Caring Concept In Nursing

Afza.Malik GDA

Philosophy of Care

Caring Concept  In Nursing

What Is Caring, Literature Review About Caring . Meta Synthesis of Sherwood's, Smith's (2004) Review ,Watson's Compendium of Instruments , Future of Care In Nursing.

What Is Caring

     Caring has been identified as a central concept in the discipline of nursing. In the past 25 years theory and research on caring have grown steadily, contributing to a substantive body of knowledge that can be referred to as caring science. 

    While criticism has been levied against this body of literature for its lack of conceptual clarity, there seems to be a growing international consensus in nursing that knowledge about caring is key to understanding human health, healing, and quality of life. 

    One analysis (Morse, Bottorff, et al., 1991) elaborated five perspectives of caring in nursing literature as: 

(a) a human trait or condition of being human

(b) a moral imperative

(c) an affect 

(d ) an interpersonal interaction

(e) a therapeutic intervention. 

    In another. analysis of caring theory, Boykin and Schoenhafer (1990) argue for a multidimensional approach that poses ontological (meaning of caring), anthropological (meaning of being a caring person), and ontically (function and ethics of caring) questions to fully understand the concept. 

    Watson (2001) defined caring as an ontology, a way of being, or a quality of consciousness that potentiates healing. She also defined caring as an ethical or moral imperative for relating with the other in which the humanity of the person is preserved. 

    Swanson (1991) defined caring as "a nurturing way of relating to a valued other toward whom one feels a personal sense of commitment and responsibility". She identified five processes by which caring is activated: knowing, being with, doing for, enabling, and maintaining belief.

Literature Review About Caring 

    Three reviews of the research literature on caring have been published. Swanson (1999) summarized and categorized the research related to caring in nursing science and Sherwood (1997) reported a meta-synthesis of the qualitative research on caring. 

    Smith (2004) reviewed the research related to Watson's theory of human caring. Many different designs and methods have been used to investigate caring including descriptive qualitative designs, surveys, phenomenology, and quasi-experimental designs using standardized scales and physiological measurement.

    Swanson (1999) reviewed 130 databased articles, chapters, and books on caring published between 1980 and 1996. 

    The studies were categorized into five levels; the capacity for caring (characteristics of caring persons); concerns and commitments (beliefs or values that underlie nursing caring); conditions (what affects, enhances or inhibits the occurrence of caring); caring actions (what caring means to nurses and clients and what it looks like; and caring consequences (outcomes of caring). 

    In her summary of 30 qualitative studies that described outcomes of caring and noncaring relationships Swanson found that outcomes of caring for the recipients of care were: emotional and spiritual well-being ( dignity, self-control, personhood); enhanced healing and enhanced relationships. 

    Consequences of noncaring were humiliation, fear, and feeling out of control, desperate, helpless, alienated, and vulnerable. who care report a sense of personal and professional satisfaction and fulfillment while noncaring is related to outcomes of becoming hardened, oblivious, depressed, frightened, and worn down.

 Meta Synthesis of Sherwood's

    Sherwood's (1997) meta-synthesis of 16 qualitative studies revealed four patterns of nurse caring: interaction, knowledge, intentional response, and therapeutic outcomes. 

    Caring was defined within content, context, process, and therapeutic or healing outcomes. Two types of caring knowledge and skills were identified as person-centered and technical-physical.

Smith's (2004) Review 

    Smith (2004) reviewed 40 studies published between 1988 and 2003 that focused specifically on Watson's theory of transpersonal caring, four major categories of research were identified: the nature of nurse caring, nurse caring behaviors as perceived by clients and nurses, human experiences and caring needs, and evaluating outcomes of caring in nursing practice and education. 

    The highest number of studies were focused on nurse caring behaviors as perceived by clients or nurses. It is important to note that while patients rank behaviors such as knowledge and technological competence as the most important nurse caring behaviors, nurses rank behaviors such as presence, honoring dignity, and touch as most important. 

    These differences suggest that nurses do not consider competence with medical and technical skills within the realm of nurse caring behaviors, but patients do. Patient vulnerability and the "taken for granted" nature of the instrumental activities by nurses might explain the differences. 

    An expanding area of research is related to evaluating outcomes of caring. Research is indicating that caring based activities impact mood following miscarriage, patient satisfaction, pain and symptom distress in patients with cancer, well-being, and even blood pressure.

Watson's Compendium of Instruments

    Watson's (2002) compendium of instruments to assess and measure caring is an important contribution towards the advancement of research in the field. This text provides background on 21 instruments, citations of work in which they were used, and a copy of the tools. Some of these tools are: 

(a) the Caring Assessment Report Evaluation Q-sort (CARE-Q) to measure perceptions of nursing caring behavior

(b) the Caring Behavior Inventory (CBI) to measure that which is associated with the process of caring

(c) the Caring Behavior Assessment Tool (CBA) and the Caring Assessment Tool (CAT) to measure patient perceptions of nurse caring behaviors

(d) the Nyberg Caring Attribute Scale (CAS) to measure caring, attributes of nurses

(e) the Caring Efficacy Scale (CES) to measure the belief in one's ability to express a caring orientation and develop caring relationships.

Future of Care In Nursing 

    The future of research in caring is promising. An international community of scholars is actively building knowledge in caring science. The International Association for Human Caring (IAHC) meets annually to disseminate the work of its members and the International Journal in Human Caring publishes research and scholarship that expands caring science. 

    Scholars are examining the transtheoretical linkages between caring theories and other nursing conceptual systems (Watson & Smith, 2002). 

    Important research questions center on the relationship between caring and healing outcomes, the qualities of a caring consciousness, the ontological competencies and types of nursing therapeutics that are caring-based, and the types of environments and communities that facilitate caring. 

    Nursing is the discipline that is studying the relationship between caring relationships and healing. Research needs to move beyond examining caring in nurse-patient relationships to caring in relationships with family, friends, God, etc. and how these relationships affect health and healing outcomes. 

    It will be important to study both caregiver and recipient outcomes of caring theory-based models of practice in different settings. Swanson (1999) offered several suggestions for future research related to caring: developing measures of caring capacity, examining the effects of nurturing and experience on caring capacity, identifying and measuring the competing variables that may confound the links between caring actions and their outcomes.

    That moving from studying the individual as unit of analysis to studying aggregates, and developing clinical trials to test the effectiveness of caring-based therapeutics in promoting health and well-being. 

    Different designs and methods must be used to capture the emerging questions in the field. Multiple ways of knowing from empirics to aesthetics are required to explore all dimensions of caring phenomena. 

    A model of research that integrates these multiple perspectives and ways of knowing may be the preferred epistemological model for studying caring (Quinn, Smith, Ritenbaugh, Swanson, & Watson, 2003).

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