Providing Nursing Care Women and Babies Deserve

Commentary Photo CREATISTA / thinkstockphotos.com Providing Nursing Care Women and Babies Deserve Catherine Ruhl TThe young woman holds the tiny, hours-old newborn s hand and begins to sing You Are My Sunshine. The baby opens his eyes. The baby s mother isn t the person singing. Instead, the baby s nurse is singing to her small charge in the NICU. Hodges (2014) frames this story of singing during the last minutes of a premature baby s life and seeing his eyes open for the first time as a story of receiving the gift of humility. She was carrying Zola Golub Anne Santa-Donato Carolyn Davis Cockey Debra Bingham out the wishes of his mother, who was 2 hours away and recovering from cesarean. Hodges had the courage, compassion, and wisdom to convey to the mother how difficult she thought it must have been to ask for someone else to serenade her baby as he slipped out of this world. The mother s response that she was singing right along with Hodges from afar crystallizes what we do as Abstract Nursing Care Women and Babies Deserve describes the core habits of character, also called virtues, that nurses can strive to incorporate into their care of women and newborns. This commentary provides background on the development of Nursing Care Women and Babies Deserve, as well as inspiring examples of how nurses incorporate these virtues into their nursing practice. http://dx.doi.org/10.1016/j.nwh.2016.02.002 Keywords ethics nursing practice virtues nwhjournal.org 2016, AWHONN 129

Commentary nurses when we engage with women and families in their joys and sorrows, providing compassionate, courageous, and wise care with integrity and humility. These are virtues of caring nursing practice that are lived every day in every place where nurses touch the lives of the patients for whom they care, and for their own families and The nursing practice outlined in Nursing Care Women and Babies Deserve guides nurses as they strive to enhance their capacity to demonstrate AWHONN s core virtues when taking AWHONN s Core Virtues Virtues are habits of character that predispose one to do what is right. A nurse s virtues are revealed in practice as recurring actions that are considered desirable and morally good. Virtues are learned and may be fostered. Virtues are not to be confused with personality traits, which are genetically determined characteristics (ANA, 2015, p. 46). The core virtues described in Nursing Care Women and Babies Deserve reflect those core habits of character that AWHONN believes to be essential to providing the optimal, expert, and empathetic family-focused care that women and babies deserve. Catherine Ruhl, MS, CNM, is director of women s health programs at AWHONN in Washington, DC. Zola Golub, MEd, RN, IBCLC, is a nursing education consultant in New York, NY. Anne Santa-Donato, MSN, RNC, is director of obstetric programs at AWHONN in Washington, DC. Carolyn Davis Cockey, MLS, is director of publications at AWHONN in Washington, DC. Debra Bingham, DrPH, RN, FAAN, is vice president of nursing research, education, and practice at AWHONN in Washington, DC. The authors report no conflicts of interest or relevant financial relationships. Address correspondence to: cruhl@awhonn.org. care of women and newborns friends. Sometimes we are keenly aware of practicing these virtues, sometimes we aren t, and sometimes we may not make the most of our opportunities to practice in this way. Background In the hectic pace of clinical practice, thoughtfulness about the meaning of what nurses do may not rise to the forefront of nurses daily reflections. The Association of Women s Health, Obstetric and Neonatal Nurses (AWHONN s) Nursing Care Women and Babies Deserve (see Figure 1) was developed to raise women s health, obstetric, and neonatal nurses consciousness about the significance of their work so that they and others may fully appreciate how what they do matters. AWHONN s core virtues are defined in Nursing Care Women and Babies Deserve, and examples of how nurses incorporate these virtues into their nursing practice serve as a guide for nurses to improve their own practice. The American Nurses Association (ANA) Code of Ethics (2015) is the foundation for Nursing Care Women and Babies Deserve. AWHONN s core virtues, outlined in Nursing Care Women and Babies Deserve and described in this commentary, apply the ANA s Code to our specialties and show how nurses demonstrate these core virtues in patient care and in nursing leadership roles. The nursing practice outlined in Nursing Care Women and Babies Deserve guides nurses as they strive to enhance their capacity to demonstrate AWHONN s core virtues when taking care of women and newborns. How Nurses and Nurse Leaders Demonstrate the Core Virtues Compassion A nurse who demonstrates compassion engages with empathy and respect for the whole being of others. compassion interacts with others with an understanding and an appreciation of the difficulty and complexity of nursing practice. Courage A nurse who demonstrates moral courage speaks up and asks questions when discussing decisions about care with patients and with health care colleagues. She practices self-reflection about personal, health-related values and beliefs so as to increase the capacity to respect the same in others. moral courage advocates and promotes independent nursing practice, and uses shared reflection about current clinical situations to educate nurses about the provisions of the ANA Code and their professional ethical responsibilities. Engagement A nurse who demonstrates engagement in relationships establishes trust by attending to the patient s experience, and begins with kindness extended as compassion for all, including those for whom it is not easy to show compassion. engagement in relationships engages with staff and patients in ways that establish therapeutic relationships, and encourages nurses to share stories about patient care to illustrate and discuss 130 Nursing for Women s Health Volume 20 Issue 2

Figure 1. Nursing Care Women and Babies Deserve Nursing Care Women & Babies Deserve Optimal Women and babies deserve nursing care that is: A nurse who protects, promotes, and restores health and well-being; prevents illness and injury; and alleviates suffering. 1 Expert A nurse whose expert practice unites attentive, evidence-based knowledge and skill with personal concern and relationship. Empathetic A nurse who is compassionate, kind and engaged; a nurse who is a caring presence. 2 Commentary The Six Core Virtues Nurses who provide the care that women and babies deserve incorporate habits of character that predispose them to do what is right in everyday nursing practice: Compassion: An awareness of suffering, tempered with reason, coupled with the desire to relieve the suffering. 3 Courage: The strength to act on one s beliefs in difficult or threatening circumstances or situations. 4 Engagement: Doing with caring and actively including a woman and her family in shared decision-making. Humility: An intense self-awareness and an openness and willingness to learn from others. Integrity: The manifestation of honesty and moral consistency in the caring relationship. 5 Wisdom: Possessing experience, knowledge and good judgment. The above list is not inclusive of all possible virtues, but reflects those core habits of character that AWHONN believes to be essential. Suggestions for fostering these six virtues in your nursing practice Read and consider the nursing stories in Providing Nursing Care Women and Babies Deserve. 6 These stories illustrate how nurses used the virtues to decide how they would act. Reflect on the choices you made the last time you provided care. Were you faced with a situation where you used one or more of the six virtues? What did you like about how you responded and what would you change? Discuss with colleagues the definitions and short examples of each virtue. How will you incorporate this virtue into your nursing practice? Share your insights and stories with a colleague whose actions illustrated one or more of the virtues. Ask this colleague to describe what motivated her or him to make these choices. References 1, 3, 4, 5 American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author. 2 Bishop, A.H., & Scudder, J.R. (1996). Nursing ethics: Therapeutic caring presence. Boston: Jones & Bartlett. 6 Ruhl, C., Golub, Z., Santa-Donato, A., Cockey, C., & Bingham, D. (2016). Providing nursing care women and babies deserve. Nursing for Women s Health, 20(2). doi:10.1016/j.nwh.2016.02.002. Copyright 2016. Association of Women s Health, Obstetric and Neonatal Nurses. All rights reserved. Copyright 2016, AWHONN. All rights reserved. The full-size version of this document can be downloaded from the AWHONN store at awhonn.org. April May 2016 Nursing for Women s Health 131

Incorporating these virtues into our practice can have a positive long-term effect on the lives of the women and newborns for whom we provide care how a therapeutic relationship contributes to healing or empowerment. He also sets the tone for patient care on a unit by incorporating patient participation and feedback in the planning, implementation, and evaluation of nursing care. Humility A nurse who demonstrates humility combines a capacity to learn and grow with a willingness to contribute to making conditions better and possesses a balanced sense of self-worth one that is neither self-absorbed nor fearful. humility collaborates with and respects the contributions of others, fosters an environment that values learning from mistakes, and leads by setting aside self-interest in pursuit of the common good. Integrity A nurse who demonstrates integrity is honest, respectful, and nonjudgmental. He will stand up for what is right and just, even at the risk of being criticized or disliked. integrity leads by example and maintains credibility by walking the talk consistently. She supports other nurses in acting with integrity in all circumstances. Wisdom A nurse who demonstrates wisdom responds and cares for patients by combining knowledge of a particular patient and his or her experience of illness with expert clinical knowledge and judgment. wisdom listens, observes, and reasons within the context of a particular situation using experience and knowledge about what is good and right. Examples of Core Virtues in Action A Nurse Compassionately Engages With a Family in Crisis Towne (2014) eloquently describes compassionate nursing care. Towne reassures a weak, new mother early in her recovery from a severe postpartum hemorrhage that it s alright to cry when she holds her baby for the first time. She extends her compassion as she considers the emotional and mental recovery this woman, whose husband had suddenly died two months before, needs to make by coordinating referrals for social service and grief counseling. She engages with the woman and her extended family to provide nursing care that respects their privacy and facilitates healing on all levels, acknowledging the balance she needs to create for herself as she witnesses the family crossing this deep chasm of grief (Towne, 2014, p. 439). A Nursing Instructor Uses Wisdom and Humility in Clinical Education A nursing instructor s wisdom (Ierardi, 2013) is rewarded when she assigns a timid nursing student to assist in the care of a traumatized woman in labor. Ierardi, the instructor, could have refrained from assigning the student to this particular woman, who is a victim of rape and is newly arrived in the United States. She considered protecting the student from a difficult situation, but her wisdom and experience informed her choice of assignment. The experience yields rich benefits for both the woman in labor and the nursing student. The woman in labor received calm reassurance from a caregiver who spoke her language. The student gained an unforgettable learning experience about providing labor and birth support. And both the student and her instructor were humbled to witness the Photo Monkey Business Images / thinkstockphotos.com 132 Nursing for Women s Health Volume 20 Issue 2

woman s strength as she labored and birthed in an unfamiliar environment. A Nurse Acts With Integrity and Courage to Promote Recovery Mann (2012) recounts her personal experience of watching a family member struggle with addiction during pregnancy. She captures the integrity and courage of nurses who offer encouragement and motivation to women who use and abuse addictive substances, emphasizing that words and tone do matter (Mann, 2012, p. 259). An approach to women who suffer with substance abuse disorders that is consistent with the compassionate care nurses would offer pregnant woman with other physical or mental disorders shows integrity and courage and may open doors to recovery during a critical window of opportunity. What You Can Do There are many ways in which you can work to incorporate these six virtues into your nursing practice, such as the following: Recognize ways you incorporate these virtues in your daily practice. Reflect on past examples of your own and your colleagues experiences of providing care demonstrating these virtues. Consider keeping a journal where you record both positive and negative examples to track your personal insights throughout your nursing career. (See Box 1 for how to share your stories of the core virtues in action.) Plan for how you can continue to broaden your understanding and demonstration of these virtues. Post a copy of AWHONN s Nursing Care Women and Babies Deserve where nurses can easily refer to it. Encourage and recognize your colleagues when they demonstrate the virtues, and mentor nurses who are less experienced to develop their practice by incorporating the virtues of Nursing Care Women and Babies Deserve. Conclusion Reflecting on the virtues that create caring and competent nursing practice is the essence of nursing. Understanding how nurses undergird their practice with these six virtues and striving to incorporate them into practice is a lived experience, rather than a finite goal or an academic exercise. Making time for introspection and modifying our practice to incorporate these core virtues is an ongoing process, similar in concept to life-long learning. The beauty and power of embracing these virtues in practice extend beyond the practice setting to how we live our lives. Most importantly, incorporating these virtues into our practice can have a positive long-term effect on the lives of the women and newborns for whom we provide care. NWH Box 1. Share Your Stories Photo graytown / thinkstockphotos.com AWHONN is collecting stories that demonstrate how you or your colleagues practice nursing care women and babies deserve. Submit your story to www.awhonn.org/nursingvirtues. References American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author. Bishop, A. H. & Scudder, J. R. (1996). Nursing ethics: Therapeutic caring presence. Boston, MA: Jones & Bartlett. Hodges, A. L. (2014). On becoming a nurse. Nursing for Women s Health, 18(4), 354 356. doi:10.1111/1751-486x.12142 Ierardi, J. A. (2013). With calm and steady hands. Nursing for Women s Health, 17(4), 354 356. doi:10.1111/1751-486x.12057 Mann, C. J. (2012). Baby steps toward recovery. Nursing for Women s Health, 16(3), 259 260. doi:10.1111/j.1751-486x.2012.01740.x Towne, K. (2014). When joy and grief collide. Nursing for Women s Health, 18(5), 439 440. doi:10.1111/1751-486x.12155 April May 2016 Nursing for Women s Health 133