Human Caring Multiple Ways of Knowing Holistic Nursing Conference

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4/30/2013

Mary Rockwood Lane PhD RN FAAN

Human Caring Multiple Ways of Knowing

© WCSI. All Rights Reserved.

Holistic Nursing Conference May 3 , 2013

© WCSI. All Rights Reserved.

Mary Rockwood Lane PhD, RN, FAAN

• Associate Professor College of Nursing • Shands Arts In Medicine Director Emeritus • Center of Spirituality in Healthcare • WCSI Faculty 3 2

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History of Caring Science and Art as Healing Force

© WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

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“Caritas” comes from the

Latin word meaning cherish, to appreciate, to give special attention, if not loving, attention to: connotes something that is very fine, that indeed is precious. Eriksson in Finland has used the word caritas in her theory to convey similar meanings. Caritas/Christ Church Oxford University 6

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Watson Caring Science Institute Caritas‐Ways of Being‐Becoming 1. 2. • • • • • • • •

Loving Kindness Heart-centered Authentic Presence; Compassionate Forgiveness Gratitude- Appreciation Energetic Caritas Consciousness Giving –Receiving Stillness-Silence Connecting with field of Universal Love Manifesting Caritas Field - to sustain caring and our humanity Other – Infinite

Personal and Professional Practices of Caring • Nursing is the most noble profession – our work is sacred and precious. • Self care is a essential aspect of our work. • Remember the promises we are privileged to keep: to honor connections of body and spirit in all relationships, with a sustaining passion, from the present until we are old. • Being in right relation with self and others 8

The Core of Caring Theory 1.

Heart/Soul – Source of Compassion; Philosophy, Ethics, Love, Values & Human Spirit Connection

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Voice – Language & Structure Caritas Processes

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Hearth – Where Theory Lives – “In the Caring Moment”

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Mind - Caring as Consciousness, Presence, Intentionality & Informed Moral Action

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1. Practice Loving Kindness 2. Instill Faith and Hope 3. Nurture Individual Spiritual Beliefs and Practices 4. Develop Helping – Trusting Relationships 5. Promote & Accept Expressions of Positive & Negative Feelings 6. Use Creative Scientific ProblemSolving Methods for Decision Making 7. Perform Teaching and Learning that Address Individual Needs and Styles 8. Create a Healing Environment for the Physical and Spiritual Self which Respects Human Dignity 9. Assist with Physical, Emotional and Spiritual Human Needs 10. Allow Space for Miracles to Take Place

Caritas: the basis of love for the ultimate meaning and destiny of other humans. Hands/Praxis – Caritas Modalities, Artistry: All Ways of Knowing/Being/ Becoming/Doing © WCSI - 2011

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Expanded View of Person: Light Energy Consciousness: MindBodySpirit Connectedness Heart-Connectedness with Source Alex Grey ‘Sacred Mirror’ © WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

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Era III – Non Local Transcendent Consciousness • Connecting with Universal Source • Holographic Notions • Consciousness Transcends Time and Space, and Physicality • Consciousness is Joined • Consciousness – Omnipresent, Infinite, Immortal and Ultimately One; Unitary Being; Unitary Field • Evolving Heart-Centered Human – Deepening /Sustaining Our Humanity 11

Alex Grey 12

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“Nightingale ‘Divine Laws”

Stillness 

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Electromagnetic Field of the Heart

Receiving

Giving 

Caritas Process 8: Becoming the Healing Environment – Setting the Tone 

The heart radiates an electromagnetic field that energetically affects  each others’ moods, attitudes and feelings. 

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Source: Caring/Compassion – Inner Truth; Beauty, Our Very Humanity

Watson – WCSI Copyright 2010 – HM Slide with Permission

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Contemplative Pause: Reconsidering Nightingale

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Nightingale Caring-Healing Modalities: Auditory, Visual, Sensory, Consciousness, Tactile, Voice,Environmental, Healing Arts

• • • • • • • •

Beauty, aesthetics Light (bed should face outdoors/nature) Water, Clean air Mood – quiet, soft voices Human Touch Smell, Taste, Sight, Sound Imagination, (Visualization)Movement, Attitude and Relationships © WCSI. All Rights Reserved.

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Florence Nightingale Caring Science Ancient wisdom and contemporary science/art/spirituality converge • •

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Nightingale: Health for All 20

Caring Science as Sacred Science • Ethics of ‘Belonging’ - Infinite Field of LOVE – Sustaining Divinity of Humanity – Grace and Dignity • Connectedness of All – Relational Cosmology • Dwelling and Aligning with Infinite Field of Universal Love

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Connecting

• Purposeful emphasis on integrating the wholeness of the patient, patient patterns and patient meaning into the nursing initiatives .

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BACK TO BASICS OF HUMANKIND jeanwatsoncopyright2012

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Energy, Intent and Multiple (All) Ways of Knowing © WCSI. All2009 Rights Reserved. Diane Swengros Caritas Coach InovaHealth

© WCSI - 2009

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Fundamental Patterns of Knowing - Carper • Empirics – Scientific Knowing • Esthetics – Artistic Knowing • The component of “personal knowledge” • • Ethics – Moral knowing in Nursing Carper, B., Advances in Nursing Science (1978) 1 (1) 13-23. © WCSI - 2011

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Aesthetic Spiritual Ethical

Personal Creative

Empirical

Intuitive

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Ways of Knowing •

EMPIRICAL

• Factual, objective, and verifiable by “outcome measures” • Application of theories • Body of knowledge that is research based and systematically organized © WCSI - 2011

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Ways of Knowing

• AESTHETIC • Holistic expressions and perceptions of creativity, openness, meaning, and empathy • Expanding caring healing modalities to include voice, touch, presence, poetry, music, aroma therapy or any other aesthetic medium © WCSI - 2011

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© WCSI - 2011

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Ways of Knowing • PERSONAL • Knowing, encountering and actualizing of the self • Self-actualization through interpersonal processes and interactions • Present meaning that are brought into relationship with

Ways of Knowing

• ETHICAL • Make choices within situations involving moral judgments • Analysis and clarification of shared values; justice, compassion • Examining what is worth being and preserving © WCSI - 2011

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Ways of Knowing • SOCIOPOLITICAL • Changing environments toward highly integrated, continuum-based and multifaceted • Engaging issues such as gender, diversity, culture, power • Caritas Path to Peace © WCSI - 2011

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© WCSI - 2011

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Ways of Knowing • EMANCIPATORY • Engaging issues of equity, justice and transformation, attends to social barriers • Creates clearing for bringing together art, science, spirituality for new depth for “unabashed love” for caring & healing ti

Caritas Process 1: Humanistic – Altruistic Values – Practice of Loving-Kindness and Equanimity with Self and Other

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Magnetic Reminders: Pausing - Practicing Presence: Loving Kindness

• VALUES: Preserving Human Dignity: Magnets on Patientʼs Door INOVA Health, Fairfax, VA

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Caritas Expression of Loving Kindness

Art

• Practice from what is in your He

• With loving expression using voice and touch; - one word from your heart can express profound kindness • Value what Jean Watson has taught us, “that what we hold in our heart matters” 35

Caritas Process 2:

Faith and Hope, Being Present Authentically

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Art is A Caring Moment

Caring Moment

• A heart centered love-filled, energetic field; a turning point; A call to higher/deeper consciousness, intentionality; An authentic choice of caring/living; Requires presencecentering-search for meaning; New level of authenticity- potentiating self healing and wholeness. 38

Caritas Process 3: Sensitivity to Self & Others, Ongoing Spiritual Development

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TS Eliot ‘The Still Point - in midst of chaos.” Healthcare: What is Basic health and human caring?

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Love: Intelligent Heart Centered Human-to-Human Caring Practice • “Love… The Old Unfamiliar Name... • Behind the Hands, Not Known • Because Not Looked For, • But Hidden in the Stillness, • Behind the Scenes

Where is Our Patient? T.S. Eliot 41

Lifelong skills: Meaning • • • • • •

Relaxation Meditation Guided imagery Prayer Creativity Trust

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Caritas Process 4: Developing Authentic Trusting Caring Relationships

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Caritas Process 5: Allowing Expression of Positive-Negative Feelings: Listening to Another’s Story

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Caritas Process 6: Creative Problem-Solving Caring Process

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Creativity and Spirituality In Healthcare • • • •

Arts In Medicine Programs: Practice Spirituality in Healthcare groups: Practice Shamanism Artist as healer

Caritas Process 7: Relational Teaching Learning / Inner Subjective Meaning

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From “Implementation” to “Partnering” • From doing to and for the patient to being with the patient- mutual process • Giving information to a patient in away they can understand-genuine teaching – learning staying within the other’s frame of reference. Creating a caring healing relationship • How can I best help you learn about your medications? • What will life be like for you when you go home on a low sodium diet? 48

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From “Evaluation” to “Reflection”

• Evaluation is often done by the nurse to the patient • Reflecting involves open communication- “how do you feel?” • What are you experiencing?

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Caritas Process 9:

Creating a Healing Environment Physical Environment: Privacy/Windows Healing Garden/ Nature Light, color, sounds, flow of movement Nurse as Environment: Voice, touch, eye contact, energy, feelings • Family connection • Health care team collaboration • • • •

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Healing Arts Program

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Creating a Healing Environment • • • • • • •

Guided Imagery Music, Dance, Poetry, Art Listening Healing touch Artistic expressions Human interactions Beauty / Nature 52

Healing Environments • • • •

Gardens Rooms Views Altars

Caritas Process 9: Assistance With Basic Needs – Sacred Acts • Embodied Spirit: • Touching • Mind • Body • Spirit • Not Just Body Physical

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Bea “Everyday a patient should have something beautiful to look at...” Nightingale

blooming in midst of thorns 55

Health Outcomes • • • • •

Patient care humanized Quality of life improved Clinical practice enhanced Environments illuminated Cost effectiveness

Caritas Heart Moment:What song does your heart Sing?

© WCSI. All Rights Reserved.

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Caritas Process 10: Open to Existential - Spiritual Unknowns: Allow for Mystery & Miracle

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Caritas Nursing Praxis Application of Learning to Practice – Study of Practice

• “Informed Passion”

Caring Practices

• New Caring Modalities • Practice of Knowing and Being and Doing in Caring Relationship • Natural Healing Modalities Practice is informed by our world view and our knowledge base

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Connected to Infinite Love and Grounded to the Earth

Healing Touch Meditation by Cynthia Hutchinson

Watson Caring Science Institute

© WCSI. All Rights Reserved.

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Art as a Way of Caring

© WCSI. All Rights Reserved.

Art as A Healing Force

© WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

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Call to Artists Everyone is an Artist

“If you can walk You can Dance If you can talk You can Sing!” © WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

Call to Healers • • • • • •

Human Caring Reclaiming the art Bringing in art Starting a program In your life In your practice

Art As a Way of Caring

© WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

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Shands Arts in Medicine • • • • • • •

Artist in residence: Visual artist Musician Dancer Poet Storyteller Theatre

The Hospital as a Healing Community

• • • • •

Sacred Space For all How does it feel? Its broken, fix it Healing spirit

Art as Healing • • • •

On the walls Content Meaning Story

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Art Heals

• • • •

Yourself Others Neighborhood Earth

Enhanced Practice • • • •

Loving Mindful Present Caring

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Art as Advanced Therapeutics • • • • • •

Leadership Facilitator Advocate Do it yourself Be Creative Enhanced practice

Research • Develops a knowledge base • Defines art in healing • Defines health outcomes • Changes practice

Research Findings • David Speigel, support group patients • Diane Tusek, One hospital day shorter , decreased meds • Ulrich- art on the walls and a window shortened hospital stay and ½ pain meds • Candice Pert Psychoneuroimmunology endorphins and neurotransmitters from relaxation

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Physiology: Symptom Reduction with art Physical

• Decreased muscle tension Decreased pain Increased oxygenation Increased circulation Improved sleep Improve appetite

Psychological

• Decreased anxiety Increased intuition Improved clarity in thinking Enhanced faith Increased acceptance

Caring Science Outcomes • “The outcomes we have seen since adopting Caring Science, include improved nurse retention, increased satisfaction scores and improved benchmarking on our clinical Lance Anastasio, President and CEO outcomes.” Winterhaven Hospital, Winterhaven, FL

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Rational for Assessing and Measuring  Improvement of Caring Practices; Mindful – Intentional Interventions;  Benchmarking Settings, Structures for Improvement;  Tracking Caring Against Routine-Robotic Practices; (from Bio-cidic to Bio-genic)  Evaluating Caring-Non-Caring: Patients/Practitioners © WCSI. All Rights Reserved.

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Rational for Assessing and Measuring • Improvement of Caring Practices; Mindful – Intentional Interventions; • Benchmarking Settings, Structures for Improvement; • Tracking Caring Against Routine-Robotic Practices; (from Bio-cidic to Bio-genic) • Evaluating Caring-Non-Caring: Patients/Practitioners © WCSI. All Rights Reserved.

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Caring Science Research: Caring assessment instruments  Assessing  Measuring Caring and • Outcomes 2009 2012

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CPAS© Caritas Patient Assessment Score 1. Develop a Quick and Easy Instrument to Administer and Measure Patient Perceptions of Caring – An “APGAR Score”

 Maintain Integrity of Caritas Processes 2. The 5 Items Selected Account for 78% of the Explained Variance of Caring 3. #1 – “Providing Care with Loving Kindness” Accounts for the Majority of Variance – 67.8% 4. Develop Instrument for Use by Facilities Interested in Measuring Patient’s Perceptions of Caring Practices © WCSI. All Rights Reserved.

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WCSI International Comparative Caring Research

(University of AZ – Dr. B. Brewer PI ) To Apply the Watson Caritas Patient Score Instrument in multiple hospitals using Caring Theory as Professional Practice model 1. To Use the Data for Ongoing Performance Improvement and Clinical Investigation – unit level comparison; quarterly reports online; 2. To Build an Accurate and Reliable National Comparative Database of Authentic Caritas practices Perceived by Patients; relationship bx caring system, nurse sensitive patient safety and quality indicators; 3. To Improve the Validity and Reliability of the WCPS •

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Empirical – Theoretical Measurement of Authentic Caring WCPS© –Tool Watson Caritas Patient Score - WCPS (Apgar* score of caring) WCPS© - ©Watson Caring Science Institute: Watson, Brewer, & DʼAlfonso, 2009

© WCSI. All Rights Reserved.

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New Caring Science Criteria: New Outcome Indicators

Leaders/Managers NOW Seek ʻEvidenceʼ of:

 Human Flourishing: Staff and Patients, Family, Community.  Purposive Involvement: Contributing to Something Larger Than Self – Inspired Vision.  Building Capacity: Inspired Organizational Leadership, Workgroup Cohesion, Workgroup Learning Processes.  Honor and Use of Unique Individual Talents for Advancement – Progression; Relational Coordination  Allowance for Creative Emergence 85

Caritas HeartMath Pilot Baptist Health, Jacksonville, FL • Personal Clinical Indicators of Stress (e.g. Outlook, Motivation, Fatigue, Resentful, etc.) – 10 or 10 Indicators Improved with Caritas HM Program After 1 Month • Organizational Qualities (e.g. Work Attitude, Strategic Understanding of Organizational Goals, Goal Clarity, Value of Contributions, Communication Effectiveness, Productivity, Time Pressure, Morale Issues and Intention To Quit.) 86

Opportunities For Ritual “Handwashing” An ACT Initiative

• PROVIDES A PAUSE TO: Quiet Busy Mind Wash Away Old Experience Center in Caring Intention Honor Self and Other Reconnect to Core Values Bless and Release Last Person/Situation • Purify Sacred Space for Authentic Presence • Open to Ability to Give and Receive Next Person/Situation • • • • • •

The Children’s Hospital, Denver 87

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Into “The Caritas Staff Retreat” with a Stone Waterfall Feature

• From Smoking Area to Caritas Garden Angie Fontaine, RN Caritas Coach, Jacksonville Baptist, FL , 2009 88

Cultivating Consciousness and Listening for Meaning

Wyoming Medical Center

• Afternoon Tea Where: • Reflective Practice is Cultivated • Where Nurse’s Own Experiences are Shared • Where We Learn to Listen for the

jeanwatsoncopyright2012

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Healing Environment Quiet Time

The Children’s Hospital Denver

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CP: 10 Sanctuary – Healing Room for Nurses

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Kaiser - Antioch Medical Center

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Reflections

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Vijali’s Three Questions • • • • • •

What is your essence? What keeps you from getting there? What can you do to achieve it? No Fear Open heart Total commitment

A Sacred Pilgrimage or Vision Quest • • • • •

Go Into peace and silence Listen Remember Return

My heart leaps up when I behold a rainbow in the sky! by William Wordsworth (1802)

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May beauty be all around you • Come join us…………. • “Walk on a rainbow trail. Walk on a trail of song and all around you will be beauty. • There is a way out of every dark mist. • It is over a rainbow trail.” Navajo Poem

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Individual Artistic Renderings

Multiple Ways To Express Experience

© WCSI. All Rights Reserved.

Books

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Spirit Body Healing A phenomenological hermeneutic study of the lived experience of art in healing © WCSI. All Rights Reserved.

Themes in Art and Healing –pain and darkness going elsewhere being creative in a turning point slipping through the veil knowing the truth and trusting the process embodying spirit feeling healing energy and compassion

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© WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

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Pain

© WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

© WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

Trigger © WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

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© WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

© WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

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Going Elsewhere

© WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

© WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

Pet Therapy: Something to Care for and Love

Marlienne Goldin, RN Caritas Coach & Faculty Watson – WCSI Copyright 2010

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Art as Turning Point

© WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

© WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

© WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

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Slipping Through the Veil

© WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

© WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

© WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

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Healing Energy

© WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

© WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

© WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

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Habitat for Healing • Influencing the Environmental Field • Using Creative Caring-Healing Modalities • For Staff, Patients and Families Wyoming Medical Center jeanwatsoncopyright2012

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Embodiment of Spirit

© WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

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© WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

© WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

© WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

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Transcendence

© WCSI & Jean Watson, Used by permission  Visit www.watsoncaringscience.org

Thank You! Each one of you is the light and beauty of the rainbow of caring. © WCSI. All Rights Reserved.

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Reflections

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Human Caring Multiple Ways of Knowing Holistic Nursing Conference

4/30/2013 Mary Rockwood Lane PhD RN FAAN Human Caring Multiple Ways of Knowing © WCSI. All Rights Reserved. Holistic Nursing Conference May 3 , 20...

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