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11/21/2013
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Marian C. Turkel RN PhD NEA-BC
Director Professional Nursing Practice and Research
Einstein Healthcare Network
Faculty Associate Watson Caring Science Institute
President International Association for Human Caring
© WCSI. All Rights Reserved.
Moving From the “Case” to the “Face”
From Patient to The Spirit Filled Person Behind a Disease
From Medical Diagnosis to The “Meaning” Given to the
Illness;
From Performance/Doing – to Presence and Being;
From Medical-Clinical Views of Humanity to Unity of
Mindbodyspirit, Oneness - Connectedness
From Industrial Models to Creative, Mature Professional
Models of Caring-Healing Education, Practice & Research
Caring Science Transformation
Watson – WCSI Copyright 2010 2
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• Traditional qualitative or quantitative research on specific caritas process, caritas process serve as a framework for the research
• Traditional qualitative or quantitative research on caring healing modalities
• Caring co-related to NDNQI data, patient satisfaction, RN satisfaction, or economic data
Relationships: Uncaring to Caring (Halldorsdottir, 1991)
Biocidic or Life Destroying (Toxic, Leading to Anger, Despair, Decreased Well-Being);
Biostatic or Life Restraining (Cold or Treated as Nuisance);
Biopassive or Life Neutral (Apathetic or Detached);
Bioactive or Life Sustaining (Classic Nurse-Patient Relationship as Kind, Concerned and Benevolent);
BIOGENIC or Life Giving/Life Receiving
Transpersonal Caring – Manifesting Caritas Field
ULTIMATE GOAL of CARITAS HEALING MODEL
4 © WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
11/21/2013
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Patient Consequences
Caring
Emotional-Spiritual Well-Being (Dignity, Self Control, Personhood)
Physical - Enhanced Healing, Saved Lives, Safety, Energy, Costs, Comfort, Loss
Trust Relationship, Alienation, Family
Non-Caring
Humiliation, Frightened, Out of Control, Despair, Helplessness, Alienation, Vulnerability, Lingering Bad Memories
Decreased Healing
5 Watson – WCSI Copyright 2010
(Swanson, 1999)
Nurse Consequences
Caring
Emotional-Spiritual Sense of Accomplishment, Satisfaction, Purpose, Gratitude, Preserved Integrity, Fulfilment, Wholeness, Self-Esteem, Living Own Philosophy, Respect for Life, Death, Reflective… Love of Nursing, Knowledge
Non-Caring
Hardened, Oblivious, Robot-Like
Depressed, Frightened, Worn Down
6 Watson – WCSI Copyright 2010
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7 Watson – WCSI Copyright 2010
Reclaim Nursing ARTS: General –Advanced Healing-Caring Modalities
Intentional Touch (Therapeutic – Healing)
Visualization
Imagery
Music –sound
Expressive Journaling
Massage
Centering
‘Caritas/HeartMath Method’
Humor
Prayer
Pet Therapy
Meditation-Silence
Art-Dance –Movement
Etc., Etc., Etc…
Caring Science Criteria for Return on Investment
What Can You Anticipate in Doing This Work?
You
Your Hospital
Patients
The Community
Culture of Safety
Human Flourishing
ROI (Key Financial &
Organizational Indicators)
Quality & Clinical Outcomes
Constituent Satisfaction
Recruitment & Retention
Community Health and
Relationships
Results, Rewards & Recognition
8 Watson – WCSI Copyright 2010
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Quality and Service
Clinical Quality Index
Customer Service Index
Employee Satisfaction
(or Pride in the Organization)
Caring Science Impact
Quality Indicators
Service Indicators
Retention & Recruitment
Measures
Teamwork
Caregiver Support
Organizational Excellence
9 Watson – WCSI Copyright 2010
Shifting Foci of Health Care and Health Professions
Focus on Disease or Health Problem
Focus on Tasks-Data
Focus on Medical Specialties-technology
Focus on Hospital Unit-Inpatient
Focus on Admin Solving Problems – Institutional Data
Authoritarian Industrial – External Control
Consumerism/Profits
Focus on Individual Person-Inner Meaning Behind Diagnosis/Condition
Focus on Authentic Caring Relationships/Understanding
All Caring is Holistic-Spiritual
Post-hospital Community: Self-Caring; Self-Control; Self-Knowledge, and Self Healing-Renewal
“Meaningful Use” of Information, Data/Technology
Autonomous: Visionary, Inspired Leadership – Creative Transformative Models
Life-Sustaining Systems/Civilizations
Today Near Future
Watson – WCSI Copyright 2010 10
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Inspiring and Assuring Human Caring: Emerging Authentic Caring Science Criteria
and Indices –New Standards
Giving Voice, Language and Action to Values, Ethics, philosophies Economics of caring-healing at individual and system level
Creating a System-Wide Culture of Caring-Healing – Ethical-Theory-Value- Guided Professional Practices;
Assuring Personalized Human Caring Relationships in a Healing Environment for Staff and Patients/Family;
Evidence of Caring Processes/ Language and Action for Personalizing Caring-Healing Practices; Caring –Healing Modalities;
Organizational Qualities: Meaningful Support/Involvement: Board/ CEO/Executives /Administrators/ Managers /Staff/Patients/Families
11 Watson – WCSI Copyright 2010
Inspiring & Assuring Human Caring: Responsibilities: (Cont.)
Invite Staff to Rediscover Their Own Practice of Human Caring/ Expand and Deepen Theoretical Models of Personal/Professional Caring:
Utilize Caring Language – Document Caring Practices with Language; Informatics Systems:
Promote Research on Caring –Patient Outcomes, Nurse Retention, Costs
12 Watson – WCSI Copyright 2010
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Assessing and Measuring Caring in Nursing and Health Sciences
Jean Watson, 2009
“Measuring caring? Yes, but intentionally and mindfully, with a consciousness that deep caring cannot be fully measured at this time. At best these measurements serve as quality empirical indicators of caring and point back toward the deeper aspects behind the measurements.”
13 Watson – WCSI Copyright 2010
1. Develop a Quick and Easy Instrument to Administer and Measure Patient Perceptions of Caring – An “APGAR Score” If You Will
Maintain Integrity of Caritas Processes
2. The 5 Items Selected Will 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
14 Watson – WCSI Copyright 2010
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©WCSI, 2010
WCPAS
Two most important practices
Deliver care with loving kindness
Have helping trusting relationships with me
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Marian C. Turkel RN PhD NEA-BC
Director Professional Nursing Practice and Research
Einstein Healthcare Network
Faculty Associate Watson Caring Science Institute
President International Association for Human Caring
© WCSI. All Rights Reserved.
• Intentionality or manifesting intention
– Practice of loving kindness to self allows one to enter the caring relationship with others with intention to become the energetic environment that potentiates caring and healing
Watson Caring Science Institute © WCSI. All Rights Reserved. 18
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• Caring for self allows for the emergence of creative, caring energy
• Maintaining the balance between our doing and our being
• We need to nourish our inner strength and beauty to reach out others from our authentic caring selves
• Self care is critical to health and healing
• If the nurse does not care for herself it is impossible to compassionately care for others
• Inability to care for self shows up as violence in the workplace
• Failure to care for self leads to burnout or compassion fatigue- new language of “compassion energy”
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• Caring for self is essential to create a caring harmonious work force environment
• When organizations are infused with compassionate caring values they reflect a human face which is necessary for the continued existence of humanity.
• As self is renewed, personal and professional commitments become balanced and inner energy is replenished
Watson Caring Science Institute © WCSI. All Rights Reserved. 21
• Having the knowledge, judgment, skills, ENERGY, experience and motivation required to respond adequately to the demands of one’s professional responsibilities. (Roach,1987)
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Impact of Stress on Patient Safety
Journal of the American Medical Association – Sept 23, 2009
- JAMA. 2009;302(12):1294-1300 - stress and fatigue among
medical residents can lead to medical mistakes and potentially
cause devastating injuries for patients. Mayo Clinic researchers
surveyed 430 internal medicine residents from 2003 through
2008. They found as symptoms of fatigue, depression and stress
increased, so did the number of major medical mistakes doctors
reported.
Watson – WCSI Copyright 2010 – HM Slide with Permission 23
Impact of Stress on Patient Safety
Journal of the American Medical Association – Sept 23, 2009
- JAMA. 2009;302(12):1294-1300 - stress and fatigue among
medical residents can lead to medical mistakes and potentially
cause devastating injuries for patients. Mayo Clinic researchers
surveyed 430 internal medicine residents from 2003 through
2008. They found as symptoms of fatigue, depression and stress
increased, so did the number of major medical mistakes doctors
reported.
Watson – WCSI Copyright 2010 – HM Slide with Permission 24
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Health Results – Heart Centering
• Blood Pressure in Hypertensive Employees (HP) 20% reduction in diastolic and systolic blood pressure
• Diabetes (LifeScan Division of J & J) 1.1% reduction in HbA1c in Type 2 diabetes (1% HbA1c reduction = 35% reduction in microvascular damage)
• Congestive Heart Failure (Stanford Hospital) 14% improvement in functional capacity (6 min. walk)
• Heart Arrhythmias (Kaiser Permanente) 75% of patients had significantly fewer episodes of atrial fibrillation, and 20% were able to stop medication all together
Watson – WCSI Copyright 2010 – HM Slide with Permission
• Focused thoughts in the present
• Set boundaries at home and in the workplace
• Maintained a calmer state
• Felt more focused in the workplace
• Shared positive energy with coworkers
• Did not allow others to affect their mood
• Had better interactions with others
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27 © WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
27 Jean Watson Copyright 2011
PROVIDES A PAUSE TO:
Wash away old experience
Start clean and fresh
Center in CARING INTENTION
Honor Self and Other
Reconnect to core values
Purify sacred space for
authentic presence
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Caritas Process 8: Creating Healing Environment – Being/Becoming the
Caritas Field
29 © WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
29 Jean Watson Copyright 2011
• Intentionality or manifesting intention
– Practice of loving kindness to self allows one to enter the caring relationship with others with intention to become the energetic environment that potentiates caring and healing
Watson Caring Science Institute © WCSI. All Rights Reserved. 30
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An existential, 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.
31 © WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org
31 Jean Watson Copyright 2011
Caritas/Heart Field: Subtle Healing Environment
Watson – WCSI Copyright 2010 – HeartMath Slide with Permission
32 © WCSI & Jean Watson, Used by permission Visit www.watsoncaringscience.org 32 Jean Watson Copyright 2011
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Watson Caring Science Institute © WCSI. All Rights Reserved. 33
Watson Caring Science Institute © WCSI. All Rights Reserved. 34
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• Centering
• Breathing
• Movement
• Self hand massage
• Aromatherapy
Watson Caring Science Institute © WCSI. All Rights Reserved. 35
• What self care do you already do?
• What self care will you begin to do at work or on days off?
Watson Caring Science Institute © WCSI. All Rights Reserved. 36
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• Caring for self-leadership meetings start with a centering tea ritual
Watson Caring Science Institute © WCSI. All Rights Reserved. 37
• Marian C. Turkel PhD RN NEA-BC FAAN • Faculty Associate Watson Caring Science Institute
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CariingLeaders
• Caring leaders are the change agents in the organization.
– We are the ones we have been waiting for Hopi Quote
– Changing healthcare, one nurse, one practitioner, one system at a time; One HEART at a time .
What We Carry in Our Hearts Matters Most
– What energy are you vibrating to others?
– Caring leaders are Creating Caring Environments for Self- Renewal
– Caring for self is important to have the energy to lead others
Watson Caring Science Institute
11/21/2013
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Reframing the Language of Leadership
Traditional
• FTEs
• Discipline
• Management by walking around
• The budget data
• Making decisions out of fear
• LOVE MONEY and use people
• Compliance
Caring • Registered nurses
• Performance accountability
• Honoring caring moments through authentic presence
• A caring story
• Making decisions out of LOVE
• LOVE PEOPLE and use money
• Participation
Being With Others As a Caring Leader
Always the most important hour is the present.
Always the most important person is the one you are facing.
Always the most important act is Love ** Meister Eckehart
Always LOVE "Never believe that a few caring people can't change the
world. For, indeed, that's all who ever have."
**Margaret Mead
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Closing Ritual
Moving Forward by Letting Go
Ritual Touchstones