This chapter examines the roots and major influences of the first of Watson’s Caritas Processes, Caritas Process 1—Cultivating the practice of loving-kindness and equanimity within the context of caring consciousness. It describes the foundations of loving-kindness and equanimity in humanistic altruistic values as noted in nursing literature. It helps the caring-healing nurse to reflect on the meaning of the Caritas Process of Cultivating the Practice of Loving-Kindness and Equanimity Toward Self and Other. The chapter compares exemplars of loving-kindness and equanimity practices across nursing, patient, and organizational systems. Loving relationships have the potential of transforming healthcare and have been incorporated into clinicians’ daily practice. In addition, the practice of mindfulness meditation to achieve loving-kindness, literature and workshops of many professions on loving-kindness, and operationalized clinical actions have helped to influence caring outcomes. Researchers have asserted that nurse–patient relationships, shaped by caring interactions, affect patient health and healing.

Rituals, often described as symbolic, ceremonial practices performed by cultural groups, are ever present in human activity. Rituals serve many goals that can be clarified by examining types, such as personal or self-oriented and professional or group-oriented examples. When considering the everyday lives of professional nurses, it can be argued that rituals are present in both personal and professional domains. This chapter explores exemplars of personal and professional rituals as performed by professional nurses every day. To assist in achieving this purpose, a number of databases were searched in English, including Summon, Essential Nursing, SocINDEX, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Google. Dates were specified in some cases. Search terms consisted of nurse/nurses, daily ritual, well-being, bedside rounds, self-care, pre-shift, ritual, shift preparation, shift recovery, and huddle. The chapter explores a few nursing rituals and presents them as beneficial practices.

Human care is viewed as the central focus and essence of nursing. This chapter describes the dimensions of the process of nurse caring through a factor analysis of nurses’ and patients’ responses to the Caring Behaviors Inventory (CBI). Caring-healing is communicated through the consciousness of the nurse to the one being cared for. Riemen has described caring nurse-client interactions in a phenomenological study. Mayer has replicated Larson’s study with 28 oncology nurses and 54 cancer patients. Patient names have been obtained from the database of a hospital and from diagnostic clinics, patient education groups, and personal contacts. Nurses have ranked 75 items selected from the caring literature on an instrument using a 4-point Likert-like scale. Respectful deference to other, assurance of human presence, positive connectedness, professional knowledge and skill, and attentiveness to the other’s experience and the responses within each dimension can be explored through hermeneutical analysis.

This chapter aims to create an international standard of care for caring useful by nurses, and other healthcare providers, in health care agencies and communities. A Delphi method has been used. Nurses’ ability to provide compassionate care is undermined daily by the forces of specialization, science, technology, cost containment, and the interference of organizational priorities. The emphasis on measuring the quality of health care practices and on the development of criteria, standards, and protocols has challenged clinicians and administrators in the last two decades. It is timely to articulate caring practices, that is, to make private knowledge public, since the professional and academic credibility of the science of nursing continues to emerge. According to Williams patients perceive quality nursing care as caring, interpersonal interactions. Caregivers are more able to care for patients and are more effective when they feel supported.

This chapter addresses the multiplicity of issues facing health care organizations that prevent them from focusing on their primary service mission of caring and patient-centered care. Some of these issues include quality, safety, lack of coordination and collaboration among nurses, physicians, and other health care providers and units of care, stressful workplace environments, inefficiencies, hospital-physician alignment and reimbursement, and monetization/output/revenue imbalances. The chapter also addresses a historical perspective about the carative or caring and curative traditions in health care that have helped to define the current state of health care systems. It describes a framework for examining the challenges in today’s health care system, organized according to some initiatives proposed in 2003 by a leading health care system chief executive officer (CEO) and a chief medical officer (CMO), a proposal that calls for more accountable care rather than our current ineffective, inefficient, and costly system.

The Caring Behaviors Inventory (CBI) was the second empirical measurement instrument of caring to be reported in the nursing literature. The first version of the CBI was a Likert-scaled instrument with total scores ranging from 42 to 168. The CBI is one of the earliest to be developed with clarity of conceptual-theoretical basis, along with ongoing testing and refinement of the instrument. It is one of the few instruments in caring that provides supporting evidence for empirical validation of Watson’s transpersonal caring theory. The instrument has been reported to be among those with the shortest length of time; it has consistent language, with easy to understand instructions, and easy to analyze results, which have been used in descriptive, correlational, cross-sectional, predictive, comparative descriptive, and mixed methods design studies. The CBI has been described as useful in determining perceptions of nurse caring in patients and nurses in hospitals and nurse practitioners.