Caritas in Action

Creating a Caring Environment for staff in an acute Oncology Unit

A caring-healing environment is “biogenic” in nature; it is life-giving for both the patient and the caregiver. Mindful attention to the care of the nurse is a health care imperative for the safe and quality care of the patient.  The backbone of a caring-healing healthcare system is an engaged, healthy, and productive workforce. At the core of workforce engagement is the experience of joy and meaning in their work.  When nurses do not work in an empowered environment with trust and autonomy, stress levels, burnout, and increased turnover rates with nurses leaving the profession; contributing to the ongoing nursing shortage.
Nurses flourish in an environment where nurse leaders embody caring consciousness and nurses care for themselves and each other. Co-creating a caring-healing environment guided by Caring Science theory incorporates attending to wholeness of humans in their everyday creation and sustenance of a meaningful life.



Caring Science Framework

The 2014 employee satisfaction survey identified three areas for improvement.  Using Watson's Caring Science theory as the foundational framework, nursing leadership engaged in meaningful dialogue and authentically listened to unit management, charge nurses, shared leadership council members, and inter-professional clinical staff to review survey results and gather additional feedback.  This revealed the fourth area for improvement, the need for self-care and resilience practices.


The Collaborative Plan

An inter-professional collaborative plan was developed, integrating mindful communication, authentic presence, self-care and resilience practices to promote healing, comfort and dignity among staff.   The survey domains identified included

  1. Nurses Support Each Other

  2. Nurse Administration Consults with Clinical Staff

  3. Unit Leadership Consults with Clinical Staff.

  4. Need for Self-Care was added at the request of staff as they reported high levels of burnout.


Caritas Action Bundle

A Caritas Action Bundle was created which included: highlighting positive aspects of staff in daily huddles, presentation of WOW cards, a visibility wall promoting dialogue amongst staff, and a Time Out Huddle allowing clinical nurses and other clinical staff to request a time out during shift when work feels overwhelming and they need assistance.


Most Improved!!

This systematic integration of Caritas in Action” approach resulted in a significant improvement for NDNQI 2016 in unit employee engagement and autonomy scores

  • Employee autonomy from a mean of 3.90 to 4.39

  • RN to RN interaction from a mean of 4.53 to 5.17

  • Nursing Administration from a mean of 3.15 to 4.05

The Acute Care Oncology Unit was recognized throughout the hospital as most improved for NDNQI Scores.


Co-creating a Healthy Work Environment

Nursing leadership played a critical role by focusing on engaging staff at all levels and co-creating a healthy, engaged work environment through practical compassionate strategies. 

  • Authentic listening and developing helping-trusting-caring relationships with staff are key to increasing employee engagement.

  • The “Caritas in Action” Bundle involved frontline staff in every aspect—from its creation and design through implementation and integration. Utilizing Watson Caring Science gave nurses an opportunity to infuse their practice with presence, awareness, and receptivity providing nurses with language and guidelines of how to practice and live “Caritas in Action.”

Contributed by:

Judy Berry-Price, BSN, RN, BMTCN

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300 Pasteur Dr
Palo Alto, 94304​

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