Boykin and Schoenhofer: Theory of Nursing as Caring

The theory of Nursing as Caring was developed by Anne Boykin and Sarvina Schoenhofer. In the late 1980’s, the two were involved in research involving elements of caring and the practical implications of caring elements when they discovered there was little to no research or literature in this area. Caring and its varying definitions made it difficult to define in research terms. What caring means, how it is demonstrated, how it is measured, and how it is received are complex multi-dimensional concepts. Caring is the central and unifying focus of the nursing profession (Welch & Leininger, 2002).

Through their work, Boykin and Schoenhofer created a grand nursing theory that is intended to be used as a framework to guide practice at all levels of nursing. Both women have similar backgrounds. They are from large families. Boykin from Wisconsin was the eldest of six, and Schoenhofer from Kansas was one of nine children. Both theorists have credited their close knit families and small town upbringings as significant determinants in their overall personhood and character development. Both served in various academic positions throughout their careers. Together and individually they have published books, articles, and research projects surrounding the Nursing as Caring theory.

Analysis

The Nursing as Caring theory is designed around six key assumptions:

1. Persons are caring by virtue of their humanness.

2. Persons live their caring moment to moment.

3. Persons are whole or complete in the moment.

4. Personhood is living life grounded in caring.

5. Personhood is enhanced through participating in nurturing relationships with caring others.

6. Nursing is both a discipline and a profession (Boykin &Schoenhofer, 2001).

Boykin and Schoenhofer intended for the theory to show that caring is an element of being human, that all humans are caring by nature, and caring is a growth process. Developing the full potential of expressing caring is an ideal and for practical purposes, is a lifelong process (Boykin & Schoenhofer, 1993). Both espouse that caring enhances personhood for all of the participants in the relationship. Enhanced personhood directly links to the theory by specifying that the nursing situation is a shared lived experience in which the caring between the nurse and the ones nursed enhances personhood ( Boykin &Schoenhofer, 2001). The theory asks nurses to embrace caring not simply as a task or professional obligation, but as the focus of their own being and nursing identity ( Brunton & Beaman, 2000). This identity can only be created in concert with developing a relationship with the nursed. The nurse endeavors to know the other as a caring person and seeks to understand how that person might be sustained, supported, and strengthened in their unique process of living caring and growing caring (Boykin and Schoenhofer, 1993).

Aside from the relationship between the one being nursed, the nurse’s relationship with self is critical to the implementation and practicality of the theory. In order to be fully utilized, the nurse needs to recognize and demonstrate caring at each moment. For this to happen, the nurse must make a commitment to recognizing and actualizing caring. The nurse must believe that caring has real meaning and value to each individual and relationship. A distinctiveness of NP practice resides in the tendency to dialogue with, and really come to know, their patients (the nursed) and then tailor treatment regimens, including appropriate teaching and health promotion activities that match the patient preferences and lifestyle ( Martin, 1995). Boykin and Schoenhofer believe this authentic and intentional caring relationship produces improved outcomes for the nursed and gives increased satisfaction to the nurse on both personal and professional levels. Further analysis of the Nursing as Caring theory is limited. Most published analysis is theoretical in its discussion. The implications of the theory in practice have been largely untested.

Two research approaches have been developed with the context of studying Nursing as Caring. One focused on the everyday lived meaning of everyday caring and the second directed towards understanding the value experienced in nursing situations (Boykin & Schoenhofer, 2001). In 2005, Boykin and Schoenhofer participated in designing a phenomenological study that aimed to uncover the caring experience in the NP-nursed relationship. The results of the study concluded that three major implications for advanced practice nursing emerged. Spirituality between the nurse and the nursed proved to be a significant factor in the building and maintaining of the relationship, personhood of the NP was enhanced, and the caring emanating from the NP enhanced the personhood of the ones nursed beyond immediate physical needs (Thomas, Finch, Schoenhofer & Green, 2005). The larger message was that there are many avenues for additional research of the Nursing as Caring theory in practice. Many of the nursed participants of the study reported feeling empowered by and connected to their NP’s. The caring relationship was important to them and improved their overall experience and exceeded their expectations.

Relevance

As a professor at Florida Atlantic University, Anne Boykin teaches a course called “Nursing as Caring Spirituality.” Instructing this class, she has the opportunity to teach future nurses her theory of nursing as caring. Boykin is also the director of the Christine E. Lynn Center for Caring. In this center, nurses and scholars focus on humanizing care in the community through the integration of teaching, research, and service grounded in caring. Savina Schoenhofer used Nursing as Caring theory teaching at Alcorn State University. Together Boykin and Schoenhofer engaged in a two-year funded demonstration project, where they demonstrated the value of a model for healthcare delivery in an acute care setting that is intentionally grounded in Nursing as Caring. (Boykin & Schoenhofer, 1993) In order to use Nursing as Caring theory in practice, there are several tasks one must first overcome. One must gain insight into emotions, thoughts, bodily sensations, and other feelings, which contribute to well being. (Duffy, 2009)

Using the Nursing as Caring theory daily in practice may become challenging. Nurses need to put differences aside and work in harmony with each other, providing every patient with individualized care, listening to the needs of the patient. There are three concepts strongly utilized in the theory, which should be incorporated in practice, such as concern, participation, and keeping an open mind. The most important task is to first know yourself as a caring person, then learn to care for your patients. In order to show your caring spirit, it is important that simple gestures such as always to making eye contact with your patients, listening to their stories, and sharing with them your story are present.

Boykin and Schoenhofer expressed that one of the most essential roles as a caring nurse was to respect your patient’s value and desires, making sure not  to be judgmental. People need to be non-judgmental in order to be better caregivers and accomplish caring in difficult situations. If a person is judgmental, they give off the impression that they are better than the other person, and that is not a good way to start a caring relationship. In practice Boykin and Schoenhofer consider that you go the extra mile to demonstrate your love, respect, and mutual interaction. As their caregiver, when planning their care, do not talk over patients as though they were not there, and always try to include what it is important to them. (Boykin & Schoenhofer, 1993)

Caring, as defined by Boykin and Schoenhofer, means providing physical, emotional, and spiritual support. Life experience is what transforms us into the caring individuals that we are. A nurse must listen to her patient as well as the rest of the healthcare team, in order to provide well-rounded optimal care, aspiring to exemplify respect, compassion, and competence. Working together as a team, everyone must aim towards one goal, excellent care, providing patients with the highest level possible of satisfactory nursing care. To help accomplish this goal, Boykin and Schoenhofer have provided certain guidelines which include but are not limited to, diligent attention towards needs, prompt caring response, keeping patients and families informed, maintaining excellent nursing skills, respect and compassion, human connection, and growing in caring. (Boykin & Schoenhofer, 2001).

Each year, Boca Raton Community Hospital rewards their caring nurses with an award which recognizes their significant impact on the community. The “Dr. Anne Boykin Nurse as Caring Award” goes to the individual that has gone above and beyond in portraying caring and compassionate patient care. (Luana, 2010)

Summary
Exceptional nursing care can be accomplished when the Nursing as Caring theory is put into practice. A nurse must embrace the theory and focus on using it in everyday life. Great appreciation is felt from the patient when a nurse demonstrates that level of attention. Unfortunately, it may become difficult to exhibit that level of meticulousness when working under stressful conditions. Today, with the high nurse-to-patient ratio, it becomes difficult to offer consistently outstanding quality of care, as required by nursing as caring theory, to every patient. Although caring should come naturally, there are external stressors that may easily alter a nurse’s attitude and dedication to caring as nursing. A nurse can only strive to consistently be an example of the Nursing as Caring Theory.

References

Boykin A., & Schoenhofer S. O. (1993). Nursing as caring: A model for transforming practice.

New York: National League of Nursing Publications.

Boykin A., & Schoenhofer S.O. (2001). The role of nursing leadership in creating caring

environments in health care delivery systems. Nursing Administration Quarterly, 25(3),

Boykin, A., & winland-Brown, J. (1995). The dark side of caring: Challenges of caregiving.

Journal of Gerontological Nursing, 21(5), 13-18

Brunton B., & Beaman M. (2000). Nurse practitioners’ perceptions of their caring behaviors.

Journal of American Academy of Nurse Practitioners. 2000 (12), 451-456.

Duffy, Joanne R. (2009). Quality care in nursing: applying theory to clinical practice, education,

and leadership . Spriger Publishing Company LLC,New York, Ny: 2-3

Luana (2010). Boca Hospital presents excellence awards as part of National
Nurses Week. The

Boca Raton Tribune, May 14, 2010.

Martin SR. Caring advanced nursing practice. Nurse Practitioner. 1995; 16-23.

Schoenhofer, S. O., & Boykin, A. (1993). The value of caring experienced in nursing.

International Journal for Human Caring, 2(4), 9-15.

Welsh A.Z., & Leininger M. Cultural care and universality of theory. In: Tomey AM, Alligood

AR, eds. Nursing theorists and their work, 5th ed. St. Louis, MO: Mosby; 501-526