Nursing theory drew much attention in the last century, and it continues to drive professional expansion and growth in nursing today. This text covers some of the theorists in the field of nursing, and their works. The nurses of the past provided great healing service to patients; however, much of the knowledge they passed down was mainly functional and skills based (Alligood, n.d.). While several of the practices were quite effective, they weren't grounded on solid evidence or widely tested. Their usage was also not uniform across the board. The twentieth century saw leaders in the nursing industry seek to develop nursing theory and knowledge to guide nursing practice, improve the quality of patient care, and improve the stature of nursing as a profession. A -- Mid-Range Theory -- Theory of Caring by Kristen Swanson

Background of the Theorist

Kristen M. Swanson is a distinguished academician that has worked as the Dean of School of Nursing, and served as a distinguished professor at Chapel Hill's University of North Carolina. She is an alumnus of University of Rhode Island, University of Pennsylvania, and the University of Colorado, where she earned her Ph.D. In 1978 in psychosocial nursing (Samuels, 2012).

The theory Dr. Swanson put forth was developed empirically through studies done in different perinatal environments in the eighties, and later refined in the nineties. The theories presented by Swanson have been adopted by various hospitals to guide their nurses' practice. Swanson continues to consult internationally.

Swanson's efforts began with a simple patient-centered question - "what does it feel like to miscarry?" Swanson's postdoctoral work was done at a neonatal intensive care unit (NICU); this context was chosen because it was there that Swanson had delivered her second child (Samuels, 2012). Swanson formulated concepts as she began her study; with the progress of her research, the five theoretical categories of caring were honed. With application of these precepts in various environments, her theories have so far matured but the concepts remain intact (Samuels, 2012).

2. Work of Theorist and other Authors

The five caring processes, Swanson says, aren't specific to nursing only but can be applied to a broad range of caring relationships. Nonetheless, as far as nursing is concerned, guidance is given on what is deemed 'central caring behaviors' that a nurse should take part in. Swanson's theories help in facilitation of caring behaviors in the daily practice of nurses. Her theory makes a basic proposition that both the nurse and the person cared for are involved in a caring relationship; therefore the interaction should be beneficial to both of them.

Noddings (1984) made a philosophical analysis of caring: that the motivation for caring is resolving another person's discomfort, because the individual 'carer' has allowed himself or herself to be engrossed in another's plight. 'Engrossment" as used by Noddings (1984) denotes willful acceptance of, and entrance into another person's reality.

Benner and Wrubel (1989) hold the same belief as Noddings and say that caring is essential for one to intervene on another's behalf. They also make a claim that the area focused on shall be defined by the caring of the nurse.

Another thought leader, Gilligan (1982), notes that connectedness and caring both have ethical perspectives. Nurses have to apply their ethical attitudes in their dealings with clients and have to differentiate what is wrong from what is right.

3. Concerns or Problems addressed by the Theory

The theory considers 'caring' as being grounded in understanding and/or empathizing with another person's reality. The anchor of caring is 'knowing', and this is shown by 'doing for', "being with' and through 'enabling' (Swanson, 1993, p. 354).'Knowing' involves eliminating assumptions and actually seeking to comprehend how an event (such as an illness) affects another person's reality. The concept emphasizes genuine concern for the well being of the client and showing empathy. The caregiver ought to step into the shoes of the client and experience their reality.

'Being With' in terms of nursing refers to being available emotionally as a means of sharing emotions and experiences. This transcends just being there physically. (Swanson, 1998, p. 355). 'Doing For' is doing for another person something that they would do if the capability was there and may include actions that involve protection and the preservation of dignity (Swanson, 1998, p. 356).

'Enabling' assists the patients to care for themselves. It involves facilitating another person's journey through life and may include coaching, giving explanations, informing, and giving support. It also involves giving good guidance in the way of feedback and providing validation (Swanson, 1988, p. 356).

The structure of the theory is consistent with the definition the author gives caring. Caring is defined as "nurturing way of relating to a valued other person, towards whom one feels a personal sense of...

165). (Samuels, 2012).
B. Theory Description

Inductive Reasoning

'Women's care' is an adaptation of Swanson's Theory of Caring (1991) and includes Swanson's five processes that are characteristic of caring. Swanson's theory was developed and refined based on evidence derived from practice.

Major Concepts of Theory of Caring

The five concepts of Swanson's theory include: 'Knowing', 'Being With', 'Doing For', 'Enabling' and 'Maintaining Belief': these are central to the theory.

'Knowing' involves seeking to comprehend how an event affects the life of another person. Assumptions are not to be made, but earnest effort ought to be made to understand the person being cared for as an individual. The caregiver should look for cues that can aid efficient communication between him/her and the cared for person. Through effective communication, the patient can translate their experience to the caregiver and so he/she can figure out the best way to care for them.

'Being With' implies presence. The presence implied isn't just physical presence but also emotional presence and giving oneself fully to another by way of open communication, empathy, and listening. Effective listening involves correctly interpreting what the patient may imply through non-verbal cues (Anderson, 2008).

'Doing For' involves doing for the other person what they would do for themselves were they capable of doing it themselves. It involves skillfully doing what they need done. The caregiver should also be able to anticipate the needs of the client and take the necessary action before they ask for it.

Also addressed by the theory is the concept of 'enabling' which is basically facilitating another person's life journey and also the concept of 'maintaining belief' which entails fulfilling expectations with life realities.

Explicit or Implicit

Swanson's theory has been explicitly explained and very little doubt is left in terms of clarity. Nonetheless, its application can be complex depending on the environment of its application. On a macro level, the concepts become fluid when considering the needs of big organizations like the World Health Organization (WHO). On a micro level, its application is more manageable but may vary depending on the complexities and the seriousness as well as risks involved in a caring environment.

Relationship among the Major Concepts

The relationships to be taken into account according to Swanson are persons, nursing, environment, and health/well being. Persons refer to individuals or groups of individuals or societies.

Environment is important in caring. The influence of biophysical, social, psychological, spiritual, economic, cultural, and political environments need to be taken into account (1993, p 353).

Health and well-being are some of the relationships attached to the theory. The five principles contribute greatly in assisting the client get, maintain, and regain their optimal living level (Swanson, 1993, p. 353).

Finally, Swanson discusses the relationship between informed caring and nursing. Swanson makes clarifications that informed caring can span from novice level to the level of an expert; she felt that the practice of nurses is based on nursing knowledge, knowledge of humanities, personal experience, and personal insight.

Evaluation

Clarity: the theory clearly draws the boundaries between the caring subcategories and gives examples of caring conduct that meets the processes and so reduces the risk of being ambiguous (Samuels, 2012).

Consistency: the theory's concepts have remained consistent over time. Their flexibility and ability to fit in various caring needs has been helpful. Nursing practice has continued to evolve, but the theory's ability to remain consistent has allowed for it to be easily recognized and so easily applied by caregivers.

Complexity: the theory is easily understandable and this has made it easy to apply in a wide range of environments and by various professionals of different skill levels. The boundaries between the various subcategories have been clearly drawn and this eliminates the guesswork and the complexity.

Application: the theory has gone beyond the primary environment of its conception -- prenatal context -- and can now be applied to a wide variety of caring contexts including dementia, home care, mental disorders, palliative care, and many others (Samuels, 2012).

Accessibility: the wide applicability of the theory has made it widely accessible in several settings and so it is a preferred option among health care givers (Samuels, 2012).

Four meta-paradigms concepts of nursing

The definition Swanson gave to humans appreciates the fact that humans are in the process of becoming; for individuals, experience is wrapped in feelings, behaviors and thoughts. This approach draws from the definition given by Wagner, but adds the concept of spiritual connection…