In a 2003 position statement, the National League for Nursing (NLN) urged educators to engage in a curriculum revolution and challenge the status quo in curriculum design. Although written a decade and a half ago, this message has even more urgency in today's current nursing and health care arena. Caputi (2017) emphasized that nurse educators must be catalysts for change and respond to the NLN call for action with a renewed sense of urgency.
Caring is considered to be the core of nursing. However, as nurses today are challenged to expand comprehensive, clinical care with inadequate resources, opportunities to offer acts of human caring are often compromised. Likewise, as nursing education programs experience the demand to meet broader curricular standards with the rising pressure to satisfy accreditation requirements, including licensure pass rates, the focus often veers away from the relatively intangible art of caring. Educators are thus faced with the question: How and when are nursing students taught this critical component we claim is the cornerstone of our profession?
The need for a caring pedagogy in nursing is evident, and faculty must strive to effectively integrate objectives focused on caring behaviors in order to graduate nurses who possess the expected outcomes and competencies (Brown, 2011). Hills and Watson (2011) emphasize that a great need remains to direct a nursing curriculum that is both grounded in and builds upon caring science, one that encompasses greater structure, content, innovative pedagogical strategies, and relevant relationships. By creating such a curriculum, educators will meet the requirement to prepare nurses adequately as fully developed caring and healing practitioners (Hills & Watson, 2011).
CONCEPT OF CARING/CARING THEORIES
Caring involves the personal concern for people, events, projects, and things. It allows the nurse to establish a connection with others and give as well as receive help. One aspect of self-knowledge is the awareness of whom and what is important. Treas, Wilkinson, Barnett, and Smith (2018) highlight that caring is not an abstraction; rather, it is always specific and relational for each nurse-patient encounter and involves thinking and acting in ways that preserve human dignity and humanity. Caring is the central concept in several nursing theories that provide for students the basis and context for the iCare features described in this article:
* Watson's (1988) nursing theory, the science of human caring, considers caring to be the essence of nursing and describes what caring means from the nursing perspective. Watson (2012) believes that nursing is both an art and a science and focuses on the four components any nursing theory should possess: human being, health, environment/society, and nursing.
* Other caring theorists include Madeline Leininger, Patricia Benner, Judith Wrubel, and Kristen Swanson. Swanson's (1993) midrange theory of caring describes five dimensions of caring: knowing, being with, doing, enabling, and maintaining a belief.
CONCEPTUAL MODEL AND iCARE FEATURE
As nurse educators cannot realistically impart all knowledge and skills to learners, a concept-based curriculum is used to foster critical thinking and clinical reasoning as the basis for deeper learning (Giddens, Caputi, & Rodgers, 2015). Treas et al. (2018) present a full-spectrum nursing model as a concept-based approach that encompasses four essential dimensions of nursing practice: thinking, doing, caring, and patient situation. Caring is one aspect of the full-spectrum nursing model.
Treas et al. (2018) describe but do not directly teach caring theory in detail. Rather, they integrate theoretical and practical knowledge using an innovative teaching strategy they call iCare. With this approach, prelicensure students learn what it means to care for patients, families, and caregivers within specific patient situations. It is important to note that, in all steps of the nursing process, nurses use critical thinking. Each iCare feature (Goncalves, 2018) depicts a patient care issue or concern with nursing actions or teaching that display caring. Narrative, storyline descriptions show how the nurse (or nursing student or family) can express compassion or offer comfort in a typical patient scenario or extraordinary situation. Students model the inspirational examples of caring behaviors to promote caring and compassionate, patient-centered care. (See Supplemental Digital Content, available at http://links.lww.com/NEP/A151, for examples.)
PLATFORM FOR EXPLORATION IN THE CURRICULUM
There is no standard template for exactly what caring looks and feels like. Caring attitudes, behaviors, and acts are individualized to each nurse, patient, and situation as practice environments warrant. iCare features are intended to be used by educators and students as thought-provoking examples of how a nurse can interact with patients and families displaying "caring" and "caring behaviors," thus strengthening the nurse-patient relationship.
Recognizing and acknowledging that all iCare examples may not be feasible in all situations and health care settings, educators are encouraged to seize the teaching moment to explore alternatives. For example, in one vignette, the nurse has taken the time to talk with Rebecca, who is dying, about how she loves to walk on the beach to feel the warmth of the sun. After obtaining administrative approval, the nurse takes Rebecca outdoors to feel the sun on a beautiful day. This example demonstrates dimensions of knowing, being with, and doing for. Although this is a lovely act of caring and an ideal approach, it prompts questions and a challenge: What if the nurse cannot obtain approval to go outside? What modifications can the nurse employ? The teacher might ask students to consider different options the nurse might implement, for example, making sure the blinds are open and positioning a chair near the window; bringing Rebecca to a sunroom, lounge, or lobby to find a sunny spot; and engaging in a therapeutic conversation, helping Rebecca reminisce about times she spent outdoors and her favorite memories of the beach. The nurse could use audio of calming ocean sounds and just sit quietly (being with) to further enhance the experience.
By providing a variety of different scenarios, these innovative features can foster robust classroom discussions where students can express freely their thoughts, fears, and passion for how to promote caring in the clinical setting. There are no limitations or obstacles in which "caring" should not exist, and the iCare features provide the optimum platform in which to assimilate these caring discussions and ignite caring as the crux of nursing back into the curriculum.
CONCLUSIONS AND RECOMMENDATIONS
Redesigning nursing education to integrate basic nursing principles, such as caring, into the nursing curriculum can be challenging. One innovative approach uses an iCare feature with short, affective "how to" examples relevant to chapter concepts that illuminate ways for nurses to put the caring back into patient care. This creative teaching strategy addresses the call posed by the NLN (2003) for nurse educators to engage in reformation and innovation with the development and infusion of new and creative pedagogies that are responsive to our rapidly changing health care environment. Educators must continue to explore creative and innovative strategies in the teaching, learning, and curricular domains as we navigate the fast-paced, ever-changing, and demanding times in today's health care environment.
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