human caring multiple ways of knowingmed.dartmouth-hitchcock.org/documents/human_caring.pdf ·...

4/30/2013

Human CaringMultiple Ways of Knowing

Mary Rockwood Lane PhD RN FAAN

Holistic Nursing ConferenceMay 3 , 2013

Mary Rockwood Lane PhD, RN, FAAN

• Associate Professor College of Nursing

• Shands Arts In Medicine Director Emeritus

• Center of Spirituality in Healthcare

• WCSI Faculty

4/30/2013

History of Caring Science and Art as Healing Force

“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” 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

4/30/2013

Watson Caring Science InstituteCaritas‐Ways of Being‐Becoming

1. Loving Kindness2. 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 ProfessionalPractices 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

The Core of Caring Theory1. 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. 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 Kindness2. Instill Faith and Hope3. Nurture Individual Spiritual Beliefs

and Practices4. Develop Helping – Trusting

Relationships5. Promote & Accept Expressions of

Positive & Negative Feelings6. Use Creative Scientific Problem-

Solving Methods for Decision Making7. Perform Teaching and Learning that

Address Individual Needs and Styles8. 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.

4/30/2013

Alex Grey ‘Sacred Mirror’

ExpandedView of Person:

LightEnergy

Consciousness: MindBodySpiritConnectedness

Heart-Connectedness with Source

Era III – Non LocalTranscendent 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 Humanity

Alex Grey

4/30/2013

“Nightingale ‘Divine Laws”

Electromagnetic Field of the Heart

Caritas Process 8: Becoming the Healing Environment – Setting the Tone

Giving

Stillness

Receiving

The heart radiates an electromagnetic field that energetically affects each others’moods, attitudes and feelings.

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Source: Caring/Compassion –Inner Truth; Beauty, Our Very Humanity

Contemplative Pause: Reconsidering Nightingale

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

4/30/2013

Florence Nightingale Caring Science

Ancient wisdom and contemporary science/art/spirituality converge •

Nightingale: Health for All

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

4/30/2013

Connecting

• Purposeful emphasis on integrating the wholeness of the patient, patient patterns and patient meaning into the nursing initiatives .

BACK TO BASICS OF HUMANKIND

Energy, Intent and Multiple (All) Ways of

Knowing

Diane Swengros Caritas Coach InovaHealth 2009 © WCSI - 2009

4/30/2013

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) 13-23.

Aesthetic

Ethical

Personal

Empirical

Spiritual

Creative

Intuitive

Ways of Knowing

• EMPIRICAL• Factual, objective, and

verifiable by “outcome measures”

• Application of theories• Body of knowledge that

is research based and systematically organized

4/30/2013

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

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 - 2011

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

4/30/2013

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

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 - 2011

Caritas Process 1: Humanistic – Altruistic Values –Practice of Loving-Kindness and Equanimity with Self and Other

4/30/2013

Magnetic Reminders: Pausing - Practicing Presence: Loving Kindness

• VALUES: Preserving Human Dignity:

Magnets on Patientʼs Door

INOVA Health, Fairfax, VA

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”

Caritas Process 2:

Faith and Hope,Being Present Authentically

4/30/2013

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 presence-centering-search for meaning; New level of authenticity- potentiating self healing and wholeness.

Caritas Process 3:Sensitivity to Self & Others, Ongoing Spiritual Development

4/30/2013

TS Eliot ‘The Still Point - in midst of chaos.” Healthcare: What is Basic health and human caring?

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

T.S. Eliot

Where is Our Patient?

Lifelong skills: Meaning

• Relaxation

• Meditation

• Guided imagery

• Prayer

• Creativity

• Trust

4/30/2013

Caritas Process 4:Developing AuthenticTrusting Caring Relationships

Caritas Process 5:Allowing Expression of

Positive-Negative Feelings: Listening to Another’s Story

Caritas Process 6:Creative Problem-Solving Caring Process

4/30/2013

Creativity and Spirituality In Healthcare

• Arts In Medicine Programs: Practice

• Spirituality in Healthcare groups: Practice

• Shamanism

• Artist as healer

Caritas Process 7:Relational TeachingLearning / Inner Subjective Meaning

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?

4/30/2013

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?

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

Healing Arts Program

4/30/2013

Creating a Healing Environment

• Guided Imagery

• Music, Dance, Poetry, Art

• Listening

• Healing touch

• Artistic expressions

• Human interactions

• Beauty / Nature

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

4/30/2013

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?

4/30/2013

Caritas Process 10:Open to Existential - Spiritual Unknowns: Allow for Mystery & Miracle

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

Connected to Infinite Love and Grounded to the Earth

Healing Touch Meditation by Cynthia Hutchinson

4/30/2013

Art as a Way of Caring

Art as A Healing Force

4/30/2013

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

4/30/2013

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

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Art Heals

• Yourself

• Others

• Neighborhood

• Earth

Enhanced Practice

• Loving

• Mindful

• Present

• Caring

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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

4/30/2013

Physiology:Symptom Reduction with art Physical

• Decreased muscle tensionDecreased painIncreased oxygenation Increased circulationImproved sleepImprove appetite

Psychological

• Decreased anxiety Increased intuitionImproved clarity in thinkingEnhanced faithIncreased 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

4/30/2013

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

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

Caring Science Research:Caring assessment instruments

Assessing

Measuring Caring and

• Outcomes

4/30/2013

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 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

Watson Caritas Patient Score - WCPS(Apgar* score of caring)

4/30/2013

New Caring Science Criteria:New Outcome Indicators

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 Allowance for Creative Emergence

Leaders/Managers NOW Seek ʻEvidenceʼ of:

Caritas HeartMath PilotBaptist 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.)

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

4/30/2013

Angie Fontaine, RN Caritas Coach, Jacksonville Baptist, FL , 2009

Into “The Caritas Staff Retreat”with a Stone Waterfall Feature

• From Smoking Area to Caritas Garden

Cultivating Consciousness and Listening for Meaning

• Afternoon Tea Where:

• Reflective Practice is Cultivated

• Where Nurse’s Own Experiences are Shared

• Where We Learn to Listen for the

Wyoming Medical Center88

Healing Environment Quiet Time

The Children’s Hospital Denver

4/30/2013

CP: 10 Sanctuary –Healing Room for Nurses

Kaiser - Antioch Medical Center

Reflections

4/30/2013

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 Pilgrimageor 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)

4/30/2013

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

Individual Artistic Renderings

Multiple Ways

To Express Experience

4/30/2013

Spirit Body Healing

A phenomenological hermeneutic study of the lived experience of art in healing

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

4/30/2013

Trigger

4/30/2013

Going Elsewhere

Pet Therapy:Something to Care for and Love

Marlienne Goldin, RN Caritas Coach & Faculty

4/30/2013

Art as Turning Point

4/30/2013

Slipping Through the Veil

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Healing Energy

4/30/2013

Habitat for Healing

• Influencing the Environmental Field

• Using Creative Caring-Healing Modalities

• For Staff, Patients and Families

Wyoming Medical Center121

Embodiment of Spirit

4/30/2013

Transcendence

Thank You!

Each one of you is the light and beauty of the rainbow of caring.

4/30/2013

Reflections

human caring multiple ways of knowingmed.dartmouth-hitchcock.org/documents/human_caring.pdf ·...

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