April 25, 2020
Theory of Caring by Swanson 1991 Background
Nowadays much attention is paid to the depiction and assessment of various theories, which explain caring. The current work is focused on the description and evaluation of the theory of caring introduced by Kristen M. Swanson in 1991. This theory has a strong theoretical background. Moreover, it is based on a real-life study with the participation of patients and health care providers. The major emphasis will be made on providing the background of the theory formation, description, evaluation, and its application in health care providing institutions. Precise consideration of Swanson’s theory of caring from different standpoints and analysis of its characteristics enable to obtain a clear vision of this theory and its relevance in the real world.
Theorist’s Background and Factors which Have Impacted the Theory Development
Swanson (1991) based her theory on the recognition of caring as the central element of nursing practice. Nurses provide care to individuals “experiencing actual or potential health deviations” (Swanson, 1991, p. 161). Ministration is administered until the individual can care about himself independently.
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Swanson (1991) based her understanding of caring by analysis of descriptions provided by different researchers. Noddings (1984 in Swanson 1991) stated that caring represents the motivated actions of caregivers to resolve and improve the discomfort of others “as a result of having let the self-become engrossed in the other’s plight” (Swanson, 1991, p. 161). Benner and Wrubel supported this idea and emphasized that nursing care is more focused on the individual’s stress and coping needs (Swanson, 1991). Gilligan (1982 in Swanson, 1991) in her studies views caring as the reflection of morality and ethics. Ray defined critical caring expression of nurses as technical competence, transpersonal caring, maturation, ethics, and communication (Swanson, 1991). In such a manner, Gilligan and Ray noted the enormous importance of ethics in caring.
The additional attention should be paid to the identification f caring acts performed by various researchers. As per studies performed by Brown, Riemen, and Larson, nursing care could be characterized as proactive, person-centered, physically comforting, anticipatory, and coming beyond the common care (Swanson, 1991). At the same time, there are significant discrepancies in the understanding of care by nurses and patients. These discrepancies were first noted by Larson (Swanson, 1991) who stated that caregivers consider that they were valued for psychological support when patients paid more attention to physical ministration. All the introduced ideas did not provide a clear definition and conceptualization of caring.
Such factors as the separation of studying of caring, gender, and application of the phenomenological method introduced by Swanson-Kauffman and Schonwald had an impact on the development of the theory (Swanson, 1991). Separation of caring is reflected in the division of participants of the study into three groups: miscarried, a caregiver from the intensive care unit and parents who rendered care, and individuals who obtained long-term intensive public health intervention from nurses. All the participants were females. The applied phenomenological method was based on the sequential execution of bracketing, intuition, analysis, and description (Swanson, 1991). Bracketing is reflected by conscious attempts of the researcher to be critical, and be aware of personal bias and its influence on the investigation. Intuition results in the openness of the researcher to the reflections of the studied phenomenon. The analysis concerns the elicitation, documentation, coding, and categorization of empirical accounts. The last phase undermines definition and supported by sufficient information. These factors formed the framework of the introduced caring theory by enabling to identify the major dimensions and sub-dimensions of the caring process
Examination of References
Swanson (1991) based the theory on the researches of caring performed by other scientists. They provide the overwhelming explanation of ministration and its major characteristics. The majority of sources are from peer-reviewed journals. This provides an understanding of the reliability of used literature and made conclusions.
Tonges & Ray (2011) also based their study on Swanson’s theory of nursing. They have applied the major concepts of this theory in real health care providing institutions for guiding the caring practices and improving the quality of provided services. The reliability and relevance of this research are based on the fact that it was published in the peer-reviewed journal only 5 years ago.
Problem Addressed by Theory
The theory of Caring introduced by Swanson addresses the existing concern about the definition of nursing care and its major categories. Swanson (1991) critically analyzed the existing considerations of caring, assessed the outcomes of special research, and provided a clear and coherent explanation of caring and its integral parts.
There are three different types of reasoning: deductive, inductive, and reproductive (also known as abductive). Deductive reasoning includes hypotheses and the examination of the observations to support or reject these hypotheses (Bradford, 2015). Inductive reasoning provides a broad generalization of the observations for inferring explanations and stating theories (Bradford, 2015). Abductive reasoning has its roots in making and analyzing hypotheses on the basis of an incomplete set of best available information and observations (Bradford, 2015).
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The discussed theory uses inductive reasoning. Firstly, the author of the theory noted the application of this reasoning in the description of the research: “the purpose of this study id to describe the inductive development and refinement of a factor-naming theory” (Swanson, 1991, p. 161). Secondly, Swanson (1991) provides the definition of the theory of caring and its major categories on the background of performed observations and their analysis. In such a manner, making observations was the primary phase, when the development of the theory was the second phase. This aligns with the course of actions of inductive reasoning.
The Major Concepts of the Theory
The major concepts of the theory are represented by caring and its categories: “knowing, being with, doing for, enabling, and maintaining belief” (Swanson, 1991, p. 163). Knowing is the desire to understand the events and their meaning in the lives of patients. This definition aligns with Nodding’s consideration of caring as the reflection of teaching and “apprehending the other’s reality” (Swanson, 1991, p. 163). The second category of “being with” is explained by emotional sharing and openness between the caregiver and the patient (Swanson, 1991). Noddings (1984 in Swanson, 1991) also considered this category as engrossment in the other individual (Swanson, 1991). The category of “doing for” undermines doing for the other (i.e. rendering such care) that the caregiver would render to himself. The similar aspect of caregiving was described by Bowers and Noddings (1984 in Swanson, 1991). The next category of “enabling” undermines facilitating the patients’ passage through unfamiliar life events for the stipulation of personal ability to heal and perform self-care (Swanson, 1991, p. 164). Meyerhoff (1957 Swanson, 1991) in his researchers noted this aspect of caring as helping patients to grow and actualize themselves (Swanson, 1991). The concept of maintaining belief undermines the support of patients’ belief in a personal capacity to get through the difficulties (Swanson, 1991). Noddings (1984 in Swanson, 1991) depicted this category as being sensitive to others’ ideas of perfection as well as promoting these ideals. Moreover, Swanson’s categories of caring could have derived from Benner’s helping roles of nurses and Watson’s carative factors (Swanson, 1991).
The explanation of these categories forms the background for understanding the notion of ‘caring’. Swanson (1991) defined it as a “nurturing way of relating to a valued other toward whom one feels a personal sense of commitment and responsibility” (Swanson, 1991, p. 165). This definition aligns with Gaut’s (1983 in Swanson, 1991) idea that caring comprises personal attention, responsibility, regard, and attachment. Swanson’s explanation of caring also consistent with Cobb’s definition of social support: being cared, loved, valued, esteemed, and belonging to the chain of mutual obligations without the expectation of reciprocating (Swanson, 1991)
Described concepts are defined both operationally and theoretically. The operational definition refers to the understanding of the concept in a particular work when theoretical definition evolved from the works of other researchers who studied the theory of caring (Carolyn, Strickland & Strickland, 2010). The first one enables one to focus on meaning, while the second provides a broader explanation. Swanson (1991) provided the operational definition, explained it and supplemented it by the theoretical definition and explanation of the concept given by other authors.
Notably, the definition of caring has derived only after clarification of its categories. This order follows a logical pattern because Swanson (1991) explained the composing parts of caring and only then generalized them in the form of theory definition. Swanson (1991) is totally consistent in the use of categories and explanations of the caring theory.
The concepts and theory are defined explicitly, i.e. the author provided a clear explanation. Categories of caring are strongly linked with each other and support each other. Swanson (1993) stated that the five caring processes represent the common and integral features of caring relationships between caregivers and patients. In the definition of caring “nurturing” refers to growth and health productivity, “way of relations” represents established relationships between the caregiver and patient, “toward whom one feels a personal” shows the individualized character of ministration, “sense of commitment” reflects passion, and “responsibility” is the accountability and duty of a health care provider.
These categories represent overlapping proceses that compose the single over-arching phenomenon of caring.
Explicit and Implicit Assumptions
The theory of caring by Swanson is based on both explicit and implicit assumptions. The explicit assumptions are represented by well-being and nurses (Swanson, 1993). Well-being means living in a state when the person feels dully integrated into his life and death (Swanson, 1993). The establishment of well-being is associated with the ability of safe space, acquisition of information, and release of emotions. Nurses are individuals who “diagnose and treat human responses to actual or potential health problems” (Swanson, 1993, p. 353). Therapeutic practices of these health care providers are based on the combination of knowledge of their profession and related sciences, humanities, experimental understanding, and personal insights (Swanson, 1993). This mix enables to enhance the well-being of patients/
The implicit assumptions of the developed theory of caring are the following include persons/clients, environment, health/well-being (Swanson, 1993). Persons/clients are individuals with unique life experiences whose wholeness is manifested by their thoughts, behaviors, and feelings (Swanson, 1993). The wholeness is constantly changing because people are seeking self-reflection, growth, and interaction with others. Moreover, they are influenced by the outer environment. Spiritual endowment connects each individual with the universal source of life, mystery, and creativity (Swanson, 1993). The examples of the spiritual endowment are soul, higher power, grace, and positive energy. Each person/client expresses free will by making a decision about how to act when they have several possibilities of action.
The definition of environment is implicit because it depends on various factors, like the person who considers it (health care provider or patient), realm, persona demands, constraints and resources, and current considerations (Swanson, 1993). The examples of realms include social, cultural, political, psychological, spiritual, biophysical, and economic ones (Swanson, 1993). The additional attention should be paid to the fact that in some health care providing institutions community is considered as the client. Health can be viewed as an “absence of illness, ability to perform personal roles, capacity to adapt, and as the pursuit of eudemonistic well-being” (Swanson, 1993, p. 353). Social, political, economic and cultural factors have a direct impact on this phenomenon.
Four Metaparadigm Concepts of Nursing and Theory of Caring by Swanson
The essence of nursing is represented by its meta-paradigms: nursing, environment, person, and health (Current Nursing, 2012). Nursing is represented by the combination of actions, attributes, and characteristics of the caregiver. The environment is considered both internal and external conditions and influences, which affect the physical and psychological state of individuals. A person is defined as the recipient of ministration (either an individual or community). In this definition, ministration comprises physical, psychological, cultural, and spiritual care. Health refers to the extent of wellness or illness of the person.
Swanson (1993) provides a clear definition of nursing as diagnosing and treating personal response to potential and actual issues. It is considered as the act of ministration to assure the patient’s well-being. Caregiving is based on knowledge of nursing-related disciplines (for example, humanities), experimental understandings and personal insights (Swanson, 1993).
Swanson (1993) defined the environment as situational and depending on the position of an individual who makes this definition and realms noted above. For health care providers, the environment in the context of influences, which affect the physical and psychological state of the patient. Consequently, the environment may be inside and outside the individual’s mind and body.
According to Swanson (1993), persons are unique personalities who have inimitable life experience, and wholeness of manifestation of their ideas, feelings, and behaviors. The researcher made an emphasis on the fact that people are spiritually connected with the universal source of life, mystery, and goodness (Swanson, 1993). In her understanding, spirituality may be represented as soul, higher power, grace, and positive energy. Individuals have the capacity to exercise their free will
The researcher provided a clear explanation. This condition has such inherent attributes as the ability to perform roles, absence of illness, ability to adapt and persuasion of well-being (Swanson, 1993). Health is associated with the individuals’ wholeness, i.e. “a sense of integration and becoming wherein all facets of being are free to be expressed” (Swanson, 1993, p. 353). The described facets incorporate spirituality, sexuality, intelligence, etc (Swanson, 1993).
Discussion of the Clarity of the Theory
Swanson (991) gave a clear definition and an explanation of her theory of caring. The researcher provided numerous examples, which help to understand introduced terms and concepts. The theory of caring by Swanson is introduced in a consistent manner. The author presented previous theoretical considerations, described the methodology of the research and the analysis of observations, discussed the obtained outcomes and made conclusions in the form of a clear definition of caring and its major categories. The presentation of the theory is logically coherent.
The Theory of Caring by Swanson provides understandable and easily applicable guidelines for nursing practice. The example of ministration actions, which can be incorporated into the nursing work, is introduced in Figure 2. These practices were carried out in University in North Carolina Hospitals (Tonges, 2011)
For example, such categories of nursing as “being with” and “doing for” serve as the guidelines for the performance of hourly rounds (Tonges, 2011). These actions assure that patients’ needs are met and addressed in due time. The patients feel more secure and the quality of ministration is increased. The same categories of Swanson’s caring theory form the background for “no passing zone” actions. These actions undermine “no passes by patients’ call light regardless of the specific assignment for patient care” (Tonges, 2011, p. 377).
Application of the Theory in the Personal Area of Nursing
The concepts introduced in Swanson’s theory of nursing can be applied to real-life situations in medical-surgical floors of health care providing institutions to respond to medical errors. Swanson’s theory of caring undermines making blameless apology (Tonges, 2011). Caregivers can apologize by acknowledging an error, providing a clear understanding of what happened, stating negative consequences, taking responsibility, interacting with patients and parents, and initiating actions for correcting the issue. Health care providers should address patients’ concerns and assure that they would do everything possible to improve patients’ physical and psychological state. Blameless apology, in this case, refers to such concepts of Swanson’s caring theory as being with and enabling (Tonges, 2011).
To conclude, the current work provides a clear understanding of Swanson’s theory of caring and the possibility of its application in modern health care providing institutions. Swanson (1991) formed her theory on the strong theoretical background developed by such researchers as Noddings, Gilligan, Ray, Brown, Riemen, Larson, etc. The presented theory is also based on practical investigations of perception of ministration by patients and nurses. The combination of theoretical knowledge and analysis of observations enabled to develop the definition of caring and its major categories. These categories include knowing, being with, doing for, enabling, and maintaining belief. The theory and concepts are presented in a coherent and logical manner. The theory of caring was developed with the help of explicit and implicit assumptions. It aligns with four metaparadigm concepts of nursing. The introduced theory can serve as guidance for nursing practice in health care providing institutions, and particularly in surgical floors.
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