Nursing as Caring:

A Model for Transforming Practice

Anne Boykin, PhD, RN
Savina O. Schoenhofer, PhD, RN

Marguerite J. Purnell, PhD, RN; AHN-BC

Florida Atlantic University
 Contents

 Caring
 Major assumptions
 Key Concepts
 Focus of nursing
 The nursing situation
 Direct invitation
 Calls for Nursing and Nursing
responses of caring
 Dance of Caring Persons
 6 Major Assumptions

Major assumptions are stated by the theorists to present

their values that ground the theory, and to illuminate their
worldviews . This means that you know “where they are
coming from”. The theory of Nursing As Caring
in grounded in 6 major assumptions which provide
distinctive meanings:
 Persons are caring by virtue of their humanness.
 Persons are caring moment to moment.
 Persons are whole or complete in the moment.
 Personhood is living grounded in caring.
 Personhood is enhanced through participating in nurturing
relationships with caring others.
 Nursing is both a discipline and a profession.
 CARING
Following are excerpts from
the Theory of Nursing as
Caring (2001)
 About Caring
 All persons are caring by virtue of their humanness –
caring is an essential feature and expression of being
human. The view of person as caring and complete is
intentional – prevents segmenting into parts, such as
mind, body, and spirit.
 Fundamentally, potentially, and actually, each person is
caring.

 Each person, throughout life, grows in the capacity to

express caring. Being a person means living caring.
 Through knowing self as caring, I am able to be authentic
to self and others.

 Caring is living in context of relational responsibilities.

 Caring is responsibility to self and others.
 Caring shapes relationships.
KEY CONCEPTS
These are important concepts
that can be operationalized, i.e.
they can be put into action and
studied, recognized, described
or measured
 Caring in Nursing: The intentional and authentic
presence of the nurse with another who is recognized as
person living in caring and growing in caring. If you look
at the 6th basic assumption listed, it states that nursing is
both a discipline and a profession. This assumption
supports and validates how a nurse approaches
professional caring practice, that is, from an informed
stance grounded in disciplinary knowledge. This clearly
distinguishes “lay” caring from professional nurse caring.

 Authentic Presence:
Authentic presence may be understood as one’s
intentionally being there with another in the fullness of
one’s personhood.
 Caring communicated through authentic presence is the
initiating and sustaining medium of nursing within the
nursing situation.
 Key Concepts con’t

Person as Whole and Complete in the Moment

 Person as caring centers on valuing and celebrating
human wholeness, that is, the human person as
living caring and growing in caring; valuing and
respecting each person’s beauty, worth, and
uniqueness.


The person is at all times whole. To encounter a

person as less than whole fails to encounter person.
 Personhood is
living grounded in caring

 Personhood implies living out who we are as caring

persons.
 Personhood implies living the meaning of one’s life.
 Personhood implies demonstrating congruence between
beliefs and behavior.
 The Focus of
Nursing
(What do nurses think about while they
are nursing?)

 The focus of nursing is nurturing

persons living caring and growing in
caring.
 Nursing Situation
 The nursing situation is the shared, lived experience in
which the caring between nurse and nursed enhances
personhood.

(What does the nurse do?)

 It is in the nursing situation that the nurse attends to calls

for caring, creating caring responses that nurture
personhood.
 Calls for Nursing
 A call for nursing is a call from the
one nursed, perceived in the mind of the nurse.
This call for acknowledgement and affirmation of
the person living caring in specific ways in the
immediate situation.
 Calls for the nurturance that is Nursing are
personal expressions that communicate in some
way - “know me as caring person and affirm me.”
 What the nurse does…
 In the nursing situation:

The nurse enters into the world of the other with the
intention of knowing, affirming, supporting, and
celebrating other as caring person. Direct invitation is
integral to this.

 Nurses should offer the direct invitation as part of their

coming to know other. The direct invitation raises
awareness of nurse and nursed that nursing IS the
service that nursing offers.

 The Direct Invitation opens the door to explicit

“caring between.”
 Example of Direct invitation
Instead of asking “What can I do for you?” - turn the
focus away from yourself to the one you are nursing.

Ask, in your own words, sincerely desiring to

know: What matters to you most, right now?”
 This is a very powerful question – wait for
the answer in stillness, with patience.

The one being nursed will respond to the invitation in
many different ways with unique calls for nursing that
arise from what matters.

 Nursing responses of caring

 The nurse responds to these calls for nursing

with specific caring responses to sustain and
enhance the other as caring person.
 This caring nurturance is what we call the
nursing response.
 Caring between
 Presence develops as the nurse is willing to risk
entering the world of the other, and as the other
invites the nurse into a special, intimate space.

 The encountering of the nurse and the nursed

gives rise to the phenomenon of caring between,
within which personhood is nurtured.

 The nurse as caring person is fully present and

gives the other time and space to grow. Through
presence and intentionality, the nurse is able to
know the other in his or her living caring and
growing in caring.
 The Caring Between…

This full engagement within the nursing

situation allows the nurse to truly experience
nursing as caring, and to share that experience
with the one nursed.

This is the caring between, the shared

relation within which nursing is created
and experienced.
Dance of Caring Persons

(Nursing As Caring: A Model For Transforming Practice, 2001, p. 37)

 Dance of Caring Persons
A Person-Centered, Caring-Focused Relational Model

 Acknowledgement that all persons have the capacity to care by

virtue of their humanness
 Commitment to respect for person in all institutional structures
and processes
 Recognition that each participant in the enterprise has a unique
valuable contribution to make to the whole and is present in the
whole
 Appreciation for the dynamic though rhythmic nature of the Dance
of Caring Persons, enabling opportunities for human creativity
 References

Boykin, A., & Schoenhofer, S. O. (1991). Story as

link between nursing practice, ontology,
epistemology. Image, 23, 245-248.

Boykin, A., & Schoenhofer, S. O. (2001). Nursing as

caring: A model for transforming practice.
Sudbury, MA: Jones and Bartlett.

Mayeroff, M. (1971). On caring. NY: Harper and

Row.