Evolution of the Attending Caring Nurse Model: Three Part Series
from Caring For Our Future, Summer 2004
By Sue Stuller, BSN, RN
In 2002, the Third Floor Program (3 North) piloted the theory-guided, evidence-based, collaborative-practice Attending Caring Nurse Model with health-care professionals who care for hospitalized children in pain. The Attending Caring Nurse Model, based on Dr. Jean Watson’s Theory of Human Caring, is evolving and creating changes that will be influential for the future of nursing and the health-care profession as a whole.
The Attending Caring Nurse Model was renamed to reflect the multidisciplinary nature of the project. The new name is “The Attending Caring Team” (ACT). What started out as a research project related to pain management for hospitalized children has blossomed into a multidisciplinary change in practice involving all kinds of health-care providers.
In a three-part series to be published in Caring for Our Future, we will explain the adjustments in education, management and clinical practice on 3 North that resulted from ACT. Three North is a 37-bed inpatient intermediate care and surgical services unit at The Children’s Hospital in Denver.
The first article of the series is on education and orientation practices of the program. The second article will focus on incorporating the ACT philosophy into daily clinical practice of patient and family care. The third article will focus on the management aspect of the practice. Authors include ACN co-investigator and clinical director on 3NO, Bridget Theunissen, MAOM, RN; 3NO Holistic Clinical Nurse Specialist Terri Kay Woodward, MSN, CNS, RN; and Sue Stuller, BSN, RN, the 3 North Department Education Coordinator.
Creating a Culture of Caring Through the Education and Orientation of Nurses
Orientation can be a stressful time for new nurses and nurse preceptors. This stress can translate into negative energy, which can stifle the positive progression of orientation. It is important for participants to gain comfort and be fully present in the new practice environment. Stress can make that difficult.
The majority of orientation is focused on the clinical competence of new hires to successfully perform tasks, and on the preceptor to teach them. We have extensive and complex task-oriented checklists to be completed and verified during orientation. The checklists can be overwhelming and often have little to do with the act of caring. Caring is central to patient satisfaction, and should be central to all that nurses do. Formerly, checklists were the primary focus of bi-weekly tracking meetings between the new hire, the preceptor, the department education coordinator and the clinical coordinator. A portion of time during tracking meetings always has been devoted to the effectiveness of teaching style and communication between the preceptor and the new nurse.
Attending Caring Team practices started to change. A desire to perpetuate caring practice and immerse staff in Caring Theory caused previous practices, including orientation, to be viewed through a new lens. A new tracking tool was developed for orientation. Previously the nurse might have been asked, “Have you had the opportunity to manage a chest tube? Tell me about it.”
It’s not hard to see that this type of question does not solicit much response, or add dimension to a culture of caring. The equipment is the focus. It does not recognize the patient at all. The question is not reflective of human caring. It does not even address the patient.
Now the question’s focus is more sensitive to human caring and specifically to the patient/nurse interaction. Caring vocabulary is woven into questions asked during orientation to evaluate progress. For example, “Tell me about a caring moment you had with Grace.” (Grace is a patient who has a chest tube.)
We still use the standard checklist to ensure skill/task competency; we simply don’t dwell on it. The majority of evaluation is done through open-ended questions that incorporate caring. These interactions are documented in a narrative style for review of the new hire’s progress.
During orientation, the nurse is further introduced to caring vocabulary through discussion of patient interactions. Some examples: “It sounds like you were able to be fully present with the family during the difficult time they were having. You really made a difference for them.”
A class on caring is now required during the didactic portion of orientation. Additionally, Woodward teaches a class on self-care. This class is based on concepts of Caring for the Caregiver – “Take care of yourself so you can care for others.”
Creating a caring environment requires a revision of everything with which the caregiver comes in contact. The spirit of caring needs to be incorporated into all documents, practices and processes. All members of the culture need to have input into this process if it is to succeed. The patients and families, nurses, support staff, therapists, doctors and administrators must have a voice in the creation and maintenance of a caring culture.
It is impossible to apply a singular one-dimensional definition of what a culture of caring is or looks like. Creating a caring environment is a personalized process, different for each individual, each group and each relationship. Like any culture, it is not something that is easily taught; it is absorbed by living within it.
We will achieve a caring environment when we have accepted its changing and evolving nature. The basic framework of intentional caring and the commitment to being fully present remains a constant.
