s notion of the

Categorical Imperative.

Most discussions of the caring aspects of nursing introduce Jean Watson and her Theory

Human of Caring. As a nursing theorist and professor, Watson attempts to define how the

profession of nursing is unique. In examining her theory, one uncovers her belief that the

objective of nursing is to care, not just for the patient, but for the nurse as well. This belief

relates to the Theory of Human Caring’s three main elements: carative factors, transpersonal

caring, and caring moments/occasions. To understand Watson’s theory, it is essential to take a

closer look at each element.

The first of these elements are what Watson calls carative factors. When considering the

profession, Jean Watson identified ten carative factors which are unique to nursing (see

Appendix I). It was Watson’s belief that these factors should serve as a guide to the nursing

profession (Cara, 2004). An examination of these factors shows they focus on caring for a

patient’s mind and soul, rather than merely caring for his or her body. Caruso et al. (2008)

support this focus, arguing that “[w]hile some of the primary outward activities of direct nursing

care often involve care for the physical body, there is a significant part of the practice that


involves the mind and spirit of the patient as well.” As a guide then, these carative factors work

to remind nurses of this aspect of their care. Moreover, by attending to these factors, nurses

express what is unique to their profession, which is the art of caring.

The second aspect of Watson’s theory uses these carative factors to build what she calls

transpersonal caring. Watson believes that nurses should strive to develop transpersonal caring

relationships with their patients. This type of relationship “happens when the nurse goes beyond

her objective assessment and shows more concern towards the subjective and deeper meaning of

the client towards her own health care situation” (Quizon, 2008). In such a relationship, the

nurse recognizes the patient’s humanity. She acknowledges the patient as an individual with

distinct needs and concerns. As Cara (2004) states, this is the goal of the transpersonal caring

relationship: it “corresponds to protecting, enhancing, and preserving the person’s dignity,

humanity, wholeness and inner harmony.” In Watson’s theory, accomplishing this is a

requirement for caring for the patient.

The last aspect of Watson’s theory involves the caring occasion or moment. This

occasion/moment is defined as “the focal point in space and in time wherein two persons come

together in creating a caring occasion” (Quizon, 2008). Essentially, they are those moments

when a human-to-human connection is obtained on a physical, mental, and spiritual level.

During this connection, both the patient and nurse recognize the humanity in the other, which

consequently allows for true care to be administered. Achieving such an occasion requires the

participation of both the nurse and the patient, where both make a choice to enter into such a

relationship. Consequently, these occasions depend on the nurse’s ability to build a

transpersonal caring relationship with the patient, using, of course, Watson’s carative factors as a

guide.


This relationship involving both the patient and the nurse underscores one of the

important distinctions of Watson’s theory: her recognition of the caregiver. In fact, she is one of

the few nursing theorists who considered not only the patient but also the caregiver. Watson

believes that the well-being of the caregiver is an essential part of the equation in caring for

patients. According to her view, it was important for nurses to have healthy bodies, minds, and

souls so that they could be present during caring moments in order to make human connections

(Cara, 2004). A nurse who is distracted by deficiencies in her own well-being would not be able

to accomplish the goals of Watson’s Theory of Human Caring. When, however, the caregiver is

healthy, she can provide care that is not merely a sequence of mindless tasks, but instead, is one

where the nurse is attentive to the patient’s distinctive needs. The healthy caregiver is one who

can be present in the moment, focusing on the patient.

Within Watson’s theory, there exists an understanding of morality and bioethics. While

morals involve specific beliefs concerning how one should act, ethics is the “branch of

philosophy dealing with values relating to human conduct, with respect to the rightness and

wrongness of certain actions and to the goodness and badness of the motives and ends of such

actions” (Ethics, 2012). In other words, ethics places these beliefs into as system of principles.

Regarding both of these notions, the healthcare field often turns to the theories of German

philosopher Immanuel Kant as a guide.

Writing in the 17th century, a good share of Kant’s work on morality involves the motives

behind an individual’s actions. Kant recognized that “since we are rational beings our actions

always aim at some sort of end or goal” (Rholf, 2010). Essentially, the individual, as a rational

being, always has a motive for her action. Thought, therefore, accompany action; and action is

never performed for merely the action’s sake. What was important to Kant was the overlying


moral structure that affected these actions. For Kant, morality involved a sense of duty. It was

his belief that “we should never act in such a way that we treat Humanity, whether in ourselves

or in others, as a means only” (Johnson, 2008). This is how he arrives at his Categorical

Imperative. The Categorical Imperative is “a moral law that is unconditional or absolute for all

agents, the validity or claim of which does not depend on any ulterior motive or end” (Categorial

Imperative, 2012). Therefore, for someone to act ethically, the individual’s actions must be

performed purely out of duty, and the moral worth of the actions must focus on the intent or

motive of the action, not the consequence. This is where Kant’s notion of duty lies. To him

there is a duty to do good, and that duty is not based on what can be gained, but is merely based

on the morality of the action itself.

This examination of theories produced by Watson and Kant provides a framework for

understanding the importance of the art of caring. Using these frameworks as guides, one can

ascertain the actions required by a nurse. A nurse must not view her duties as merely consisting

of actions taken to cure the body, but must instead recognize her patient as a person and care for

him or her as a whole. Doing so requires the nurse to make the care specific to the patient for

whom she is caring. Additionally, it requires the nurse to avoid viewing patient care as a means

to an end (task-oriented), and instead, requires the nurse to view it as her duty in protecting the

dignity of a human being. This requires the practice of the art of caring.

While these theories demonstrate the importance of the art of caring, the current

healthcare system is not always supportive of the notion. Certainly, policies do exist within the

system, which work to recognize the human aspect of nursing care. There are, however, a

number of other factors, which undermine nurses’ ability to practice their art. Some of these

factors have to do with the structure of the healthcare system. These include healthcare reform,


organizational policy and issues with resources. Additionally, educational constraints exist that

undercut the goals of the art of caring. Finally, when assessing the current healthcare system, it

is also important to examine the perception of caring in the healthcare setting and the limitations

that such perceptions place on the art.

An assessment of the structural constraints in the current healthcare system begins with a

consideration of healthcare reform. This reform dictates how healthcare organizations operate.

Healthcare reform centers on the Affordable Care Act, which requires that healthcare

organizations submit quality data. This data provides a measurement of the implementation of

evidence-based care, patient outcomes, and patient satisfaction. This compiled data is then used

for making payment determinations where organizations who demonstrate a higher performance

receive higher reimbursement.

The problem with such measures of performance is that they rely on the notion of

standardized care. Cara (2004) notes the problematic nature of such a structure, stating that “[a]s

most health care systems around the world are undergoing major administrative restructuring, we

expose ourselves to the risk of dehumanizing patient care.” Under such a system, precedence is

given to those decisions which produce the greatest reimbursements. Certainly, components

exist within these measurements that focus on care, such as those regarding patient satisfaction.

The problem, however, is that when care is standardized the individuality of patients and their

needs are lost. The care becomes one-size-fits-all where the patient resembles an object rather

than a person. Caring for the patient essentially becomes a performance of tasks, a means for

accomplishing an end.

When assessing the structural constraints that inhibit a nurse’s ability to practice the art of

caring, one must contemplate existing organizational policies. One of the most evident obstacles


has to do with staffing policies. Staffing plays a huge role in a nurse’s ability to provide the type

of care that makes her profession unique. Unfortunately, the nurse-to-patient ratios in most

healthcare settings are inadequate for realizing the art of caring. Many organizations use staffing

grids to determine the number and types of staff assigned to care for a given number of patients.

The use of such grids presents several problems when attempting to create a healthcare

environment where nurses can practice their art.

The first problem with this type of staffing policy is that it does not adequately consider

the work completed by nurses during their shift. With such grids, staffing levels are determined

at the start of the shift and do not take into account shift activity. For example, while a shift may

begin and end with the unit consisting of sixteen patients and five nurses, these numbers do not

adequately reflect the work performed during the shift. During the shift, a number of the original

patients may be discharged. Additionally, during the same shift a number of patients may also

be admitted. Although the number of patients at the beginning and end of the shift remain the

same, the work required for the discharges and admits is not considered. As any nurse can attest,

these discharges and admits often require the most work and are arguably the most time-

consuming of a nurse’s daily duties.

Similarly, staffing policies and the ratio they determine often do not take into account the

skill levels of the individual nurses on each unit. These skill levels are not evenly distributed

amongst units and shifts. Basically, any given unit on any given shift is comprised of nurses

who possess similar skill sets. Experienced nurse, for example, usually possess higher seniority

and can generally be found on day shifts due to it being a preferred shift. The less preferred

shifts are consequently comprised of nursing staff possessing less experience and less developed

skill sets.


The implications of such staffing policies suggest that the quality of patient care and the

art behind such care are both suffering. First, the implementation of such staffing policies

reduces a nurse profession to task-oriented duties. Staffing becomes concerned with crunching

numbers, rather than providing appropriate care. In fact, as Maben (2008) attests “[m]any nurses

question their ability to give good care under the new systems and describe how their caring

work has been infiltrated by numerous efficiency-oriented interruptions that distract them and

leave them vulnerable to making mistakes.” Additionally, by creating units and shifts that lack a

nursing staff with diverse skill sets, staffing policies further exacerbate conditions for poor

quality care.

There are those organizational policies, however, that work to bolster the ethical concerns

central to the art of caring. Ethics policies do exist on some level in most, if not all, healthcare

organizations. These policies actually work to provide a source of support for nurses who

approach the care of their patients from a holistic approach. They may include a code of

conduct, patient rights policies, and bioethics committees. Ethics policies assist the nurse in

guiding the ethics of her care and provide an avenue for voicing ethical concerns. The existence

of these ethics policies implies that healthcare organizations are concerned on some level with

the ethics behind providing patient care. Furthermore, these policies can certainly be use as a

foundation for implementing additional initiatives that support the notion of caring.

When assessing the structural constraints that exist in the current healthcare system and

affect the practice of the nursing art, one must also consider the resources organizations have at

their disposal. These resources include financial resources, human resources and physical

resources. Each has a profound impact on type of care patients receive at an institution.


Financial resources play an important role in determining the type of care that a nurse is

able to provide. Hospitals are experiencing a decrease in financial resources for a variety of

reasons. The most evident is the struggling economy. Such an economy produces increased bad

debt and charity care. Furthermore, it creates a healthcare situation where fewer patients are

having elective procedures. Such decreases in financial resources are further compounded by the

initiatives of healthcare reform which have previously been discussed. These reforms create

decreased reimbursement for struggling organizations, non-payment for healthcare acquired

conditions, and penalties for excessive readmissions. All of these can have profound effects on

an organization’s financial resources, which potentially lead to further constraints when it comes

to practicing the art of caring. Decreased financial resources, for example, have, in turn, led to

less staffing and, therefore, nurses “are no longer able to provide care they were trained to do”

(Gugerty, 2008). Quality care, therefore, requires sound financial resources.

A consideration of resources should certainly involve an assessment of human resources.

The fact is that nurses practice in an environment that is highly stressful. This stress is the result

of several factors. These include working in an environment where things cannot be predicted or

controlled, expectations to perform well in an environment with multiple tasks and competing

priorities, and personal stressors outside of work that can impact performance while caring for

patients. High levels of stress can have a variety of adverse effects on nurses. Such levels may

result in more missed work days, may produce a distracted nurse who makes more errors, and

may increase fatigue amongst staff, resulting in nurses being unable to make a human connection

with their patients. Ultimately, these high levels of stress result in nurse burnout.

Another characteristic of the nursing workforce that requires attention is the fact that the

average age of a nurse is increasing. This aging workforce certainly affects the art of caring. As


nurses age, they leave the profession, which produces a loss of experienced nurses. These

experienced nurses have the ability to provide more care due to their experience. They are

generally more efficient with concern to their task-oriented duties and thus have more time to

spend with the patients. Additionally, they often have fine-tuned the caring aspects of their

duties. Moreover, it is also important to recognize that there is a lack of new nurses entering the

profession. Consequently, those nurses who are leaving are not being replaced. This obviously

places a heavier workload on the existing nurses and compounds the problem.

Because the art of nursing involves a relationship between both the caregiver and the

patient, it is also important to consider the latter when assessing the current healthcare system.

Like the nursing workforce, the patient population is an aging population. This means that

patients are often sicker, have less of a support system, and are usually in greater need of care

when they come to the hospital. In fact, due to their financial woes and potentially their lack of

insurance, many of these patients put off seeking care until it is absolutely necessary.

Consequently, they are much sicker, and of course, sicker patients require more resources.

Furthermore, these patients have become extremely healthcare savvy, which raises the

expectations they have regarding the care they receive. These characteristics of the patient

population imply that personalized care is even more essential in order to meet patient concerns

and demands.

Finally, a consideration of resources must include the physical constraints that the work

environment produces. Healthcare setting are not always conducive to the art of caring. Some

nurses, for example, work in older facilities, which were built at a time when patients were less

ill, and thus required less medical equipment. Such cramped settings certainly impact the type of

care a nurse can provide and have the potential for creating safety hazards for both the patient


and the nurse. Like any work environment, the setting in which nurses work affects their

performance. If the setting is not ergonomically designed to meet the needs of the nurse and

patient, then the art of caring will suffer.

Another aspect of the healthcare system which impacts the art of nursing pertains to

education. There is a lack of instruction involving caring at all levels of nursing. This may be in

part due to the assumption that caring cannot be taught. As Herbst, Swengros, and Kinney

(2010) put it, “[t]eaching human caring is more than imparting cognitive information about

theory or demonstrating psychomotor intentional human caring behaviors. Teaching human

caring involves cognitive and psychomotor prompts that elicit an affective response in the

nurse.” This statement rests on the belief that one can teach another the physical actions behind

caring (e.g. a smile, a touch), but one cannot teach another the feeling and intention underlying

the act of caring. Consequently, many nurses enter the profession without any serious

consideration of the caring aspect of nursing. This aspect is usually only encountered in theory

courses and is limited to those who pursue their bachelors.

Regarding those nurses who are currently practicing in the healthcare system,

requirements do not exist which necessitate a continued education in caring. Standards do exists

with other aspects of nursing such as pain management where a nurse periodically must attend

educational seminars on the topic. However, caring and its art do not benefit from such

standards. Requirements merely exist for the task-oriented components of the nursing

profession.

This lack of caring in education sends a message to the professionals working in the field

that caring is not an important aspect of a nurse’s duties. Moreover, education that does not

focus on caring will only produce nursing professionals that do not focus on caring. This will


eventually lead to an environment completely devoid of interpersonal care. When coupled with

continuing education that merely focuses on clinical tasks, the suggestion is made that these

clinical aspects take precedence over the very core of the nurse’s profession: the art of caring.

This leads to a discussion of the perceptual constraints that undermine the practice of the

art of caring. As already mentioned, within the healthcare field, there persists the perception that

clinical duties should take precedence over the more interpersonal aspects of nursing duties.

This belief can certainly be seen in the education of nurses as well as the evaluation of their daily

duties. Many might point to such favoring of clinical aspects as partially due to the notion that

caring aspects are completely subjective and, therefore, immeasurable. This point of view,

however, cannot completely explain the notion’s persistence since healthcare providers are

evaluated based on patient satisfaction scores. These scores reflect the care given and can

certainly be used as a means of measurement. Whatever the cause of these perceptions, they are

consistently reinforced by a system that undervalues the transpersonal care provided by nurses.

Until these perceptions are altered, they will inhibit and slow any changes to the healthcare

system that will promote caring as an art.

This assessment of the healthcare system aims to give an overview of the environment in

which nurses work while attempting to practice the art of caring. While it is not all-inclusive, it

does provide one with a sense of the various challenges the nursing profession faces.

Furthermore, the implications are evident. First, the art of caring, which is central to the

profession of nursing, is at risk of becoming extinct for a variety of reasons. Until nurses can

clearly define and measure their unique art, it will be hard to place any value on this important

aspect of care. Additionally, patients as well as the profession of nursing will ultimately suffer.

To ensure the survival of this art, changes are required. The remainder of this discussion will


focus on recommendations for these changes. Due to the limited scope of this discussion, the

recommendations provided here will not address every aspect of the healthcare system that

complicates the practice of the art of caring. Instead, this discussion will present four

recommendations which are seen as essential to ensuring the survival of this art.

The first recommendation, and perhaps the most essential to ensuring the survival of the

art of caring, has to do with nursing education. Changes must be made to the current system of

education in order to produce nurses who recognize caring as a cornerstone of their profession.

These changes involve both pre-licensure as well as the continuing education of professional

nurses.

An individual’s first impression of what nursing entails comes from their pre-licensure

education. This is why it is essential that the caring aspect of nursing is emphasized at this

juncture. This initial education must stress the QSEN competency of Patient-Centered Care to

ensure that new nurses understand the role interpersonal caring plays in providing quality care.

Again, many in the field assume that caring cannot be taught. This assumption relies on the

belief that caring does not innately exist in the individual and must therefore be taught. The truth

is that most individuals possess the potential for caring, but must merely be taught to embrace

and engage in caring activities. This can certainly be accomplished. Take, for example, the

study highlighted by Waterman (2007), in which students were successfully taught the caring

aspect of nursing through the use of role modeling, a supportive learning environment, and overt

teaching methods. The study argues that “[w]ithin this curriculum the theory of caring was

taught, first in the classroom setting, and then the theory was applied in clinical by the faculty

through role modeling, and by students when they implemented their actual nursing practice”

(Waterman, 2007). This same sort of curriculum needs to be implemented throughout pre-


licensure education to ensure new nurses possess an understanding of the role caring plays in the

profession.

Additionally, the continuing education of nurses must reflect this same concern. This

continuing education should involve a specific number of hours devoted to the topic of the art of

caring. These working nurses are already required to attain continuing education with concern to

task-oriented aspects of their job. Requiring periodical seminars on the role of caring in the

profession will help keep this notion fresh in nurses’ mind. Addtionally, such seminars will

disseminate new studies and perspectives on the topic, which these professionals can then

implement in their daily duties.

These educational recommendations support both ANA standards as well as QSEN

competencies. According to the American Nurses Association (2010), there exist education

standards which necessitate that a nurse “acquires knowledge and skills appropriate to the role,

population, specialty, setting, role, or situation.” These educational recommendations will

certainly accomplish this. Consider also the QSEN’s competency regarding Patient-Centered

Care. One of the key skills to this competency involves “providing patient-centered care with

sensitivity and respect for the diversity of human experience” (QSEN, 2012a). Educating nurses

in the art of caring, which acknowledges the patient as an individual, will certainly address this

competency. Furthermore, the ANA standards require that the nurse “participates in ongoing

educational activities related to appropriate knowledge bases and professional issues” (American

Nurses Association, 2010). The recommendation for continuing education concerning the caring

aspect of the profession supports this standard and is definitely appropriate since this aspect is

central to the profession.


This discussion’s second recommendation involves allowing nurses to spend more time

at the bedside developing interpersonal relationships with their patients. This can be

accomplished by utilizing a technical staff to perform clinical tasks as well as standardizing the

technical aspects of the job to promote efficient use of time. Both of these initiatives can then be

supported by the implementation of technology. Bolton, Gassert, and Cipriano (2008) provide

evidence that the use of technology can serve to lighten nurses’ workloads and reduce waste,

which would consequently return nurses to bedside care. Once at the bedside, nurses can

concentrate on the caring aspects of their duties and foster interpersonal relationships with

patients.

As already mentioned, building such relationships acknowledges a patient’s individual

needs and concerns. Such an acknowledgment supports the ANA ethics standard in which a

nurse “delivers care in a manner that preserves and protects healthcare consumer autonomy,

dignity, rights, values, and beliefs” (American Nurses Association, 2010). Additionally, it

allows the patient to be an active partner in their healthcare choices. This participation by the

patient also supports the QSEN competency of Patient-Centered Care. This competency states

that nurses must “[r]ecognize the patient or designee as the source of control and full partner in

providing compassionate and coordinated care based on respect for patient's preferences, values,

and needs” (QSEN, 2012a). To recognize the patient as such acknowledges his or her humanity,

which is a key component to the art of caring.

The next recommendation has to do with improving communication amongst all

members of the healthcare team. To accomplish this recommendation, the use of

interdisciplinary care teams must be encouraged and education must be provided which allows

an understanding of the roles and expertise of other members of the healthcare team. Inter-


disciplinary teams provide a number of benefits, “such as continuity of care, the ability to take a

comprehensive, holistic view of the service user’s needs, the availability of a range of skills, and

mutual support and education” (Mental Health Commission, 2006). In fact, studies show that

such interdisciplinary teams produce great benefits with regards to patient outcomes. One such

study involving breast cancer patients showed that a reliance on an inter-disciplinary team’s

expertise, which included specialist nurses, reduced patient mortality by eighteen percent

(Kesson et al., 2012). Nurses must, therefore, rely on the expertise and support of other

healthcare professionals to ensure their patients receive the type of care which lies at the core of

their profession.

The communication required by such interdisciplinary care is essential for ensuring

quality care and patient safety. According to the American Nurses Association (2010), “[t]he

registered nurse communicates effectively in a variety of formats in all areas of practice.” This

includes communication with patients, their families, and other healthcare professionals.

Furthermore, trained nurses should possess the QSEN competency of teamwork and

collaboration which states that a nurse should “[f]unction effectively within nursing and inter-

professional teams, fostering open communication, mutual respect, and shared decision-making

to achieve quality patient care” (QSEN, 2012a). Opening this channel of communication will

only benefit the patient, which is central to the ethics and duties of the art of caring.

The final recommendation involves ensuring that the caregiver’s well-being is properly

addressed. To accomplish this recommendation, several initiatives must be taken. First, a limit

needs to be placed on the number of hours a nurse works in a given time period. Nurses also

need to be provided with essential health and well-being benefits. Additionally, organizations

need to provide nurses with an environment ergonomically designed for the type of care they


strive to provide. The importance of such an initiative is supported by a recent study by Letvak,

Ruhn, and Gupta (2012) which shows that “nurses' health affects work productivity, which in

turn affects quality of care.” One must only return to Watson’s Theory of Human Caring to

understand the importance of nurses’ well-being.

Additionally, this last recommendation finds support in the American Nurses

Association’s quality of practice standards. These standards state that “[t]he registered nurse

contributes to quality nursing practice,” and that the registered nurse “implements activities to

enhance the quality of nursing practice” (American Nurses Association, 2010). Both nurses and

healthcare administrators must, therefore, recognize how a nurse’s own physical, emotional, and

spiritual health impact the quality of the care that she provides.

To ensure this quality of care and to protect their profession, nurses must embrace that

which makes their profession unique: the art of caring. This art is essential in providing holistic

care which recognizes the patient’s humanity. Because the current healthcare system presents

many obstacles to providing such care, it is the duty of these nursing professionals to challenge

this system. Nurses must actively promote their art, demonstrate its capabilities, underscore its

benefits, and make others in the healthcare field take notice.


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Appendix I

Jean Watson’s Ten Carative Factors

Embrace altruistic values and practice loving kindness with self and others.

Instill faith and hope and honor others.

Be sensitive to self and others by nurturing individual beliefs and practices.

Develop helping – trusting- caring relationships.

Promote and accept positive and negative feelings as you authentically listen to another’s

story.

Use creative scientific problem-solving methods for caring decision making.

Share teaching and learning that addresses the individual needs and comprehension

styles.

Create a healing environment for the physical and spiritual self which respects human

dignity.

Assist with basic physical, emotional, and spiritual human needs.

Open to mystery and allow miracles to enter. (Watson Caring Science Institute)

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