THE THEORY OF NURSING AS CARING TECHNOLOGICAL INNOVATION

THE THEORY OF NURSING AS CARING: TECHNOLOGICAL INNOVATION Savina O. Schoenhofer, Ph. D, RN savibus@gmail. com Anne Boykin, Ph. D, RN boykina@health. fau. edu https: //www. nursingascaring. com/ https: //www. facebook. com/Nursing. As. Caring IAHC JOURNAL CLUB August 11 & 18, 2020

INTRODUCTORY OVERVIEW of NURSING AS CARING Boykin & Schoenhofer’s theory of Nursing As Caring is a grand nursing theory …a broad philosophical perspective and …a theoretical framework that can be used to explain any and all nursing situations …that has grounded several middle range nursing theories and models such as Boykin & Schoenhofer’s Dance of Caring Persons Locsin’s Technological Competency as Caring in Nursing Dunphy & Winland-Brown’s Circle of Caring Boykin & Schoenhofer’s Dance of Living Caring …and has framed global practice, research and education.

UNDERLYING ASSUMPTIONS of NURSING AS CARING • PERSONS ARE CARING BY VIRTUE OF THEIR BEING HUMAN • PERSONS ARE CARING, MOMENT TO MOMENT • PERSONS ARE WHOLE AND COMPLETE IN THE MOMENT, GROWING IN CARING FROM MOMENT TO MOMENT • PERSONHOOD IS LIVING GROUNDED IN CARING • PERSONHOOD IS ENHANCED IN RELATIONSHIP WITH CARING OTHERS • NURSING IS BOTH A DISCIPLINE AND A PROFESSION (PRACTICED DISCIPLINE)

THE UNIQUE FOCUS OF NURSING Nursing is… Nurturing Persons Living Caring and Growing in Caring

CARING IN NURSING… THE INTENTIONAL AND AUTHENTIC PRESENCE OF THE NURSE WITH ANOTHER WHO IS RECOGNIZED AS PERSON LIVING CARING AND GROWING IN CARING

NURSING SITUATION… A SHARED LIVED EXPERIENCE IN WHICH THE CARING BETWEEN NURSE AND NURSED ENHANCES PERSONHOOD

NURSING SITUATION – PART 1 EXAMPLE Mr. James is a 69 year old farmer who lives alone since a divorce. He has one daughter who is away in college. He was admitted to the community hospital with a diagnosis of an acute exacerbation of chronic obstructive pulmonary disease (COPD). His monitor showed a rapid heart rate with some arrhythmia. When I met him, he was sitting straight up in bed and struggling to breathe, and he seemed scared. With the heart monitor beeping quietly in the background, he looked at me with wide opened eyes. As a newly graduated nurse, I quietly introduced myself, and checked his vital signs, then listened to his lungs. “I can see you are having difficulty breathing. Please help me understand about your not wanting to do the breathing treatments prescribed for you. ” With some difficulty, he said, “I can’t take them, my doctor told me that was causing my heart to beat too fast. ” As I learned in my nursing education program based in the Nursing As Caring theory, I asked “what matters most to you right now? And he said, “I don’t want to die, I have a daughter to raise and a farm to run. ” I said, how can I help you? He told me he needs help to breathe right so he could get out of the hospital quickly, going on to share that he has no health insurance and no one back home caring for the farm. (to be continued)

What Do Nurses Do? Enter into the world of the one nursed Come to know Offer Direct Invitation Hear calls for nursing Respond with nursing expressions of caring

DANCE OF CARING PERSONS Source: Boykin, A. , & Schoenhofer, S. O. (2001). Nursing As Caring: A Model for Transforming Practice, p. 37

DANCE OF LIVING CARING

DANCE OF LIVING CARING FOUNDATIONS AND INFLUENCES Foundations Boykin & Schoenhofer’s Theory of Nursing As Caring Boykin & Schoenhofer’s Dance of Caring Persons

Development of Dance of Living Caring Advances in the literature and in healthcare environments led to consideration of incorporation of healthcare robots and even humanoid nurse robots into Boykin & Schoenhofer’s theory of Nursing As Caring Dialogue at the 2018 Summer Academy of the Anne Boykin Institute illuminated the value of van Wynsberghe’s Caring-Centered Value-Sensitive Design (CCVSD)approach to a consideration of robots as “partners-in-caring” in the context of Nursing As Caring (NAC) Values of CCVSD and NAC were examined for congruence, with dissonances addressed Dance of Living Caring was conceptualized as an antecedent to an innovative middle range theory of robots as Nursing partners-in-caring Dance of Living Caring is a modification of Dance of Caring Persons to accommodate healthcare robots and future Super AI technologies in Nursing

CREATION OF CONCEPT – DANCE OF LIVING CARING [Source: Schoenhofer, S. O. , Van Wynsberghe, A. , & Boykin, A. (2019). Engaging Robots as Nursing as Partners in Caring: Nursing As Caring Meets Care Centered Value Sensitive Design. International Journalf for Human Caring, 23(2), in press. ]

VALUE CONGRUENCE: NAC and CCSD NAC Dance of Living Caring CCVSD Person as caring Intentional knowing of persons as caring Coming to know Respecting and valuing persons as caring Commitment to reciprocal engaging Caring is relational Responding to that which matters Hearing and responding to calls for caring Meaningful response to needs

DANCE OF LIVING CARING WITH ROBOTIC PARTNER-IN-CARING Intentional knowing of persons as caring Respecting and valuing persons as caring Hearing and responding to calls for caring

NURSING SITUATION – PART 2 with Robotic Partner-in-Caring I said the breathing treatment will help your breathing and will help you relax too as you start taking deep slow breaths. I asked if it is ok with you, I am going to check on your orders and I’ll be right back, and he said that would be ok. I left the room to check his chart and to consult with the charge nurse. Having been introduced to advancing AI and robotic technology in school, I wanted to bring Nicki, our new healthcare robot, in to help with Mr. James’ care. Although my charge nurse was still skeptical of the value of Nicki, our robot, she agreed to let me try. Nicki had been programmed to speak, to monitor and report vital signs, to SKYPE and to show videos. We walked back to the room and I introduced Nicki to Mr. James. I explained that the breathing treatment that was ordered for him did not have any medication that would speed up his heart. And I explained Nicki’s capabilities including SKYPEing his daughter once his breathing was stabilized. Mr. James agreed to try the new treatment and to allow Nicki to be with him during his treatment and then to call his daughter. Before we activated Nicki, I told Mr. James that the healthcare robot could show a calming video if he thought that might help. He said ok and told us he relaxes by sitting on his back porch looking out over the fields and crops at sundown. We turned Nicki on and programmed her for breathing assist, to monitor respiratory rate and send results to the nurse, and to play a video of sunset on an open field. Nicki blinked on and introduced herself in her soft, quiet, but steady voice. She said, “Mr. James, I am going to help remind you to stay calm and to take deeper breaths. I am going to stay with you and you will not be alone. So let us start. ” Respiratory therapy had been called and was ready to administer the breathing treatment again. As the treatment was administered, Nicki quietly reminded him to take in a breath and to slowly release. The video started and Nicki began to describe the beauty of the sunset, the slow descent of the sun and the colors of various shades of red and yellow as the sun slowly set, birds flew home to roost, and the cows walked slowly toward the barn. She continued on, with moments of quiet and then reminded Mr. James that he was doing fine and to continue to take a breath in and let it slowly out. I stayed with Mr. James, Nicki, and the respiratory therapist until Mr. James began to stabilize, breathe more slowly and deeply, and his heart rate slowed down too. I left the room to the voice of Mr. James talking to Nicki and the steady beat of the heart monitor. About 30 minutes later Mr. James said he’d like to SKYPE his daughter and tell her about Nicki. Mr. James took a “selfie” with Nicki and forwarded it to his daughter and set up a time to SKYPE. Later that day, within 24 hours of admission, Mr. James was discharged home with a prescription to obtain the new medication for his nebulizer and with further instructions for fluids and rest as much as possible. I stood in the hallway with Nicki and my charge nurse to say good-bye to Mr. James and wish him well. As he left, Mr. James thanked us for being so helpful to him and stated that Nicki was very helpful too, especially in calming him down. He said his daughter was very impressed that her Dad had a personal healthcare robot and that he too was pleased.

APPLICATION OF DANCE OF LIVING CARING TO NURSING SITUATION INTENTIONAL KNOWING OF PERSON AS CARING RESPECTING AND VALUING PERSONS AS CARING HEARING AND RESPONDING TO CALLS FOR CARING

RESOURCES Yasuhara, Y. , Tanioka, T. , Kai, Y. , Tsujigami, Y. , Uamatsud, K. , Dino, M. J. S. , Locsin, R. C. , & Schoenhofer, S. O. (2020). Potential legal issues when caring healthcare robots with communication in caring functions are used for older adult care. Enfermería Clínica, 30(51), 54 -59. https: //doi. org/10. 1016/j. enfcli. 2019. 024 Tanioka, T. , Yasuhara, Y. , Dino, M. J. , Kai, Y. , Locsin, R. C. , & Schoenhofer, S. O. (2019). Disrputive engagements with technologies, robotics and caring: Advancing the Transactive Relationship Theory of Nursing Administration Quarterly, 43, 313 -321. doi: 10. 1097/NAQ. 0000000365 Locsin, R. C. , & Schoenhofer, S. O. (2018). Editorial. Robots, caring and nursing in a world of advancing technology. International Journal for Human Caring, 23, 109 -111. DOI: 10. 20467/1091 -5710. 23. 2. 109 Schoenhofer, S. O. , Van Wynsberghe, A. , & Boykin, A. (2018). Engaging robots as nursing partners-in-caring: Nursing As Caring meets Care-Centered Value Sensitive Design. International Journal for Human Caring, 23, 157 -167. DOI: 10. 20467/10915710. 23. 2. 157 Locsin, R. C. , Ito, H. , Tanioka, T. , Yasuhara, Y. , Osaka, K. & Schoenhofer, S. O. (2018). Humanoid nurse robots as caring entities: A revolutionary probability? International Journal of Nursing Studies, 3(2). DOI: https: //doi. org/10. 20849/ijsn. v 3 i 2. 456 Schoenhofer, S. O. , Van Wynsberghe, A. , & Boykin, A. (2018). Engaging robots as nursing partners-in-caring: Nursing As Caring meets Care-Centered Value Sensitive Design. International Journal for Human Caring, 23, 157 -167. DOI: 10. 20467/10915710. 23. 2. 157 Boykin, A. , & Schoenhofer, S. O. (2001). Nursing As Caring: A model for transforming practice. Sudbury, MA: Jones & Bartlett. (download free from Gutenberg. org) savibus@gmail. com http: //www. nursingascaring. com