Heating—HIV +Your wounds weepedPurulent with the discharge of ourPain and fear.They tried to hide, only to reappear.The treatment gentle, slowA warm, loving balm to your soul.Your stomach was fed the comfortFood of your youthAnd your lips drank in deeply allYou knew and understood.The memories sweetened each momentYou stood, face to face with terror ofWhat might be mistook.All inside shifted as slowly it came,A gradual awakening; embracing of painAs you conquered your demonsA lightness appearedTo stay forever andAbolish all fears. (Wheeler, 1990)
Many of the nursing situations described in this book have taken place in hospital settings, where the nursing service is a shared responsibility of many nurses in a range of functional roles. Nurses in such settings generally nurse many persons intensively and simultaneously and share direct nursing responsibility with one or two other nurses. How can nurses in institutional practice settings be supported so that calls for nursing can be heard and nursing responses made? What is the role of the nurse administrator in supporting the practice of nurses?
It is important to understand clearly the difference between the practice of administration which happens to be delivered by nurses and the practice of nursing administration. Tead (1951) defines administration as "the comprehensive effort to direct, guide, and integrate associated human strivings which are focused toward some specific ends or aims" (p. 3). For example, goals of administration could be business, governmental, education, or nursing. In this definition, it is evident that the focus must be made clear. It is not adequate to have an understanding of administration as a role which is focused in functions such as interpersonal, informational, and decisional. Such a perspective ignores the value of persons and the ministering responsibilities inherent in the role. The administrator must connect his or her work to the direct work of nursing.
Nursing administration by name suggests a groundedness in the discipline. The role of the nursing administrator could indeed be questioned if the focus of the administrative practice is not nursing. There is the assumption that the administration of nursing is practiced from a particular conception of nursing in which the focus or goal of nursing is clear. What the nursing administrator says and does as nurse must reflect the uniqueness of the discipline so that nursing's unique contributions are assured. Nursing administrators must also be able to articulate the unique contributions of nursing to other members of the interdisciplinary health care team.
The relationship of the nurse administrator's role to direct care is implicit in this perspective. The nursing administrator describes him or herself as directly involved in the care of persons. All activities of the nursing administrator are ultimately directed to the person(s) being nursed. It is essential that this direct connection to the goal of nursing be made and that persons assuming nursing administration positions be able to articulate their unique role contributions to nursing care. Without this clarity of focus, one may be engaged in the practice of administration but not nursing administration.
From the viewpoint of nursing as caring, the nurse administrator makes decisions through a lens in which the focus of nursing is nurturing persons as they live caring and grow in caring. All activities in the practice of nursing administration are grounded in a concern for creating, maintaining, and supporting an environment in which calls for nursing are heard and nurturing responses are given. From this point of view, the expectation arises that nursing administrators participate in shaping a culture that evolves from the values articulated within nursing as caring.
Although often perceived to be "removed" from the direct care of the nursed, the nursing administrator is intimately involved in multiple nursing situations simultaneously, hearing calls for nursing and participating in responses to these calls. As calls for nursing are known, one of the unique responses of the nursing administrator is to directly or indirectly enter the world of the nursed, understand special calls when they occur, and assist in securing the resources needed by the nurse to nurture persons as they live and grow in caring. All nursing activities should be approached with this goal in mind. Here, the nurse administrator reflects on the obligations inherent in the role in relation to the nursed. The presiding moral basis for determining right action is the belief that all persons are caring. Frequently, the nurse administrator may enter the world of the nursed through the stories of colleagues who are assuming other roles such as nurse manager. Policy formulation and implementation allow for the consideration of unique situations. The nursing administrator assists others within the organization to understand the focus of nursing and to secure the resources necessary to achieve the goals of nursing. When the focus of nursing can be clearly articulated, nursing's contribution to the whole will be understood, If the focus of practice is clouded, however, this becomes an insurmountable task. Recognition of nursing's value is contingent upon the ability of nurses to articulate their contribution. Traditionally, systems define contribution through patient outcomes and other total quality measures. Future articulation of nursing and its contributions would emanate from the values and assumptions offered in the Nursing as Caring theory.
Sharing nursing situations with others is one way to promote the knowing of nursing. It also is a way for other members of the organization to see how their roles contribute to the well-being of the nursed. The following is a nursing situation, re-presented as the poem "Last Rights," that cries out for nursing administration, that is, nursing support for nursing.
Last RightsTight faced, they found and cornered her at workAs quick as hammers pounding down a wall ofwords came hard and nailed that little quirk ofhonest so fast she held the rail."Who were you to say he was a dying man,though he lay white, his lifethread thin.How were you to know the speed his flying heartwould race away from bone and shin.He was hopeless, yes, beneath that tent offilmy gauze, but who were you to say his fatewas hinged in prayer-our magic spent.Who knows, he might have lived another day."He held my hands, asked the truth," she said.Then turned away to smooth the empty bed.—Yelland-Marino (1993)
The nurse administrator can nurture the living in caring and growing in caring of the person in this story by creating ways to support the nurse at the bedside in order that the call for hope of being known and supported as caring person, not object, can occur. What are some of the strategies that the nurse administrator could engage in which would reflect the nursing focus?
Because budget determination is such a prominent matter for nurse administrators, we will begin there. Budget decisions should be directed from the perspective of what I ought to do as nurse administrator that would have the greatest effect on nurturing persons being cared for in their living and growing in caring. One aspect of budget essential to this story is time—time for the nurse to focus on knowing self and other colleagues. As Paterson & Zderad (1988) state, for nursing practice to be humanistic, awareness of self and others is essential. The budget should include time allocations for staff to participate in dialogues focused on knowing self as caring person in order that calls, such as the one in the previous story, can be heard. The notion of dialogue is central to transforming ways of being with others in organizations. Bohm (1992) refers to dialogue as creating "a flow of meaning in the whole group, out of which will emerge some new understanding, something creative" (p. 16). Persons engaged in dialogue are focused on trying to understand situations as perceived through another's eyes in order that new possibilities may be recognized. Through the allocation of time, nursing staff come to better know self and other. Shared meanings emerge which become the "glue or cement that holds people and societies together" (p. 16). These opportunities for knowing self assist the nurse to achieve, as Tournier (1957) would put it, a reciprocity of consciousness with other.
Through the opportunity to better know self as caring person, the nurse will learn to intentionally and authentically enter nursing situations focused on knowing and supporting the nursed as they live caring and grow in caring. Time for reflection and collegial dialogue is necessary to maintain this nursing lens in a period of increasing responsibility. Such time allocation communicates the commitment of the nurse administrator to enhance the growth of the nurse in the discipline of nursing.
To propose that the budgeting of time is one of the most essential tasks of a nursing administrator may seem outrageously naïve in a time when organizations seem to be interested only in bottom-line figures. Ironically, however, the time allocation strategy offered here supports the goal of cost containment. Studies have shown that caring behaviors of nurses (Duffy, 1991) and nursing staff attitudes (Cassarea et al., 1986) are directly related to patient satisfaction. Benner and Wrubel (1989) also found that caring is integral to expert practice. As a result, and from the standpoint of quality of care as revenue producing, this strategy of allowing time for dialogue and reflection has merit.
From the viewpoint of the Nursing as Caring theory, the nurse administrators' beliefs about person would require that new ways of being with the nursed are created and supported. The nursing administrator models a way of being with others that portrays respect for person as caring. Through modeling, others grow in their competency to know and express caring. Of course creating and sustaining environments that nurture and value the practice and study of nursing remains the challenge facing nurses caught in the maze of various organizational structures. Systems tend to perpetuate existing ways of being even though their members may repeatedly question the legitimacy of actions flowing from these structures. It is our belief that nursing can create a culture that values caring within systems and organizations. Systems and organizations can be reshaped and transformed through living out the assumptions and values inherent within nursing as caring.
Assumptions on which Nursing as Caring is built serve as stabilizers for the organization. These assumptions directly influence the climate of the organization and serve as the organizational pillars. The climate of organizations is determined by beliefs and values of persons within it. An organization grounded in the assumptions of person as described in Chapter 1 would not support arbitrary and capricious decision making in which the input of all persons has not been discerned. Mission statements, goals, objectives, standards of practice, policies and procedures emerge from assumptions, beliefs, and values that emphasize one's humanness. If one accepts the assumption that persons are caring by virtue of their humanness, then it follows that cultures are comprised of caring persons. Respect for person as person is engendered within this context. There is a desire to know and support the living of caring; to support each other in being who we are as caring persons in the moment. Therefore, assumptions of Nursing as Caring ground not only the theory but may likewise influence the ontology of the organization itself.
Generally, organizational structures reflect bureaucratic values. Structures imply ways of being with and relating to people. The process of relating is typically illustrated in a hierarchical fashion. The concept of hierarchy carries with it the notion that there is a "top" and a "bottom." Competition, levels, and positions of power are implicit. In climbing the rungs of a bureaucratic ladder, it is difficult for the employee to be authentic and valued as a unique person with special ideas because the risks of such valuing are often too great for the bureaucracy to bear. Competition too remains the driving force of most organizations.
Within an organization, however, we can imagine each person's hands as clinging to the rungs of the bureaucratic ladder. Taken further, this image would clearly portray persons who are not and can not be open to receive and know other. Because of the vertical axis of the bureaucratic hierarchy, persons, more often than not, are viewed as objects. The ladder positions people so that they are either looking up or down but rarely eye-to-eye. Obviously, the hierarchical model does not support the idea of each person as important in and to him or herself.
By contrast, and from the assumptions posited in Nursing as Caring, the model for being in relationships resembles a dance of caring persons (Boykin, 1990). The same persons are present in this circle that were in the hierarchical structure described above. The difference between the two models is the philosophical way of being with other. Because the nature of relating in the circle is grounded in a respect for and valuing of each person, the way of being is diametrically opposed to traditional patterns of relating in organizations. Leaving the security provided by known hierarchical structures, however, requires courage, trust, and humility. Building on the assumptions of this theory, one can infer that the basic dance of all persons in relationships is to know self and other as caring person. Each person is encouraged and supported in a culture that values person-as-person, person as caring.
dancing
The image of a dancing circle is also used to describe being for and being with the nursed. In the circle, all persons are committed to knowing self and other as living and growing in caring. Each dancer makes a distinct contribution because of the role assumed. The dancers in the circle do not necessarily connect by holding hands although they may. Each dancer moves within this dance as called forth by the nature of the nursing situation. The nursed calls for services of particular dancers at various points in time. Each person is in this circle because of their unique contribution to the person being cared for ... nurses, administrators, human resources, etc. These roles would not exist if it were not for the nursed. There is always room for another person to join the dance. Rather than the vertical view described earlier, this model fosters knowing other. Eye-to-eye contact assists one to know and appreciate each other as caring persons. Each person is viewed as special and caring. No one person's role is more or less important than the other's. Each role is essential in contributing to the process of living grounded in caring. As each person authentically expresses their commitment in being there for and with the nursed, caring relationships are lived. When the focus in any health care institution fails to be the person cared-for, purpose, roles, and responsibilities become depersonalized and bureaucratic rather than person-centered and caring.
Personal knowing—knowing of self and other—is integral to the connectedness of persons in this dance. The nursing administrator interfaces with persons of many disciplines as well as with the nursed. With each interaction, the nurse administrator is honest and authentic in encouraging others to know and live out who they are. Each encounter with another is an opportunity for knowing other as caring person. From an organizational standpoint the nursing administrator assists in creating a community that appreciates, nurtures, and supports each person as they live and grow in caring moment to moment. The nursing administrator assists nurses to hear and understand the unique calls for nursing and supports and sustains their nurturing response.
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In this chapter, we address the implications of our theory for nursing education, including designing, implementing, and administering a program of study. The assumptions that ground Nursing as Caring also ground the practice of nursing education and nursing education administration. The structure and practices of the education program are expressions of the discipline and, therefore, should be explicit reflections of the values and assumptions inherent in the statement of focus of the discipline. From the perspective of Nursing as Caring, all structures and activities should reflect the fundamental assumption that persons are caring by virtue of their humanness. Other assumptions and values reflected in the education program include: knowing the person as whole and complete in the moment and living caring uniquely; understand that personhood is a process of living grounded in caring and is enhanced through participation in nurturing relationships with caring others; and, finally, affirming nursing as a discipline and profession.
The curriculum, the foundation of the education program, asserts the focus and domain of nursing as nurturing persons living caring and growing in caring. All activities of the program of study are directed toward developing, organizing, and communicating nursing knowledge, that is, knowledge of nurturing persons living caring and growing in caring.
The model for organizational design of nursing education is analogous to the dancing circle described earlier. Members of the circle include administrators, faculty, colleagues, students, staff, community, and the nursed. What this circle represents is the commitment of each dancer to understanding and supporting the study of the discipline of nursing. The role of administrator in the circle is more clearly understood when the origin of the word is reflected upon. The term administrator is derived from the Latin ad ministrare, to serve (Guralnik, 1976). This definition connotes the idea of rendering service. Administrators within the circle are by nature of role obligated to ministering, to securing and to providing resources needed by faculty, students, and staff to meet program objectives. Faculty, students, and administrators dance together in the study of nursing. Faculty support an environment that values the uniqueness of each person and sustains each person's unique way of living and growing in caring. This process requires trust, hope, courage, and patience. Because the purpose of nursing education is to study the discipline and practice of nursing, the nursed must be in the circle. The community created is that of persons living caring in the moment, each person valued as special and unique.
We have said in Chapter 1 that the domain of a discipline is that which its members assert. The statement of focus that directs the study of nursing from this theoretical perspective is that of nurturing persons as they live caring and grow in caring. The study of nursing is approached through the use of nursing situations. The knowledge of nursing resides in the nursing situation and is brought to life through study. The nursing situation is a shared lived experience in which the caring between the nurse and the one nursed enhances personhood or the process of living grounded in caring. These situations, like the many cited in earlier chapters, become available for study through the use of story (recounting the situation in ways that convey the essence of the lived experience). These stories create anew the lived experience of caring between the nurse and the nursed, and bring to life the basic values described in Chapter 1.
Story then becomes the method for studying and knowing nursing. Carper's (1978) four patterns of knowing serve as an organizing framework for asking epistemological questions of caring in nursing. Those patterns include personal, ethical, empirical, and aesthetic knowing. Each of these patterns comes into play as one strives to understand the whole of the situation. Personal knowing centers on knowing and encountering self and other, empirical knowing addresses the science of caring in nursing, ethical knowing focuses on what "ought to be" in nursing situations, and aesthetic knowing is the integration and synthesis of all knowing as lived in a particular situation. The poem, "Intensive Care," a representation of a nursing situation, is given here to illustrate the organization of sample content.
Carper's (1978) patterns of knowing offer a framework for organizing the content for studying this nursing situation.
Who are the nurse and nursed as caring persons in the moment?How are the nurse and nursed expressing caring in this moment?What is the meaning of this situation to the nurse and nursed interms of present realities and future possibilities?What is the meaning of vulnerability and mortality?What is the value of intuition in practice?Empirical KnowingWhat nursing and related research exists on modes of communication,the meaning of presence in practice, touch, objectification,recovery of cardiac patients, technological caring,understanding the experience of fear and loneliness?What factual knowledge is needed to be competent in this particularsituation—e.g. knowledge of monitors, chest tubes,medications, cardiac care, diagnostic data?
If nursing is practiced from the perspective of Nursing as Caring,what obligations are inherent in this situation?How is the nurse demonstrating the value that all persons are caring?Respect for person-as-person? Interconnectedness?What dilemmas are present in this story?
How is the nursed supported to live dreams of living and growing in caring?How could the nurse transcend the moment to create possibilitieswithin this specific nursing situation?What metaphors might express the meaning of this nursing situation?
Students studying this nursing situation are challenged to know the person as caring, as living caring uniquely in the moment, as having hopes and dreams for growing in caring, and as being whole or complete in the moment. The student is also challenged to know the nurse as caring person in the moment and to project ways of supporting the nurse as caring person.
Through the study of this situation, students and faculty identify a range of calls for nursing as well as nurturing responses. In this process, there is dialogue focused on knowing the nurse and nursed in the story as caring person. We would contribute the following as our knowing of the nursed as caring person. Through her honest expression of "I'm scared—just look in my eyes," we know her as living hope, honesty, and transcending fear through courage.
Calls for nursing might include a call to be known as caring person and a call to have interconnectedness recognized and affirmed. The nurse's response to these calls is individual and evolves from who one is as person and nurse. Therefore, the range of responses is multiple and varied—each reflecting the nurse's informed living of caring in the moment. Each nurturing response is focused on nurturing the person as he or she lives caring and expresses hopes and dreams for growing in caring.
If the nurse is responding to the call of the person for recognition and affirmation of interconnectedness, perhaps the nurse would express hearing this call by being present with the intention of knowing other as caring person. This may be communicated through active patience—giving the other time and space to be known; through touch which communicates respect and interconnectedness; through the nurse sharing who he or she is as caring person in this relationship—perhaps through tears as the resonance of commonality of this experience is known; through music or poetry if a shared love of these has been discovered.
Through dialogue, students and faculty openly engage in the study of nursing. The dialogue encourages and supports students and faculty to freely express who they are as person and nurse living caring through the re-presented story. It provides an opportunity to affirm values of self and discipline and to study how these values may be lived in practice. It is in this dialogue of nursing that faculty communicate their love for nursing. Time is needed for both faculty and students to reflect on the meaning of being a member of this discipline and more specifically, on the meaning of being a member of a discipline focused on nurturing persons as they live and grow in caring. Dialogue facilitates the integration of this understanding and is a key concept in present and future transformations of nursing education. Common engagement in dialogue as nursing stories are shared and studied is the way of being.
The story lived anew provides students the opportunity to participate in a lived experience of nursing and to create new possibilities. Since nursing can only occur through intentionality and authentic presence with the nursed, students and faculty share how they prepare to enter the world of the nursed, and how they come to understand that world. This process requires that students be encouraged to live fully their personhood. To facilitate such living, faculty support an environment in which students are free to choose and to express self in various ways. For example, perhaps the holistic understanding of a nursing situation would be expressed as aesthetic knowing through dance, poetry, music, painting, or the like. We view this process of education as critical to moral education. When students enter nursing situations to know other as living and growing in caring, they are living out the moral obligation that arises from the commitment to know person as caring. Here, then, is an expression of a dynamic view of morality in which caring is always lived in the moment.
In the study of the situation, Intensive Care, brought to the dialogue are personal experiences of being alone, being afraid, and being with someone and not being heard or seen as caring person. This personal knowing fosters human awareness of our connectedness and interdependence. In this context, the nurse does not study the empirics of cardiac pathology to understand a perceived deficit but rather to become competent in drawing forth the knowledge that is specific to knowing this person as whole in the moment. The nurse comes to know the person as living caring and growing in caring, situated within a particular set of circumstances, some of which the nurse knows explicitly. Each student entering the nursing situation will ask, "How can I nurture this person in living and growing in caring in this situation?" Because each nurse may hear calls for caring in many different ways, nursing responses are many and varied. For nursing faculty, openness to multiple possibilities presents a particular challenge and an opportunity to suspend entrenched patterns of teaching nursing.
Faculty and students study nursing together. Faculty join students in a constant search to discover the content and meaning of the discipline. Undoubtedly, this understanding of extant possibilities presents a different view of the role of teacher. Yet, it is a view that engenders the sort of humility essential to nursing for there is always more to know. Although past methods of teaching of nursing may have been comfortably structured through textbooks organized around medical science, faculty are now empowered to question what should be the focus of study in the discipline of nursing. Faculty are encouraged to take risks and let go of the familiar. The perspective that Nursing as Caring conveys—the fullness and richness of nursing—will allow faculty to willingly assume the risks inherent in a new way of guiding the study of nursing.
In teaching Nursing as Caring, faculty assist students to come to know, appreciate, and celebrate self and other as caring person. Mayeroff'sOn Caring(1971) provides a context for the generic knowing of self as caring. Through dyads or small groups, students share life situations in which they experienced knowing self and other as caring person. Mayeroff's caring ingredients (knowing, alternating rhythm, trust, honesty, hope, courage, humility, patience) also serve as a source for reflection as one asks "who am I as caring person?". As students engage in this exercise, their emerging reflections begin to ground them as they grow in their understanding of person as they live and grow in caring. Students will also draw on the knowledge gleaned in the study of arts and humanities as they attempt to gain a deeper understanding of person. The process of knowing self and other as caring is lifelong. In an educational program grounded in Nursing as Caring, however, the focus on personal knowing (in the study for every nursing situation) provides a deliberate opportunity for greater knowing of self and other as caring person.
Students, as well as faculty, are in a continual search to discover greater meaning of caring as uniquely expressed in nursing; journaling is an approach that facilitates this search. For example, in a special form of journaling, students actively dialogue with authors whose works they are reading and with the ideas expressed in their works. This process enhances the students' understanding of caring in nursing. Over time, students integrate and synthesize many ideas and create new understandings. Examination is another process to facilitate learning. From this theoretical perspective, essay examinations that present nursing situations provide opportunities for students to express their knowledge of nurturing persons living and growing in caring. Aesthetic projects also allow the student the opportunity to communicate understanding of a nursing situation. We would like to share with you a project from a course in which the students were asked to express the beauty of a nursing situation. In this nursing situation, the nurse, Michelle, shared her gifts of therapeutic touch and voice as expressions of caring for David in the moment, drawing on an earlier dialogue in which David told her of his love of meditation and the Ave Maria, she wrote:
AVE MARIAAND THERAPEUTIC TOUCHFOR DAVID"David, let me know your pain;From fractured leg and heart,Share with me your private hell.Next to one who's far,Far away his own world:Moaning, crying, weak.What's it like to lie besideOne who cannot speak?"Tell me David, what you doTo cancel out the sound;Eliminate the smell of dungIn which your roommate's found?Who can you complain about?Are you worse off than he?Tied to IV, traction linesYou cannot be free."David, I can see your pain.Tell me where you are.Tied in bed. Powerless.From loved ones you're apart.I can't move you from this placeTo take your pain away.But let me lay my hands on youAnd sing to you today."Ave Marie, gratia plenaMaria, gratia plena.Ave dominus, dominus tecum.Benedicta to in mulieribus.Et benedictusEt benedictus, fructus ventris;Ventris tui, Jesu.Ave MariaI sang the song he loved and usedTo meditate and flee,Escape tormenting stimuli.He needed to be freed,To understand why he must bearThis trial, this hell, this pain,I sang the tune; I touched with careTo give him peace again.—Stobie, 1991
Expressions of nursing such as this, which was partly sung, beautifully portray the living of caring between the nurse and the nursed and exemplify how caring enhances personhood. Faculty play a vital role in fostering in students the courage to take such risks. Faculty encourage self-affirmation in students, open, nonjudgmental dialogue, living the caring ideal in the classroom and development of the students' moral groundedness in caring (Boykin & Schoenhofer, 1990). Faculty also take the risk of sharing self through their stories of nursing. The sharing of nursing situations is, in essence, a sharing of our innermost core of common identity and forms a type of collegiality among those who are studying the discipline together.
How can faculty be supported to teach nursing in new ways? The administrator of the program fosters a culture in which the study of the discipline from the caring perspective, as presented here, can be achieved freely and fully. All actions of the dean are directed toward creating, maintaining, and supporting this goal. The theoretical assumptions ground the activities of the dean in both internal and external areas of responsibility.
Internally, the administrator, faculty, staff, and students model commitment by creating an environment that fosters the knowing, living, and growing of persons in caring. The dean "ministers" by assuring that faculty, students, and staff are presented ongoing opportunities to know themselves ontologically as caring persons and professionals and to understand how caring orders their lives. Who we are as person influences who we are as student, colleague, nurse, scholar, and administrator. Therefore, attention must be directed to knowing self. Time must be devoted to knowing and experiencing our humanness.
The constant struggle to know self and other as caring person nourishes our knowing of the nursed. Through constant discovery of self, the other is also continually discovered. This culture sensitizes each person to ways of being with other that necessitate that each action reflect respect for person as person. Therefore, when issues are to be addressed, they are addressed openly and fully. Persons are encouraged to bring forth who they are so there is congruence between actions and feelings. Understanding each other's views is essential to the unfolding of this culture. Dialogue assists one to know the other's needs and desires, and to image oneself in the other's place. As such, the dean, faculty, staff, and students become skilled in the use of the caring ingredients, internalized as personally valid ways of expressing caring: knowing, alternating rhythms, trust, hope, courage, honesty, humility, and patience (Mayeroff, 1971).
Of utmost importance in fostering this culture are decisions regarding selection of faculty. Although many prospective faculty have a fairly traditional lens for the study of nursing (that is, the lens of medical science or frameworks borrowed from other disciplines), this actually becomes an insignificant factor in the process of selection. At the heart of choosing new faculty is knowing their passion for and love of nursing. A focus of the interview process is discerning the person's devotion to the discipline. It is our belief that this attitude, this love of nursing, is the music for the dancers in the circle. One way to know if prospective faculty love nursing is to ask them to share a significant story from practice. Having faculty share a story illuminates their conceptualization of the discipline. Many faculty who have not had the opportunity to teach nursing through an articulated nursing lens, can yet communicate nursing clearly through story.
Faculty are supported in their struggles to conceptualize nursing in a new way. Forums in which faculty come together and aesthetically re-present and share their nursing story is one strategy that effectively engages self and other in the knowing of nursing. It is also a wonderful way to orient faculty as to how to use nursing situations to teach nursing. Faculty support each other as colleagues in learning to teach nursing in a new way, in becoming expert in the practice of nursing education, and in living out the basic assumptions of this theory. This need for support holds true not only for faculty-faculty relationships but for all relationships. The comfort of faculty teaching nursing from the perspective of Nursing as Caring is enhanced as the value of knowing other as caring, as living our histories and as having special nursing stories to share is appreciated.
The administrator, faculty, and staff assist in fostering an environment that furthers the development of the students' capacity to care. Competency in caring is a goal of the educational process. Students are continually guided to know self and other as caring person as faculty and administrators model actions that reflect respect for person as person. Each student is known as caring person, as special and unique. Policies allow for consideration of individual situations and diverse possibilities. In this culture, the dean and faculty attempt to know the student as caring person and student of the discipline. The intention of the dean to know students in this way can be evident through invitations for regularly scheduled dialogue in which students share openly their conceptions about nursing. The administrator is truly with students to know them as caring persons and to hear from them their understanding of nursing as caring.
Externally, the dean "ministers" to faculty, students, and staff through securing resources necessary to accomplish program goals. The dean articulates to persons in the academic and broader community their role in the dance of nursing. The role of these persons is to provide resources such as scholarships, faculty development possibilities, learning resources, and research monies. Although this may be a primary responsibility of the dean by nature of the role, all persons in the circle share in this process by virtue of their commitment to nursing.
The administrator brings to the circle a skillful use of the caring ingredients. Alternating rhythms are used to understand and appreciate each person's unique contributions that support the achievement of program goals. For example, the budgetary process is essential to creating an environment that reflects the valuing of nursing. Commitment of the dean to securing resources necessary to accomplish the program goals drives the budget rather than the budget driving the commitment. The administrator's devotion to the discipline and to the basic assumptions of the theory direct all activities. The administrator makes decisions that reflect the basic beliefs of this theory. All decisions would ultimately be made from this standpoint: "What action should I take as administrator which would support the study of nursing as nurturing persons living in caring and growing in caring?"
What we have tried to suggest here is that every aspect of nursing education is grounded in the values and assumptions inherent in this theoretical focus. Thus, not only is the curriculum a direct expression of Nursing as Caring, but all aspects of program are similarly grounded.