N3006 Interpersonal Caring

1
N3006Interpersonal Caring

• NURSING THEORY COURSE

2
Content of Presentation

• Attributes of Caring
• Background of Developing Interpersonal Caring
• Concept of Interpersonal Caring (IC)
• An Empirical Testing of IC

3
Attributes of Caring (Roach, 1984)

• 1. Compassion
• 2. Competence
• 3. Confidence
• 4. Conscience
• 5. Commitment
• - True caring encompasses these attributes.
• - A mother, caring for her infant illustrates
• these characteristics beautifully.

4
1. Compassion

• A sensitivity to the pain and brokenness of the
  other person
• A quality of presence which allows one to share
  with and make room for the other person
• Worlds greatest energy source (Fox,1979)
• Ultimate source of compassion is God.

5
2. Competence

• The state of having the knowledge, judgment,
  skills, energy, experience and motivation
  required to respond adequately to the demands of
  ones professional responsibilities.
• Competence without compassion can be brutal and
  inhumane.
• Nursing practice requires a high degree of
  cognitive, affective, technical and
  administrative skills responsibilities.

6
3. Confidence

• The quality which fosters trusting relationships,
  a relationship of respect.
• Stems from ones trustworthiness and
  faithfulness.
• Is built on the foundation of competence and
  compassion.
• Nurses are to create trusting relationships with
  clients/patients.

7
4. Conscience

• A personal sense of the moral goodness or
  blameworthiness of ones conduct, intentions or
  character with regard to a feeling of obligation
  to do right or be good.
• ICN Code of ethics challenges that nurses moral
  awareness should be fine-tuned by the discipline
  of knowledge and moral iniquity

8
5. Commitment

• A quality of investment of self in a task, a
  person, a choice, or a career which become so
  internalized as a value that what one is
  obligated to do is not regarded as a burden
• A call which draws one to a conscious, willing,
  and positive course of action.

9
Attributes of Caring

Commitment
Conscience
Confidence
Competence
Compassion
10
Interpersonal Caring

• Background
• - Peplaus Interpersonal Relations
• No mention about specific WHAT and HOW
• - Encountering with a discharged patient in 1983
• - Derived from data by
• Grounded Theory Approach Study
• Would you share with me your experience of
  living
• as a mentally ill person? (N9)
• - Descriptive Study
• Can you describe the experiences in which
  you
• were cared for (N13, N25), 198
  descriptions
• - Categorized into 10 concepts through
• Principal Component Analysis (N50)

11
Noticing
Sharing
Participating
Active Listening
Complimenting
Caring
Comforting
Companioning
Hoping
Accepting
Forgiving
12
Noticing

• The act of recognizing the persons existence by
  taking interest in him/her.
• - Acknowledging the characteristics, status,
• situation, feelings, etc. of the other person.
• - Finding out their interests/desires/needs
• I feel good, Thankful
• Bolsters my self esteem
• I feel like Im an important person

13
Participating

• Sharing in activities that are needed to maintain
  living of the other person.
• - Reaching a common goal together
• - Achieving something together
• I am encouraged, because you do with me
   
• I dont feel isolated 
• I have a sense of community through our
  shared life

14
Sharing

• The kind act of giving out valuables such as
  feelings, touch, thoughts, experiences, and
  knowledge (information), etc.
• - Disclosing thoughts, feelings, dreams, plans,
• worries, every good thing, and openly
  discussing
• - Share what I have with others
• I feel peaceful, Gives me a new mindset
• I can open up my heart,
• I am grateful and feel close

15
Active Listening

• Concentrating on and listening to the other
  persons words sincerely with whole heart and
  body.
• - Paying close attention in order to
• understand the meaning of spoken words.
• - Listening seriously, not superficially.
• Treats me like an important and valuable
  person,
• not carelessly
•    Grateful because you take interest in me
  and help me

16
Companioning

• Living life together the same way, towards the
  same direction.
• - Being at the other persons side and
• spending time together.
• - Experiencing life together.- Becoming a
  friend/companion.
• Not lonely or anxious
• I dont falter because you watch over me
• Faith develops that you will accompany me in
  lifes
• journey

17
Complimenting

• The action of seeking the other persons
  strengths and good qualities, and recognizing
  them with expressing gratitude. - Eliciting
  someones strong points and
• recognizing them
• I feel proud of myself and want to do even
  better  
• Feel like life is worthwhile I also want
  to praise the person to praised me
• The whole world looks beautiful

18
Comforting

• Taking sides with an empathizing attitude, the
  action of understanding and comforting the person
  in their sadness or pain.
• - Instead of defending the third party that
  caused
• hurt, becoming an unconditional ally with
  this
• person.
• - Telling them How hard it must be !,
• How upset you must be
• - Treating the other person warmly and gently
• Im really comforted that you believe in me
• My heart opens up and worries disappear   

19
Hoping

• The act of helping someone to ultimately entrust
  everything to God
• - Blowing the hope into
• - Confirming that you will stay close by to
  encourage
• - Informing them of successful examples
• My problem burdened me so much but now I feel
  like I can breathe again
• I can see a new possibility and feel like I can
  be restored  
• I have confidence that I can do something to
  solve my problem

20
Forgiving

• The act of acknowledging that I was wrong, with
  expression of Im sorry, and asking for
  forgiveness.
• - Seeking mercy with a sincere heart without
• attempting to explain or make excuses
• Grateful for your unconditional
  acceptance
• Tension (guilt) goes away and I feel at peace

21
Accepting

• Receiving the other person just as he/ she is
  without critiquing.
• - Using words/attitude that indicate
• I like you
• - Demonstrating warmth by receptive physical
  actions (hugging, patting their back, etc.)
• Grateful that you accept me
• Tension (guilt) goes away and I feel at peace

22
Empirical Testing

• Persons with SMI in the community
• Persons Families in
• Palliative and Hospice Care Settings
• Persons with Chronic Arthritis
• Persons with COPD

23
UNDP Project

• An Empirical Testing Study for Persons with SMI
  in the community-based

24
A Background of UNDP Project

• Mental Health Act passed in December 1995.
• First Psychiatric NP Training Program (12 months
  intensive) started at EWU in 1991.
• 20 Psychiatric NPs visited homes of discharged
  patients form psychiatric sanatoriums, in Sungbuk
  district area, Seoul, summer, 1995.
• Found 204 long-term psychiatric patients.
• in homes without proper treatments, cares.
• Funded by UNDP (Aug.1996-July 1998).
• First nurse-initiated and nurse-managed CMHC.
  Day Care Programs, and Home visits services at
• 4 different sites in Seoul.

25
To break the vicious circle of hospitalization -
discharge rehospitalization
To help patients to establish meaningful
relationships in family conduct normal life in
the community
To facilitate psychosocial functions of the
mentally ill people
To strengthen and support the mentally ill people
to live an integrated life in over all
26
It is possible to reduce symptoms and to
rehabilitate socially by providing desirable
social stimuli and therapeutic milieu
Family-involved care is more effective than
otherwise
Family can provide effective informal care
27
N259 Average Length of Treatment 14.05
years(9mos.44yr) Average Number of
Admission 13.02 times Average of
Length of Hospital stay 231.98 days
28
1. Home care
2. Day Care
3. Educational programs for family
4. Education training programs for patients
5. Educational training programs for
volunteers
6. Educational programs for health professionals

29
Training education on self-care and medication
Connecting patients with available services
Physical illness care
Coordinating service delivery systems
Crisis intervention
Referring
Provision of continuous comprehensive services
Advocating activities for patients and their
families
30
Understanding Mental illness
Medication Management
Symptom Management
Stress Management
Effective Communication Skills
Coping Strategies
31
(No Transcript)
32
(No Transcript)
33
(No Transcript)
34
Daily living skills training
Community adjustment training
Social skills training
Group therapy
Inter-personal relations training
Recreation and leisure activities
Mental health education
Various art therapies
35
(No Transcript)
36
Quality of Life
Self Esteem Self-care Activities
Family Burden Compliance
Perceived Family Support Interpersonal
Relationship
Daily Living Skill Social Functioning
Interview with key informant, Demographic
data, psychological status, Physical
Status Familys Assessment of Patients, etc
37
(No Transcript)
38
Education Training for Rehabilitation
Creating New Environment
39
(No Transcript)
40
(No Transcript)
41
(No Transcript)
42
(No Transcript)
43
(No Transcript)
44
(No Transcript)
45
(No Transcript)
46
(No Transcript)
47
(No Transcript)
48
Conceptual Framework of Caring forLong-Term
Psychiatric Patients

• PSR Interpersonal
• (Situations)
  relationship
• ICS Self-care
• Social
• 
  Functioning
• 
  

Self-esteem
QOL
49
Accessibility ???
Affordability ????
Availability ???
Applicability ???
Achievability ???
50
Holistic Caring in Nursing
Biological Mechanisms
Psychosocial
Physical
Spir
itual
Functional Change (Health)
Emotional
Environmental
51
Psychoneuroimmunology A Biobehavioral Model

• Neuro
• Endocrine
• Immune

Health Outcomes
Psychosocial Factors
52
Multidimensional Factors Affecting
Well-Being Model for Therapeutic Nursing
intervention(Bennett, 2002)
Modifying Factors (Complementary Intervention)
Psychological Factors Socio-Spiritual Factors
Patient Education Caring Counseling
Clients Exercise Humor Music Dancing Arts
Crafts Support Groups Social work Spiritual
Support
Stressful Life Events Bereavement, Work/Family
Related Role-Strain, Social Support Cultural
Values Spiritual Values Meaning,
Compassion, Love Intimacy, Behavioral Factors
Environmental Factors
PNI Network Psycho-neurological
functioning Neuro-Endocrine functioning Endo-Immun
ological functioning
Physiological Factors
Wholistic
Well-Being (Optimal Physical, Mental, Emotional,
Spiritual functioning)