Just like other professions in health, nursing draws upon the principle of service to humanity. Nursing emphasizes the significance of creating a caring and healing environment to help communities, families, and individuals preserve or achieve an optimum wellness state during life stages ranging from birth, adulthood, and the end of life (Alligood, 2014). The notion of altruistic caring, guided by a code of ethics, research, and theory, is at the heart of nursing values. The progress in nursing science has resulted in a heightened interest in the caring concept of this profession. In the last couple of decades, theories have been developed, and research has been conducted with the aim of defining the caring approach in nursing, outlining caring behaviors, and identifying the impacts of caring on society, organizations, nurses, families, and patients (Butts, Bandhauer, & Rich, 2015). One of the most prominent theories on this concept is Swansons Theory of Nursing, which is a middle-range theory that is popular among health practitioners since it is simple, relevant, and can be applied in practice, research, and education with relative ease. This paper describes, evaluates, and discusses the application of Swansons Theory of Caring.
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Swansons Theory of Caring
Swanson developed an interest in the science of caring rather rapidly. Working as a rookie nurse, Swanson found herself at a hospital facility that concentrated on providing primary care. When undertaking her doctoral studies at the University of Colorado, Swanson developed a keen interest in the caring concept as it is evident from her scholarly as well as professional endeavors (Peterson & Bredow, 2016). Her doctoral dissertation involved conducting a descriptive phenomenological study with a sample of 20 women who recently miscarried to determine the kinds of caring behaviors that were most beneficial to them. Through analyzing the data inductively, Swanson developed a caring model with five key processes including maintaining belief, enabling, doing for, being with, and knowing (Peterson & Bredow, 2016). These caring actions provided the basis for developing her theory of caring.
During a later study, Swanson explored the matter from the viewpoint of seven parents of hospitalized children and 19 qualified caregivers. The findings of her research indicated that the processes of caring she had discovered in her doctoral work could also be applied to parents as well as caregivers tasked with providing help to hospitalized children (Peterson & Bredow, 2016). Swanson retained and refined the definitions of the caring acts, but the proposed clinical care also needed balancing for others and self, managing responsibilities, attachment to others, and ensuring good outcomes for society, self, and others. The next stage in the advancement of the theory of caring started at the Caring and the Clinical Nursing Models Project, where she studied how young mothers who had been subjected to a long-term nursing intervention remembered and described nursing care (Peterson & Bredow, 2016). Using the findings of this research, she defined caring as a nursing concept and subsequently polished the definitions of the processes of caring.
In developing the theory, Swanson referred to the works of other nursing theorists who had contributed to understanding the caring concept. Essentially, she acknowledged that caring had been central in nursing since the inception of the profession (Smith & Liehr, 2014). For instance, Florence Nightingale believed that caring for patients required one to understand patients and their environments to restore their health. She also cited the works of other nurse theorists such as Jean Watson and Madeleine Leininger in affirming the significance of caring in the nursing practice. Swanson also drew upon numerous philosophical debates as well as theoretical sources to develop her caring theory. The author once stated that, during the early stages of her career, the knowledge she had gained from clinical practice and formal nursing education helped her become aware of the essential role played by caring in supporting, healing, and upholding human dignity (Alligood, 2014). Swanson also acknowledged various nurse scholars who significantly influenced her beliefs concerning caring and nursing. For instance, she recognized Dr. Fawcett Jacqueline for assisting her in appreciating and understanding the pivotal role played by nursing in caring for people and the significance of altruistic caring in enhancing the well-being of others. Furthermore, she credited Dr. Jean Watson for inspiring her to study caring using an inductive approach (Smith & Liehr, 2014). Finally, Swanson acknowledged Dr. Barnard Kathryn for motivating her to test and apply the caring theory using randomized controlled studied.
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Other authors have also written about Swansons caring theory. Peterson and Bredow (2016) point out that Swansons work has been cited in more than 160 research-based publications. This method has been utilized as a theoretical framework in numerous studies. Peterson and Bredow (2016) further elucidate that the situations under which a theory can be applied should not be limited. In this respect, Swansons theory of caring has been utilized as a foundation for guiding professional nursing practice in the U.S., Sweden, and Canada.
The Phenomenon of Concern
The phenomenon addressed in this theory is caring. In essence, Swanson shares insights on how healthcare professionals can provide care that promotes healing. Caring has been acknowledged as a key aspect of nursing; however, the concept of caring in nursing is complex and multifaceted (Peterson & Bredow, 2016). To this end, Swanson developed her theory to provide guidelines that can help healthcare specialists practice caring when attending to patients. It is achieved through outlining the caring processes as well as understanding the ways they interrelate.
Theory Description. The reasoning of the Theory
There are several techniques that can be adopted in order to develop a theory. The inductive approach to theory development entails creating a theory using research. It lies in contrast with the deductive method characterized by deriving middle-range theories from grand ones. A theory can also be developed through a synthesis of ideologies found in published study results, obtaining them from the guidelines of clinical practice, and combining extant non-nursing and nursing theories (Smith & Liehr, 2014). Swanson developed the caring approach using empirical research that employed an inductive methodology. As Peterson and Bredow (2016) explain, an inductive technique involves proposing relationships and hypotheses through either observation or lived experienced prior to finally devising certain conclusions. Swansons caring theory was developed using a descriptive phenomenological research involving women who had experienced miscarriage, caregivers of hospitalized children, and mothers who had been subjected to long-term interventions (Alligood, 2014). Therefore, the theory uses inductive reasoning.
The key concepts in Swansons theory relate to the caring processes, which are knowing, being with, doing for, enabling, and maintaining belief. These actions are defined clearly and presented in a logical sequence (Butts et al., 2015). They are identified operationally (Peterson & Bredow, 2016). In this respect, Swanson describes the concepts in her theory by outlining the practical steps for healthcare practitioners to follow in order to complete the caring processes. They are not presented as abstract concepts, but rather in the form of practical procedures that can be done. In addition, there is consistency in the manner in which the structural components of the theory are described. The definitions of the concepts and how they interrelate are rational and clearly used. For example, in describing the concept of knowing, Swanson states the activities that can be performed include refraining from making assumptions regarding the meaning associated with an event, focusing on the needs of the other person, performing an in-depth evaluation, looking for non-verbal and verbal cues, and engaging oneself and the other person (Peterson & Bredow, 2016). A similar approach is used to describe other concepts. For example, being with encompasses emotional presence, sharing feelings with the other person and checking to ensure that the one offering care does not pose a burden on the one receiving care. Doing for is defined as doing for the other person what he/she would do for him/herself if they had the capability to do so. Doing for entails providing care that can be described as anticipatory, protective, and comforting. It also involves undertaking ones duties in a competent and skillful manner while at the same time upholding the dignity of the person being cared for. Swanson even developed a psychometric scale for measuring these concepts Caring Mater/Caring Other Scale.
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Interpretation of the Concepts
The concepts in Swansons theory are outlined explicitly. In her work, Swanson provided the definition of key terms to illustrate how her key notions should be viewed. For instance, knowing is defined as endeavoring to understand an event because it is meaningful in the life of another person. Being with is described as being present emotionally for the other person through expressing continuing availability, sharing feelings with them, and checking to ensure that the care does not appear to be cumbersome. Doing for is explained as doing for the other person what he/she would do for him/herself if they could. Enabling is presented as helping the other person to transition through life stages and unfamiliar events through thinking over the problems, coming up with alternatives, supporting them, focusing on pertinent concerns, informing them, and explaining (Smith & Liehr, 2014). Maintaining belief is outlined as maintaining faith in the capacity of the other person to get through a transition or an event and face the future with a purpose. Maintaining belief has the main aim of convincing the person that, despite the constraints that they are facing, they can find meaning and have hope. Based on these processes, caring in nursing hinges upon the belief in people including their capacities. Thus, caring refers to a nurturing way of relating to another individual in a way that they feel a personal sense of responsibility.
Relationships among Major Concepts
The processes of caring in Swansons theory follow a logical order as depicted in Figure 1. Caring commences with maintaining belief, which means the philosophical attitude of the nurses towards persons in general and the patient in particular. The second step in the process of caring is knowing, which involves nurses having informed understanding of the client in particular and the general clinical condition (Butts et al., 2015). The third step is being with, wherein the message is conveyed to the patient. Doing for and enabling are the fourth and fifth steps respectively, which comprise therapeutic actions.
All assumptions of the research are stated explicitly in Swansons theory. The first one is that caring is an important aspect of the nurse-patient relationship in any practice setting. The second assumption of the theory is that caring takes place in every nurse-patient relationship typified by the skillful application of the processes of caring including maintaining belief, knowing, being with, doing for, and enabling. Another assumption of Swansons theory is that, irrespective of the experience of the nurse, caring is determined by the attitude of the nurse (maintaining belief), understanding the experience of the patient (knowing), non-verbal and verbal interactions with the patient (being with), enabling (the belief in the patients capacity to sail through difficult times), and the outcomes of caring (the expected results associated with the process of nursing) (Peterson & Bredow, 2016). Another assumption of Swansons theory is that there is an overlapping and coexistence of caring processes; thus, caring processes cannot be provided linearly or in isolation from one another. Finally, Swanson posits that the process of caring should be observed in any circumstance wherein caring is considered a component of interpersonal relationship (Smith & Liehr, 2014).
Four Concepts of the Nursing Metaparadigm
Swansons theory contains an explanation of the four concepts outlined in the nursing metaparadigm including nursing, person, health, and environment. In the theory, nursing is described as informed caring for the well-being of other people. Swanson states that scientific knowledge obtained from nursing and other non-nursing related fields provide the foundation for the nursing discipline. Also, nursing benefits from the knowledge gained from cultural beliefs and values, clinical practice, and humanities (Peterson & Bredow, 2016). The concept of person in Swansons theory is described as a unique being in the process of becoming, whose wholeness is manifested in their behaviors, feelings, and thoughts. Swanson believes that experiences in each persons life are determined by a mix of various factors including spiritual endowment, genetics, and the capacity of the individual to exercise free will. Therefore, the environment shapes the person and is at the same time shaped by the person (Peterson & Bredow, 2016). Persons are perceived to have a desire to connect with others, be self-reflecting, growing, and dynamic. They are also spiritual entities. The other person in this theory denotes an individual who is served by the nursing discipline and can extend to include even societies, groups, and families. Given this conceptualization of personhood, nurses have an obligation to advocate for equal healthcare access, human rights, and other altruistic causes (Peterson & Bredow, 2016). Finally, when nurses serve the other person whom they are caring for, they should also think of themselves, other nurses, and the nursing practice as the recipients of their caring.
With regard to the concept of health, Swanson contests that experiencing well-being and health is akin to having a subjective and meaningful state associated with wholeness and typified by a sense of becoming and integration in which all levels of being can be expressed freely. It includes sexuality, masculinity, femininity, relatedness, creativity, intelligence, feelings, thoughts, creativity, and spirituality among others (Alligood, 2014). As a result, restoring wholeness is characterized by a complex process involving healing and caring at various levels such as spiritual, psychosocial, mental, and physical.
In this theory, the environment is defined as being situational instead of physical; thus, the environment is viewed as any type of situation. The client also has a significant influence on the environment. Another important point is that the environment is dynamic and constantly changes in the economic, political, biophysical, social, and cultural dimensions. The environment also varies depending on the influences of the patient. Swanson believes that the terms patient/client/person and environment can be used interchangeably. Additionally, the environment might be specified at the intra-individual level of the particular patient, wherein the patient can be the cellular domain (Smith & Liehr, 2014). In this case, the environment can be body tissue in which the cell is located. Conversely, the patient can be perceived as an entire community including the political, social, and cultural elements. Thus, when using Swansons caring theory in practice or research, one should take into consideration the opinion that an environment in a particular situation might be a patient in another situation.
Clarity of the Theory
The structural components of Swansons theory including the explanations of their relationships are rather straightforward and can be comprehended with ease. She elucidates that the environment is akin to an ecological model having nested levels both outside and within the patient (Alligood, 2014). She also explains the manner in which these environments interact with one another. Such a conceptualization is crucial in clarifying that the environment and the patient might be actually the same entity in some settings. This theory has been described as simple, which explains its popularity (Peterson & Bredow, 2016). The theory also has consistency and lucidness. The manner in which the structural components are described and defined, as well as their relations, are clear and logical.
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Guiding Nursing Actions
The theory depicts caring in nursing as a human attribute and provides a description of the ways nurses can practice caring for patients in their environment. Essentially, the caring processes outlined in the theory can be helpful in guiding healthcare interactions as well as intervention programs (Alligood, 2014). Additionally, these actions can be used for conducting nurse-patient interactions. This theory emphasizes the importance of nurses recognizing how their interactions can impact the environment as well as the patients overall well-being.
Application in Practice
A useful theory is one that offers a sense of applicability to clinical practice. In this respect, Swansons caring philosophy provides a useful framework for practical application. This theory can be utilized in communication with patients and their family (Peterson & Bredow, 2016). A notable implication of this theory in practice is that, when communicating with a patient, a nurse must be present to convey the message that he/she is genuinely concerned about the well-being of the patient (Butts et al., 2015). Another important practice implication of this theory is that nurses should understand the distinctive experience of each patient for them to be able to appreciate the exceptional meanings that a patient attaches to his/her social-environmental interactions, nurse-patient interactions, and how the patient defines well-being and health.
Swansons theory of caring is useful in the nursing practice. Swanson developed the idea that caring was at the core of nursing from the early years of her career. This principle was reinforced by her mentors, her clinical practice, and the findings she discovered after conducting phenomenological research studies. This theory has clarity in the sense that it is simple and easy to understand, which can be attributed to the fact that its structural components and concept definitions are described clearly and used consistently. The relationships between the concepts are also presented in a logical order. Overall, it can be stated that Swansons theory depicts a comprehensive approach to the process of caring that concurs with the mission and values of nursing. Structural components are described distinctly, which makes the theory applicable and understandable.