Practice/Theory Exemplar (Watson Caring Science)

Main Site: La Crosse, Wisconsin, USA

Description of the setting

(from http://www.gundersenhealth.org/our-system/)

• National Caring Partner with Watson Caring Science Institute
• A physician-led, not-for profit healthcare system
• Located throughout western Wisconsin, northeastern Iowa andsoutheastern Minnesota caring for patients in 21 counties
• A regional referral center with regional hospitals
• A teaching hospital with 325 beds and a Level II Trauma and Emergency Center
• Repeatedly named among the top 50 hospitals in the nation, placing us in the top one percent
• The designated Western Academic Campus for the University of Wisconsin School of Medicine & Public Health
• Environmentally responsible, the first health system to achieve energy independence in October 2014.

Key nurses involved in implementation

Denise Nicholson, BSN, RN, Nursing System Specialist, Caritas Coach, Advance Care Plan Facilitator, Registered and Certified Clinical Aromatherapist

Beth Smith-Houskamp, PhD, RN, Chief Nursing Officer, Administrative Chief Operating Officer

Theoretical Framework

Watson Caring Science is used to guide nursing practice and is infused throughout the system. Caritas is at the center of the professional practice model. Gundersen Health System is proud to be designated by Dr. Jean Watson as a National Watson Caring Science Partner of Watson Caring Science Institute.  Our Nursing Professional Framework – with Caritas as the foundation – supports, guides, strengthens and empowers our more than 2120 RNs, LPNs (NPs, CNMs, etc. as well) to evolve in their professions as individuals and as a whole.

Implementation

Caritas and Healing Environment are foundational to the entire system. Some examples of this are:

• New employee orientation, patient care orientation, centralized nursing orientation, the Nurse Residency Program and the Chaplain Residency Program include a focus on Caring Science/Caritas at Gundersen Health in La Crosse, WI.
• The site is in the 5th year of an interprofessional residency in Caring Science that includes nursing, other clinical professionals, as well as non-direct care/nonclinical employees (e.g., coding). Individuals graduating from this program implement a caring science-based project in their work environment.  Examples are a respiratory therapist providing Caritas education to colleagues at department staff meetings and an administrator of a clinic creating a centering room for staff.
• Several times a year, Nightingale Rounds, presented and attended by physicians and nurses and any other interested individuals, highlight stories of how Caritas is seen in the care of patients, families and each other.
• A Caritas Circle meets monthly with the purpose of bringing together interprofessional colleagues to learn about Human Caring Theory/Caritas to help expand its meaning throughout our organization.  Examples of expansion include a physician’s work with incorporating Caritas/caring/empathy into medical students’ evaluation process and a sustainability coordinator’s education to department peers.
• Reflective Fridays provides quarterly conversation, lunch and reflections for managers to better understand our Nursing Professional Framework and its Caritas foundation.
• Shared governance meetings being with centering, focusing on caring and often, specific Caritas Processes.

Key Literature Sources:

Watson, J. (2008). Nursing: the philosophy and science of caring. Boulder, CO: University Press of Colorado.

Watson, J. (2005).  Caring science as sacred science.  Philadelphia, PA:  F.A. Davis Company.

Watson, J. (2010).  Postmodern nursing and beyond.  Boulder, CO:  Watson Caring Science Institute.

Watson Caring Science website

Approach to evaluation of outcomes:

• Nurse Residents complete Caritas reflections based on the day’s learnings and a written evaluation for each session.
• Verbal feedback and from many attending Nightingale Rounds prompted additional presentations.
• Nurses interviewed and filmed for vignettes shown in orientation are able to articulate influence of Caritas on their practice.
• Research done by physician with medical students shows increased empathy in their care of patients and with each other.
• Earlier participation in caring science patient survey showed the “percentage of caring comments increased and uncaring comments decreased over the 2-year period” – source: Hayter, K.L.; Brewer, B.B. (2017).  Halldorsdottir’s Modes of Being with Another to evaluate patient comments.  International Journal of Human Caring, 2017, 21 (4); 172-175.

Practice Recommendations: 

• Increase numbers of Caritas Coaches in organization, whose role is to gain: “insight, intellect, and skills to give voice as ‘living caritas’: more able to translate and live-out the theory and philosophy of human caring-healing, in service for deep system change.” (https://www.watsoncaringscience.org/caritas-coach-education-program-ccep)

This has been approved by chief nursing officer with plan for two individuals to attend each year.

• Continue current programs as listed above and continue to weave into the tapestry of our organization as opportunities present themselves.