Nightingale to Watson:

Nursing Quality, Research, and Caring

Coming of Age
32nd International Association for Human Caring Conference
San Antonio, Texas - June 4th, 2011

Donald D. Kautz, RN, PhD, CNE, CRRN

Associate Professor of Nursing
UNC Greensboro
ddkautz@uncg.edu
 Publishing Quality Caring
Intersections
7- B Practice/Clinical
32nd International Association for Human Caring
Conference, San Antonio, Texas
June 3, 2011

Donald D. Kautz, RN, PhD, CNE, CRRN

Associate Professor of Nursing
UNC Greensboro
ddkautz@uncg.edu
Publishing Quality Indicators of Caring
Formal reporting of quality care indicators is a
requirement for all health care facilities
Focusing ONLY on Quality Indicators without ensuring
caring may promote mechanistic, technical care.
On the other hand, no matter how caring staff are, if they
are not competent, and quality is not ensured, care may
become dangerous.
I have had the privilege of assisting nurses to publish
their work, and from 2007 2011, I am a coauthor on 30
published articles. and am currently working on 30
more, which are in various stages.
In the next few minutes, I will highlight a few of these
articles. A more complete list is on your DVD, I will be
happy to e-mail you any of these articles if you e-mail
me.
Don wants you to Promote Family Integrity
Kautz, D.D. and Van Horn, E. (2009). Promoting family integrity
to inspire hope in rehab patients: Strategies to provide
evidence-based care, Rehabilitation Nursing, 39, 168-173.

Kautz, D.D. & Van Horn, E. R. (2008). An exemplar of the use of

NNN language in developing evidence-based practice
guidelines. International Journal of Nursing Terminologies
and Classifications, 19, 14-19

Van Horn, E. R. & Kautz, D.D. (2007). Promotion of family

integrity in the acute care setting. Dimensions of Critical Care
Nursing, 26, 101-107.
Don wants you to Promote Family Integrity
Kautz, D.D. and Van Horn, E. (2009). Promoting family integrity
to inspire hope in rehab patients: Strategies to provide
evidence-based care, Rehabilitation Nursing, 39, 168-173.

Kautz, D.D. & Van Horn, E. R. (2008). An exemplar of the use of

NNN language in developing evidence-based practice
guidelines. International Journal of Nursing Terminologies
and Classifications, 19, 14-19

Van Horn, E. R. & Kautz, D.D. (2007). Promotion of family

integrity in the acute care setting. Dimensions of Critical Care
Nursing, 26, 101-107.
 Don wants you to Inspire Hope

Kautz, D.D. (2008) Inspiring hope in our rehabilitation patients,

their families and ourselves, Rehabilitation Nursing, 33, 148-
153.

Kautz, D.D. (2007). Reading childrens books to awe and inspire

nursing students. Nurse Educator, 32, 223-226.

Smith, A.D. & Kautz, D.D. (2007). Case study: A day with Blake:
Hope on a Medical-Surgical unit. MEDSURG Nursing, 16, 378-
382.
 Don wants you to Address Sexuality and
Intimacy Concerns
Kautz, D.D., Van Horn, E. R., and Moore, C. (2009). Sex
after stroke: An integrative review and
recommendations for clinical practice. Critical
Reviews in Physical and Rehabilitation Medicine, 21,
99-115.

Kautz, D.D. (2007). Hope for love: practical advice for

intimacy and sex after stroke. Rehabilitation Nursing,
32, 95-103.
Don wants you to meet patients spiritual needs

Williamson, W. and Kautz, D.D. (2009). Lets get

moving, lets get praising: Promoting health and
hope in an African American Church. ABNF Journal,
20(4), 102-105.

Hubbartt, B., Corey, D., Kautz, D.D., and Rasmussen, B.

(2009). Nurse, please pray with me. RN Journal.
Available at http://rnjournal.com
 Published Caring Quality Intersections
Montana C. & Kautz, D.D. (2011). Turning the
nightmare of complex regional pain syndrome into a
time of healing, renewal and hope. MEDSURG Nursing,
20(3), 139-142.
Christina is a nurse anesthesia student who has had
CRPS since 2004
The article tells the story of her illness and treatment
with excellent recommendations for providing high
quality nursing care, to ensure a hospitalization that
helps the patient to heal and experience renewal and
hope
 Montana & Kautz, continued
In addition to aggressively treating pain, preventing
post-op complications, and providing individualized
comfort measures, we recommend taking a few
minutes to sit and talk with the patient to provide hope
and renewal.
Margo McCafferywrote more than 30 years ago,
when your patients still in pain dont just do
something: sit there. She recognized the importance
of a nurses presence with a patient in pain to provide
comfort and hope for both of them.
 Published Caring Quality Intersections
Ziel, R. and Kautz, D. D. (2009). The highest priority in
the Emergency Department may be a patients spiritual
needs. Journal of Emergency Nursing, 35, 50-51.
Ruth, the charge nurse in a busy ED, received a call
that they were getting a transfer to their E.D. of
John, a gravely ill elderly man.
At the familys request, Ruth arranged for a priest to
be present when John arrived at the E.D. to
administer last rites. The hospital chaplain conveyed
to the family who lived hours away, that last rites had
been administered.
 Ziel & Kautz - continued
John survived to be transferred to the ICU after
resuscitation in the emergency department, and Ruth
went on with the days work. While we do not know his
outcome, we reflect on this sequence of events and
feel certain that Ruths small act was critical for this
patient and his family. This act, on that busy, busy day,
is the one that she will always remember, and the
memory of this event gives us hope on particularly
frustrating days.
 Published Quality Caring Intersections
Levigne, D. and Kautz, D.D. (2010). The evidence for
listening and teaching may reside in our hearts.
MEDSURG Nursing, 19, 194-196.

Debbie describes the care of the Mrs Logan and her

husband in the special care unit (ICU step-down)
The expert care of bathing, turning her, ensuring
there are no wrinkles in the sheets bothering her
shingles lesions, as well as administering medications
and treatments.
But also taking the time to listen and teach
 Levigne & Kautz continued
the primary evidence for listening and teaching may
be in the gratitude of patients and families, the
nurses knowledge he or she has done the right
thing, and a feeling today was a good day to be a
nurse
 Published Quality Caring Intersections
Kautz, D. D. (2011). Great rehabilitation nurses combine
art and science to create magic. Rehabilitation
Nursing, 36(1), 13-15, 24. Published in January 2011
Don describes the care of a new quadriplegic young
mother who was especially challenging helping her
cope, aggressively treating her pain, getting her ready
for rehab, and truly involving her in decisions about
her care at times using some unconventional
methods
 Published Caring Quality Intersections

In the June 2011 issue of Nursing Clinics of North America,

Monsivias writes: Not only does clinical expertise include
knowledge of research findings at all levels but also includes
knowledge of the most effective interpersonal approaches for
dealing with challenging patients. Kautz provides a stunning
example of provider expertise. His knowledge and experience
guide his patient interaction in a rehabilitation in a way that
wont be found in any clinical practice guideline, and couldnt be
taught, yet worked in that situation. Expert clinicians have an
internalized knowledge and sense of effective strategies and
know when an unconventional approach might be effective.
 The bottom line:
Everyone here has great stories to tell of
caring quality intersections
Submit your stories for publication there are
many, many options.
 Nightingale to Watson:
Nursing Quality, Research, and Caring
Coming of Age
32nd International Association for Human Caring Conference
San Antonio, Texas - June 4th, 2011

Donald D. Kautz, RN, PhD, CNE, CRRN

Associate Professor of Nursing
UNC Greensboro
ddkautz@uncg.edu
 2010 was the 100th Anniversary
of Florence Nightingales Death
and
The International Year of the Nurse
Randy L. Williams, II, RN, MSN, MBA
Associate Faculty, Watson Caring Science Institute
 Objectives
1. Apply Nightingales philosophy & Watson's
science to quality, research, and caring in our
everyday practice.
Nightingale's philosophy, research and
practice transformed hospitals and nursing.
Watson's evolution of caritas science assists each
of us to see the connectedness between
nursing quality, research, and our care.

2. Illustrate Watsons tenets through patient

scenarios and story telling.
 Plan for this session
Nightingale and Watson the similarities and how
we have come of age.
- Research
- Evaluating quality care
- Caring
Patient scenarios which illustrate research quality
and caring intersections
A wonderful book Grandads Prayers to show that
when we reach for unattainable goals, reflect on our
practice and are proud, speak from the heart, and
remember that when we change ourselves, we
change the world
 Nurse Educator

Nurse Educator Vol. 32, No. 4, pp. 223-226

Copyright 2007 Wolteers Kluwer Health I
Lippincott Williams & Wilkins

Reading Childrens Books to Awe

and Inspire Nursing Students
Donald D. Kautz, PhD, RN, CNRN, CRRN-A

Reading illustrated childrens books in the classroom to nursing students is 1 way

to inspire students to be great nurses. After offering guidelines for the types of
books to use and the courses books can be used in, the author describes the
effects on student learning.
 Why do I read childrens books to nurses?

Years after having one of my classes a nurse told me I will never

forget the book, the Whispering Cloth and how important it is
for me to help my patients tell their own stories for them to
heal and to be able to picture a future full of hope. With that
simple line, these graduates not only show their own ability to
be great nurses, they also in essence tell their own story and
picture their future as nurses, full of hope. As instructors, we
are reminded of why we became nurses in the first place, and
we are filled with hope as we light the way for those who will
come after us. Kautz, 2007, p. 226
 Nightingales Legacy
Believing nursing is a profession
Cleaning up the hospitals
Changing soldiers outcomes
Statistical analysis of outcomes
Philosophy of nursing from:
Notes on nursing: What it is, and what it is not
THUS theory & research drive professional practice
And because of ALL of these, she became
Lady with the Lamp
Before and After
Dons Mom, Alice (a.k.a. Florence)
In more theoretical terms, Nightingale:
Challenged nurses to the full use of self, by connecting
ourselves to:
The divine all around us
All of humanity
Our environment
The nature and cosmos
As a means of learning, understanding, caring and
healing. Watson, 2010

Illustrated by Amies patient

(Smith & Kautz, 2007)
Statistics Legacy McDonald, 2010

Nightingale
Was a passionate statistician
Belief based on her faith in a God of order
Used statistics to indicate serious problems, assist in
policy making, monitor outcomes
Legacy for Nursing
Statistics is a required course in BSN programs
Even though.....
We are all taught, we must show the effect of our
care......
 Unfortunately our data....
Nursing is still billed as part of the room charge
Nurses enter data everyday which is never used......
This data is rarely available to practicing nurses.
Legacy for nurses in 2011
We say that our practice is based on evidence, but
much of our care is still based on tradition.
The technology is here for us to now to use ALL the
data we collect. There will be more and more and
more changes to come...
 Is it STILL the Crimean War? Here?
Today? NO? Yet we act like it is!
Through the continued development of theory, science, and
practice we can continue to REDUCE the rare
incidences of:
Nosocomial infections
Patient Falls
Medication Errors
I believe Nightingale would be horrified we continue to
focus our measurement of quality on the reduction of rare
occurrences. But this is where nursing needs to come of
age
We need to truly use the data we collect and enter into the
electronic medical record.
A nurse caring for an elderly man who had an elective hip
replacement the day before should be able to walk in and say:
I see from this mornings print out that:
Your wound was clean and dry yesterday, and the surgeon
changed the dressing this morning. You inspected the wound,
and told the surgeon how you would care for it at home. You
were also able to state all the signs of infection, and when you
should come back to see your doctor after you are discharged.
Your blood pressure and temperature have been normal. You
ate all of your dinner and breakfast without nausea, had a bowel
movement, have been up to the bathroom with help, and
walked 100 feet in the hallway. Your pain has never been above
a 3 by taking Vicodin every 4 hours. Your son, Joe, from
Milwaukee is here to stay with you for the next week, and you
should be ready to go home tomorrow.
 Nightingales Personality Type
(Dossey, 2010)
I (Introversion)
Nightingale was an introvert. When she
was alone, she experienced her best
ideas her intuition and brilliance
flourished when she worked by herself
T (Thinking)
Nightingales preference was to make
decisions based on her logical analysis of
the facts and her own experience. She
was proud that she had never been
swayed by a personal consideration of
anothers feelings.
N (Intuition)
Nightingales greatest gifts came from
her intuition flashes of inspiration,
insights into relationships of ideas and
meaning of symbols.
J (Judging)
Nightingale loved to live her life in a
manner that is decided and settled.
Nightingale had a system for everything,
a planned life, sustained effort, and
acceptance of routine.
 INTJ Personality Type
A major legacy for nursing
Traditionally, nursing has valued nurses who are
independent, individualistic, single-minded, love
rules and order, and tough minded with others and
follow the leaders who think and act just like them.
The pitfall is that nursing leaders may have difficulty
letting go of impractical ideas, ignore the impact of
their leadership style on others, and criticize others
who strive for the ideal.
Some would argue that this personality type has led us
to be a profession that
New leadership models are emerging!
 New Leadership Models
A Caring Leadership Model for Nursings Future
Williams, McDowell, and Kautz, 2011
Caring Leadership Model
Model of Care
Patient/Family, Team, Self, Community
McDowell-Williams
Core Values of Caring Leadership
Always live with kindness, compassion and equality
Generate hope and faith through co-creation
Actively innovate with insight, reflection and wisdom
Purposely create protected space founded upon
mutual respect and caring
Embody an environment of caring-helping-trusting
for self and others
Shared Decision-Making
Exemplar of Caring Leadership:
I have two RNs in my
department who desire to cut
back on their work hours.
These employees are long-
time, seasoned nurses. I sat
down with both of these
employees and allowed them
to discuss their concerns and
wishes. I could have ignored
their request but instead have
worked with them to create
work hours that meet their
personal needs. I allowed
them to vent and gave them
guidance and support. We
are in a trial period with their
schedules.
~~C. M.
 New Leadership Models
Goldin, M. & Kautz, D.D. (2010) Nurturing Nursing
Students During Intensive Care Unit Clinical Practicum.
Dimensions in Critical Care Nursing, 29(5), 238-240.
With Marlienne Goldins leadership, staff transformed
the ICU using Watsons 10 Caritas processes:
Practice of loving kindness
Staff nurses love having students
Relationship based care (based on Watson science)
 New Leadership Models
Goldin, M and Kautz, D.D. (2010) Applying Watsons
caring theory and caritas processes to ease life
transitions. International Journal of Human Caring, 14,
11-14.
This personal account of Mariliennes transformed life illustrates
how as a clinical expert, confronted by a major change,
Marlienne applied Watsons (2008) caring theory and caritas
processes to her life. By sharing her story our hope is that others
who find their lives turned upside down can see it is possible to
take control, heal and grow.
 Nightingales Challenge for Nurses
Dossey, 2010
Nightingales INTJ personality allowed her to be a practicing
mystic, mange her chronic illness, and her ability to
create new models of nursing care.
Nightingales legacy is a challenge for nurses to:
- educate political leaders to create health reform
- integrate healing, spirituality AND technology
- respond with the same courage she demonstrated in
carrying our vision to the world
Nightingale would argue there is still a need for a rebirth
of the true values of nursing which is what Watson
argues
For an eye-opening source on rebirth of nursing see the
Future of Nursing: Leading Change, Advancing Health
(www.nap.edu) (Often referred to as the IOM report)
 In summary, Nightingale was:
A nursing theorist

A visionary

A statistician

A nursing instructor

And also believed

 Some of Watsons Basic Tenets
Art and the artistry of beginning and advanced caring-
healing arts
Return nursing and health-care to wholeness
Honoring the unity of body/spirit
Restoration of individuals and systems seeking harmony
with environment, nature, and God
Being authentically present
Transformation in the caring moment

Illustrated in Lillys gift from Africa (Kautz & Kautz, 2011)

 Lillys Gift from Africa
Lilly describes seeing a very poor boy, of 4 or 5
playing in a mud puddle letting the water sift
through his fingers and laughing.
I wrote: Lillys story reminded me that our patients
are so much more than the reason theyve come to
see us. Her story also made me think that in order to
recruit teens to nursing careers, we must share the
hope, joy, and wonder we experience in our practice.
We need to tell them that as nurses, we have the
opportunity to experience life in its simplest terms.
Lilly wrote:

At that moment, in watching this boy, I came to

understand two things. First, happiness is temporary,
but so is sadness. This boys life was obviously filled
with hardship, but for the 10 minutes that I watched
him play, this seemed to enter his mind.
Second, even though this child might die soon, hed
experienced true pleasure. His mother didnt have to
buy him presents to make him understand happiness.
At this point in his life, he was truly and incandescently
happy.
 Lilly wrote:
As we drove away, I began to laugh. I hoped that
one day Id find my puddle of happiness. When that
day comes, Ill run my fingertips across its shimmery
surface and find pleasure in the soft feeling drifting
across my fingers. Seeing the joy in that boys face,
Ive seen what some people never get the chance to
see. Ive seen life, in its simplest terms, at its core.
 Nightingale and Watsons work
Nightingales work expanded:
From thoughts on nursing and guidelines for practice
to a Philosophy of Nursing

Watsons work expanded:

From a theory of caring with Caritive factors
To a Caritas Ethic/Science with Caritas Processes

The major difference between theories and a science or

philosophy is

The MAIN difference between Nightingale & Watson

 Just as Don believes
Our outcomes are better that ever,
through care provided every day
We often see the connectedness of what we do every
day, with everyone else our spiritual side

Don also believes we all need to be reminded

And to help reduce the complexity of Watsons model
My gift to you is to hear Nightingales philosophy and
Watsons caring science in a childrens book.
 Grandads Prayers
This childrens book was written to help a boy who
forgot how to pray.

As I read the book, think about the times you have

forgotten why you became a nurse
Or, think of someone else who has forgotten

You will see the connectedness to the earth and to all

people that Nightingale and Watson see in what we
do everyday
 Watson & Nightingale see
When we provide care to others, we
Reach with the trees
Are silent with the rocks
Reflect with the lakes
Laugh and Play with the streams
Breathe with the flowers
Sing with the wind
 Watson & Nightingale see:
There are GREAT rewards as we:
Reach for unattainable goals
Are silent to listen and learn
Reflect on our practice and are proud
Laugh and find humor
Breathe the spirit that we all share
Sing with joy about what we do
 Watson & Nightingale see
There are GREAT rewards as we:
Greet each new day

Remember what holds us together

Speak from the heart

And remember that when we change ourselves, we

will change the world.
 Watson & Nightingale also see
We will be rewarded when we:
Greet each new patient
Show through our theory, science, and practice that
the care we provide is
I believe that all of us are GREAT caritas nurses
And if we speak
But in order to do that
Because in that moment, when we change
I believe, I
 Articles on Nightingale all from the
March 2010 (Volume 28, Issue 1) issue of
the Journal of Holistic Nursing
Dossey, B. M. (2010). Florence Nightingale: Her
personality type. Journal of Holistic Nursing, 28(1), 57-67.
McDonald, L. (2010). Florence Nightingale: Passionate
statistician. Journal of Holistic Nursing, 28(1), 92-98.
Watson, J. (2010). Reflections: Florence Nightingale and the
enduring legacy of transpersonal human caring-healing.
Journal of Holistic Nursing, 28(1), 107-108.
 Kautz and Colleagues sources
Kautz, D. D. and Kautz, L. (2011). Lillys gift from Africa.
Nursing, 41(4), 53-54. doi: 10.1097/01.NURSE.0000395205.88237.5a
Williams, R.L. III, McDowell, J. and Kautz, D.D. (2011). A caring leadership
model for nursings future. International Journal of Human Caring,
15(1),
Kautz, D. D. (2011). Great rehabilitation nurses combine art and science
to create magic. Rehabilitation Nursing, 36(1), 13-15, 24
Goldin, M. and Kautz, D. D. (2010). Nurturing nursing students during
intensive care unit clinical. Dimensions in Critical Care Nursing, 29,
238-240. doi: 10.1097/DCC.0b013e3181e6cd55
Goldin, M. and Kautz, D. D. (2010). Applying Watsons caring theory and
caritas processes to ease life transitions. International Journal of
Human Caring, 14, 11-14.
Smith, A. and Kautz, D. D. (2007). A day with Blake: Hope on a medical-
surgical unit. MEDSURG Nursing, 16, 378-382.