Theory-Based Nurse Practitioner Practice: Caring in Action

Susan Hagedorn, PhD, RN, PNP, WHCNP; Agatha A. (Tracy) Quinn, PhD, RN, FNP


Topics in Advanced Practice Nursing eJournal. 2004;4(4) 

In This Article

Advanced Education and Caring Theory

The National Organization of Nurse Practitioner Faculties (NONPF) issued domains and competencies for every NP graduate that included emphasis on the nurse-patient relationship, use of healing modalities, respect of the worth and dignity of the patient, and incorporation of spiritual beliefs into the plan. These competencies describe the core abilities of NP graduates. NONPF states that these competencies are a "gold standard" to maintain and shape quality graduate NP programs. NONPF's emphasis on caring qualities in the NP-patient relationship is further evidence that NPs do not practice from a medical perspective but, rather, as facilitators of holism and health.[15]

In 2000, Brunton and Beaman surveyed over 200 Illinois NPs to explore their perspectives of their own caring behaviors. The researchers used a revised Wolf's Caring Behaviors Inventory instrument and modified it for use with NPs. A majority of the respondents had a master's degree (72%, n = 104), and had practiced an average of 8.71 years. Top caring behaviors were: (1) appreciating the patient as a human being; (2) showing respect and being sensitive to the patient; (3) talking to, listening to, and being honest with the patient; (4) maintaining confidentiality; and (5) encouraging patients to call if problems arose. NPs who had worked for a longer period of time in their role expressed more positive connectedness with patients than NPs with less practice experience.[16]

Sister Simone Roach proposed that the core of nursing is caring.[10] Because NPs practice within a nursing (caring) context, their interactions with patients and communities are defined by compassion for patients; competence in practice; confidence in the ability of the patient to practice self-care; conscience or ethical practice; comportment in their way of being with others; and commitment to the well-being of the patient, family, and community.

Kristin Swanson defined caring as, "a nurturing way of relating to a valued other, toward whom one feels a personal sense of commitment and responsibility" (p. 163).[9] Swanson stated that 5 processes characterize caring: knowing, being with, doing for, enabling, and maintaining belief. NPs practice knowing (empathy), being with (presence), doing for (evidence-based practice), enabling (empowerment), and maintaining belief (instilling hope).

Susan Hagedorn proposed a Theory of Primary Caring that includes 5 domains: connection, consistency, commitment, community, and change ( Table 1 ).[8] Connection describes how the NP's effectiveness is based on relationship-centered caring with the patient, the family, and the community. The NP's practice is based on engagement with all 3 of these groups. Through authentic listening, the NP serves patients with respect and compassion. Consistency describes the importance of evidence- and theory-based care in NP practice. Consistency is providing clinically competent healthcare that assures patients' positive health outcomes. Consistency, too, refers to the importance of consistent care and care providers, and a healthcare home. Commitment describes how the NP is committed to serve each patient and family to her or his best ability. The NP is committed to providing ethical care within a context of confidentiality, compassion, and respect. Community illustrates the role of the NP in facilitating full access to healthcare for all persons and strives to meet unmet community health needs. As a nurse, the NP manages patients' care like "glue" that connects the patient to the services she or he needs to achieve optimal health. The NP must be culturally competent -- able to listen openly and sensitively to the patients' cultural stories and empathize with the cultural influences of the patient's experience of health and disease. Lastly, change explains how NPs introduce innovative models of healthcare and share decision-making with patients. The NP assesses patients analytically and facilitates patients' self-care. She or he must be involved in social change in order to support patient and community health initiatives. The NP also functions as a member of a healthcare team that includes not only health professionals but also auxiliary specialists.

Watson, in her most recent work on the concepts of caritas, defined the work of nursing as, "the practice of loving-kindness...being authentically present...developing and sustaining a helping-trusting...relationship [with patients]...being...supportive of the expression of positive and negative feelings...creative use of self...attempting to stay within other's frame of reference...creating healing environments...assisting with basic needs...soul care for self and the one-being-cared-for."[7] NPs creatively use themselves therapeutically with individual patients, families, communities, and systems to assist patients by being authentically present and developing helping-trusting relationships.


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