Circle of Caring Model
Dumphy, Winland-Brown, Porter & Thomas (2007), derived a caring model for advanced practice from the philosophical work of Boykin and Schoenhofer (1978). The faculty of the School of Nursing drew upon these works to further develop a model for curriculum development for nursing based on caring as “the central concept in nursing, uniquely known and expressed in nursing” (Dumphy, et al 2007, p. 11). It is the belief of the faculty of the School of Nursing that Nursing is a discipline of knowledge and a professional service that has as its goal nurturing persons, living caring and growing in caring. Nursing practice is not linear but is a continual unfolding.
The attributes of caring include courage, authentic presence, advocacy, knowing, commitment, and patience. These attributes characterize the nurse-patient relationship and foster healing. The faculty believes that these attributes also foster an environment of teaching and learning that cultivates a character of caring among students and faculty. The attributes of caring identified by Dumphy, et. al. (2007) are depicted in the center of the circle of caring and as such not only represent the attributes of caring but the core values of the School of Nursing.
Courage is the human act of making deliberate choices. It is the daily application of values and forms the ethical grounding for the practice of nursing. “As part of courage, the nurse understands and acts on the obligation to come to know that which matters to those seeking care” (Boykin & Schoenhofer, 1978).
Authentic presence is based on an awareness and knowledge of self. The degree of self-knowledge influences one’s presence with others and the degree of commitment possible in specific situations. It is the act of “intentionally being with another in the fullness of one’s personhood” (Dumphy, et al, 2007). Authentic presence also is an act of mindful attention in the nurse-patient relationship.
Advocacy is the act of speaking up for persons as “unique and worthwhile, as having personal hopes, dreams, intentions, and preferences that are honorable” (Dumphy, et al, 2007). It includes advocating for alternative interpretations of particular situations as warranted, based on experience and specialized knowledge.
Knowing encompasses knowledge of facts and data, empirically and objectively derived. It also includes being deeply attuned to the person, and an openness to “unfolding, a humble sense that all is not yet known” (Dumphy et al 2007). Knowing occurs from an ethical stance, the personal and professional values that enter into the situation. It is aesthetic knowledge, co-creation within the nurse-patient relationship of an understanding of the unfolding picture.
Because nursing always occurs in a relational context, continued commitment to understand the lived experiences of patients and colleagues is required. Commitmentdirects obligations in particular situations, responses to what is right, deliberate, conscious, fair, and caring. It includes a sense of agency wherein patients are able to make well-informed decisions.
Trusting people to grow in their own way and in their own time requires Patience. This attribute is the ability to remain engaged with persons while honoring individual circumstances and freedom of choice.