Humanising Care: Applying Todres Framework to Nursing Video Story

This essay critically analyses the application of a humanised approach to care, using the Todres et al (2009) humanization framework, with specific reference to the 'What do you see nurse?' video. The essay focuses on three dimensions of the framework: insiderness versus objection, togetherness versus isolation, and personal journey versus loss of personal journey. The analysis highlights instances in the video where the patient experiences objection and isolation, emphasizing the importance of communication, compassion, and recognizing the patient's past and present experiences. The essay argues for a more patient-centered approach, advocating for nurses to create a supportive and understanding environment that respects the patient's dignity and promotes a sense of belonging and value.

Humanised Approach to care 1
HUMANISED APPROACH TO CARE
by [Name]
Course:
Tutor:
Institution
City
Date

Humanised Approach to care 2
Contemporary healthcare practice is increasingly embracing the client-centered
concept and empowering it in day to day practice (McCaffrey and McConnell 2015, 3007). A
lot of efforts are being put in place especially at research level to ensure that person based
care is as humanized as possible. However Norton (2015) posits that the existing knowledge
on this phenomenon has not been adequately passed down and across the medical fraternity.
Paolo (2017) criticises the implementation strategies for humanization approach in healthcare
provision arguing that there are adequate and sufficient frameworks such as the Todres et al
(2009) framework of encompassing humanization in healthcare but cites unprofessional
working culture and apparent resistance to adoption among the previous and already
practicing medics and caregivers. Todres et al (2009) came up with an eight-point
humanization framework of introducing and adopting and maintaining humanized approach
to healthcare practice. This paper will therefore discuss the humanization framework with
specific reference to three of the eight dimensions proposed in this model. The three
dimensions are insiderness versus objection, togetherness versus isolation and personal
journey versus loss of personal journey. The author will refer to the online video ‘what do
you see nurse’ to conduct a critical analysis of the patient-nurse association and relationship
in personal healthcare provision.
The need to attend to a patient from heart has for long been a concern among
healthcare professional (Pascuci et al 2017). Nursing is regarded a caring profession and it is
challenging for one to fully meet the physical, emotional, physiological and psychological
needs and expectations of each individual patients (Jacobs et al 2017). However, by adhering
to the standards of best practice and such as the six C’s of nursing profession and
humanizing models in healthcare provision, quite a substantial level of satisfaction can be
achieved in meeting the patients expectations. Several models including the Todres et al

Humanised Approach to care 3
(2009) have been fronted to help nursing practitioners to improve their approach in person-
based care. This section will provide an overview of the Todres model with a view of
providing a snippet understanding of the humanized approach in healthcare. The framework
presents key perspectives of the meaning of human in eight humanization and
dehumanization dimensions.
The first dimension is the insiderness versus objectification which explains that being
human as experiencing life in current state exhibited through emotions, mood and feelings.
The second dimension is agency versus passivity which contemplates that humans make
choices in life and are responsible for them. As such people do not always see themselves as
totally passive (Hansen-Flaschen 2015, 318). Nurses therefore, ought to give room of
freedom to their clients to make independent choices. Uniqueness versus homogenization is
the third dimension and addresses the issue of each individual patient’s exclusivity. Although
classifications such as gender, ethnicity, race and age do exist, they are not sufficient enough
to discern an individual from another. The principle thus advises nurse to treat each patient as
he or she is in his or her individual context. Togetherness versus isolation stipulates that
being part of a community is what makes one feel human and separation bear’s detrimental
effects to one’s health. This aspect will be discussed further in this paper.
Making sense or making none addresses the element of caring about the meaning of
one’s environment which includes events and experiences. Humans naturally tend to be
sensitive about their surrounding and in the event that they are unable to, nurses have an
obligation to explain to their patients what is happening around them and help them fully
understand the situation around them. The sixth dimension deals with personal journey versus
loss of personal journey and talks about familiarity people bear with the past and present and
the excitement or otherwise they have with the future. This dimension too will be explored in
detail in this document. The seventh dimension is the sense of place versus dislocation. Every

Humanised Approach to care 4
human has a sense of origin (Davidson et al 2017). Everybody wants to end up at home
where home is not just a collection of objects but rather familiarity comfort and experiences.
No patient in his or her right mind would want to stay in hospital any longer implying that the
whole experience of being in hospital apart from illness is unpleasant. Nurses are thus called
upon to create a homely environment to mitigate the sense of dislocation felt by patients. Last
but not least is the aspect of embodiment versus reductionism which discuss the experiences
humans go through with their bodies whether positive or otherwise. It is difficult to
understand an individual’s body without keeping in mind their social, physiological and
socio-cultural aspects. The element thus seek to instil sense of respect to the caregivers and
treat their clients with respect and dignity (Todres, Galvin, and Holloway, 2009).
As already mentioned, this paper will refer to a short story titled ‘what do you see
nurse?’ and attempt to resonate the application of humanized approach in health care by
reviewing the events in the movie clip. ‘What do you see nurse?’ is a short deeply moving
story extracted from a poem that revolves around an elderly patient in a medical facility. In
the story, the old woman pleads with the care-giver to see beyond the feeble and confused old
woman before her. The patient urges the nurse to bear in mind the life she the patient has
been through since childhood. The hopes dreams and all the aspirations of a beautiful
journey. With this overview in mind, the author will now attempt to analyze the three
aforementioned dimensions and how they manifest in the story.
Insiderness versus objection is the first of the eight dimension the humanization
/dehumanization framework. This dimension recognizes that one’s current state of mind
determines his or her current feeling of association to human family. This is what Todres et al
(2009) define insiderness. Care givers should work focusing on the patients knowledge,
motivation and skills and attempt to improve the rather than looking at their problems. The
moment they focus on the patient’s problems then they will end up treating them like objects.

Humanised Approach to care 5
I the short story, there are two instances where the patient experiences objection rather than
insiderness. While in a bathtub, she feels some sort of sharp pain and tries to speak
something. Although the nurses were busy washing cleaning her, they do not pay keen
attention to find out what caused the sharp pain or even what the old woman could be saying.
She is left to feel like a burden or an object of need. In a second instance, one of the nurses is
seen feeding the elderly patient. At some point, the woman does not want to feed and the
nurse simply tells her “I wish you could” but does she bother to make her express herself or
tell why she isn’t eating anymore? No. This focus does not bring out a shared vision of care
but rather an absolute dependency on the care-giver to make decisions.
A more humanized approach would be to try and involve the patient as much as
possible in activities and decisions pertaining to his or her welfare. For instance the nurses
would have tried to find out what happened to the lady in the bathtub instead of merely
asking “what did she say?” Asking another person what a patient said while with the patient
herself makes the patient feel completely incapable and dependent on other people including
their opinions. Showing care and compassion as part of the Insiderness can be enhanced by
creating a culture that works for, on and with the patient (Cowie and Jones 2017). Nurses
need to be trained to never make those under their care feel helpless or merely objects.
The togetherness versus isolation dimension recognizes the human desire to associate
and relate with others. This is achieved through communication. Pound and Jensen (2018)
note that the communication doesn’t have to be necessarily verbal, in fact body language
speaks volumes. Cheraghi et al (2016) observes that social seclusion bears detrimental effects
health and is responsible for a number of psychological and chronic physical ailments.
Caregivers therefore need to know the significance of interacting with patients even if the
latter incapacitated in some way. From the beginning of the story, one does not see anywhere
where the nurses attempt to communicate or establish some association with the elderly

Humanised Approach to care 6
patient. At the beginning we see them talking to each other and although one of the nurses
tries to talk to the elderly woman later, her body language and facial expression is nothing
short of ‘duty only’.
Nurses need to establish friendship between themselves and the patient, friends, care-
givers and family members of the sick. This leads to development of trust between patients
and nurses and is significant to the dignity of the patient (Cowie and Jones, 2017). In the
story a friendly face and gentle approach when attending to the old woman or even a smile
will make her feel part of the society but cold face on a sick person will drift her into
isolation and begin thinking about the past and the moments he was in society just like the
woman in the video did.
Nurses have an obligation to offer support to their patients and open opportunities to
develop relationships. Traditionally, nursing as a profession has been perceived as a vocation
that provides divine care and services to the society and some of its doctrines have their
origin in religious principles (Rathert et al 2016, 141). Nurse are bound to inspire hope into
the patients and make them feel wanted rather than needy. They, therefore, should encompass
compass as much as possible in their practice. Body language such us eye contact and facial
expressions such as smiling provides mental healing and spares the patients the worries,
distress and agony of feeling isolated or miserable (Brousseau et al 2017).
People’s lives can be summed up in three aspects that is the past present and future.
People are familiar with the past and will tend to drift back to the same and admire the good
moments they had then. This is common when confronted with unpleasant experiences like
being hospitalized. As Walker and Mann (2016) assert, this throwback does not only deter
quick recovery but may also be a source of other complications. When patients are labelled or
perceived as being needy, the resultant distress becomes overwhelming and tend to forget to

Humanised Approach to care 7
live their present and drift to the past. It becomes worse if they drift into the past and reflect
on the bad moments they had as this only adds to make them feel more miserable.
Although the nurse does well to feed the elderly woman, the hasty way she does it
makes the patient feel like the former is wasting the latter’s time and that she is a bother.
Bradshaw (2016) observes that nursing is an emotionally and physically demanding
profession. There are six qualities that should be adhered to when practicing as a nurse. These
are care, compassion, competence, communication, courage and commitment. Of the six,
compassion is the most valuable virtue for a nurse (Walker and Mann, 2016).
Quite often, patients find themselves in unfamiliar conditions that they have no
control over (White 2018, 52). Nurses need to appreciate the value of their patients’
trepidations and lend them a hand in adapting. They bear the responsibility of psychologically
creating a soft landing for the patients who may be still struggling to come to terms with their
current condition. In the video, the old woman needed to be assured that she is still as loved,
needed as she was in her childhood and teenage years. That is why she urges the nurse to see
and regard her as she would have seen her in her early life.
This paper agrees that although adult nursing is an arduous specialization, nurses
taking care of the aged have to put care and compassion at the center of their practice. By
understanding the eight dimensions of humanizing healthcare, nurses can deliver their
services without appearing to be uncaring. As qualified professionals nurses have both a
collective and individual obligation to maintain best standards of care. Focusing on what is
important to each individual patient as members of one human family will enable caregivers
to comprehend and fully appreciate each individual patient’s experience and expectation in ill
health. By so doing, dignified and respectful approach in service provision could be ensured.

Humanised Approach to care 8
References

Humanised Approach to care 9
Bradshaw, A., 2016. An analysis of England's nursing policy on compassion and the 6 C s:
the hidden presence of M. S imone R oach's model of caring. Nursing inquiry, 23(1),
pp.78-85.
Brousseau, S., Cara, C.M. and Blais, R., 2017. A Humanistic Caring Quality of Work Life
Model in Nursing Administration Based on Watson's Philosophy. International
Journal for Human Caring, 21(1), pp.2-8.
Cheraghi, M.A., Esmaeili, M. and Salsali, M., 2017. Seeking Humanizing Care in Patient-
Centered Care Process. Holistic nursing practice, 31(6), pp.359-368.
Cowie, L. and Jones, I.R., 2017. Adult Social Care Social Enterprises and the Foundational
Economy in Wales.
Davidson, J.E., Aslakson, R.A., Long, A.C., Puntillo, K.A., Kross, E.K., Hart, J., Cox, C.E.,
Wunsch, H., Wickline, M.A., Nunnally, M.E. and Netzer, G., 2017. Guidelines for
family-centered care in the neonatal, pediatric, and adult ICU. Critical care
medicine, 45(1), pp.103-128.
Hansen-Flaschen, J., 2015. A practical approach to humanizing care for patients who are
expected to die in an intensive care unit. Annals of internal medicine, 163(4), pp.318-
319.
Jacobs, G., van der Zijpp, T., van Lieshout, F. and van Dulmen, S., 2017. 5 Research into
Person‐Centred Healthcare Technology: A Plea for Considering Humanisation
Dimensions. Person-Centred Healthcare Research, p.61.
McCaffrey, G. and McConnell, S., 2015. Compassion: a critical review of peer‐reviewed
nursing literature. Journal of clinical nursing, 24(19-20), pp.3006-3015.

Humanised Approach to care 10
Norton, E., 2015. The application of humanization theory to health-promoting
practice. Perspectives in public health, 135(3), pp.133-137.
Paolo, G.G.M., Graziano, A. and Castelli, G., 2016. Humanization of Care Ethical and Social
in Clinical-Care. World Journal of Research and Review, 3, pp.01-08.
Pascuci, L., Meyer Jr, V., Nogueira, E.E. and Forte, L.T., 2017. Humanization in a Hospital:
A Change Process Integrating Individual, Organizational and Social
Dimensions. Journal of Health Management, 19(2), pp.224-243.
Pound, C. and Jensen, L.R., 2018. Humanising communication between nursing staff and
patients with aphasia: Potential contributions of the humanisation values
framework. Aphasiology, 32(10), pp.1225-1249.
Rathert, C., Vogus, T.J. and McClelland, L.E., 2016. Re-humanizing Health Care. The
Oxford Handbook of Health Care Management, p.141.
Todres, L., Galvin, W., and Holloway, G., 2009.Humanization framework
Walker, M. and Mann, R.A., 2016. Exploration of mindfulness in relation to compassion,
empathy and reflection within nursing education.
White, S., Stainer, L., Cooper, K. and Waight, S., 2018. The personal tutor as a role model
for students: humanising nursing care. British Journal of Nursing, 27(1), pp.52-55.

Humanised Approach to care 11