The theory of nursing as caring: A model

for transforming practice

Marguerite J. Purnell

Savina O. Schoenhofer

Anne Boykin
“The nature of relationships is transformed through caring”
(Boykin & Schoenhofer, 2001a, p. 4).

Credentials and background of the theorists

Anne boykin
Anne Boykin grew up in Kaukauna, Wisconsin, the eldest of six children. She began her career
in nursing in 1966, graduating from Alverno College in Milwaukee, Wisconsin. She received
her master’s degree from Emory University in Atlanta, Georgia, and her doctorate degree from
Vanderbilt University in Nashville, Tennessee. Dr. Boykin is married to Steve Staudenmeyer,
and they have four children. Anne Boykin retired in fall 2011 and is Professor Emeritus of the
Christine E. Lynn College of Nursing at Florida Atlantic University. She has relocated to
Asheville, North Carolina, where she enjoys being surrounded by mountains and lakes.
Dr. Boykin is currently the Director of the college’s new Anne Boykin Institute for the
Advancement of Caring in Nursing. Boykin has a longstanding commitment to the
advancement of knowledge in the discipline, especially regarding the phenomenon of caring.
Positions she has held in the International Association for Human Caring include president
elect (1990 to 1993), president (1993 to 1996), and member of the nominating committee (1997
to 1999). As immediate past president, she served as coeditor of the journal, International
Association for Human Caring, from 1996 to 1999.
Boykin’s scholarly work is centered on caring as the grounding for nursing. This is
evidenced in her book (coauthored with Schoenhofer), Nursing as Caring: A Model for
Transforming Practice(1993, 2001a), and her book, Living a Caring-Based Program (1994b).
The latter book illustrates how caring grounds the development of a nursing program by
creating the environment for study through evaluation. In addition to these books, Dr. Boykin
is editor of Power, Politics and Public Policy: A Matter of Caring (1995) and coeditor (along
with Gaut) of Caring as Healing: Renewal Through Hope (1994). She has written numerous
book chapters and articles and serves as a consultant locally, regionally, nationally, and
internationally on the topic of caring.

Savina o. schoenhofer
Savina Schoenhofer was born the second child and eldest daughter in a family of nine children
and spent her formative years on the family cattle ranch in Kansas. She is named for her
maternal grandfather, who was a classical musician in Kansas City, Missouri. She has a
daughter, Carrie, and a granddaughter, Emma.
During the 1960s, Schoenhofer spent 3 years in the Amazon region of Brazil, working as a
volunteer in community development. Her initial nursing degree was completed at Wichita
State University, where she also earned graduate degrees in nursing, psychology, and
counseling. She completed a PhD in educational foundations and administration at Kansas
State University in 1983. In 1990, Schoenhofer co-founded Nightingale Songs, an early venue
for communicating the beauty of nursing in poetry and prose. An early study made it apparent
to Schoenhofer that caring was the service that patients overwhelmingly recognized. In addition
to her work on caring, including co-authorship with Boykin of Nursing as Caring: A Model for
Transforming Practice (1993, 2001a), Schoenhofer has written numerous articles on nursing
values, primary care, nursing education, support, touch, and mentoring.
Schoenhofer’s career in nursing has been influenced significantly by three colleagues: Lt.
Col. Ann Ashjian (Ret.), whose community nursing practice in Brazil presented an inspiring
model of nursing; Marilyn E. Parker, PhD, a faculty colleague who mentored her in the idea of
nursing as a discipline, the academic role of higher education, and the world of nursing theories
and theorists; and Anne Boykin, PhD, who introduced her to caring as a substantive field of
study in nursing.
Dr. Schoenhofer serves on the Ethics Advisory Committee at the University of Mississippi
Medical Center, where she consults and advises on questions of ethics in clinical situations that
arise in practice and health care ethics education in clinical and education settings. She is
Professor of Nursing at University of Mississippi Medical Center School of Nursing in Jackson
and Adjunct Professor at the Florida Atlantic University College of Nursing, Boca Raton. Dr.
Schoenhofer is committed to the study of nursing as caring.

Theoretical sources
The Theory of Nursing as Caring was borne out of the early curriculum development work at
Florida Atlantic University College of Nursing. Anne Boykin and Savina Schoenhofer were
among the faculty group revising the caring-based curriculum. When the revised curriculum
was instituted, each recognized the importance and human necessity of continuing to develop
ideas toward a comprehensive conceptual framework that expressed the meaning and purpose
of nursing as a discipline and as a profession. The point of departure from traditional thought
was the acceptance that caring is the end rather than the means of nursing, and the intention of
nursing rather than merely its instrument. This work led Boykin and Schoenhofer to
conceptualize the focus of nursing as “nurturing persons living caring and growing in caring”
(Boykin & Schoenhofer, 1993, p. 22).
Further work to identify foundational assumptions about nursing clarified the idea of the
nursing situation as a shared lived experience in which the “caring between” (Boykin &
Schoenhofer, 1993, p. 26) enhances personhood. Personhood is illuminated as living grounded
in caring. The clarified notions of nursing situation and focus of nursing bring to life the
meaning of the assumptions underlying the theory and permit the practical understanding of
nursing as both a discipline and a profession. As critique and refinement of the theory and study
of nursing situations progressed, the notion of nursing as being primarily concerned with health
was seen as limiting. Boykin and Schoenhofer now propose that nursing is concerned with the
broad spectrum of human living.
Three bodies of work significantly influenced the initial development of the theory. Paterson
and Zderad’s (1988) existential phenomenological theory of humanistic nursing, viewed by
Boykin and Schoenhofer as the historical antecedent of Nursing as Caring, was the source for
such germinal ideas as “the between,” “call for nursing,” “nursing response,” and
“personhood,” and it served as substantive and structural bases for their conceptualization of
nursing as caring. Roach’s (1987, 2002) thesis that caring is the human mode of being finds its
natural expression and domain in the assumptions of the theory. Her “6 C’s”—commitment,
confidence, conscience, competence, compassion, and comportment—contribute to a language
of caring (Roach, 2002). Mayeroff’s (1971) work, On Caring, provided rich, elemental
language facilitating recognition and description of the practical meaning of living caring in
the ordinariness of life. Mayeroff’s (1971) major ingredients of caring—knowing, alternating
rhythms, patience, honesty, trust, humility, hope, and courage—describe the wellspring of
human living. In the Theory of Nursing as Caring, these concepts are essential for
understanding living as caring, and for coming to appreciate their unique expression in the
reciprocal relationship of the nurse and the nursed.
Boykin and Schoenhofer’s conception of nursing as a discipline was influenced directly
by Phenix (1964), King and Brownell (1976), and Orem (1979), and as a profession
by Flexner’s (1910) ideas. In addition to the work of these thinkers, Boykin and Schoenhofer
are longstanding members of the community of nursing scholars whose study focuses on
caring. Their collegial association and mutual support also undoubtedly influenced the work.
Nascent forms of the Theory of Nursing as Caring were first published in 1990 and 1991,
with the first complete exposition of the theory presented at a theory conference in 1992
(Boykin & Schoenhofer, 1990, 1991; Schoenhofer & Boykin, 1993). These expositions were
followed by Nursing as Caring: A Model for Transforming Practice, published in 1993
(Boykin & Schoenhofer, 1993) and re-released with an epilogue in 2001 (Boykin &
Schoenhofer, 2001a). Gaut points out in Boykin and Schoenhofer (2001a) that the theory is an
excellent example of growth by intension, or gradual illumination, characterized by “the
development of an extant bibliography, categorization of caring conceptualizations, and the
further development of human care/caring theories” (p. xii).
MAJOR CONCEPTS & DEFINITIONS
Focus and intention of nursing
Disciplines of knowledge are communities of scholars who develop a particular perspective on
the world and what it means to be in the world (King & Brownell, 1976). Disciplinary
communities hold a value system in common that is expressed in its unique focus on knowledge
and practice. The focus of nursing from the perspective of the Theory of Nursing as Caring is
that the discipline of knowledge and professional practice is nurturing persons living and
growing in caring. The general intention of nursing is to know persons as caring and to support
and sustain them as they live caring (Boykin & Schoenhofer, 2006). This intention is expressed
uniquely when the nurse enters the relationship with the nursed with the intention of knowing
the other as a caring person, and affirming and celebrating the person as caring (Boykin &
Schoenhofer, 2001a). Caring is expressed in nursing and is “the intentional and authentic
presence of the nurse with another who is recognized as living in caring and growing in caring”
(Boykin & Schoenhofer, 1993, p. 24). Sensitivity and skill in creating unique and effective
ways of communicating caring are developed through the nurse’s intention to care.
Perspective of persons as caring
The fundamental assumption is that all persons are caring. Caring is lived by each person
moment to moment and is an essential characteristic of being human. Caring is a process, and
throughout life, each person grows in the capacity to express caring. Person therefore is
recognized as constantly unfolding in caring. From the perspective of the theory,
“fundamentally, potentially, and actually each person is caring” (Boykin & Schoenhofer,
2001a, p. 2), even though every act of the person might not be understood as caring. Knowing
the person as living caring and growing in caring is foundational to the theory.
Nursing situation
Caring is service that nursing offers and lives in the context of the nursing situation (Boykin
& Schoenhofer, 2006). The nursing situation is the locus of all that is known and done in
nursing (Boykin & Schoenhofer, 2001a) and is conceptualized as “the shared, lived experience
in which caring between nurse and nursed enhances personhood” (Boykin & Schoenhofer,
1993, p. 33). The nursing situation is what is present in the mind of the nurse whenever the
intent of the nurse is “to nurse” (Boykin & Schoenhofer, 2001a). It is within the nursing
situation that the nurse attends to calls for caring or reaching out of the one nursed. The practice
of nursing and the practical knowledge of nursing are situated in a relational locus of the person
being nursed with the person nursing in the nursing situation. The nursing situation involves
an expression of values, intentions, and actions of two or more persons choosing to live a
nursing relationship. In this lived relationship, all knowledge of nursing is created and
understood (Boykin & Schoenhofer, 2006).
Personhood
Personhood is a process of living that is grounded in caring. Personhoodimplies being who we
are as authentic caring persons and being open to unfolding possibilities for caring. We are
constantly living out the meaning of our caring from moment to moment. Within the nursing
situation, the shared lived experience of caring within enhances personhood, and both the nurse
and the nursed grow in caring. In the intimacy of caring, respect for self as person and respect
for other are values that affirm personhood. “A profound understanding of personhood
communicates the paradox of person-as-person and person-in-communion all at once” (Boykin
& Schoenhofer, 2006, p. 336).
Direct invitation
Within the nursing situation, the direct invitation opens the relationship to true caring between
the nurse and the one nursed. The direct invitation of the nurse offers the opportunity to the
one nursed to share what truly matters in the moment. With the intention of truly coming to
know the one nursed, the nurse risks entering the other’s world and comes to know what is
meaningful to him or her. The focus is on what is meaningful for the one being nursed.
Invitations to share what matters, such as “How might I nurse you in ways that are meaningful
to you?” or “What truly matters most to you at this moment?” are communicated in the personal
language of the nurse. The power of the direct invitation reaches deep into the humility of the
nursing situation, uniting and guiding the intention of both the nurse and the one nursed. These
uniquely expressed invitations of caring call forth responses of mutual valuing in the beauty of
the caring between.
Call for nursing
Calls for nursing are calls for nurturance perceived in the mind of the nurse (Boykin &
Schoenhofer, 2001a, 2001b). Intentionality (Schoenhofer, 2002a) and authentic presence open
the nurse to hearing calls for nursing. The nurse responds uniquely to the one nursed with a
deliberately developed knowledge of what it means to be human, acknowledging and affirming
the person living caring in unique ways in the immediate situation (Boykin & Schoenhofer,
1993). Because calls for nursing are uniquely situated personal expressions, they cannot be
predicted, but originate within persons who are living caring in their lives and who hold hopes
and aspirations for growing in caring. “Calls for nursing are individually relevant ways of
saying ‘Know me as caring person in the moment and be with me as I try to live fully who I
truly am”’ (Boykin & Schoenhofer, 2006, p. 336).
Caring between
When the nurse enters the world of the other person with the intention of knowing the other as
a caring person, the encountering of the nurse and the one nursed gives rise to the phenomenon
of caring between, within which personhood is nurtured (Boykin & Schoenhofer, 2001a).
Through presence and intentionality, the nurse comes to know the other, living and growing in
caring. Constant and mutual unfolding enhances this loving relation. Without the caring
between the nurse and the nursed, unidirectional activity or reciprocal exchange can occur, but
nursing in its fullest sense does not occur. It is in the context of caring between that personhood
is nurtured, each expressing self and recognizing the other as caring person (Boykin &
Schoenhofer, 2001a).
Nursing response
In responding to thenursing call, the nurse enters the nursing situation with the intention of
knowing the other person as caring. This knowing of person clarifies the call for nursing and
shapes the nursing response, transforming the knowledge brought by the nurse to the situation
from general, to particular and unique (Boykin & Schoenhofer, 2001a). The nursing response
is co-created in the immediacy of what truly matters and is a specific expression of caring
nurturance to sustain and enhance the other living and growing in caring. Nursing responses to
calls for caring evolve as nurses clarify their understanding of calls through presence and
dialogue. Such responses are uniquely created for the moment and cannot be predicted or
applied as preplanned protocols (Boykin & Schoenhofer, 1997).
Story as method for knowing nursing
Story is a method for knowing nursing and a medium for all forms of nursing inquiry. Nursing
stories embody the lived experience of nursing situations involving the nurse and the nursed.
As a repository of nursing knowledge, any single nursing situation has the potential to
illuminate the depth and complexity of the experience as lived, that is, the caring that takes
place between the nurse and the one nursed. The content of nursing knowledge is generated,
developed, conserved, and known through the lived experience of nursing situations (Boykin
& Schoenhofer, 2001a). The nursing situation as a unit of knowledge and practice is re-created
in narrative or story (Boykin & Schoenhofer, 1991). Nursing situations are best communicated
through aesthetic media such as storytelling, poetry, graphic arts, and dance to preserve the
lived meaning of the situation and the openness of the situation through text. These media
provide time and space for reflecting and for creativity in advancing understanding (Boykin &
Schoenhofer, 1991, 2001a, 2006; Boykin, Parker, & Schoenhofer, 1994). Story as method re-
creates and re-presents the essence of the experience, making the knowledge of nursing
available for further study (Boykin & Schoenhofer, 2001a).

Use of empirical evidence

The assumptions of Nursing as Caring ground the practice of nursing in knowing, enhancing,
and illuminating the caring between the nurse and the one nursed. As such, rather than
providing empirical variables from which hypotheses and testable predictions are made, the
theory of nursing as caring qualitatively transforms practice. In the theory, persons are unique
and unpredictable in the moment and therefore cannot and should not be manipulated or
objectified as testable, researchable variables. Ellis believed that theories should reveal the
knowledge that nurses must, and should, spend time pursuing (Algase & Whall, 1993). The
Theory of Nursing as Caring reveals the essentiality of recognizing caring between the nurse
and the one nursed as substantive knowledge that nurses must pursue. From this perspective,
the outcomes of nursing care reflect the valuing of person in ways that communicate “value
added” richness of the nursing experience (Boykin, Schoenhofer, Smith, et al., 2003, p. 225).
Characteristics of personhood are essential to the theory, such as unity, wholeness, awareness,
and intention. In Nursing as Caring, outcomes of nursing are articulated in terms that are
subjective and descriptive, rather than objective and predictive (Boykin & Schoenhofer, 1997).

Major assumptions
Fundamental beliefs about what it means to be human undergird the Theory of Nursing as
Caring. Boykin and Schoenhofer (2001a) address six major assumptions that reflect a set of
values to provide a basis for understanding and explicating the meaning of nursing.

Person
One: Persons are caring by virtue of their humanness
The belief that persons are caring by virtue of their humanness sets forth the ontological and
ethical bases on which the theory is grounded. Being a person means living caring, through
which being and possibilities are known to the fullest. Each person throughout his or her life
grows in the capacity to express caring. The assumption that all persons are caring does not
require that each act of a person be caring, but it does require the acceptance that
“fundamentally, potentially, and actually, each person is caring” (Boykin & Schoenhofer,
2001a, p. 2). Through entering, experiencing, and appreciating the life-world of other, the
nature of being human is more fully understood. From the perspective of Nursing as Caring,
the understanding of person as caring “centers on valuing and celebrating human wholeness,
the human person as living and growing in caring, and active personal engagement with others”
(Boykin & Schoenhofer, 2001a, p. 5).

Two: Persons are whole and complete in the moment

Respect for the person is communicated by the notion of person as whole or complete in the
moment. Being complete in the moment signifies that there is no insufficiency, no brokenness,
and no absence of something. Wholeness, or the fullness of being, is forever present. The view
of the person as caring and complete is intentional, offering a unifying lens for being present
with the other that prevents segmenting into parts such as mind, body, and spirit. Through this
lens, the person is at all times whole, with no insufficiency, brokenness, or absence of
something. The idea of wholeness does not preclude the idea of complexity of being. Instead,
from the perspective of Nursing as Caring, to encounter a person as less than whole fails to
truly encounter the person.

Three: Persons live caring, moment to moment

Caring is a lifetime process that is lived moment to moment and is constantly unfolding. In the
rhythm of life experiences, we continually develop expressions of ourselves as caring persons.
Actualization of the potential to express caring varies in the moment. As competency in caring
is developed through life, we come to understand what it means to be a caring person, to live
caring, and to nurture each other as caring. This awareness of self as a caring person brings
forth to consciousness the valuing of caring and becomes the moral imperative, directing the
“oughts” of actions with the persistent question, “How ought I act as caring person?” (Boykin
& Schoenhofer, 2001a, p. 4).

Health
Four: Personhood is living life grounded in caring
Personhood is a process of living caring and growing in caring: It is being authentic,
demonstrating congruence between beliefs and behaviors, and living out the meaning of one’s
life. Personhood acknowledges the potential for unfolding caring possibilities moment to
moment. From the perspective of Nursing as Caring, personhood is the universal human call.
This implies that the fullness of being human is expressed in living caring uniquely day to day
and is enhanced through participation in caring relationships (Boykin & Schoenhofer, 2001a).

Environment
Five: Personhood is enhanced through participating in nurturing relationships
with caring others
As a process, personhood acknowledges the potential of persons to live caring and is enhanced
through participation in nurturing relationships with caring others. The nature of relationships
is transformed through caring. Caring is living in the context of relational responsibilities and
possibilities, and it acknowledges the importance of knowing person as person. “Through
knowing self as caring person, I am able to be authentic to self, freeing me to truly be with
others” (Boykin & Schoenhofer, 2001a, p. 4).

Nursing
Six: Nursing is both a discipline and a profession
Nursing is an “exquisitely interwoven” (Boykin & Schoenhofer, 2001a, p. 6) unity of aspects
of the discipline and profession of nursing. As a discipline, nursing is a way of knowing, being,
valuing, and living in the world, and is envisaged as a unity of knowledge within a larger unity.
The discipline of nursing attends to the discovery, creation, development, and refinement of
knowledge needed for the practice of nursing. The profession of nursing attends to the
application of that knowledge in response to human needs.
Nursing as caring focuses on the knowledge needed for plenary understanding of what it
means to be human and the distinctive methods needed to verify this knowledge. As a human
science, knowing nursing means knowing in the realms of personal, empirical, ethical, and
aesthetic all at once (Carper, 1978; Phenix, 1964). These patterns of knowing provide an
organizing framework for asking epistemological questions of caring in nursing.

Theoretical assertions
The broad philosophical framework of the theory assures its congruence in a variety of nursing
situations. As a general theory, Nursing as Caring is appropriate for various nursing roles, such
as individual practice, group or institutional practice, and a variety of practice venues such as
acute care, long-term care, nursing administration, and nursing education.
The fundamental assumptions of Nursing as Caring underpin the assertions and concepts of
the theory. They are as follows: (1) To be human is to be caring, and (2) the purpose of the
discipline and profession is to come to know persons and nurture them as persons living caring
and growing in caring. These assumptions give rise to the concept of respect for persons as
caring individuals and respect for what matters to them. The notion of respect grounds and
characterizes relationships and is the starting place for all nursing caring activities.

Dance of caring persons

The Dance of Caring Persons is a visual representation of the theoretical assertion that lived
caring between the nurse and the nursed expresses underlying relationships (Figure 19–1). The
egalitarian spirit of caring respect characterizes each participant in the dance of caring persons,
where the contributions of each dancer, including the one nursed, are honored.

FIGURE 19-1 The

Dance of Caring Persons. (From Boykin, A., & Schoenhofer, S. O. [2001a]. Nursing as
caring: A model for transforming practice [p. 37] [Re-release of original 1993 volume, with
epilogue added]. Sudbury, (MA): Jones & Bartlett; graphic created by Shawn Pennell,
Florida Atlantic University, Boca Raton, FL.)
Dancers enter the nursing situation, visualized as a circle of caring that provides organizing
purpose and integrated functioning (Boykin, Schoenhofer, Smith, et al., 2003). Dancers move
freely; some dancers touch, some dance alone, but all dance in relation to each other and to the
circle. Each dancer brings special gifts as the nursing situation evolves. Some dancers may hear
different notes and a different rhythm, but all harmonize in the unity of the dance and the
oneness of the circle. Personal knowing of self and other is integral to the connectedness of
persons in the dance, in which the nature of relating in the circle is grounded in valuing and
respecting person (Boykin & Schoenhofer, 2001a). All in the nursing situation, including the
nurse and the nursed, sustain the dance, being energized and resonating with the music of
caring.

Outcomes of nursing care

Outcomes of nursing care are conceptualized from values experienced in the nursing
relationship, and in normative documentation, these outcomes are unacknowledged. Boykin
and Schoenhofer (1997) note that it is the responsibility of the courageous advanced practice
nurse to “go beyond what is currently accepted in delimiting and languaging the value
expressed by persons who participate in nursing situations” (p. 63).

Logical form
The theory is presented in logical form grounded in nursing as a discipline of knowledge and
a profession, and in general assumptions related to persons as caring in nursing. The theory is
a broad-based, general theory of nursing rendered in everyday language. Mayeroff’s (1971)
work, On Caring, and Roach’s (1987) “5 C’s” provided language that illuminated the practical
meaning of caring in nursing situations.
Key concepts of caring, nursing, intention, nursing situation, direct invitation, call for
nursing as caring, caring between, and nursing response are described as general assumptions,
and interrelated meanings are illustrated in the model of the dance of caring persons. The direct
invitation, introduced in the 2001 edition of Nursing as Caring: A Model for Transforming
Practice, is an elaboration of the nursing situation and further clarifies the role of the nurse in
initiating and sustaining caring responses. Story as a method for knowing focuses on nursing
situations as the locus for nursing knowledge as a fluid and logical extension of the framework.

Acceptance by the nursing community

Practice
Nursing is a way of living caring in the world and is revealed in personal patterns of caring.
Foundations for practice of the Theory of Nursing as Caring become illumined when the nurse
comes to know self as caring person “in ever deepening and broadening dimensions” (Boykin
& Schoenhofer, 2001a, p. 23). Practicing nursing within this framework requires the
acknowledgment that knowing self as caring matters and is integral to knowing others as
caring. This is especially important in light of practice environments that depersonalize and
support the notion of the nurse as an instrument and a means to an end. Rather than nursing
practice focused on activities, the lens for practice becomes the intention to know and nurture
the person as caring. Often, realization of the self as caring person does not occur until the
nurse articulates and shares the story of the caring transpiring in the nursing situation. When
reflecting upon their caring, nurses describe “Aha!” moments, signal realizations of self as
always having been caring, and rediscover freedom in caring possibilities within the nursing
situation: “freedom to be, freedom to choose, and freedom to unfold” (Boykin & Schoenhofer,
2001a, p. 23). Honoring caring values in explicit ways reaffirms the substance of nursing and
refreshes the caring intention of the nurse. Through the sharing of story, new possibilities arise
for living nursing as caring.

Nursing service administration

In living Nursing as Caring, the nursing administrator makes decisions through a lens
in which activities are infused with a concern for shaping a transformative culture that
embodies the fundamental values expressed within nursing as caring. All activities of
the nursing administrator must be connected to the direct work of nursing and be
“ultimately directed to the person(s) being nursed” (Boykin & Schoenhofer, 2001a, p.
33). These activities include creating, maintaining, and supporting an environment
open to hearing calls for nursing and to providing nurturing responses.
Boykin and Schoenhofer (2001a) point out that contrary to the perception of nurse
administrators being removed from the direct care of the nursed, they are able to
directly or indirectly enter the world of the nursed, respond uniquely, and assist the
nurse in securing resources to nurture persons as they live and grow in caring. The
nursing administrator is also able to enter the world of the nursed indirectly, through
the stories of colleagues in other roles. Other activities of the nursing administrator
within the interdisciplinary environment of the organization include facilitating
understanding and clarity of the focus of nursing and informing other members of the
interdisciplinary health care team of the unique contributions of nurses. Sharing the
depth of nursing with others through nursing situations illuminates meanings and
allows for fluid reciprocity among colleagues.
The work of the nurse administrator must also reflect the uniqueness of the
discipline so that nursing is being reflected, portraying respect for persons as caring
and extending through mission statements, goals, objectives, standards of practice,
policies, and procedures (Boykin & Schoenhofer, 2001a). The following story was
related by Nancy Hilton, MSN, RN, Chief Nursing Officer, at a Florida hospital. This
nurse administrator, practicing from the perspective of Nursing as Caring, reflects the
complexity and intentional caring expressed in living caring uniquely and
courageously:
We are intentionally refocusing our culture from a traditional bureaucratic
one to a person-centered, caring-based values organization. In 2007, our
Nursing Councils at St. Lucie Medical Center selected the Theory of
Nursing as Caring as the theoretical model to guide our nursing practice.
As a Nursing Administrator, I pondered how I could intentionally ground
our hospital environment, and the practice of the nurses within its walls, in
a perspective of caring. I made a deliberate commitment to deepen our
knowledge and awareness by allocating time for all of us to participate in
dialogues focused on knowing ourselves as caring persons.