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368 UNIT IV Nursing Theories

Foundation, and completed at JFK Medical Center in staff, including physicians, nurses, and support ser-
Atlantis, Florida (Boykin, Bulfin, Schoenhofer, et al., vices staff, were included, emulating the organization
2005). For this study, a practice model based on the of the Dance of Caring Persons. Evaluation began
Theory of Nursing as Caring was implemented in a early because of the success of the model in the busy
telemetry unit. Persons from all stakeholder groups venue of the emergency department. Although inte-
were invited to tell a story illustrating caring as it was gration of the Theory of Nursing as Caring at JFK
lived in a nursing situation on the pilot unit. The Medical Center and Boca Raton Community Hospital
model evolved from shared values of Nursing as Car- was carried out on individual units, the theory dem-
ing, including those expressed by patients, patients’ onstrated flexibility and broad-based application and
families, nurses, other members and staff of the pilot has been integrated system-wide at St. Lucie Medical
unit, and members of the administrative team. Center, Port St. Lucie, Florida. This continuing inte-
Themes were uncovered in a narrative analysis and gration was described in the Nursing Service Admin-
synthesis and served as explicit components of the istration section earlier in the chapter.
model. Major themes of the nursing practice model In 2007, the nursing staff and administrative person-
were based on the Theory of Nursing as Caring, and nel at St. Lucie Medical Center adopted the Theory of
strategies and operational structures were created to Nursing as Caring throughout the medical center. The
reflect these themes. Support for the core of the car- first step in this process began with a study conducted
ing-based model arising from direct invitation to determine how best to uniquely adapt and integrate
(Boykin & Schoenhofer, 2001a, 2001b) led to a new the Theory of Nursing as Caring. The caring modeled
and renewed focus on “responding to that which mat- in the theory was extended to all personnel throughout
ters” (Boykin, Schoenhofer, Smith, et al., 2003, the hospital, from organization executives, to nurses,
p. 229), which nurses now recognize as integral to physicians, managers, technicians, therapists, and
caring in the nursing situation. maintenance personnel. Living caring authentically and
This project demonstrated that transformation of nurturing the wholeness of others within the rigors
care occurs when nursing practice is focused inten- and ordinariness of daily work were studied and exem-
tionally on coming to know person as caring and on plified in all departments and infused throughout the
nurturing and supporting the nursed as they live their organization (Pross, Boykin, Hilton, et al., 2010; Pross,
caring. Within this practice model, the nursed were Hilton, Boykin, et al., 2011).
able to articulate the experience of being cared for, In 2009, a study was incepted at St. Mary’s Medical
patient and nurse satisfaction increased dramatically, Center, Palm Beach County that focused on develop-
retention increased, and the environment for care ing a dedicated education unit grounded in the Theory
became grounded in the values and respect for person of Nursing as Caring (Dyess, Boykin, & Rigg, 2010).
(Boykin, Schoenhofer, Smith, et al., 2003). An out- Participants included health care administrators, staff,
come of use of the model was that nurses sought students, and faculty. Prior to undertaking this project,
opportunities to work in a satisfying place with caring the health care organization did not have a specific
others. When nurses transferred from the demonstra- nursing theory to guide practice, and outcomes of the
tion unit to other floors, they carried a new focus of project proved to be rich. They included a growing
nursing with them. appreciation for knowing each other as caring, the
A similar project began in 2003 (Boykin, Bulfin, development of clinically seasoned and dedicated
Baldwin, et al., 2004; Boykin, Bulfin, Schoenhofer, nurses who supported the advancement of theory-
et al., 2005) in the emergency department of Boca based caring nursing, an administrative team who were
Raton Community Hospital. The first phase of a eager to mentor staff, and dedicated educators who
model of care based on the Theory of Nursing as Car- modeled living theory-based practice to new nurses.
ing was titled “Emergency Department: Transforma- Caring from the heart (Touhy, 2004; Touhy &
tion from Object Centered Care to Person Centered Boykin, 2008; Touhy, Strews, & Brown, 2005) is a
Care Through Caring.” In creating the model, staff model of practice based on the Theory of Nursing as
realized that changes were needed in conceptualiza- Caring in a unit at a long-term care facility. The
tions of nursing practice. Initially, all emergency services model of practice was designed through collaboration