Multiple organizations have made the call to improve the concept of caring in the curriculum, toward patient centered care, improve healthy work environments and civil communication (AACN, 2008a; AACN, 2016b; ANA, 2015a, 2015b; IOM, 2010; NLN, 2010, NLN 2018). What remained to be understood beyond the call for caring was how nurse educators intentionally incorporated caring into the curriculum and create healthy working and teaching environments (AACN, 2016b; Lee et al., 2017; NLN, 2018; Thies & Serratt, 2018; Woodworth, 2016).
Methods: Two conceptual frameworks were chosen for this study: Koloroutis’ (2004) Relationship-Based Care and Lewin’s Force Field Analysis (1951). Koloroutis was the framework for developing the interview questions to identify the nurse educators’ perception of the components of caring in the nursing curriculum and discussed their experiences with the patients, student nurses, colleagues, and the community. The Lewin Model was used with the focus group to identify driving and restraining forces as they explored their perspectives on ways in which caring could be further integrated into the curriculum. The significance of this study was to add to the existing literature and increase knowledge by understanding the ways caring was integrated and role modeled into the nursing curriculum.
Utilizing a case study design, twelve nurse educators’ (n=12) were interviewed to gather data to answer the research question of how nurse educators perceive the processes used to incorporate and role model caring into an undergraduate nursing curriculum. The data from the individual interviews was presented to a focus group comprised of representatives of the interview participants (n=4) to identify caring actions by examining tactics to support nurse educators and student nurses. The demographic information of the participants was nine (n=9) taught a combination of theory, clinical and/or skills and the remaining three (n=3) participants taught clinical only. The average age was 54 years, the average registered nursing experience was 30 years, and the average time as an educator was 15 years. The perceptions from the nurse educators were explored using a case study on ways to achieve successful implementation of caring concepts in theory and practice and the meaning they give to the concept of integrated caring into the nursing curriculum. The interactions between the researcher and the participants who meet the inclusion criteria showed that a qualitative approach allowed participants, in this case, nurse educators, to express their viewpoints in a setting that felt natural to them.
Results: After the interviews were completed, the data emerged into six themes: 1) defining the concepts of caring within the curriculum, 2) needed commitments from nurse educators/leadership, 3) describing a work-life balance, 4) merging community outreach with curriculum, 5) defining caring barriers, and 6) describing strategic solutions. The first process of defining the concepts of caring became an underlying foundation to initiate caring and begins with a belief that “all are kind, intelligent, honorable, and good.” This process initiates the integration of caring into the curriculum as it begins with role modeling a positive mindset toward patients, student nurses, and colleagues.
The second process is the commitment stage in which nurse educators and nurse leaders should commit to “care for” and “care about” patients, student nurses, and colleagues. Caring “about” a person is a more passive approach since the essence of nursing is to care about others. Caring for others required active listening in order to see caring integrated into the curriculum. The third stage is establishing a work-life balance which moves toward ways nurse educators can role model self-care behaviors that incorporate caring into the curriculum. Caring for, is seen as a more active approach to assisting those that are ill, drained or exhausted physically, mentally, and/or spiritually.
The fourth process is merging community outreach with the curriculum by demonstrating how the value of volunteerism can empower student nurses to move outside of their comfort zone. Nurse educators can show the value of empathy when helping patients outside of the classroom in real world scenarios versus textbook case studies. The fifth process is to avoid the caring barriers of incivility, technological dependence, lack of empathy and unclear expectations.
The sixth process evolved when the participants identified three strategic solutions to integrate caring into the curriculum. The three solutions were caring lectures/videos, narrative pedagogy, and debriefing. The participants discussed the need to increase the use of narrative pedagogy and storytelling to guide through the destructive values of incivility, technological dependence, disrespect, and lack of transparency, integrity, and empathy.
Conclusion: The proactive process to integrate caring into the curriculum emerged as a practical approach to make caring visible by reinforcing and maintaining caring actions with student nurses and colleagues. These strategies were identified as a way to help nurse educators improve the synergistic relationship with students, colleagues, self, and the community through positive behaviors that impact personal choices and moral judgments. Incorporating a proactive process of integrating caring into the curriculum does not mean that a disagreement will never take place; however, there should be a desire to listen and debrief until a consensus in mutual understanding can occur. This is not the same as mutual agreement, but a mechanism for nurse educators to use integrity, wisdom, and empathy to keep united and to serve student nurses by helping them to grow and reach their full potential.