Duffy

nursing admin

1. Joanne R Duffy’s Quality Caring Model By SARA ALJANABI KAWAKEB A ALAED

2. Outline: Introduction Duffy’s life, education, position and achievement Concepts of the revise Quality-Caring Model Assumptions of the revised Quality-Caring Model Propositions from the revised Quality-Caring Model Caring Relationships The Caring Factors Application Critique and analysis

3. Objectives: By the end of this presentation you’ll be able to: - Explore the early life of theorist. - Overview of Joanne R Duffy’s and Quality Caring Model. - Identify major concepts and assumptions of Quality Caring Model. - Emphasize the role of professional nurse. - Apply Quality Caring Model to education and practice. - Evaluate quality carin g model.

4. Education graduate of St. Joseph’s Hospital School of Nursing in Providence, RI. BSN at Salve Regina College in Newport, RI MSD and PHD degrees from The Catholic University of America

5. Carrier development Critical care nurse Dr . Duffy has held associate director of nursing positions at two academic medical centers Georgetown University Medical Center - George Washington University Medical Center

6. She developed the Cardiovascular Center for Outcomes Analysis and administrated the Transplant Canter at INOVA Fairfax Hospital in Virginia . She is at present a professor at Indiana University School of Nursing

7. … Dr. Duffy is a Fellow of the American Academy of Nursing, a Magnet Hospital appraiser, and an international consultant. She was a nursing consultant to the multidisciplinary study team for the national APACHE study of outcomes the First Annual Health Care Research Award from the National Institute of Health Care Management for this work.

8. Quality Caring in Nursing: Applying Theory to Clinical Practice, Education, and Leadership (Duffy, Quality Caring in Nursing)Dec 15, 2008 Winner of an AJN Book of the Year Award for 2009 Professional Practice Models in Nursing: Successful Health System Integration

9. the first to link nurse caring to patient outcomes , Designed and tested multiple versions of the Caring Assessment Tool developed the Quality-Caring Model .

10. Quality-Caring Model studying the linkage between nurse caring and selected health care outcomes (Duffy, 1992, 1993). to measure caring developing tools to study human interactions during illness, ( Duffy, 2002; Duffy, Hoskins , & Seifert, 2007 )

11. Quality-Caring Model Dr . Duffy found that hospitalized patients who were dissatisfied often expressed, “ nurses just don’t seem to care .” This concern was corroborated in the literature and represented a clinical problem that significantly impacted patient quality this consider as The seeds of the model

12. The Quality-Caring Model was initially developed in 2003 to guide practice and research (Duffy & Hoskins, 2003 ). Drs. Duffy and Hoskins developed and tested the model in a group of heart failure patients (Duffy, Hoskins, & Dudley-Brown , 2005 )

13. Purpose of the Quality-Caring at 2003 1- Guide professional practice 2- Describe the conceptual–theoretical– empirical linkages between quality of care and human caring 3- Propose a research agenda that would provide evidence of the value of nursing (Duffy & Hoskins, 2003).

14. Concepts of revise Quality-Caring model four main concepts : 1- humans in relationship. 2- Relationship- centered professional encounters. 3- Feeling cared for. 4- Self-caring.

15. humans in relationship humans are multidimensional beings with various characteristics that make them unique . provides an understanding that influences human interactions and nursing interventions . Humans are also social beings connected to others and local communities .

16. Relationship- centered professional encounters The independent relationship between the nurse and patient/family and the collaborative relationship that nurses establish with members of the health care team.

17. Feeling cared for a positive emotion that signifies to patients and families that they matter . It allows one to relax and feel secure about health care needs.

18. Self-caring (self advancing system) It is a human phenomenon that is stimulated by caring relationships. Self-caring is a capacity that cannot be controlled; it emerges over time driven by caring connections . Self-caring represents quality in that it is dynamic and enhances an individual’s well-being.

19. Assumptions of the revised Quality-Caring Model: Humans are multidimensional beings capable of growth and change.

20. Humans exist in relationship to themselves, others , communities or groups, and nature.

21. Humans evolve over time and in space.

22. Humans are inherently worthy .

23. Caring is embedded in the daily work of nursing .

24. Caring is a tangible concept that can be measured.

25. Caring relationships benefit both the one caring and the one being cared for.

26. Caring relationships benefit society .

27. Caring is done “in relationship.”

28. Feeling “ cared for” is a positive emotion .

29. Propositions from the revised Quality-Caring Model: Caring relationships are composed of discrete factors .

30. Caring relationships require intent, choice, specialized knowledge and skills, and time.

31. Engagement in communities through caring relationships enhances self-caring .

32. Human caring capacity can be developed .

33. • Independent caring relationships between patients and nurses influence feeling “cared for.” • Collaborative caring relationships among nurses and members of the health care team influence feeling “cared for.” • Feeling “cared for” is an antecedent to self-advancing systems.

34. • Feeling “cared for” influences the attainment of intermediate and terminal health outcomes . • Self-advancement is a nonlinear, complex process that emerges over time and in space. • Self-advancing systems are naturally self-caring or self-healing. • Relationships characterized as caring contribute to individual, group, and system self-advancement (Duffy, 2009).

35. “The overall role of the nurse in this model is to engage in caring relationships with self and others to engender feeling ‘cared for ’” ( Duffy, 2009 , p. 199 ).

36. What The revised Quality-Caring Model emphasize to professional nurses? • Attain and continuously advance knowledge and expertise in the caring factors .

37. • Initiate, cultivate, and sustain caring relationships with patients and families. with other nurses and all members of the health care team.

38. • Integrate caring relationships with specific evidence-based nursing interventions to positively influence health. • Maintain an awareness of the patient/ family point of view. • Carry on self-caring activities, including professional development.

39. • Maintain an open, flexible approach. • Advance quality health care through research and continuous improvement. • Using the expertise of caring relationships embedded in nursing, actively participate in community groups. • Contribute to the knowledge of caring and ultimately the profession of nursing, using varied approaches of inquiry.

40. Caring Relationships

41. Caring Relationships 1- relationship with self ( generating an orientation of the self that represents a source of understanding often lost in the business of life ) In nursing, remaining self aware is a necessary prerequisite for caring relationships because in knowing the self, it is possible to know others.

42. Caring Relationships (patients and families ) primary focus of nursing, patients and families who are ill. Initiating , cultivating , and sustaining caring relationships, is an independent function of professional nursing that involves intention, choice, specific knowledge and skills, and time (Duffy, 2009). Intending to care depends on one’s attitudes and beliefs; it shapes a nurse’s choice and resulting behaviour's, specifically whether “to care” for another.

43. Caring Relationships (members of the health care team ). Collaborative are essential to quality health care ( Knaus , Draper, Wagner, & Zimmerman, 1986) and are depicted as an important relationship in the Quality-Caring Model. through genuine collaboration contributes to a healthy work environment that may increase work satisfaction.

44. Caring Relationships ( communities) caring for the communities is essential to the revised Quality-Caring Model . predicated on the belief that humans interact with groups beyond the family to connect, share similar history and customs, and enhance the lives of each other. Engaging in communities provides professional nurses opportunities to use caring relationships as the basis for improving health or decreasing disease.

45. The Caring Factors

46. The Caring Factors Mutual problem-solving Attentive reassurance Human respect Encouraging manner Appreciation of unique meaning Healing environment Affiliation needs Basic human needs ( Duffy, Hoskins, & Seifert , 2007)

47. Mutual problem-solving Largest factor assisting patients and families to learn about, question, and participate in their health or illness. This factor recognizes that patients and families are the decision-makers.

48. Attentive reassurance being available and offering a positive outlook to patients and families that helps them feel secure .

49. Human respect implies valuing the person of the other by acting in such a way that demonstrates that value. Eg .: calling a patient by his or her preferred name. performing tasks in a gentle manner. maintaining eye contact.

50. Encouraging manner a supportive demeanor during interactions conveys confidence in the patient and is expressed verbally and nonverbally. important to maintain uniformity between messages expressed and those implied by body language.

51. Appreciation of unique meaning nurses aim to see things from the patient’s point of view including his or her sociocultural meanings. In this way, nurses tailor interventions in the patient’s frame of reference.

52. Healing environment including appealing surroundings , decreasing stressors (noise, lighting). ensuring patient privacy and confidentiality , and practicing in a safe manner are included in this factor.

53. Basic human needs nursing activities such as assessments, teaching and learning, and emotional support. Providing for basic human needs is an opportunity to further the development of caring relationships.

54. Affiliation needs making sure that patients are not only allowed access to their families, but also that families are included in care decisions and keeping them informed is important to patients’ well-being.

55. The Caring Factors on patient needs and the context of the situation. Not all factors are necessarily used at once; rather, the professional nurse uses his or he "feeling cared for” is calming to the patient, leaving him or her to concentrate on the meaning of illness and the requirements for health and healing. ” (Duffy, 2009).

56. Application Using the Quality-Caring Model to Organize Patient Care Delivery Joanne R. Duffy, PhD, RN, FAAN ,Jennifer Baldwin, MPA, RN, BSN, CNAA ,Mary Jane Mastorovich , MS, RN, 2007

57. Critique and analysis By chin and Kramer(2007) - How clear is this theory? - How simple is this theory? - How general is this theory? - How accessible is this theory? - How important is this theory?

58. Critique and analysis - How clear is this theory? Semantic clarity and consistency : Duffy uses specific and general traits to define caring and relationships. The quality caring concepts definitions are consistent with the common meanings of the terms within nursing . Structural clarity and consistency : The diagrams are clear and self-explanatory. Duffys revised quality caring diagram clearly and simply shows the link between caring relationships and quality care (Parker and Smith, 2010 )

59. - How simple is this theory? There are four concepts of the theory, which keeps it to a minimum but their interrelationships make it more complex. - How general is this theory? Duffys 2009 revised Quality caring theory is a middle range theory as it draws on others works (Parker and Smith, 2010) It has parsimony as it is conceptually simple but allows for a broad range of empiric experiences ( Chinn and Kramer, 2008)

60. - How accessible is this theory? Duffys concepts ( such as “feeling care for”) are linked to the empiric indicators (such as attentive reassurance), that can be used to assess the phenomena ( caring relationship) that the quality caring theory describes .

61. - How important is this theory? Quality caring is linked to nursing sensitive patient outcomes, improving existing care, caring based interventional research, educational caring, and cost benefit analysis. The quality caring model benefits patients, nurses the profession and the health care system. The quality caring model offers a way to relate to and engage with other health care providers and the community. Through measurement of the caring relationships consequences are assessed which provides an evaluation design for improvement of services.(Parker and smith,p.405)