Evaluation of Authentic Human Caring Professional Practices

1 JONAV olume 45, Number 12, pp 00-00 CopyrightB2015 Wolters Kluwer Health, Inc. All rights JOURNAL OF NURSING ADMINISTRATIONE valuation of Authentic Human CaringProfessional PracticesBarbara B. Brewer, PhD, RN, FAANJean Watson, PhD, RN, FAANOBJECTIVE:The aim of this study was to present aninstrument and comparative database designed to evalu-ate patients_perceptions of Caring behaviors of :Acute care leaders are under pre-ssure to improve publicly reported patient satisfactionscores. Some nurse leaders have implemented profes-sional practice environments based on Human caringtheory, whereas others have used scripting to standard-ize communication between staff and :The Watson Caritas Patient Score (WCPS)is collected quarterly from a random sample of :The WCPS was able to discriminate acrossunit types and hospitals.

2 Items were related to publiclyreported nursing communication :Participation in research based onhuman Caring theory has given nurse leaders the op-portunity to evaluate effectiveness of Professional prac-tice environments. It may provide the opportunity tofocus staff communication with patients more au-thentically and in a way that enriches the experiencefor purpose of this article is to report on a caringscience research project, which measures patients_experience of Authentic Professional Human Caring science practice approachapplies to caregivers toward each other as well aspatients/families and as an Intervention to Demonstrate CaringAs hospitals seek approaches to improve patient sat-isfaction, and address finances, many administratorsresort to scripting as 1 way to solve nurse-patientcommunication and improve outcomes.

3 Perhaps thereis some benefit to scripting as a means to guide com-munication and interactions; however, inauthenticcommunication is detectedimmediately by wisdom dictates that administrators canhave the greatest strategy to improve patient care,butBit is culture, which will eat strategy for lunch.[3To be successful, communication and nurse-patient re-lations requireBauthentic presence[and ways of being,which are reflective, sensitive, and present to the patient/family situation in the momentVconnecting self-reports from nurses in hospitalswhere scripting is used find the requirement intrusive,artificial, demoralizing, and is especiallytrue for nurses committed to theory-guided, professionalcaring science practice.]]

4 Caring Science hospitals andstaff hold a sacred covenant with their patients. Whennurses are most in touch with that covenant, they ap-preciate the need to form trusting relationships withpatients/families and to be authentically present duringinteractions and even brief moments of at scripting a Caring moment7and anyauthentic interaction is an oxymoron. Such a structuredapproach, based on administrative attempts to improveoutcomes, undermines the possibility for an authen-tic Human -to- Human , scriptinggoes against long-standing, educational teachings ofJONA Vol. 45, No. 12 December 20151 Author Affiliations:Associate Professor (Dr Brewer), Collegeof Nursing, The University of Arizona, Tucson; and Director,Watson Caring Science Institute, Boulder, Colorado; and Dis-tinguished Professor and Dean Emerita (Dr Watson), College ofNursing, University of Colorado, authors declare no conflicts of :Dr Brewer, College of Nursing, The Uni-versity of Arizona, 4575 E Blue Mountain Dr, Tucson, AZ digital content is available for this article.

5 DirectURL citations appear in the printed text and are provided in theHTML and PDF versions of this article on the journal_s Web site( ). 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is use of self,[common to all nurses, em-bedded in the timeless, classic teachings of Peplau,8and, more recently, Practices informed and guided bycaring science theoreticalvalues, philosophy, and ethicsas a mature Professional ,9 Indeed, recent Insti-tute of HeartMath research affirms that inauthenticcommunication is detected immediately, energetically,and intuitively and affects the larger field of commu-nication. So, both philosophically, as well as empiri-cally, scripting is not a solution to improved patient careand hospital maturing of nursing Professional practicemodels, despite the dominant medical disease hospitalsystem and conventional administrative attempts toscripting as a way forward, is revolutionary.]

6 MagnetAhospital_s success in instituting a Professional nursingmodel has had major impact on hospital staff, pa-tients, and society ,12 However, even with thesebest practice hospital successes, and with the maturingof nursing as a distinct discipline and profession, theprofessional Practices for improving patient care arestill surrounded by an outdated scientific Western world-view. This worldview is confined to physical body care,medical-disease, acute sick-care hospital Practices , com-pounded by external technical interventions. This ap-proach to patient care and models of care delivery isbased on latent and overt norms established by theinstitutional, industrial product-line, hospital cultureof this so-called modern to HealthGlobal shifts are upon us in healthcare.

7 These shifts areawakening toward philosophical value-guided healthapproaches toward whole-person/whole-system Caring -healing health. The Human consciousness shifts towardwellness are awakening to energetic models and possi-bilities of inner healing and emotional and mental health,oriented toward subjective, experiential indicators suchas individual self-love, self- Caring , self-knowledge, self-control, and self-healing health approaches, addressingindividual and collective Human suffering. This evolv-ing view for humankind and population health returnsus to the heart of our humanity and heart of nursing;it invites and requires Practices for sustaining a healthyenvironment and Human environment Caring for is happening today, in this era in Human his-tory, demands an expanded,dramatically different,worldview, quantum shift.

8 The quantum move is awayfrom episodic sick care and from material medicine andexternal interventions and cure of body, at all costVphysically, mentally, economically, spiritually. New re-search models are needed to generate data that exploreauthentic Human Caring -healing health, in contrast tothe physical-cure biomedical views of sick <15 MethodsTo shift the focus from objective, problem-oriented cri-teria and measures that address the status quo, thisstudy, grounded in Caring science, represents an expandedframework for healthcare and subjective outcomes,guided by Authentic Human -to- Human Caring and as-sessing core variables of patient experiences of study uses a descriptive design and is part of anongoing national comparative database project.

9 Partic-ipants submit quarterly responses from a randomsample of patients who are hospitalized on adult acutecare and rehabilitation units. Further description of thedata collection procedure is below. The results reportedhere are from the 2nd quarter of and SettingThe sample consists of 1010 patient responses from48 units in 8 hospitals located throughout the UnitedStates. All hospitals are either affiliates or researchpartners of Watson Caring Science hospital coordinators from each of the 8 hospitalscollect a random sample of patient surveys from each ofthe 48 units and submit them to the database. Becausethe unit of comparison is patient care units, all indi-vidual patient responses are aggregated to the patientcare unit.

10 Patient care units in the sample represent 10different unit types, which are illustrated in the Figure,Supplemental Digital Content 1, The most frequent unit type is medical-surgical (n = 15), and least frequent is moderate acuityadult (n = 1).Patients reported a mean age of (SD, )years, had been on the hospital unit for (SD, )days, and had (SD, ) health problems and apain score of on a scale of 1 to 10, 1 indicating nopain and the worst possible pain (score, 10). In ad-dition, 54% of the sample was female (n = 537), withan equal proportion (40% each) reporting bad andvery bad health. Forty-five percent (n = 437) came tothe hospital with an emergency condition, 55% (n =554) were white, and 43% (n = 437) were on bed rest,whereas 37% (n = 370) were able to sit on a chair atthe measurement assessment is Watson Caritas PatientScore (WCPS) (Figure 1),17capturing the patient_sex-perience of Caring .