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w 10 M /GS2 gs q 1 0 0 1 218.38 704.841 cm 0 0 m 324.623 0 l S Q 1 g 42 42 241.5 49.758 re f BT /F6 1 Tf 8 0 0 8 42 80.0153 Tm 0 g -.0001 Tc .0768 Tw [(Vic)19.8(k)0(i D)29.8(.)39.9( Lac)9.8(h).1(man,)39.9( PhD)29.8(,)39.9( APRN,)39.9( MBE,)39.9( F)79.9(AAN,)]TJ /F1 1 Tf 21.0584 0 TD [(is Clinical Prof)29.8(essor)49.9(,)]TJ -21.0584 -1.125 TD .2914 Tw [(and Director)49.9(,).1( Inno)14.9(v)24.8(a)0(tion and Intr)9.9(a/Entrepreneurship in Adv)24.8(anced)]TJ T* .1307 Tw [(Pr)9.9(actice Nursing, Dre)29.8(x)29.7(el Univ)24.8(ersity)99.8(, College of Nursing and Health)]TJ T* .0277 Tw [(Prof)29.8(essions)14.8(, Philadelphia, P)119.8(A)-.1(.)]TJ ET .5 G 2 w q 1 0 0 1 42 90.758 cm 0 0 m 241.5 0 l S Q BT /F7 1 Tf 24 0 0 24 64.0355 643.6058 Tm -.0127 Tc .0315 Tw [(Applying the Ethics of Care to Y)89.9(o)-.1(ur)]TJ 5.0758 -1.0833 TD (Nursing Practice)Tj /F4 1 Tf 9.5 0 0 9.5 54 574.8553 Tm -.0231 Tc .0865 Tw [(I feel the capacity to car)7.8(e is the thing which gives life its)]TJ -1.2632 -1.1579 TD .0287 Tw (deepest significance.)Tj /F3 1 Tf 9.0025 0 TD [(Pablo Casals \(2000\))]TJ /F7 1 Tf 38.742 0 0 38.742 41.1868 519.8553 Tm .5 g 0 Tc 0 Tw (U)Tj /F3 1 Tf 9.5 0 0 9.5 74.375 541.8553 Tm 0 g -.0231 Tc .0272 Tw [(se of the theor)-11.9(y)0( of care ethics is discussed to help)]TJ 0 -1.1579 TD .0514 Tw [(nurses determine if they are applying this theor)-11.9(y)]TJ T* .1645 Tw [(effectively in their practice. After a basic defini-)]TJ -3.4079 -1.1579 TD .0134 Tw [(tion of caring, including W)75.9(a).1(tson)55(s)-.1( caring theor)-11.9(y)73.9(, the evo-)]TJ T* .133 Tw [(lution of the theor)-11.9(y)0( of ethics of care will be delineated)]TJ T* .1814 Tw [(briefly)73.9(. A case will be used to illustrate T)61.8(ronto)55(s)-.1( \(1993\))]TJ T* .0287 Tw [(four phases of caring and her four elements of care.)]TJ ET 0 G .5 w q 1 0 0 1 42 442.605 cm 0 0 m 241.5 0 l S Q BT /F5 1 Tf 12 0 0 12 42 446.8554 Tm -.0001 Tc [(Definition of Caring)]TJ /F3 1 Tf 9.5 0 0 9.5 54 431.8554 Tm -.0231 Tc .2132 Tw [(Caring and nursing are so intertwined that nursing)]TJ -1.2632 -1.1579 TD .0179 Tw [(always appeared on the same page in a Google sear)17.9(ch for)]TJ T* .0517 Tw [(the definition of caring. Caring is a feeling and exhibit-)]TJ T* .0587 Tw [(ing concern and empathy for others; showing or having)]TJ T* .0287 Tw (compassion \()Tj /F4 1 Tf 6.3806 0 TD [(The Fr)7.8(ee Dictionar)-12(y)]TJ /F3 1 Tf 8.1429 0 TD [(,)-292.6(2002, para. 2\). As these)]TJ -14.5235 -1.1579 TD .0668 Tw [(definitions show)73.9(,)0( caring is a feeling that also requires an)]TJ T* 0 Tw (action.)Tj 1.2632 -1.1579 TD .007 Tw [(Dr)74.1(. Jean W)75.9(a).1(tson)55(s)-.1( caring theor)-11.9(y)0( is well known in nurs-)]TJ -1.2632 -1.1579 TD .0285 Tw [(ing. The three major elements of her theor)-11.9(y)0( are the cara-)]TJ T* -.0329 Tw [(tive factors, the transpersonal caring relationship, and the)]TJ T* .0404 Tw [(caring occasion/caring moment \(W)75.9(atson, 2001\). Her car-)]TJ T* .049 Tw [(ative factors endeavor to honor the human dimensions)]TJ T* .0358 Tw [(of nursing)55(s work and the inner life world and subjective)]TJ T* -.0422 Tw [(experiences of the people we ser)-11.9(ve \(W)75.9(atson, 1997, p. 50\).)]TJ T* .073 Tw [(T)39.8(w)-.1(o examples of these carative factors, which were later)]TJ T* .0666 Tw [(changed to )]TJ /F4 1 Tf 5.3612 0 TD [(caritas factors)]TJ /F3 1 Tf 6.0997 0 TD [(in 2001, in clinical practice are)]TJ -11.4609 -1.1579 TD .045 Tw [(developing and sustaining a helping-trusting, authentic)]TJ T* .0686 Tw [(caring relationship and being present to, and support-)]TJ T* .0414 Tw [(ive of, the expression of positive and negative feelings as)]TJ T* -.0056 Tw [(a connection with deeper spirit of self and the one-being-)]TJ T* .0725 Tw [(cared-for \(W)75.9(atson, 2001, p. 347\). T)71.8(o).1( build this trusting,)]TJ T* .14 Tw [(caring relationship with the patient, the nurse must be)]TJ T* .2903 Tw [(self-aware of any judgmental feelings or feelings that)]TJ T* .016 Tw [(could foster his or her crossing boundaries into intimacy)73.9(.)]TJ T* .1101 Tw [(Caring requires the nurse to have a deep connection to)]TJ T* .2433 Tw [(the spirit within the self and to the spirit within the)]TJ T* .0067 Tw [(patient. W)75.9(a).1(tson)55(s)-.1( caring model requires the nurse to look)]TJ T* .0578 Tw [(at the uniqueness of the individual and go to all extents)]TJ T* .0351 Tw [(possible to preser)-11.9(ve the patient)55(s dignity)73.9(. The second ele-)]TJ T* -.006 Tw [(ment, the transpersonal caring relationship, describes the)]TJ 27.3158 48.6316 TD .1167 Tw [(nurse)54.9(s caring consciousness and moral commitment to)]TJ 0 -1.1579 TD .1932 Tw [(make an intentional connection with the patient. The)]TJ T* .2942 Tw [(third element, caring occasion/caring moment, is the)]TJ T* -.02 Tw [(space and time where the patient and nurse come togeth-)]TJ T* .0287 Tw [(er in a manner for caring to occur)74.1(. )]TJ ET q 1 0 0 1 301.5 497.605 cm 0 0 m 241.5 0 l S Q BT /F5 1 Tf 12 0 0 12 301.5 501.8554 Tm -.0001 Tc [(Theor)-11.9(y).1( of the Ethics of Care)]TJ /F3 1 Tf 9.5 0 0 9.5 313.5 486.8554 Tm -.0231 Tc .0754 Tw [(Edwards \(2009\) described the evolution of the theor)-11.9(y)]TJ -1.2632 -1.1579 TD .0917 Tw [(of ethics of care over the last 15 years in three versions.)]TJ T* -.0307 Tw [(First, Gilligan \(1982\) began the discussion with a focus on)]TJ T* .0458 Tw [(the context of the situation versus impartial deliberation)]TJ T* .0808 Tw [(of the ethical issue. Impartial reflection is an element of)]TJ T* .1459 Tw [(justice-based moral deliberation and does not take into)]TJ T* .0593 Tw [(consideration the level of caring or closeness in the rela-)]TJ T* .0434 Tw [(tionship. Gilligan was the first to move moral theorizing)]TJ T* -.0081 Tw [(from a position where selves were seen as independent to)]TJ T* .1362 Tw [(a position where selves are inter)17.9(connected and interde-)]TJ T* .1486 Tw [(pendent. Strangers would not receive the same level of)]TJ T* .3546 Tw [(caring as those for whom we experience a personal)]TJ T* .1249 Tw [(responsibility)73.9(. For example, you might agree to care for)]TJ T* -.0077 Tw [(your neighbor)54.9(s cat while she is away)73.9(, but that is different)]TJ T* .0577 Tw [(from agreeing to care for your sister in your home while)]TJ T* .0779 Tw [(she is in hospice care. Caring lies on a continuum, with)]TJ T* .0375 Tw [(different levels of emotional involvement for individuals)]TJ T* .0287 Tw [(in a caring relationship. )]TJ 1.2632 -1.1579 TD -.0173 Tc .368 Tw [(Second, T)61.9(ronto)55(s)-.1( \(1993\) major contributions have)]TJ -1.2632 -1.1579 TD .2124 Tw [(been in the arena of political philosophy)74(. She argued)]TJ T* -.04 Tw [(that if we focus on caring relationships and the relation-)]TJ T* -.017 Tc .0045 Tw (ships between power and caring practices, such as bring-)Tj T* -.0174 Tc .0099 Tw [(ing up children and caring for the sick, a radically differ-)]TJ T* .3124 Tw [(ent set of social arrangements will ensue \(Edwards,)]TJ T* .1044 Tw [(2009, p. 233\). Similar to Gilligan \(1982\), T)61.8(r).2(onto \(1993\))]TJ T* .0158 Tw [(differentiated between )]TJ /F4 1 Tf 10.4006 0 TD 0 Tw (obligation-based)Tj /F3 1 Tf 7.1157 0 TD .0159 Tw [(ethics and )]TJ /F4 1 Tf 4.9109 0 TD 0 Tw [(r)7.9(e).1(spon-)]TJ -22.4272 -1.1579 TD (sibility-based )Tj /F3 1 Tf 5.7683 0 TD .0224 Tw [(ethics. Obligation-based ethics are from the)]TJ -5.7683 -1.1579 TD -.0221 Tc .3169 Tw [(theories )-5.7(of utilitarianism, deontology)74.9(, or principalism)]TJ T* -.0231 Tc .1697 Tw [(\(Beauchamp & Childress, 2009\), in which the decision)]TJ T* .21 Tw [(maker determines what obligations he or she has and)]TJ T* .224 Tw [(responds consequently \(What obligation, if any)73.9(,)0( do I)]TJ T* .2581 Tw [(have for this person?\). By contrast, in responsibility-)]TJ T* .1084 Tw [(based ethics, the relationship with others is the starting)]TJ T* .3362 Tw [(point. According to T)61.8(ronto \(1993\), the ethic of care)]TJ T* .0441 Tw [(involves developing a habit of care \(p. 127\). The nurse)]TJ T* .0316 Tw [(would ask himself or herself how to best meet the caring)]TJ T* 0 Tw [(responsibility)73.9(.)]TJ 1.2632 -1.1579 TD .2123 Tw [(Third, Gastmans \(2006\) and Little \(1998\) sought to)]TJ -1.2632 -1.1579 TD -.0422 Tw [(answer the question, What is the best way to care for this)]TJ T* .0342 Tw [(patient at this time? Both did not consider the ethics of)]TJ T* .1059 Tw [(care as a theor)-11.9(y)73.9(, but as a moral orientation from which)]TJ ET 1 g 171.358 698.76 371.645 43.777 re f Q q 171.358 742.537 371.645 -43.777 re W* n 0 783 585 -783 re 292.5 391.515 m W n 0 783.015 585 -783 re W n /GS2 gs q 372.957 0 0 45.6 170.706 697.861 cm /Im1 Do Q Q q 0 783 585 -783 re 292.5 391.515 m W n 0 783.015 585 -783 re W n /GS2 gs BT /F7 1 Tf 19 0 0 19 42 724.5295 Tm 0 g -.019 Tc .0315 Tw [(Ethics, Law)73.9(,)]TJ .9826 -1.0526 TD (and Policy)Tj ET 0 G 1 w 10 M q 1 0 0 1 543.003 695.175 cm 0 0 m -501.003 0 l S Q BT /F2 1 Tf 10 0 0 10 464.8335 703.8655 Tm 1 g -.0173 Tc .0277 Tw [(V)19.9(icki D. Lachman)]TJ ET Q endstream endobj 5 0 obj <>/XObject<>/ExtGState<>/Properties<>>> endobj 20 0 obj <>stream q 1 i 0 783 585 -783 re 292.5 391.515 m W n 0 783.015 585 -783 re W n /GS2 gs BT /F2 1 Tf 8 0 0 8 173.4121 17.3444 Tm 0 g -.0001 Tc .0277 Tw [(Mar)17.9(c).1(h-April 2)57.3(0)114.7(1)172.1(2)-.1( V)55(o)0(l. 2)57.3(1)-.1(/No. 2)]TJ /F5 1 Tf 44.4765 0 TD 0 Tc 0 Tw (113)Tj ET /Document /MC2 BDC Q 0 0 0 1 k /GS2 gs 1 i q 1 0 0 1 69.656 20.888 cm 0 0 m -.01 2.739 -2.107 4.367 -5.701 4.388 c -5.701 2.993 -5.699 1.676 -5.699 .17 c -5.723 .099 l -5.723 -1.367 -5.701 -2.952 -5.701 -4.378 c -2.229 -4.408 -.926 -3.574 -.203 -1.548 c -.071 -.998 0 0 y h 1.654 -.16 m 1.542 -4.131 -.855 -5.834 -7.503 -5.457 c -7.33 -5.111 l -7.349 -.231 l -7.33 5.222 l -7.503 5.508 l -4.205 5.569 -.122 5.569 1.181 2.474 c 1.578 1.262 l 1.609 .824 1.664 .237 1.654 -.16 c f Q q 165.867 26.664 -123.867 -12.028 re 42 26.664 m W n 0 0 0 1 K 0 J 0 j .141 w 4 M []0 d /GS3 gs q 1 0 0 1 69.656 20.888 cm 0 0 m -.01 2.739 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19.442 cm 0 0 m .226 0 l .285 0 .329 .018 .357 .052 c .387 .087 .401 .13 .401 .181 c .401 .234 .386 .274 .355 .301 c .325 .329 .285 .342 .24 .342 c 0 .342 l 0 0 l h .55 -.559 m .407 -.559 l .239 -.12 l 0 -.12 l 0 -.559 l -.129 -.559 l -.129 .47 l .239 .47 l .34 .47 .414 .44 .463 .38 c .511 .319 .536 .252 .536 .179 c .536 .124 .523 .072 .497 .021 c .469 -.028 .426 -.064 .369 -.085 c .55 -.559 l h .839 -.043 m .839 .166 .777 .344 .651 .493 c .524 .641 .373 .716 .196 .716 c .021 .716 -.132 .641 -.259 .492 c -.383 .343 -.448 .164 -.448 -.043 c -.448 -.253 -.384 -.432 -.259 -.58 c -.133 -.729 .019 -.804 .196 -.804 c .373 -.804 .523 -.729 .651 -.58 c .776 -.431 .839 -.252 .839 -.043 c h .946 -.043 m .946 -.286 .872 -.495 .725 -.668 c .579 -.842 .402 -.928 .196 -.928 c -.01 -.928 -.187 -.842 -.332 -.668 c -.479 -.495 -.552 -.286 -.552 -.043 c -.552 .198 -.479 .407 -.332 .58 c -.187 .754 -.01 .841 .196 .841 c .402 .841 .579 .754 .725 .58 c .872 .407 .946 .198 .946 -.043 c f Q EMC q 0 783 585 -783 re 292.5 391.515 m W n 0 783.015 585 -783 re W n 0 G .5 w 10 M /GS2 gs q 1 0 0 1 42 720.791 cm 0 0 m 501 0 l S Q BT /F3 1 Tf 8 0 0 8 346.1366 724.5366 Tm 0 g -.0001 Tc .0286 Tw [(Applying the Ethics of Care to Y)91.7(our Nursing Practice)]TJ 9.5 0 0 9.5 42 698.0188 Tm -.0227 Tc .0032 Tw (action emanates. Such critics of the ethics of care see care)Tj 0 -1.1579 TD -.0231 Tc .0082 Tw [(as a necessar)-11.9(y)0( perspective for moral sensitivity and moral)]TJ T* .1111 Tw [(responses, but they believe other tools are necessar)-11.9(y)0( for)]TJ T* .0055 Tw [(moral problem solving. Some of these tools can be found)]TJ T* .0197 Tw [(in Beauchamp and Childress \(2009\) or in T)61.8(ronto)55(s)-.1( \(1993\))]TJ T* .0287 Tw [(four elements that will be discussed later)74.1(.)]TJ 1.2632 -1.1579 TD .1769 Tw [(Some individuals suffer from a moral blindness and)]TJ -1.2632 -1.1579 TD .0912 Tw [(are not moved by the suffering of others to take action.)]TJ T* .0936 Tw [(For some, moral vision exists but it is not as developed.)]TJ T* .0378 Tw [(However)49.9(, a care orientation is fundamental to the nurse-)]TJ T* .3489 Tw [(patient relationship and the nursing profession itself)]TJ T* .0458 Tw [(\(Edwards, 2009; Gastmans, 2006\). According to the)]TJ /F4 1 Tf 23.3256 0 TD 0 Tw (Code)Tj -23.3256 -1.1579 TD .0516 Tw [(of Ethics for Nurses,)]TJ /F3 1 Tf 8.6543 0 TD [(The measures nurses take to care for)]TJ -8.6543 -1.1579 TD -.0222 Tw [(the patient enables the patient to live with as much phys-)]TJ T* .1272 Tw [(ical, emotional, social, and spiritual well-being as possi-)]TJ T* .0287 Tw [(ble \(American Nurses Association [ANA] 2001, p. 7\).)]TJ ET q 1 0 0 1 42 499.769 cm 0 0 m 241.5 0 l S Q BT /F5 1 Tf 12 0 0 12 42 504.0188 Tm -.0001 Tc [(A Case for Caring)]TJ /F3 1 Tf 9.5 0 0 9.5 54 489.0188 Tm -.0231 Tc .0266 Tw [(Mr)74.1(. Jones, age 59, is admitted to the hospital for acute)]TJ -1.2632 -1.1579 TD -.0193 Tw [(abdominal pain with vomiting of coffee-ground material.)]TJ T* .021 Tw [(He has a long histor)-11.9(y of alcoholism and unmanaged dia-)]TJ T* .2217 Tw [(betes, and has a left below-the-knee amputation. Four)]TJ T* .0485 Tw [(months ago, his wife died after 40 years of marriage. Mr)74.1(.)]TJ T* .02 Tw [(Jones states this was the reason he stopped taking care of)]TJ T* .0981 Tw [(himself and began drinking heavily again. According to)]TJ T* .0962 Tw [(the nurse providing end-of-shift report, he asks for pain)]TJ T* .2306 Tw [(medications more frequently than other patients with)]TJ T* .1536 Tw [(this condition. Because you have provided care for Mr)74.1(.)]TJ T* .2711 Tw [(Jones on several other occasions, you know he often)]TJ T* -.028 Tw [(requires a higher level of analgesia and you are responsive)]TJ T* .0424 Tw [(to his suffering by contacting the physician for a change)]TJ T* -.0337 Tw [(in the order)74.1(.)0( The physician is hesitant to increase the dose)]TJ T* .0665 Tw [(of morphine and, in order to avoid causing harm to the)]TJ T* .02 Tw [(patient, the nurse advocates for Mr)74.1(. Jones by engaging in)]TJ T* .0585 Tw [(conflict resolution with the physician. The result was an)]TJ T* .0287 Tw [(increase in the morphine dose.)]TJ ET q 1 0 0 1 42 268.769 cm 0 0 m 241.5 0 l S Q BT /F5 1 Tf 12 0 0 12 42 273.0188 Tm -.0001 Tc [(Applying the Ethics of Caring to Practice)]TJ /F3 1 Tf 9.5 0 0 9.5 54 258.0188 Tm -.0231 Tc [(T)61.8(ronto \(1993\) offered this definition of care:)]TJ .6316 -1.1579 TD .3478 Tw [(On the most general level we suggest caring be)]TJ T* .0777 Tw [(viewed as a species activity that includes ever)-11.9(ything)]TJ T* .0553 Tw [(we do to maintain, continue and repair our world)]TJ T* -.0309 Tw [(so that we can live in it as well as possible. That world)]TJ T* -.0119 Tw [(includes our bodies, our selves and our environment,)]TJ T* .0058 Tw [(all of which we seek to inter)-11.9(weave in a complex, life-)]TJ T* .0287 Tw [(sustaining web. \(p. 103\) )]TJ -1.8947 -1.1579 TD .1801 Tw [(T)61.8(ronto suggested there is a pre-existing moral relation-)]TJ T* -.0344 Tw [(ship between people; therefore, the question is, How can)]TJ T* .0183 Tw [(I meet my caring responsibility? T)61.8(ronto)55(s)-.1( model propos-)]TJ T* .1309 Tw [(es four phases of caring and four elements of care. The)]TJ T* .1064 Tw [(phases are not necessarily in sequential order and often)]TJ T* -.035 Tw [(they overlap. The elements of care are considered the fun-)]TJ T* .0287 Tw [(damentals necessar)-11.9(y)0( in order to demonstrate caring.)]TJ /F4 1 Tf 1.2632 -1.1579 TD .3107 Tw [(Four phases of caring.)]TJ /F3 1 Tf 10.4489 0 TD [(Meeting T)61.8(ronto)55(s)-.1( \(1993\) four)]TJ -11.7121 -1.1579 TD -.0014 Tw (phases of caring for patients involves cognitive, emotion-)Tj T* .0287 Tw (al, and action strategies: )Tj 1.8947 -1.1579 TD [(1.)-1079.8(caring about)]TJ T* [(2.)-1079.8(taking care of)]TJ 27.3158 68.3158 TD 0 Tw [(3.)-1079.8(caregiving)]TJ 0 -1.1579 TD .0287 Tw [(4.)-1079.8(care receiving \(p. 165\))]TJ -.6316 -2.3158 TD .2381 Tw [(In Mr)74.1(. Jones)55(s case, the nurse in phase one \(caring)]TJ -1.2632 -1.1579 TD -.0256 Tw [(about\) recognized the need for increased pain medication)]TJ T* -.0233 Tc -.0037 Tw [(in the assessment of the patient)54.8(s pain. In phase two \(tak-)]TJ T* -.0231 Tc .0635 Tw [(ing care of\), the nurse saw a responsibility to respond to)]TJ T* .0163 Tw [(the level of pain the patient was experiencing. Therefore,)]TJ T* .0722 Tw [(in phase three \(caregiving\), the nurse took action to call)]TJ T* -.0058 Tw [(the physician for a change in the analgesia order)49.9(,)0( and the)]TJ T* -.0223 Tw [(morphine dose was increased. This is the work of reacting)]TJ T* .0181 Tw [(to a patient)54.9(s needs. Facing conflict with this physician is)]TJ T* .0757 Tw [(a necessar)-11.9(y)0( part of care \(Kohlen, 2011; Lachman, 2009\).)]TJ T* .0986 Tw [(Finally)73.9(, in phase four \(care receiving\), the nurse assesses)]TJ T* .0444 Tw [(the success of the inter)-11.9(vention with the patient \(receiver)]TJ T* .1574 Tw [(of care\). This last phase helps preser)-11.9(ve the relationship)]TJ T* .0687 Tw [(between patient and nurse, and is a distinctive aspect of)]TJ T* .0287 Tw [(the ethics of care \(Edwards, 2011\).)]TJ 1.2632 -1.1579 TD .0492 Tw [(This example illustrates the nursing process in action,)]TJ -1.2632 -1.1579 TD .0799 Tw [(and this problem-solving method is needed for effective)]TJ T* .1927 Tw [(nursing practice. However)49.9(, it is the implementation of)]TJ T* -.0405 Tw [(this process that determines if the patient experiences car-)]TJ T* .0324 Tw [(ing. Caring defines nursing, as curing often defines med-)]TJ T* .3887 Tw [(icine. The nurse attends to the vulnerability of the)]TJ T* .0558 Tw [(patient, principally because this patient)54.9(s needs have the)]TJ T* .1534 Tw [(potential to create dependency \(Edwards, 2009\). In the)]TJ T* .0603 Tw [(case of Mr)74.1(. Jones, the physician)55(s focus on cure involved)]TJ T* .0158 Tw [(an amputation, while the nurse needed to apply the four)]TJ T* .0287 Tw [(phases of caring for effective nursing practice.)]TJ /F4 1 Tf 1.2632 -1.1579 TD .2086 Tw [(Four elements of caring.)]TJ /F3 1 Tf 10.8621 0 TD [(The four elements or funda-)]TJ -12.1253 -1.1579 TD .0241 Tw [(mentals necessar)-11.9(y)0( for effective caring require certain atti-)]TJ T* .1833 Tw [(tudes and skills. Good care combines certain activities,)]TJ T* -.0248 Tw [(attitudes, and knowledge of the patient and the situation.)]TJ T* .0715 Tw [(In this case, the nurse)54.9(s past experience with the patient)]TJ T* .0777 Tw [(provided knowledge about his pain management needs,)]TJ T* .3307 Tw [(which helped the nurse avoid a judgmental attitude)]TJ T* .194 Tw [(about his pain medication requests and motivated the)]TJ T* -.0101 Tw [(action \(activity\) to request an increase in his dose of anal-)]TJ T* 0 Tw (gesic. )Tj 1.6937 -1.1579 TD .1667 Tw [(T)61.8(ronto)55(s)-.1( \(1993\) four elements of caring include the)]TJ -1.6937 -1.1579 TD 0 Tw (following:)Tj 1.8947 -1.1579 TD [(1.)-1079.8(attentiveness)]TJ T* [(2.)-1079.8(responsibility)]TJ T* [(3.)-1079.8(competence)]TJ T* .0287 Tw [(4.)-1079.8(responsiveness of the care receiver \(p. 127\))]TJ -.6316 -1.1579 TD .0457 Tw [(First, attentiveness entails the detection of the patient)]TJ -1.2632 -1.1579 TD .2068 Tw [(and/or family need. If the nurse fails to recognize the)]TJ T* .0287 Tw (need, the patient or family will not experience caring.)Tj 1.8947 -1.1579 TD .221 Tw [(Attentive nurses take up a receptive position with)]TJ T* -.0097 Tw [(respect to the patient; they are challenged to step out)]TJ T* .1001 Tw [(of their own personal preference system in order to)]TJ T* .0244 Tw [(take up that of the patient, so they can better under-)]TJ T* .4134 Tw [(stand the patient)55(s real-life situation. \(Gastmans,)]TJ T* .0286 Tw [(2006, p. 136\) )]TJ -.6316 -1.1579 TD -.0346 Tc .4124 Tw [(Hospitals also have implemented policies to foster)]TJ -1.2632 -1.1579 TD .1349 Tw [(attentiveness to the patient)54.9(s needs. Some hospitals have)]TJ T* -.0203 Tw [(signs indicating No Pass Zone \(Hendren, 2010\). This is to)]TJ T* .1881 Tw [(reinfor)17.9(ce the message that staff never walk past a room)]TJ T* .0349 Tw [(where the patient)54.9(s light is on, as this patient is expressing)]TJ T* -.0209 Tw [(a need. 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.196 .841 c .402 .841 .579 .754 .725 .58 c .872 .407 .946 .198 .946 -.043 c f Q EMC q 0 783 585 -783 re 292.5 391.515 m W n 0 783.015 585 -783 re W n /GS2 gs BT /F3 1 Tf 9.5 0 0 9.5 42 698.0188 Tm 0 g -.0346 Tc .0055 Tw [(ment is hourly rounding, where the nurse directly asks the)]TJ 0 -1.1579 TD .0444 Tw [(patient about his or her needs ever)-11.9(y hour \(Meade, Bursell,)]TJ T* .1874 Tw [(& Ketelsen, 2006\). Both these strategies help ensure the)]TJ T* .0287 Tw [(patient is not neglected when most in need.)]TJ 1.2632 -1.1579 TD -.0231 Tc .0213 Tw [(According to the )]TJ /F4 1 Tf 7.7572 0 TD [(Code of Ethics for Nurses )]TJ /F3 1 Tf 10.6272 0 TD (\(ANA, 2001)Tj /F4 1 Tf 5.1768 0 TD 0 Tc 0 Tw (\))Tj /F3 1 Tf .3098 0 TD (,)Tj -25.1342 -1.1579 TD -.0231 Tc .1894 Tw [(all professional nurses have a responsibility to care for)]TJ T* -.038 Tw [(patients under their care. Therefore, there is no uncertain-)]TJ T* .18 Tw [(ty surrounding responsibility as the second element of)]TJ T* .0074 Tw [(caring. In the context of nursing ethics, there is no ambi-)]TJ T* .0858 Tw [(guity that nurses have a responsibility for their assigned)]TJ T* .0407 Tw [(patients \(Edwards, 2009\). However)49.9(, the extent and scope)]TJ T* .0458 Tw [(of their caring can raise questions. Does the medical-sur-)]TJ T* -.0277 Tw [(gical nurse have a responsibility to care for Mr)74.1(. Jones once)]TJ T* .1016 Tw [(he has been transferred to surger)-11.9(y? This author believes)]TJ T* .2576 Tw [(that at the minimum, the nurse has responsibility to)]TJ T* .1439 Tw [(make the transfer to and from surger)-11.9(y as supportive of)]TJ T* .0287 Tw [(Mr)74.1(. Jones as possible.)]TJ 1.2632 -1.1579 TD -.0073 Tw [(The third element is competence \(T)61.8(ronto, 1993\). If the)]TJ -1.2632 -1.1579 TD .0377 Tw [(nurse executes pain management strategies that are inef-)]TJ T* .0231 Tw [(fective, either due to lack of knowledge or organizational)]TJ T* .1649 Tw [(protocols, then this nurse would not be seen as caring)]TJ T* .0829 Tw [(from the patient)55(s perspective. The administrator has an)]TJ T* .1263 Tw [(obligation to provide the nurse with pain management)]TJ T* .2933 Tw [(education and effective, evidence-based pain manage-)]TJ T* .0543 Tw [(ment protocols. The nurse has a responsibility to update)]TJ T* -.0001 Tc .5624 Tw [(competence continuously)74(. Continual professional)]TJ T* -.0231 Tc .219 Tw [(growth, particularly in knowledge and skill, requires a)]TJ T* .0287 Tw [(commitment to lifelong learning \(ANA, 2001, p. 8\).)]TJ 1.2632 -1.1579 TD .2072 Tw [(Good care requires the competence to individualize)]TJ -1.2632 -1.1579 TD .0187 Tw [(care to give care that is based on the physical, psycho-)]TJ T* .175 Tw [(logical, cultural, and spiritual needs of the patient and)]TJ T* .0393 Tw [(family \(V)54.8(anlaere & Gastmans, 2011\). Good care is aimed)]TJ T* .0773 Tw [(at helping the person be as independent as possible, yet)]TJ T* .0337 Tw [(safe. Good care needs to be delivered competently)73.9(, while)]TJ T* .0198 Tw [(considering the patient)55(s context \(e.g., death of wife after)]TJ T* .0287 Tw [(40 years of marriage\).)]TJ 1.2632 -1.1579 TD .1207 Tw [(The final element is patient/family responsiveness to)]TJ -1.2632 -1.1579 TD .3162 Tw [(care \(T)61.8(ronto, 1993\). The patient is vulnerable to the)]TJ T* .0523 Tw [(nurse)55(s actions or lack of actions. In some situations, the)]TJ T* -.0137 Tc .4209 Tw [(patient)55(s lack of responsiveness to analgesia is not)]TJ T* -.0231 Tc .0747 Tw [(reassessed to determine if a different plan of care is war-)]TJ T* .0056 Tw [(ranted. The nurse needs to verify that the caring needs of)]TJ T* .0287 Tw [(the patient are met.)]TJ 1.2632 -1.1579 TD .026 Tw [(Care is a reciprocal practice, occurring within a frame-)]TJ -1.2632 -1.1579 TD .0508 Tw [(work of a relationship between the nurse \(caregiver\) and)]TJ T* .0947 Tw [(patient \(care receiver\) \(Gastmans, 2006\). The reciprocity)]TJ T* .0632 Tw [(consists of verifying that the care given actually met the)]TJ T* .196 Tw [(needs of the patient. This inter)17.9(change always must be)]TJ T* .027 Tw [(focused on meeting the care needs of the patient or fam-)]TJ T* .0287 Tw [(ily)73.9(, so no abuse of power occurs \(e.g., paternalism\). )]TJ 1.2632 -1.1579 TD .0938 Tw [(W)75.9(a).1(tson \(2001\) also focused on this reciprocity of the)]TJ -1.2632 -1.1579 TD .2009 Tw [(relationship, which she indicated addresses the impor-)]TJ T* .0483 Tw [(tance of the nurse)55(s own caretaking. The patient is never)]TJ T* .2478 Tw [(to be used as a means to an end of self-gratification.)]TJ T* .1135 Tw [(Summarizing Gilligan)55(s \(1982\) ideas, the nurse needs to)]TJ T* .0221 Tw [(take care of self in order to be able to care for others. The)]TJ T* .0336 Tw [(nurse must engage in self-care strategies so he or she will)]TJ T* .1116 Tw [(have the energy and motivation to implement the four)]TJ T* .3188 Tw [(elements of care: attentiveness, responsibility)73.9(, compe-)]TJ T* .0287 Tw [(tence, and responsiveness \(T)61.8(ronto, 1993\).)]TJ ET 0 G .5 w 10 M q 1 0 0 1 42 720.791 cm 0 0 m 501 0 l S Q BT /F7 1 Tf 9 0 0 9 42 726.1448 Tm -.0001 Tc .0315 Tw [(Ethics, Law)73.9(,)0( and Policy)]TJ ET q 1 0 0 1 301.5 691.932 cm 0 0 m 241.5 0 l S Q BT /F5 1 Tf 12 0 0 12 301.5 696.1815 Tm 0 Tw (Conclusion)Tj /F3 1 Tf 9.5 0 0 9.5 313.5 681.1815 Tm -.0231 Tc -.0385 Tw [(Most nurses have been exposed to W)75.9(a).1(tson)55(s)-.1( caring the-)]TJ -1.2632 -1.1579 TD .07 Tw [(or)-11.9(y)73.9(,)0( but many are not aware of the ethics of care theor)-11.9(y)]TJ T* .1541 Tw [(development that began in moral psychology with the)]TJ T* .0446 Tw [(work of Gilligan \(1982\). Care is crucial for human devel-)]TJ T* .316 Tw [(opment, and is first and foremost aimed at physical)]TJ T* .2914 Tw [(needs. Caring is necessar)-11.9(y)0( on the biological level for)]TJ T* -.0062 Tw [(infants to sur)-11.9(vive, but also for the patient who is depend-)]TJ T* -.006 Tw [(ent at end of life. Care ethics stem from the idea that care)]TJ T* .0256 Tw [(is basic to human existence. Caring weaves people into a)]TJ T* .0287 Tw [(network of relationships \(V)54.8(anlaere & Gastmans, 2011\).)]TJ 1.2632 -1.1579 TD .0668 Tw [(However)49.9(, when a person chooses to be a nurse, he or)]TJ -1.2632 -1.1579 TD .3951 Tw [(she has made a moral commitment to care for all)]TJ T* .0104 Tw [(patients. Such a decision to care is not to taken lightly)73.9(, as)]TJ T* .111 Tw [(it reflects this statement in the )]TJ /F4 1 Tf 14.4335 0 TD [(Code of Ethics for Nurses)]TJ /F3 1 Tf 10.7007 0 TD 0 Tc 0 Tw (:)Tj -25.1342 -1.1579 TD -.0231 Tc .1307 Tw [(The nurse respects the worth, dignity and rights of all)]TJ T* .2121 Tw [(human beings irrespective of the nature of the health)]TJ T* .3513 Tw [(problem \(ANA, 2001, p. 7\). Caring is required if a)]TJ T* .0824 Tw [(patient, such as Mr)74.1(. Jones, has health consequences due)]TJ T* .0676 Tw [(to lack of adherence to a treatment plan for his diabetes)]TJ T* .0792 Tw [(and alcoholism. Putting aside personal biases and preju-)]TJ T* .0472 Tw [(dices to implement T)61.8(ronto)55(s)-.1( \(1993\) four phases of caring)]TJ T* .1619 Tw [(is not easy)73.9(. The four dimensions of care suggest good)]TJ T* .384 Tw [(care demands more than just good Intention; good)]TJ T* .0638 Tw [(careis a practice of combining activities, attitudes, and)]TJ T* .1996 Tw [(knowledge of the situation \(Gastmans, 2006, p. 137\).)]TJ T* .0319 Tw [(Care can be considered simply an ethical task and thus a)]TJ T* .0605 Tw [(burden of one more thing to do, or it can be considered)]TJ T* .0556 Tw [(a commitment to attending to and becoming enthusias-)]TJ T* .0287 Tw [(tically involved in the patient)54.9(s needs. )]TJ ET .5 G 2 w q 1 0 0 1 301.5 358.182 cm 0 0 m 241.5 0 l S Q BT /F6 1 Tf 8 0 0 8 301.5 346.1817 Tm -.0112 Tc 0 Tw (REFERENCES)Tj /F1 1 Tf 0 -1.125 TD -.0223 Tc .0723 Tw [(Amer)-14.7(ican Nurses Association \(ANA\).)59.9( \(2001\).)59.9( )]TJ 8 0 1.7005 8 456.3616 337.1817 Tm [(Code of ethics f)29.9(o)0(r n)9.8(u)0(rses)]TJ -16.8686 -1.125 TD .0277 Tw [(with inter)-29.6(pretiv)24.8(e statements)]TJ 8 0 0 8 412.3456 328.1816 Tm [(.)59.9( Silv)24.8(er Spr)-14.7(ing, MD:)49.9( A)29.7(u)0(thor)50(.)59.9( )]TJ -13.8557 -1.125 TD -.0335 Tw [(Beauchamp)34.9(,).1( )49.8(T)120(.).1(L., & Childress)14.8(,).1( J)29.7(.).1(F)150(.)59.9( \(2009\).)59.9( )]TJ 8 0 1.7005 8 441.8973 319.1816 Tm [(Pr)-14.7(inciples of biomedical ethics)]TJ 8 0 0 8 319.5 310.1816 Tm .0277 Tw [(\(6th ed.\).)59.9( Oxf)29.9(o)0(rd, England:)49.9( Oxf)29.9(o)0(rd Univ)24.8(ersity Press)14.8(.)59.9( )]TJ -2.25 -1.125 TD .1697 Tw [(Casals)14.8(, P)179.9(.)59.9( \(2000\).)59.9( )]TJ 8 0 1.7005 8 365.9115 301.1816 Tm [(Car)-14.7(ing quotes)]TJ 8 0 0 8 414.8663 301.1816 Tm [(.)59.9( Retr)-14.7(i)0(e)29.8(v)24.8(ed from http://think)19.7(e)29.8(x)-.1(ist.com/)]TJ -11.9208 -1.125 TD 0 Tw [(quotations/car)-14.7(ing/)]TJ -2.25 -1.125 TD .2316 Tw [(Edw)14.9(a)0(rds)14.8(,).1( S)19.7(.).1(D)69.8(.)59.9( \(2009\).)59.9( )49.8(Three v)24.8(e)0(rsions of the ethics of care)14.9(.)59.9( )]TJ 8 0 1.7005 8 516.5123 283.1816 Tm 0 Tw (Nursing)Tj -24.3874 -1.125 TD .0277 Tw [(Philosoph)29.8(y)99.8(,).1( 10)]TJ 8 0 0 8 368.6581 274.1816 Tm (, 231-240.)Tj -8.3948 -1.125 TD .0436 Tw [(Edw)14.9(a)0(rds)14.8(,).1( S)19.7(.).1(D)69.8(.)59.9( \(2011\).)59.9( Is there a distinctiv)24.8(e)0( care ethics? )]TJ 8 0 1.7005 8 491.3593 265.1816 Tm (Nursing Ethics)Tj 8 0 0 8 540.7775 265.1816 Tm 0 Tc 0 Tw (,)Tj 8 0 1.7005 8 319.5 256.1816 Tm -.0223 Tc (18)Tj 8 0 0 8 328.0388 256.1816 Tm .0277 Tw (, 184-191.)Tj -3.3174 -1.125 TD .0636 Tw [(Gastmans)14.8(, C)29.8(.)59.9( \(2006\).)59.9( )49.8(The care perspectiv)24.8(e)0( in healthcare ethics)14.8(.)59.9( In A.J)29.7(.)]TJ 2.25 -1.125 TD .132 Tw [(Da)19.8(vis)14.8(,).1( )49.8(V)124.9(.)59.9( )49.8(Tschudin, & L.)59.9( de Rae)29.8(v)24.8(e)0( \(Eds)]TJ 8 0 1.7005 8 457.1453 238.1816 Tm [(.\), Essentials of teaching)]TJ -16.9665 -1.125 TD .2196 Tw [(and lear)-24.7(ning in n)9.8(u)0(rsing ethics)]TJ 8 0 0 8 429.1437 229.1816 Tm [(\(pp)34.9(.)59.9( 135-148\).)59.9( London, England:)]TJ -13.7055 -1.125 TD 0 Tw [(Livingstone)14.9(.)59.9( )]TJ -2.25 -1.125 TD .3869 Tw [(Gilligan, C)29.8(.)59.9( \(1982\).)59.9( )]TJ 8 0 1.7005 8 374.7494 211.1816 Tm [(In a diff)29.9(e)0(rent v)24.8(oice)14.9(.)]TJ 8 0 0 8 452.4602 211.1816 Tm [(Cambr)-14.8(idge)14.8(, MA:)49.8( Har)-29.7(v)24.7(a)-.1(rd)]TJ -16.62 -1.125 TD .0277 Tw [(Univ)24.8(ersity Press)14.8(.)]TJ -2.25 -1.125 TD .0543 Tw [(Hendren, R.)59.9( \(2010, Ma)29.8(y 11\).)59.9( Nurses find simple w)14.9(a)29.8(ys to impro)14.9(v)24.8(e satis-)]TJ 2.25 -1.125 TD 0 Tw [(f)29.9(a)0(ction.)59.9( )]TJ 8 0 1.7005 8 347.464 184.1816 Tm .2841 Tw (Media Health Leader)Tj 8 0 0 8 422.8704 184.1816 Tm .2842 Tw [(.)59.8( Retr)-14.8(i)-.1(e)29.7(v)24.7(ed from http://www)59.7(.health)]TJ -12.9213 -1.125 TD .0131 Tc 0 Tw (leadersmedia.com/content/NRS-250810/Nurses-Find-Simple-)Tj T* -.0223 Tc [(W)39.9(a)29.8(ys-to-Impro)14.9(v)24.8(e)0(-Satisf)29.9(a)0(ction##)]TJ -2.25 -1.125 TD .0741 Tw [(K)39.7(ohlen, H.)59.9( \(2011\).)59.9( Comment.)59.9( Care tr)9.9(ansf)29.9(o)0(r)-24.7(m).2(ations:)49.9( Attentiv)24.8(eness)14.8(,).1( pro-)]TJ 2.25 -1.125 TD -.0166 Tw [(f)29.9(e)0(ssional ethics and thoughts to)14.9(w)14.9(a)0(rd diff)29.9(e)0(rentiation.)59.9( )]TJ 8 0 1.7005 8 491.9598 148.1816 Tm [(Nursing Ethics)14.8(,)]TJ -21.3184 -1.125 TD 0 Tw (18)Tj 8 0 0 8 328.0388 139.1816 Tm .0277 Tw (, 258-261.)Tj -3.3174 -1.125 TD -.0426 Tw [(Lachman, V)124.9(.).1(D)69.8(.)59.9( )-49.8(\(2009\).)59.9( )]TJ 8 0 1.7005 8 377.5309 130.1816 Tm .0072 Tw [(Ethical challenges in healthcare:)49.9( De)29.8(v)24.8(eloping y)19.7(our)]TJ -7.0147 -1.125 TD .0277 Tw [(mor)9.9(al compass)]TJ 8 0 0 8 371.5527 121.1816 Tm [(.)59.9( Ne)19.8(w )89.9(Y)139.8(o)0(r)-14.7(k)-.1(, NY)59.8(:)49.9( Spr)-14.7(inger)50(.)59.9( )]TJ -8.7566 -1.125 TD .1408 Tw [(Little)14.9(,).1( M.)59.9( \(1998\).)59.9( Care from theor)-29.6(y to or)-14.7(ientation and bac)19.7(k.)59.9( )]TJ 8 0 1.7005 8 508.1545 112.1817 Tm [(Jour)-24.7(nal of)]TJ -23.3427 -1.125 TD .0277 Tw 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