Strengths Based Nursing

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Strengths-Based Nursing
A holistic approach to care, grounded in eight core values
By Laurie N. Gottlieb, PhD, RN

Strengths-based nursing (SBN) is an approach to care in which eight core
values guide nursing action, thereby promoting empowerment, self-efficacy, and
hope. In caring for patients and families, the nurse focuses on their inner and
outer strengths—that is, on what patients and families do that best helps them
deal with problems and minimize deficits. Across all levels of care, from the
primary care of healthy patients to the critical care of patients who are
unconscious, SBN reaffirms nursing’s goals of promoting health, facilitating
healing, and alleviating suffering by creating environments that work with and
bolster patients’ capacities for health and innate mechanisms of healing. In doing
so, SBN complements medical care, provides a language that communicates
nursing’s contribution to patient and family health and healing, and empowers the
patient and family to gain greater control over their health and healing.
Keywords: empowerment, healing, health, nurse–patient relationship,
nursing values, patient-centered care, self-management, strengths-based nursing
the dominant practice model in
I’m looking for the light; those

health care. Most nurses have been

little glimmers that make me

trained to focus almost exclusively

think there’s something there. I

on problems and things that are not

am looking for people’s gifts of

working. They analyze the patient’s

what they’ve got going for

concerns through a ―deficit lens,‖

them.

focusing on pathology, attending to

—Nurse Heather Hart, as cited

the abnormal and the dysfunctional,

in

Nursing

with the goal of ―fixing‖ problems.

Care: Health and Healing for

Yet in many situations, there are

Person and Family1

more things that are right than are

Strengths-Based

Despite the recent attention paid to

wrong.

Strengths-based

nursing

prevention, wellness, and patient-

(SBN) brings a new balance to

centered care, the medical model,

deficit-based care. SBN focuses on

with its emphasis on a patient’s

understanding deficits and problems

deficits rather than strengths, remains
1

within a broader, holistic context that

Dan’s potential to endanger others

uncovers inner and outer strengths.

while allowing him to maintain the

Diane Bourget, a clinical nurse

status and power he held within his

specialist who attended an SBN

tribe.

study group I conducted, recounted a
case that was particularly illustrative
of the SBN approach. (All cases
discussed in this article are real, and
all nurses who are identified in this
article have given me permission to
use their names. To protect patient
privacy, patient names have been
changed and identifying details have
been omitted, except in the case of
Rabbi Cahana, whose story has
already appeared in a number of
publications.)

When

Diane

was

working on a crisis intervention team
on a hospital’s child psychiatric unit,
Dan Pacheco, a Native American
adolescent, was admitted showing
signs of a severe psychotic break,
having recently threatened the life of
a young woman. Through their initial
interview

with

Dan,

the

crisis

intervention team discovered that in
his community Dan was believed to
possess special powers because he
―heard voices‖ (that is, he had
auditory hallucinations). The challenge for the team was to reduce

After Dan had spent several weeks
on the unit, his psychosis was
controlled through medication and
his delusional ideation had subsided.
Able to recognize that he was ill,
Dan was willing to engage in a
discussion with his family and the
interdisciplinary
psychiatrists,

nurses,

team

of

and

social

workers about the best plan to treat
his

disease.

Together,

they

negotiated a way to meet everyone’s
goals by finding a medication dosage
that would reduce Dan’s psychotic
symptoms

without

completely

obliterating his ―voices,‖ so that he
was no longer a danger to himself or
others but retained his tribal status.
The

team’s

broad

focus

was

consistent with the values of SBN.
They viewed Dan as a whole person,
a greatly respected member of a
community whose values were not
completely consistent with those of
modern medicine. Had they instead
focused exclusively on his deficits,

2

Dan, his family, and his health care

treating unconscious patients in an

team might not have found a solution

ICU can use the SBN approach. For

that was agreeable to all.

example,

Undoubtedly, many nurses already

patients’ responses to stimuli, nurses

practice elements of SBN without

can schedule painful or intrusive

having labeled the approach as such.

procedures for times when they will

But the label we use is important

be best

because it can take the approach to a
different level of awareness. As
Patricia Benner has noted, SBN puts
―into words what expert nurses come
to know and experience over time in
their best practice . . . [and gives]
clarity, insight, and rigor to a central
but poorly understood value and
wisdom embedded in the best of
nursing practice.‖1 Although nurses
with a deficit-focused perspective
may sometimes seize an opportunity
to motivate patients and families by
concentrating on strengths rather
than deficits, this approach is not an
essential part of their schooling and
its consistent use cannot be relied on
in

professional

practice.

Nurses

whose practice is strengths based, on
the other hand, seek capacities,
competencies, and skills that patients
and their families might use for
recovery, survival, growing, and in

by

closely

observing

tolerated (capitalizing on inner
strengths); by noting the nature of
family responses and their effect on
the patient, nurses can communicate
caring and respect, thereby reducing
environmental stress (maximizing
outer strengths).
SBN recognizes the importance of
focusing

on

strengths

that

can

empower patients to assume greater
control over their own healing and
health—it enables nurses to help
people help themselves attain higher
levels of health. This article proposes
that SBN is an approach to care that
provides the vision, values, and
evidence that can transform and
humanize

health

care

by

reconnecting it with the concepts of
Florence Nightingale and expanding
those concepts to meet the realities
of 21st-century health care.

many cases, thriving. Even nurses

3

THE CURRENT HEALTH CARE

the role of nurses in various contexts,

CLIMATE

the SBN model has consistently

With the expansion of health care

proven superior in treating patients

coverage

with chronic conditions. Browne and

in

the

United

States

mandated by the Affordable Care

colleagues

Act, many are asking who will

meta-analysis of 27 reviews, 29

provide care for the flood of new

quality studies, and nine economic

patients expected to enter the health

evaluations of nurse-involved and

care system. Similar discussions

nurse-led interventions for patients

have taken place in Canada since

living

1947,

complex chronic medical conditions

when

provinces

some

began

Canadian

implementing

and

in

social

recently conducted

the

community

circumstances.

a

with

They

public health insurance plans that

found that interventions led by

covered hospital services, continuing

specialty

beyond 1984 when the Canada

practice nurses who ―supplemented

Health Act was introduced. As the

rather than replaced the physician,‖

largest

care

providing proactive (as opposed to

providers, nurses were expected to

reactive or on-demand) assessment

take on a much greater role to

and monitoring in the context of

accommodate the increased demand

comprehensive care (delivered in

for care. There was considerable

collaboration with family members,

debate, however, about the type of

home nursing and support personnel,

role nurses

hospital staff, and other caregivers),

group

of

should

health

play. Some

trained

or

envisioned nurses assuming more

produced

medical functions. Others believed

functioning, hospitalization rate, and

nurses should focus more on health

quality of life) that were better and

than on illness and that nursing

often less costly than those provided

should play a complemental role to

through physician-led models or by

medicine.2

nurses using a physician-substitution

Providing chronic care. Although

outcomes

advanced

(patient

or physician-replacement model.3

there are differing perspectives on

4

Prenatal and early-childhood care.

oriented,

Similar results have been reported

fragmented,

for other nurse-led initiatives that

system in which people are treated as

emphasize self-efficacy and human

diagnoses rather than respected for

ecology (working with the patient’s

their

family

described

members

and

support

depersonalized,
and

often

personhood.

uncaring

Basic

by

Kitson

needs
as

networks), most notably the Nurse–

―fundamentals of care‖—such as

Family

nutrition, elimination, bathing, and

Partnership

program

(www.nursefamilypartnership.org).4

comfort measures that promote the

Research

rest required for healing—have gone

has

demonstrated

the

benefits of these values in creating

unmet.6, 7

partnerships; building capacity and

Although the issue is complex, with

confidence; and helping patients use

many factors contributing to the

their strengths to achieve their goals,

problems inherent in our current

develop coping skills, and broaden

health care system, we lack a vision

their resources.

for nursing shaped by well-defined

Unfortunately, many seem to believe

values that could help the profession

that taking on such responsibilities as

determine

case management requires nurses to

nurses’ actions. We also need a

relinquish much of the traditional

better understanding of the fact that

nursing role—caring for the whole

nursing’s—as

person, providing direct body care,

medicine’s—unique contribution to

and spending the time to get to know

better outcomes in patient and family

both

health

the

patient

and

family.5

Relational care has been devalued—
or, in many cases, viewed as a
regrettable casualty of technologic
progress—by

nurses,

nurse

administrators and managers, nursing
school faculty, and physicians. These
developments have created a disease-

and

priorities

and

opposed

healing

has

guide

to

been

empirically established.4, 8
NIGHTINGALE’S VISION
In

1860,

Florence

Nightingale

published her seminal Notes on
Nursing: What It Is and What It Is
Not, in which she laid out her vision

5

of the nurse’s role. She described

compassion

nursing’s mandate as health and

appropriate touch.

through

nonclinical,

healing and the role of the nurse as

Nightingale’s vision was bold. She

―put[ting] the patient in the best

arrived at her understanding of health

condition for nature to act upon

and

him.‖9

understood

observation, the experience of caring

health as a process of becoming,

for both the healthy and the sick, and

while she described healing as an act

the study of many disciplines. We

or process of restoration or recovery

are

from disease. She also recognized

scientific evidence that validates

that the human body and mind had

many of Nightingale’s insights. For

innate restorative and reparative

example, she considered physical

capacities, and that nurses could em-

and emotional environments key to

power patients to contribute to their

health and healing. She also un-

own healing by creating physical and

derstood that patients need the

interpersonal environments that

support of loved ones to assist them

Nightingale

allow this to happen.10 For example,
such simple actions as turning down
room lights, controlling the number
of visitors, closing doors to control
noise levels, moving patients closer
to a window, and reminding visitors
to wash their hands help create a
physical environment that promotes
healing.

Likewise, nurses

create

interpersonal healing environments
by being fully present in their
interactions with patients, listening
attentively,

and

demonstrating

in

healing

beginning

their

through

to

astute

accumulate

recovery—thus,

while

nursing in the Crimean War, she took
the time to help soldiers write letters
to their families back home.
In support of this vision, research
over the past 30 years has repeatedly
linked perceived social support to
better physical and mental health,
with these benefits mediated through
stress-buffering mechanisms, better
self-control,
emotions.11

and
Moreover,

positive
neu-

robiologic studies have affirmed that
reducing stress enhances telomerase

6

levels, which are involved in cellular

on health, healing, and the alleviation

health.12

of suffering through actions that

RESTRUCTURING

THE

NURSE’S ROLE
The current health care system has
become more focused on disease and
increasingly sophisticated in its use
of technology. As nurses pursue
advanced education, their sphere of
practice has expanded into such
traditionally

medical

areas

as

diagnosis, treatment, and medication
prescription.13 Although nurses have
largely relinquished their assistantto-the-physician role, many have
become even more tethered to
medicine

by

substituting

for

physicians and taking on more of
what were, traditionally, physician’s
tasks, rather than expanding the
nursing role. While diagnosis and
treatment may be one aspect of
advanced practice nursing, it should
not be the nurse’s total focus.
Nursing should provide care that
differs in substantive ways from that
seen in the medical model—not
simply be a variant of the same
disease- and problem-focused care.
The nurse’s primary focus should be

draw on inner strengths and outer
resources, creating conditions that
allow patients to achieve maximum
functioning.
Another driver of the current
system has been a preoccupation
with cost-effectiveness and managed
care. When all of health care is seen
to

be

quantifiable,

nursing

is

practiced as a set of technical activities rather than as a set of relational,
social, and moral activities with a
technical base.14 Many nurses and
administrators

believe

that

performing medical tasks is more
complex, and thus a better use of
nurses’ time, than providing comfort
measures or listening to patients’
concerns. But nurses can and often
do accomplish both. Medical tasks
should not eclipse the importance of
ensuring patient comfort and safety
within the context of a caring
relationship that enables nurses to get
to know patients as individuals.
To address unsustainable levels of
spending in our health care system,
many have called for systematic
transformation, and SBN should be

7

considered a means of achieving this

THE

transformation.

OF SBN

Although

the

UNDERLYING

VALUES

Institute of Medicine’s 2010 report

SBN is based on the belief that

The Future of Nursing: Leading

relationships are the key to healthy

Change, Advancing Health suggests

functioning and healing. In keeping

that nurses can fulfill numerous roles

with Nightingale’s teachings, SBN

throughout a transformed health care

seeks

system, including on hospital boards

support the person’s innate health

and in hospital design, real change

and healing at all levels: from cells

can occur only with a shift—from

(biological) to citizens (person and

disease to health and healing, from

family) to communities (support net-

doing for to working with patients

works).

and families, from teaching and

Nightingale’s

telling

personhood, the right of people to

to

learning

transformation

from.

must

Any

include

a

have

to

create

conditions

SBN

incorporates

teaching

their

values

that

to

and

honor

beliefs

rethinking and restructuring of the

respected. But SBN goes beyond

nurse’s role and the way nursing is

that,

practiced.

experiences

Nurses need to carve out a unique

patients and their families to take

role for themselves that complements

control over their lives and health

and parallels medicine. To do so,

care decisions. SBN recognizes that

they will need to more explicitly

deficits coexist with strengths and

teachings

that problems can be understood only

about working with innate mecha-

within the context of a person’s life

nisms that support health and healing

experiences. It attempts to discern a

to

holism,

person’s strengths and use them to

compassion, and the importance of

deal with problems, compensate for

the environment and relational care.

deficits, and overcome limitations

connect

such

Nightingale’s

values

as

creating

environments

that

better

and

enable

SBN fulfills these requirements.

8

psychological, social, and spiritual
healing

abilities

through

such

processes as sleep, nutrition, and
pain control. Nurses create healing
environments

by

supporting

a

person’s efforts to recover from
physical and psychosocial insults.
SBN comprises eight interrelated
values (Figure 1).1 These values are
illustrated in the nurse–patient inter-

and

Lucille Glover, a 73-year-old woman
who was diagnosed with advanced
lung cancer. She feared dying alone

actions described below.
Health

A few years ago, I cared for

healing.

SBN

reaffirms that health and healing are
the central goals of nursing. Health

and had trouble being alone while
she slept. Aware of the reparative
powers of sleep and the therapeutic

supports the patient’s ability to adapt

value of authentic presence and

with flexibility to life’s challenges,

attentive listening, I suggested that

rally from insults, and live with
purpose

and

meaning.

Health

coexists with illness and creates
wholeness.
wholeness

Healing
and

restores

involves

the

rediscovery and reestablishment of
equilibrium.

In

the

process

of

healing, people develop new skills
that can sustain and increase their

family

consider

hiring

a

compassionate, caring person to
spend nights at her bedside. When
Ms.

Glover

was

agitated,

the

caregiver sat beside her bed, stroked
her arm, dimmed the lights, and
spoke with her quietly. The presence
of the caregiver provided Ms. Glover
with

a

sense

of

security

that

empowered her to reduce her stress.

health.
Nurses promote health by helping
people develop their capacities for
attachment, regulation, and coping.15 They seek to identify and
support

the

a

person’s

biological,

Achieving this type of serenity and,
thereby, lowering levels of cortisol
(the stress hormone) tend to improve
immunologic

function,

thus

facilitating healing. The practice of

9

SBN enabled me to see a way to help

describes her first encounter with this

the family help Ms. Glover access

family:

her inner strengths.

If I drew just a genogram [a

Uniqueness. SBN recognizes that no

visual depiction of the structure

two people are alike; each is

of the family] and wrote some

genetically different and has a par-

facts about this mother and

ticular disposition. Moreover, people

daughter on paper, any person

experience and respond to their

would say, ―What a disaster

environments

ways.

and what misery‖—and I would

Illness, tragedy, and hardship can

say: ―What resilience and what

reveal a person’s inner strengths. The

gutsiness!‖. . . The first thing

uniqueness of individuals is defined

that struck me was Sarah’s

by both their strengths and deficits—

drive; her wish to do things on

by how these affect their physical,

her

behavioral,

interpersonal

scooted around on her bum,

responses and form each person’s

asked for help when she needed

identity. Recognizing an individual’s

it, and . . . the mom put out her

uniqueness, therefore, requires an

hand and gave her daughter a

understanding of both strengths and

little help and then pulled away,

weaknesses.

so that her daughter could

Sarah Jones is the two-and-a-half-

indeed say, ―I’m doing it

year-old daughter of a 20-year-old

myself‖; and the mom could

single mother. She has a severe,

say, ―Yes you are! Yes you

debilitating form of juvenile arthritis

are!‖

that was previously misdiagnosed

—Gillian Taylor, as quoted in

and has left her unable to walk. Her

Strengths- Based Nursing Care:

nurse, Gillian Taylor, practices the

Health and Healing for Person

McGill model of nursing, which

and Family1

in

and

unique

own

was

fierce.

She

conceptual

Gillian’s strengths-based orientation

underpinning for SBN.16 Here, she

allows her to appreciate the unique

provided

the

way Sarah expresses agency and

10

autonomy (an innate strength) as

Ms. Bourne refused. Mealtime was

well as the parenting style of Sarah’s

an important social activity for Ms.

mother,

Bourne, and food was a source of

who

encourages

and

supports Sarah’s development.

pleasure that she considered very im-

Holism and embodiment. Martha

portant to her quality of life. From

Rogers describes people as unitary

the perspective of SBN, the nurse’s

beings who respond to their internal

role is to help patients achieve their

and

as

goals in the healthiest possible way.

Holism

In Ms. Bourne’s case, the goals

recognizes the interconnectedness of

would be to enable her to continue

the parts as they affect each other

enjoying food and participating in

and the functioning of the whole

mealtime

person. Symptoms, for example, are

meeting her nutritional requirements

the body’s way of signaling that

and preventing another recurrence of

something

functioning

aspiration pneumonia. I asked Ms.

properly. Enabling the innate healing

Bourne to note the foods that had

mechanism to restore a sense of

caused her to choke. She discovered

wholeness

both

that small food items, such as peas

symptom treatment and containment

and corn, were most often at fault.

or elimination of that which causes

Ms. Bourne then eliminated these

the dysfunction.

foods from her diet. I also reviewed

external

integrated

environments

wholes.17

is

not

often

requires

activities,

while

also

I once cared for Mary Bourne, a

with Ms. Bourne the foods she liked

92-year-old woman who lived in a

best and suggested new ways to

senior residence home. She de-

enjoy them in forms less likely to

veloped

her

cause aspiration, such as shakes or

that

puddings. Because I understood Ms.

aspiration

Bourne’s personhood, I was able to

pneumonia. After several hospital

work with her to find solutions,

admissions, the nutritionist suggested

rather than see her as a diagnosis in

the insertion of a percutaneous

need of medical ―fixing.‖

esophagus

a

fissure
and

between
trachea

repeatedly resulted in

endoscopic gastrostomy tube, but

11

Subjective reality and created
meaning.

Experiences

shape

that allowed him to adapt to his
quadriplegia:

understanding because they hold

You have to believe you’re

specific

Experiences,

paralyzed to play the part of a

representations,

quadriplegic; I don’t. In my

meaning.

perceptions,
emotions,

and

guide

mind and in my dreams every

people’s understanding of events

night I Chagall-man float over

(their ―reality‖) and affect their

the city, twirl and swirl. With

responses. Searching for meaning

my toes kissing the floor. I

involves creating narratives that are

know

woven together from facts, past and

statement

current experiences, perceptions, and

motion. Everything has motion.

beliefs. The construction of the

The heart pumps, the bloods

narrative is an important integrative

race

process that creates health and

culminate, the body heaves, the

facilitates healing.18, 19

mouth moves, the eyes turn

The case of Texas-reared Rabbi

inside-out. We never stagnate.

Ronnie

Life triumphs up and down.

Cahana

meanings

illustrates

how

nothing
of

about
man

course,

this

without

the

lungs

profoundly our narratives can affect

—Rabbi Cahana, as quoted in

our outlook. At the age of 57, Rabbi

―Joy,

Cahana, a deeply spiritual man, had a

Fulfillment:

Kitra

brain-stem stroke that left him

Spiritual

Transformation,‖

cognitively intact but quadriplegic.

Time20

Compassion

and

Cahana’s

Because he maintained the ability to

SBN encourages nurses to appreciate

move his eyes, the rabbi developed a

and facilitate the communication of

blinking system through which to

patients like Rabbi Cahana. Through

communicate. His reality is captured

communication, such as the rabbi’s

in a poem he dictated to his daughter

poetry, nurses come to know their

through this system. The poem

patients and gain insight into how

provides a glimpse into his inner

they

world and insight into the strengths

Through his poem, Rabbi Cahana is

experience

their

reality.

12

telling the world that he retains his

shift, when John checked on the

identity as a person and not as a

patient, he noticed that the patient

quadriplegic.

had a 5 o’clock shadow and offered
are

to give him a shave. Of the many

integral. Person and family are

actions John took to care for the

affected

both

patient during his 12-hour shift, the

One

shave was the one on which both the

Person

and

by

physical

environment

environment,

and

environment

social.

a

patient and his family remarked.

person’s best while another may

John, reflecting on the incident many

bring

person’s

years later, says, ―The shave made

vulnerabilities. People grow and

him feel so good. He went from

thrive when there is a ―goodness of

looking like a sick patient to a

fit‖ with their environments. Such

healthier-looking person. It restored

environments enable people to draw

his sense of personhood. It made the

on

provide

family feel good to see their loved

themselves with opportunities for

one looking so much better, and they

development, healing, and thriving.

responded differently to him.‖

out

their

may
the

bring
same

strengths

and

out

John Marsala, a nurse manager at a

Nurses with an SBN orientation

university teaching hospital, tells of

are acutely aware that they are an

an experience he had early in his

integral part of the environment for

nursing career when he worked on a

both patients and their families and

busy

was

can profoundly affect them, even

assigned a patient who had been

during a brief, one-time encounter.

admitted for angina. John prepared

Nurses frequently see people in times

the patient for angioplasty and

of crisis and are often remembered

started the iv fluid and medication

for such simple acts of kindness as a

line. When the patient returned from

warm smile or a compassionate

the procedure, bleeding from the

touch. People remember nurses who

catheterization entry wound, John

are knowledgeable, competent, and

applied pressure to the wound until

compassionate; who engage them in

the bleeding stopped. Later in the

conversation; and who are interested

cardiology

unit.

He

13

in their concerns and responsive to

clarify, elaborate, explain, provide

their needs. People also remember

information,

acts

unkindness,

connect people with resources, and

insensitivity, and rudeness, which

advocate for patients and their

make them feel devalued, ignored,

families so they may hear their own

and disrespected. SBN emphasizes

voices and make their voices heard.1

the importance to healing of the

Learning, timing, and readiness.

physical and social environment and

Learning, which is essential to

encourages nurses to be mindful of

survival,

noise levels and ventilation.

transformation, involves biological,

of

sullenness,

Self-determination. SBN respects

make

change,

psychological,

suggestions,

growth,

and

and

social

Without

learning,

a person’s self-knowledge and values

processes.21

choice and self-determination, even

humans

though there are always limits to the

environment.

choices available and a person’s

engage in a new activity as a prelude

ability to act in her or his own

to change is a prerequisite for

interest is affected by circumstances,

learning. Timing, in the context of

knowledge, and predisposition. The

health care, requires synchronizing

cases of Ms. Glover, Sarah Jones and

the desired outcome with the body’s

her mother, Ms. Bourne, and Rabbi

capabilities

Cahana all illustrate the importance

willingness. It requires the nurse to

of allowing patients to exercise self-

be attuned to the patient and to know

determination. Almost every act of

the point at which intervention will

living involves a choice about how to

be

respond to specific circumstances

readiness, and timing are all required

and limitations, and within the

for healing, which SBN maintains

context

can occur even during the act of

of

health

care,

what

most

cannot
But

and

navigate

their

readiness

the

successful.

to

mind’s

Learning,

interventions to undertake. SBN sees

dying.

the nurse’s role not as deciding for

Revisiting the case of Ms. Glover. At

others

listening

the end of her life, Ms. Glover

attentively and deeply in order to

developed delirium and was admitted

but

rather

as

14

to the palliative care unit. In her

SBN, I understood the importance of

delirium, she repeatedly called out

timing and was able to help Ms.

the name ―Annie.‖ When I asked Ms.

Glover’s niece recognize that her

Glover’s niece about Annie, she told

aunt might finally be ready to let go

me that Annie was her other aunt,

of the narrative she’d long held of

Ms. Glover’s older sister, who had

her sister’s death, so that she might

passed away two years earlier, also

die healed.

from lung cancer. Ms. Glover had

SBN actively engages people in their

not seen her sister for over a decade,

own learning, seeks indications of

though they had corresponded by e-

readiness, and times interventions

mail prior to Annie’s death. Even

based on knowledge of the person

when Annie was dying, Ms. Glover

and their situation, which grows out

had told her niece that she believed

of curiosity, concern, and openness.

her sister was faking her illness to

Collaborative

partnership.

get attention. Annie had known that

nature

the

her sister resented her, but she had

relationship is collaborative. Each

expressed no animosity toward her to

brings her or his own experience,

other family members. Ms. Glover’s

knowledge, and competencies to the

niece was concerned that her aunt

relationship. The nurse has formal

would die in an agitated, guilt-ridden

and practical knowledge of health

state, so I encouraged her to share

and healing, and the patient and

with her aunt memories of happier

family have knowledge of them-

times when the two sisters got along.

selves and their circumstances. A

I also encouraged her to let Ms.

collaborative partnership requires the

Glover

had

nurse to be open, nonjudgmental, and

harbored no ill feelings toward her

willing to share power.22 The patient

but rather understood and loved her.

and family are more likely to want to

A few days later, Ms. Glover was no

collaborate when they feel valued,

longer delirious or agitated. She

understood, respected, and secure.

radiated a sense of calm. She died

Focusing on them as individuals and

know

that

Annie

of

The

nurse–patient

peacefully a week later. Through

15

recognizing their strengths is key to

Dan, his nurse needed to consider

successful collaboration.

how to minimize his deficits and

Collaborative partnerships require

work with his strengths, thereby

the partners to find common ground,

allowing him to function at his

set goals jointly, and determine a

highest level (health and healing;

course of action that’s right for the

holism

patient.

recognized

The

nurse

provides

and

embodiment).
that

Dan’s

She

―voices‖

information that aligns with the

accorded him great respect within his

patient’s developing skills so that

tribe (uniqueness; subjective reality

both nurse and patient canparticipate

and created meaning; person and

fully as partners. In the case of Ms.

environment are integral), although

Bourne,

auditory

this

meant

that,

with

hallucinations

are

guidance, the patient was able to

considered pathological (a deficit) in

discover

to

the context of modern medicine. By

pneumonia.

working with Dan to manage his

preventing

her

own

solution

aspiration

When people are unconscious or

psychosis

otherwise

for

eliminating his ―voices,‖ his care

themselves, the nurse needs to

team honored his tribal beliefs (self-

assume multiple roles, including

determination),

caregiver,

understand that he needed medica-

unable

to

protector,

care

advocate,

supporter, and nurturer.
PUTTING IT ALL TOGETHER
As illustrated in the case of Dan,
SBN does not ignore deficits or
pretend they do not exist. In fact, it is
as important to consider patients’
deficits as it is to consider their

without

completely

enabling

him

to

tion in order to attain the level of
stability required for him to be
judged

safe

to

return

to

the

community (learning, timing, and
readiness) and allowing him to
participate in developing a workable
solution (collaborative partnership).

strengths; both are essential aspects

BENEFITS OF SBN

of the whole person. In trying to

To person and family. SBN is built

create a condition of wholeness for

on principles of empowerment, self-

16

efficacy, and hope. Such strengths-

desired goal and bring about a

based

the

desired outcome. After decades of

Developmental Model of Health and

research into predictors of successful

Nursing have been found to promote

change, self-efficacy has emerged as

hope, healthy behaviors, and quality

one of the most robust.24, 25 Self-

of life in stroke survivors.23 These

efficacy entails having confidence in

principles need to be in play if peo-

one’s competencies and resources,

ple are to assume greater control

which is an important prerequisite

over their lives and take charge of

for

their

challenging,

paradigms

own

health

as

and

healing.

taking

charge

in

and

often

complex,

Feelings of self-control and of being

matters of health and healing.

in charge are essential in coping with

Hope

problems and stress.

something

Empowerment. People empower
themselves, though clinicians may

is

Stephenson

the

chronic

expectation

positive

will

characterized

that
occur.
it

as

having the following attributes26:

create conditions that enable them to

• a process of thoughts, feelings,

do so by working with their strengths

behaviors, and relationships

or

• directed at an object that is

helping

them

develop

new

strengths. Feelings of empowerment

meaningful to the person

enable people to take greater control

• anticipatory in nature

over

• future oriented, but grounded in

their

health

through

self-

management, give them the confi-

the present and linked to the past

dence to be partners in their own

When problems

are viewed as

care, and help them discover inner

challenges to be overcome rather

resources and innate capacities for

than as sources of fear, uncertainty,

healing they didn’t realize they had.

denial, and helplessness, then a

Empowerment gives people choices

person’s energy can be redirected to

and, thus, enables them to choose

such areas as positive coping and

among alternatives.

self-healing. The nurse’s role is to

Self-efficacy is a belief in oneself

open up possibilities for the patient,

and in one’s ability to achieve a

creating opportunities to entertain

17

different options until a solution is

contributes to the healing process

found.27

through

A transformative shift of attention.

interventions, nursing is seen in the

SBN shifts attention away from a

SBN

preoccupation

diagnosis,

healing by creating environments

problem, or symptom and toward an

that maximize a person’s innate

appreciation of living a full life while

healing capacities. There is mounting

making necessary accommodations

evidence that stress reduction can

to deal with an illness. Disease and

improve healing,29 and recent re-

other catastrophic events are viewed

search suggests that critically ill

as challenges to be engaged as part

patients may benefit from such

of a person’s life’s journey. SBN

stress-reducing nursing interventions

honors and dignifies people, enabling

as

them to be who they are and to live

nurses attend to the fundamentals of

as they choose.

care (such as comfort, hygiene,

To nursing and nurses. We are

nutrition,

gaining a deeper awareness of our

management), they reduce stress and

innate capacities for healing and

support the body’s capacity for

well-being, and of the influence of

healing. Such evidence provides

environments and relationships in

nurses

these areas. The care of another re-

redesigning their roles within the

quires input from many disciplines,

health care system so that it makes

including nursing and medicine. It

better use of their knowledge and

requires the ability to develop both

skills and values time devoted to

theoretical and practical knowledge,

nursing care.

with

a

and a broad repertoire of analytical

medical

model

as

interpersonal

and

contributing

touch.30

positioning,

with

SBN

an

surgical

When

and

argument

also

to

pain

for

enhances

and technical skills.28

interdisciplinary

Nurses who are in touch with and

recognizing

guided by their values are more

expertise. Interdisciplinary practice

likely

and

is best achieved when there is a dif-

medicine

ferentiation of roles. Only then can

to

empowered.

feel

inspired

Whereas

practice

nursing’s

by
specific

18

professionals know how best to

make more appropriate use of health

integrate their respective knowledge

care services.3 ▼

and skills to benefit patients and
families. SBN enables nurses to have
greater control over their practice by
having an autonomous role. Nurses
report

greater

satisfaction

when

allowed to exercise their nursing
functions autonomously.31

health care organizations advertise
that they are patient centered and
focused,

yet

nursing at McGill University in
Montreal. The author acknowledges
Bruce Gottlieb, PhD, for his advice
and

support

in

manuscript.

preparing

Contact

this

author:

[email protected].

To the health care system. Most

family

Laurie N. Gottlieb is a professor of

The

author and planners have disclosed
no potential conflicts of interest,
financial or otherwise.

economic,

political, and organizational interests

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