Patient Safety / Quality

Nurses caring and sharing

In America and worldwide, nurses are improving lives through acts of compassionate caring—acts large and small, private and public, subtle and overt. Their acts embody the words of St. Francis of Assisi: “It’s in giving that we receive.”

By definition, nurses are caring people. We enter the profession wanting to help others; we dedicate our professional lives to caring for others. We serve as the primary caring presence in hospitals and other clinical settings and in schools, homes, and communities worldwide—wherever and whenever a compassionate presence is needed.

Nurses are on the front lines of caring and sharing not just in affluent, Westernized cities and suburbs where standards of living—and health care—are high. Many nurses also serve selflessly in destitute, deprived, or war-torn areas where health care barely exists. They find deep fulfillment by performing caring acts that go far beyond the expectations of conventional nursing roles, in lands far from North America. In these desolate areas, nurses are saving, healing, and transforming lives from the inside out, transcending the limitations of challenging and sometimes hostile circumstances.

I know of nurses who have made handstitched quilts for each patient’s room; sung to dying patients; held the hands of frightened, abandoned children; sat on a dirt floor in an isolated rural village to lend a caring presence; donated their own blood to save another’s life; made home visits after hours or on days off to deliver medications to someone in need; visited the home of a suicidal patient and gently convinced him to return to the hospital for treatment; cried with the bereft spouse of a sick patient; delivered the body of a draped, lifeless baby into the arms of a devastated mother; told family members of a loved one’s death and offered them healing support; washed patients’ feet; spent off-hours volunteering in homeless shelters or local food banks or giving flu vaccines to elders and homeless.

These nurses have learned to help others bear the unbearable. They’ve offered their healing presence, a soothing voice, and a kind, loving look to those caught in unimaginable circumstances.

Front-line caring: Worlds outside our comfort zone
The impulse to provide compassionate care to those in need originates from deep within the human soul. Providing such care yields reciprocal effects: When you care for others, you’re also caring for yourself.


Albert Schweitzer, the medical missionary and Nobel Peace Prize winner, spoke of the reciprocal nature of caring when he said, “The only ones among you who will be really happy are those who have sought and found how to serve.” Author and philosopher Ralph Waldo Emerson observed that one of the most beautiful compensations of life is that no one can sincerely try to help another without helping oneself. Such is the reward, the gift, and perhaps the incentive that compels nurses to perform great acts of caring and compassion.

Janis Bellipanni, a former student of mine, now serves as a public health nurse around the world. In Egypt, she served in the Baby Wash program, which offers screening and educational programs to new mothers. In a recent letter to me, she reflected on the universal importance of nurses caring for people in need: “Nurses are seeking new opportunities to practice their science and art. Many are moving well beyond the traditional Western sites and definitions of nursing. They are signing on to work in developing countries, war zones, and devastated areas of our own country. In most of these places, they’re working without a net and with extremely limited tangible resources. Yet they’re welcomed by the people they come to assist. They and their patients learn about each other’s world.”

“Historically, nurses have never limited their professional or personal pursuits to a single group of people,” Janis continued. “Trained to provide care equitably as well as compassionately, nurses have been some of the first cultural and political ambassadors in the world. Nurses are trusted in all cultures and are often able to access areas of the world where others may be neither safe nor welcome. They possess knowledge, skills, and insights that are easily portable and applicable.”

“The art of caring,” Janis emphasized, “is not dependent on high-tech equipment, tests, or interpretations. Sitting with a worried parent on a dirt floor in Africa requires the same patience, care, and concern as does sitting with a worried parent in a neonatal intensive care unit in the United States. Current political issues, wars, natural disasters, and inequitable distribution of food, water, and medicine serve as barriers for large populations not only to basic life necessities but also to our own understanding of others’ world views.”

Mutually enriching experiences
Beverly Lyne, another former student, recently wrote of her enriching experiences working in a clinic in Soroti, a city in eastern Uganda: “There is something about how we nurses really hear and see people. I loved talking with our Ugandan clinic staff about the idea that our work is about having equal exchange. I might have expertise in community assessment, but they had the expertise in being in the community. And we all left changed, enriched by each experience.”
Acting out of a deep passion, Janis and Beverly are responding to the needs of people on the underside of history. Their insight comes from their many experiences caring for people who’ve been terrorized, oppressed, or forced to flee their native villages. Having volunteered to work in places where others fear to tread, they serve as examples of how, as Janis puts it, “the nurse and the other learn together, teach each other, and open up to each other’s world.”

Working against the odds in Afghanistan
Recently, Janis flew halfway around the world to Kabul and Bamiyan in Afghanistan—where war continues to rage, maternal and child death rates approach the worst in the world, and clean water and electricity are virtually nonexistent. There, while working as a nurse midwife, she saw tremendous suffering while caring for women who’d had no previous access to prenatal or maternity care. As part of International Midwife Assistance (IMA), Janis trained midwives for clinic and home-based births while teaching them about the importance of prenatal visits and safe hospital birthing as new options for these isolated women. Jennifer Braun, another IMA nurse, donated her own blood to an Afghan teenager who had hemorrhaged severely after delivery.

In that part of the world, the dire lack of pediatric care, clinics, medical supplies, and telephones poses severe challenges to healthcare workers. What’s worse, some women are neglected and in many cases prohibited from receiving health care. Here Janis traveled long, grueling hours over dirt roads to act on her commitment to provide access to prenatal care and safe birthing practices to those who have none. She did so, she wrote, “to save mothers so they can save their children.”

Heart-to-heart sharing
In a letter Beverly recently wrote me from Uganda, she told of giving small, colored-glass hearts strung on leather thongs to clinic staff members. Lucy, a woman who’d opened up her hut to Beverly and others, “leaned over for me to put the heart on her and put her hand over the heart hanging on her chest and said, ‘My heart feels your heart.’ I think of her when I wear my heart.”

Through such acts, nurses give the gift of self, connecting with others heart to heart. I’ve heard similar stories of nurses giving from the heart all over the world—from Russia to Vietnam, Thailand, Indonesia, Africa, and Sudan.

Caring on the home front
In America, too, nurses go above and beyond the call of duty. When Hurricane Katrina struck in 2005, my faculty colleague, Gene Marsh, PhD, RN, moved quickly to assemble a team that traveled to the Gulf Coast. There, the team spent several weeks helping Katrina victims make do with only the most basic necessities. They “set up a make­shift clinic and walked the streets of the parish handing out fliers and talking to the locals to advertise our presence and ability to give free healthcare to evacuees,” Dr. Marsh wrote. “Word spread quickly and folks began to flow in.” The team provided immunizations and filled prescriptions for people with hypertension, diabetes, and other chronic or minor acute illnesses.

Although Dr. Marsh’s team performed the standard procedures that all nurses carry out—assessing patients, identifying their health problems, planning their care, finding the required resources, and implementing interventions—sometimes their most essential caring act was to merely sit and listen to the survivors. They wanted to tell their stories, and for this they needed a nurse’s caring presence. For some, this was the first opportunity to reflect on how Katrina had changed their lives forever and to express the hope that they’d somehow gather the strength and courage to move on, with or without family and friends.

Another former student of mine, Dr. Meg Irwin Crew, also went to the Gulf Coast in the wake of Katrina. A disaster management consultant, Dr. Crew worked long hours to help survivors obtain such basics as water, food, and hygiene supplies. “Folks would line up with gratitude and tears in their eyes for receiving water and food,” she said. Besides helping survivors obtain basic supplies and physical care, Dr. Crew and her nursing team performed direct interventions and provided the comforting reassurance of a loving presence. They gave of themselves, and in return received gifts from those they touched. Doing this work opened their hearts and deepened their compassion for both the other and the self. It drove home the reality that we’re all vulnerable—and all connected through our shared human needs.

Acts of caring, works of art and healing
Through such individual and collective acts of caring, these nurses and those like them are taking bold steps to meet the broader human needs of society. An inspiration to many, their work transcends Western definitions of health care, community action, and even caring itself. Their caring acts are, in essence, works of art—part of the artistry and moral calling of nursing. They make a critical difference in everyday moments, in the lives of the people they serve, and in their own lives as well.

Nurses’ caring acts take place indoors or outdoors; in hospitals, clinics, homes, schools, churches, or on street corners; on dirt floors or in makeshift shelters. Whatever the setting, nurses are helping people survive and heal their physical, mental, emotional, and spiritual wounds. They’re performing acts of spiritual healing—a deeper, more subtle process operating beyond the overt work of nurses.

Nurses who give from the heart to offer compassionate service to those in dire need act not just out of altruism but out of love. Sally Hardin, a nurse who has worked with victims of Hurricane Hugo, described this work as “all consuming—yet, probably one of the highest points of my professional life.”

Beverly Lyne expressed a similar feeling when she wrote of her overseas work with extremely needy people, “It was just the most rejuvenating experience for me. I was extremely humbled to be in their presence.”

As M.C. Wendler noted in The HeART of Nursing, “Witness to many of life’s difficult moments, nurses share an intimacy that occurs because of endless, unfolding time together and because of nurses’ commitment to alleviating the negative impacts.”

Behind-the-scenes caring: Inner worlds, paths to spiritual awareness
Another aspect of nurses’ caring is even more subtle and private, rarely discussed even among nurses. Through self-caring and self-awareness—meditation, prayer, centering, quieting the mind, being still to hear and listen from a deeper level—nurses access a deeper source of caring.

To become more whole and more open to giving and receiving, one must first practice self-caring and self-love. As nurses connect with their own inner source of energy and strength and offer compassion and forgiveness toward the self, they increase their capacity to forgive and to accept others with tenderness and compassion, without blame or judgment.

By tapping into their reservoirs of loving kindness, forgiveness, and compassion for the self, nurses radiate a caring consciousness that heals both themselves and others. Increasing numbers of self-aware nurses are actively engaged in such self-caring and self-healing. With all of humanity connected across time and space, their self-caring helps to heal us all.

Elevating the universal life field
Nurses’ self-caring contributes to the universal life field—the source of life that holds and surrounds all, to which everyone belongs and in which everyone shares. The acts of mutually giving and receiving bring love and joy to both the self and others.

Cultivating a caring consciousness allows one to respond to others from an open heart—to feel greater compassion and recognize the other person’s humanity, pain, and suffering. Self-aware nurses are helping themselves and others overcome the wounds of the world—violence, cruelty, and neglect—and improve the human condition. Their caring acts help to sustain human dignity and humanity even amid war, tyranny, anarchy, chaos, and terror.

As we continue to manifest caring in our profession, we’re upholding the tradition and heritage from Florence Nightingale onward, through personal and professional courage and a vision of sustaining human dignity and caring. Nurses and the practice of nursing serve as fountainheads of compassionate service to humankind, both on the front lines and behind the scenes. Caring, love, and peace come together in and through the work of nursing. Giving and receiving reflects the most powerful and universal need—to give and receive love.

Selected references
Bonifazi W. The gift of self. NurseWeek. December 19, 2005:8-9.

Patterson K. Reaching out for the long haul. NurseWeek. August 28, 2006:10-11.

Stringer H. Giving from the heart. NurseWeek. December 19, 2005:8-9.

Watson J. Caring Science as Sacred Science. Philadelphia: FA Davis; 2005.

Wendler MC. The HeART of Nursing: Expressions of Creative Art in Nursing. 2nd ed. Indianapolis, Ind: Sigma Theta Tau International; 2005.

Jean Watson, PhD, RN, AHN-BC, FAAN, is a Distinguished Professor of Nursing and holds an endowed Chair in Caring Science at the University of Colorado at Denver and Health Sciences Center School of Nursing. She is a past president of the National League for Nursing, founder of the original Center for Human Caring in Colorado, and a widely published author. Her latest book is Caring Science as Sacred Science. Dr. Watson’s website is www.uchsc.edu/nursing/caring.

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