Caring Science Nursing: Interview with Debra Carnes, RN, MSN

My Specialty

Caring Science Nursing: Interview with Debra Carnes, RN, MSN

Using holistic therapies to encourage healing and wellness

By Keith Carlson, RN, BSN, CPC, NC-BC
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Debra Carnes, RN, MSN, Assistant Director of Nursing, Redlands Community Hospita  l

Please share with us a brief history of your nursing career.

I have been a nurse for over 25 years. I’ve served as an ICU nurse, nursing supervisor, nurse manager and nursing director. I am presently the assistant director of nursing and serve as coordinator of the Redlands Community Hospital (RCH) ANCC Magnet journey. I have a strong passion for nursing leadership and enjoy growing those skills in our nurses.

What sparked your interest in holistic nursing and complementary therapies?

As the RCH Nursing Department embarked on its Magnet journey, it became increasingly important to integrate Jean Watson’s Caring Science theory into the bedside care we deliver. Because Watson emphasizes the effects of caring on the minds, bodies and spirits of humans, the complementary therapies opened up vast opportunities for our nurses to have various tools at their fingertips. We call them “caring modalities.”

What is the “Caring Toolbox” and how did it come into being?

The RCH Caring Toolbox is the brainchild of a nursing group known as the Caring Advocates, who are regarded by each nursing unit as the Caring Science experts. They coach their peers in the use of the toolbox contents. The essential tools of the Caring Toolbox consist primarily of the mind (creativity) and heart (presence/ empathy) of the nurse who desires to express caring to his or her patient.

Is there a trained Caring Science nurse in every department?

Yes! A representative from each department is selected and trained in Caring Science principles. That individual is responsible for coaching their peers at the bedside; that is, they help one another to optimize interpersonal communication and to establish human connection. The representatives coach nurses in how to describe the anticipated results of the various caring modalities so that the patient can be psychologically open to the suggested response.

For example, when instructing the patient in the use of the Celtic meditation plate, the nurse should explain that tracing the bends and curls of the pattern helps the brain to engage both hemispheres and thus moves the mind into a state of relaxed awareness. This is key to providing distraction from pain, so this knowledge is important to achieving the desired effect.

Other components of the toolbox include aromatherapy, massage, guided imagery, music therapy, Thought Field Therapy and therapeutic touch. RCH nurses are taught that there is always something available in the Caring Toolbox for each patient, including authentic presence and the intention to communicate caring.

How have the nurses at Redlands embraced these tools?

The nurses have done an amazing job of using the tools to enhance their practice. They have learned the importance of setting the stage before introducing the modality so that the patient is both knowledgeable and empowered to focus on the anticipated result.

Caring Science allows nurses the ability to create the circumstances, reinforce the behaviors and manage the interactions that allow a patient and family to have an experience grounded in their own viewpoint. The patient’s values and meaning are what the nurse must understand in order to be effective.

Can you share an outcome experienced by nurses who have utilized the “Caring Toolbox”?

RCH nurses realize that they have the potential to be equally impacted by their patients when sharing a caring moment. When sharing caring stories, the nurses often express that they will “never forget” certain moments with particular patients that changed and/or intensified their view of the power of human-to-human connection.

It is understood that the ability to heal through caring can occur even when a patient is at the end of their disease journey and treatment is futile. The Caring Toolbox equips the nurse to connect with the patient and to be viewed as supporting the well-being of that person.

How would you define the term “authentic presence”? What impact does it have on the nurse-patient relationships?

Authentic presence is the mindset a nurse intentionally adopts to be able to set aside her personal concerns and thoughts and be able to hear the patient’s needs, feelings and values. It requires conscious effort to close down our personal thought processes to be able to express caring by being genuinely present for the patient.

RCH nurses consistently rank highly in the nurse communication domain of HCAHPS surveys (e.g., “You are treated with respect” and “Nurses listen carefully to you”). They also rank similarly in pain management (e.g., “Nurses do everything possible to help with pain”). Patients are empowered to strengthen their bodies’ healing power through positivity, intentionality and prioritizing their health and well-being. We have both high patient and employee satisfaction scores.

How has the adoption of these modalities affected relations between the nurses? Has the culture benefited from these practices?

Absolutely! Caring is a common value in all of healthcare, but it is what our nurses do differently; caring reaps caring. Nurses need to feel supported in their work. Asking a nurse to be authentically present for each patient rings hollow if s/he does not feel capable because of lack of time or energy. It is extremely important that nursing leaders support nurses by placing value on nurturing them and their work. Our departments have “serenity rooms” that allow nurses to decompress. We also cultivate support among team members so that when a nurse is engaged at the bedside, others honor that time in order to avoid interruptions. Team members are held accountable for caring for one another.

What are your career aspirations? What would you like to further accomplish in your nursing career?

My immediate focus and short-term goal is to successfully achieve Magnet accreditation. This honor represents everything that is good about the nursing profession and the benefits of fostering an engaged and healthy work environment.   


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