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Nursing as Informed Caring for the Well-Being of Others

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Nursing as Informed Caring for the Well-Being of Others Swanson, K.M. (1993). Nursing as Informed Caring for the Well-Being of Others. Image, 25(4), 352-357. – PowerPoint PPT presentation

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Title: Nursing as Informed Caring for the Well-Being of Others


1
A Theory of Caring
Theory Critique and Presentation Jessica
Brandt Kara Rasplica Brita Hanson Hali
Saucier Kristi Eilers
  • Kristen M. Swanson

2
Background
  • Empirical Development of a Middle Range Theory of
    Caring
  • Swanson, K.M. (1991). Empirical Development of a
    Middle Range Theory of Caring. Nursing Research,
    40(3), 161-166.
  • Nursing as Informed Caring for the Well-Being of
    Others
  • Swanson, K.M. (1993). Nursing as Informed Caring
    for the Well-Being of Others. Image, 25(4),
    352-357.

3
Background
  • What are the perceptions of care givers, care
    receivers, and care observers regarding caring?
  • Previous research had studied other aspects of
    caring-
  • Noddings (1984)
  • Benner Wrubel (1989)
  • Gilligan (1982)
  • Ray (1987)
  • Larson (1984)
  • Watson (1988)

4
Background
  • Theory of Caring involved three research
    studies-
  • Caring and Miscarriage
  • What are the caring behaviors of others that
    are identified as helpful by women who have
    miscarried?
  • What constitutes caring in the instance of
    miscarriage?
  • Caring in the Newborn Intensive Care Unit
  • What is it like to be a provider of care in the
    Newborn Intensive Care Unit (NICU)?
  • Caring and the Clinical Nursing Models Project
  • How do recipients of a long-term intensive
    nursing intervention recall and describe the
    nurse-patient relationship four years post
    intervention?

5
Background
  • Five Caring Processes
  • Knowing Avoiding assumptions, centering on
    person cared for, assessing thoroughly, seeking
    clues, engaging both
  • Being With Being there, conveying ability,
    sharing feelings, not-burdening
  • Doing For Comforting, anticipating, performing
    skillfully, protecting, preserving dignity
  • Enabling Informing/explaining,
    supporting/allowing, focusing, generating
    alternatives, validating/feedback
  • Maintaining Belief believing in, holding in
    esteem, maintaining hope-filled attitude,
    offering realistic optimism, going the distance

6
Background
  • Later work Informed Caring aimed to provide
    structure for relating the five caring processes
    and describe assumptions about the four main
    phenomena of concern to nursing
  • Persons/Clients
  • Health/Well being
  • Environments
  • Nursing

7
Background
  • Persons/Clients-
  • Unique and are in the process of developing. Are
    continually growing and seeking to connect with
    others.
  • Health/Well Being-
  • Living life connected and engaged
  • Environments-
  • Influences and/or influenced by client
  • Nursing-
  • Purpose is both the ANA description of diagnose
    and treat human responses to actual or potential
    health problems but also greater than this is an
    integration of science, concern for humanity, and
    caring.

8
Background
  • Relates the Five Caring Processes as first
    grounded in the maintenance of a belief in human
    kind, anchored by knowing anothers reality,
    conveyed by being with, and enacted through dong
    for and enabling.

9
Background
  • Dr. Jacqueline Fawcett (Masters degree studies
    at University of Pennsylvania, 1978)
  • During this time she notes that she realized
    that caring for others was very congruent with
    her values.
  • Dr. Jean Watson (Doctoral degree studies at
    University of Colorado, 1983)
  • Chose Dr. Watson as her mentor specifically to
    explore the concept of caring.
  • Dr. Kathryn E. Barnard (Post-Doctoral fellowship
    at University of Washington, 1985-1987)
  • Helped Swanson to transition from interpretive
    research to intervention research.
  • Mothers support group-Reality of the fragility
    of life profoundly touched me

10
Background
  • Development of theory-
  • Empirically derived through phenomenological
    inquiry and inductive methodology.
  • What this means is that care givers, receivers,
    and observers were asked about their perceptions
    of caring, and hypotheses/relationships were then
    induced.
  • Evidence for this is Swanson her selfs
    explanation along with other scholars (Wojnar,
    Lo-Biondo-Wood, Haber).

11
Assumptions
  • Persons/Clients
  • Unique beings becoming whole (Swanson 1991,
    Swanson 1993)
  • Manifest wholeness through behaviors, thoughts,
    feelings (Ryden 1998, Swanson 1993)
  • Molded by environment
  • Spiritual endowment soul, higher power,
    positive energy, grace (Swanson 1993)
  • Free will to choose from a range of possibilities
    (Swanson 1993)
  • Each does not have equal choices
  • Environment
  • Forces that exert influence upon or are
    influenced by the patient (Hanson 2004, Swanson
    1993)
  • Cultural, economical, political, spiritual,
    social, psychological, biophysical realms
    (Swanson 1993)
  • Disturbance or change in environment or realms
    will affect the wholeness of the other

12
Assumptions
  • Health/Well-Being
  • Living in such a state that one feels integrated
    and engaged with living and dying (Swanson 1993)
  • Health includes connecting with others and
    creating lasting human bonds
  • Depends on free expression (Swanson 1991, Swanson
    1993)
  • Spirituality, thoughts, feelings, intelligence,
    creativity, etc.
  • Well-being is negatively affected by actions of
    individuals upon the other that inhibit
    expression of wholeness
  • Nursing
  • Affected by Benners Novice to Expert (Swanson
    1993)
  • Focus on the overall well-being/wholeness of
    other (Swanson, 1993)
  • Providers must be informed regarding common
    responses to health problems (Hanson 2004)
  • Past experiences increase care given by nurse
  • Includes evidence-based practices, compassion,
    understanding of other, structure of caring
    (Swanson 1991), understanding of nursing
    profession

13
Swanson Spiritual Humanism
  • Humans are individuals able to think for
    themselves
  • Humans make reasoned decisions
  • An understanding of the world is based upon
    collecting information through the senses
  • Humans are not critical of the source of ideas
  • Human knowledge is not perfect
  • Human values must be placed in the context of
    current existing human life
  • Ethical decisions are based on human
    needs/concerns not the needs of other powers
  • Humans understand that ethical dilemmas are
    situational difficult

14
Spirituality as Part of Humanism
  • Swanson Life of an individual is affected by a
    spiritual endowment
  • Brings goodness, mystery, life, creativity,
    serenity
  • Takes the form of a soul, higher power, positive
    energy, or grace
  • Can be fulfilled by the presence of caregivers
    providing informed care
  • Humanism People are to be appreciated as they
    are as their own beings
  • Are not to be used for purposes of others
  • Need will be met through the contemplation of
    beauty, through the support warmth of the human
    bond, through heightened exhilarated moments of
    joy (Chuman 1992)

15
Metaparadigm
  • Persons/clients
  • Individuals including self other nurses,
    families, groups and societies.
  • unique beings who are in the midst of becoming
    and whose wholeness is made manifest in thoughts,
    feelings, and behaviors (Swanson, 1993)
  • Shaped by environment.
  • When personhood is understood, nurses are
    mandated to take on leadership role in the fight
    for humanitarian causes.
  • Environments
  • Shape clients.
  • Depending on the situation, either influences, or
    is influenced by, the person/client.

16
Metaparadigm
  • Health/Well-being
  • Re-establishing well-being is the process of
    healing and curing that renews wholeness.
  • Wholeness all facets of being are free to be
    expressed spirituality, thoughts, feelings,
    intelligence, creativity, relatedness,
    femininity, masculinity, sexuality.
  • Nursing
  • Informed caring for the well-being of others.
  • The convergence of empirical knowledge and
    personal knowledge that includes ethics, values,
    expectations and experiences.

17
Major Concepts
  • Caring
  • Environment
  • Health/Well-being
  • Nursing client
  • Presence
  • Knowing
  • Enabling
  • These concepts are defined theoretically,
    drawing on previous advances in the nursing
    literature.
  • Some of the concepts (like so many concepts in
    nursing) are in need of further development

18
Caring Defined
  • A nurturing way of relating to a valued other
  • toward whom one feels a
  • personal sense of commitment and
  • responsibility

Occurs in relationships
Growth and health producing
Individualized and intimate
Bond, pledge, or passion
Accountability and duty
Swanson 1991 1993
19
Caring Concept Analysis
  • Swanson acknowledged the lack of universal
    definition/conceptualization of caring.
  • Identified inconsistencies and unanswered
    questions.
  • Definition A nurturing way of relating to a
    valued other toward whom one has a personal sense
    of commitment and responsibility.
  • Defining Characteristics 5 caring processes
  • Antecedents relate to the 5 caring processes.
    Ex. In order to know the patient, the nurse must
    possess knowledge of self (Swanson, 1993).
  • Consequences
  • Enhanced patient well-being, smoother life
    transitions (Swanson, 1993)
  • Increased self-esteem, reduced emotional
    disturbance (Swanson, 1999)
  • Enhanced meaning of nurses caring efforts
    (Ryden, 1998).

20
Propositions
  • Maintaining belief is the foundation of caring
  • Knowing is the anchor that moors the beliefs of
    nurse/nursing to the lived reality of the patient
  • Being with is how the nurse conveys caring
  • Doing For and Enabling are the visible ways in
    which the nurse enacts caring
  • Categories of caring are not mutually exclusive
    (Swanson, 1991). Ex. Being with and doing for can
    occur simultaneously when the nurse takes time to
    brush the patients hair while they talk.

21
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22
Structure of Caring
Maintaining belief
23
Clarity of Theory
  • Theory gives definition to caring
  • Caring is a nurturing way of relating to a
    valued other toward whom one feels a personal
    sense of commitment and responsibility (Swanson,
    1991)
  • Provides clear definitions to 5 categories of
    theory.
  • Definitions further refined through 3 studies
  • Theory easily understood and linked to practice.
  • Conclusions mapped out in a logical way.
  • Pulled from interviews and past research.

24
Congruence of Theory
  • Each process stands on its own but some also help
    to build and define the others.
  • Being with is the next step after knowing
  • Knowing, being with, doing for, and enabling work
    together to have the path filled with meaning
    will be chosen and thereby meet the goal of
    maintaining belief.
  • Limitation in theory was to show relationship
    between all 5 processes.
  • Swanson recognized this limitation, and later
    worked to link all 5 processes in Nursing in
    Informed Caring for the Well-Being of Others.

25
Congruence cont.
  • Swansons theory congruent with others work to
    show validity beyond perinatal circumstances.
  • Benner Helping Role of Nursing
  • Watson Carative Factors
  • Cross-validates and gives reasoning for
    perception Benner Watsons nurturing or helpful.

26
Swanson, K.M. (1991). Empirical Development of a
Middle Range Theory of Caring. Nursing Research,
40(3), 161-166.
27
Level of Theory
  • Descriptive
  • Theory provides definition of caring and the five
    essential categories of processes that are
    proposed to characterized caring. (Swanson,
    1991)
  • Middle Range
  • Theory developed under the limited scope of
    perinatal situations.
  • Strong correlation between research and practice.

28
Nursing Actions
  • Theory can be used to better understand how to
    relate to patients.
  • Each process allows for a nurse to formulate an
    intervention to better care for a patient.

29
Using Swansons Theory
  • Patients/the Other with Dementia
  • Maintaining Belief Protection of reduction to
    object status
  • Knowing Awareness of research about growth
    development in later life
  • Being With Center presence on the other
  • Doing For Facilitate function even if not
    efficient for task completion
  • Enabling Presence, acceptance, empathic
    acknowledgment of feelings
  • Perinatal Context
  • Education
  • Caring for Peers

30
Testability
  • Does it work beyond the perinatal setting?
  • She tested herself via a literary meta-analysis
    on caring.
  • Others have tested it as welland it has held
    up.
  • Examples
  • Hanson, M. D. () Using Data from Critical Care
    Nurses to Validate Swansons Phenomenological
    Derived Middle Range Caring Theory. The Journal
    of Theory Construction Testing, 8(1), 21-25.
  • Used to describe how personal life-experiences
    impact the caring response in critical care
    nurses.
  • Ryden, M. B. (1998) A theory of caring and
    dementia. American Journal of Alzheimers
    Disease, 13, 203-207.
  • Explored the caring process in the context of
    those providing care to those suffering with
    dementia.

31
Testability
  • Further development
  • Theory of Informed Caring
  • The care recipients capacity to integrate a
    life event and experience a state of well being
    is enhanced by receiving caring from a provider
    who is informed about common human responses to a
    specific health problem.
  • Swanson is more interested in testing and
    application in practice than in further
    development.

32
Future
  • Yes, this is a theory for the future!
  • caring defines nursing
  • nursing is moving to be an evidence-based
    profession
  • Swansons theory created a conceptual framework
    to
  • elucidate a vague concept
  • allow a structure from which research could be
    done and practice can be based
  • there is so much more research that can be done
    regarding caring
  • can it be learned or is it inherent?
  • Does it work in settings other than nursing?

33
References
  • Alligood, M.R. Marriner-Tomey, A. (2006).
    Nursing Theorists and Their Work. 6th ed. City
    Elsevier Health Sciences.
  • Chuman, J. (1992). Humanism and spirituality.
    Humanism Today, 7, 37-48.
  • Edwords, F. (2008). The humanist philosophy in
    perspective. Retrieved November 7, 2008, from
    The American Humanist Association. Website
    http//www.americanhumanist.org/humanism/perspecti
    ve.php.
  • Hanson M.D. (2004). Using data from critical care
    nurses to validate Swansons phenomenological
    derived middle range caring theory. The Journal
    of Theory Construction and Testing, 8 (1), 21-25.
  • Jakobson P. (1998). Leader interview. Caring made
    visibleKristen M. Swanson. Creative Nursing, 4
    (4), 8-11, 16.
  • Ryden, M.B. (1998). A theory of caring and
    dementia. American Journal of Alzheimers Disease
    and Other Dementias, 13, 203-207.
  • Swanson, K.M. (1999). Effects of caring,
    measurement, and time on miscarriage impact and
    womens well-being. Nursing Research, 48 (6),
    288-298.
  • Swanson, K.M. (1991). Empirical development of a
    middle range theory of caring. Nursing Research,
    40(3), 161-166.
  • Swanson, K.M. (1993). Nursing as informed caring
    for the well-being of others. Image The Journal
    of Nursing Scholarship, 25(4), 352-357.
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