Running head: Nursing Theory Evaluation Paper
Nursing Theory Evaluation Paper
Theory of Caring: Kristen M. Swanson
Concordia University, Nebraska RN to BSN Nursing Program
For partial fulfillment of the requirements of NUR410
Professional Roles, Ethical Issues and Nursing Theories
Nicole Rea RNBC
March 23, 2013
Running head: Nursing Theory Evaluation Paper
Kristen Swanson earned her Baccalaureate degree in nursing from the University of
Rhode Island in 1975, in 1978 she graduated with her master’s degree in adult health and illness
nursing from Pennsylvania and finally she graduated with her PhD in psychosocial nursing from
the University of Colorado. As part of her doctorate study she participated in a cesarean birth
support group. It was here that she discovered that women really needed to talk about their own
experiences and pregnancy loss, so this became the topic of her dissertation and her program of
research. Her dissertation, The Unborn One: A profile of the Human Experience of Miscarriage
was developed to review and describe the human experience and the caring needs of those who
experience a miscarriage. For this dissertation she set out to conduct a descriptive investigation
of 20 women all of whom had recently had a miscarriage and to identify the behaviors of caring
that they felt were most helpful in their recovery. And from this study Swanson developed her
middle range theory of caring.
Purpose of theory:
The purpose of her theory was to define caring and to define what it means to practice
nursing in a caring manner. Swanson defines caring as a “nurturing way of relating to a valued
other toward whom one feels a personal sense of commitment and responsibility” (Masters,
2012, pg.365). Within her caring theory Swanson describes five basic but very vital processes
for caring: maintain belief, knowing, being with, doing for, and enabling. Swanson developed
these processes to help nurses understand, communicate and be one with the patient.
Theory concepts:
The concept of maintaining belief is simply “sustaining faith in the other’s capacity to get
through an event or transition and face a future with meaning.” (Masters, 2012, pg.365).
This means that as nurses we need to provide hope, faith and build self-esteem to help empower
Running head: Nursing Theory Evaluation Paper
our patients no matter what the situation is. The second concept of knowing refers to “striving to
understand the meaning of an event in the life of the other, avoiding assumptions, focusing on
the person cared for, seeking cues, assessing meticulously, and engaging both the one caring and
the one cared for in the process of knowing” (Masters, 2012, pg. 366). Being with means that
you are there with the person, sharing feelings and emotions and letting them know that you will
be there for them physically without judgments or hard feelings. Doing for is simply doing unto
others as you would have done to you. The last concept is enabling. This concept refers to
“facilitating the other’s passage through life transitions and unfamiliar events by focusing on the
event, informing, explaining, supporting, validating feelings, generating alternatives, thinking
things through, and giving feedback” (Masters, 2012, pg.366). Swanson developed this theory to
help nurses deliver quality care to all patients. She believed that nursing care should be
nurturing and should be provided through the above described interrelated processes regardless
of the situation/illness.
In addition to the concepts described above the four metaparadigm concepts described in
Swanson’s theory of caring is as follows (Masters, 2012, pg.367).
Person
Environment
Health
Nursing
“Unique beings who are in the midst of becoming and whose
wholeness is manifest in thoughts, feelings and behaviors”
“Any context that influences or is influenced by the designated client”
“Health and well-being is to live the subjective, meaning filled
experience of wholeness. Wholeness involves a sense of integration
and becoming wherein all facets of being are free to be expressed”
“Informed caring for the well-being of others”
Person: Swanson acknowledges that nurses serve all types of people and it includes more
that they patient. As nurses we serve, families, friends, cultures, communities and societies.
Swanson explains that one’s life experiences are influenced by their heritage, faith, spirituality
and their capacity to exercise their free will. This requires nurses to go above and beyond to get
Running head: Nursing Theory Evaluation Paper
to know patient’s on an individual basis and to honor each person as their own.
Environment: Swanson believes that the environment and the client-person may be viewed
interchangeably, stating “what is considered an environment in one situation may be considered a
client in another. Health: In this section Swanson describes health as wholeness. “Swanson views
reestablishing well-being as a process of healing that entails releasing inner pain, establishing
new meanings, restoring integration, and emerging into a sense of renewed wholeness” (Masters,
2012, pg. 368). Nursing: Swanson describes nursing as caring for the well-being of others in an
informed manner. Nursing is informed by human life, cultures, beliefs, clinical practice and
research.
The relationships among these concepts assume that all people are spiritual, complex,
introspective, growing and need to be connected with others. It also assumes that “nurses are
responsible for taking leadership roles in fighting for human rights, equal access to health care,
and other humanitarian causes” (Masters, 2012, pg.369). Nurses are also to share their
experiences and knowledge of caring with others. I agree with this thought. As nurses we get to
experience so many different situations with so many different people and we all have so much
to learn from each other. I do not see any obvious fallacies in this theory. It is very simple and
well defined. Below is an example of what this care model would look like.
Running head: Nursing Theory Evaluation Paper
Application of theory to practice:
I feel that nursing practice can be greatly improved by using this theory. I feel that the
more time you get to know your patient, show compassion and try to understand their situation a
true relationship will evolve. I feel that once a patient can trust you not only as a nurse but a
person anything is possible. When this theory is used communication is enhanced, patient
comfort and outcomes are greatly increased. Because this theory is so broad, it can be used in a
diverse set of populations and situations, making it very useful in the nursing practice. Every
practitioner can use this model to increase patient comfort and positive outcomes; it is not
restricted to nurses.
Implementation of theory into practice:
We have implemented this theory in my workplace by having supervisors do daily rounds
to be sure that patient’s needs are being met and patient satisfaction remains high. We also strive
very hard to treat every person as an individual, even though patients may have the same
diagnosis and similar symptoms they all react differently when in crisis. We also strive not only
Running head: Nursing Theory Evaluation Paper
to make our patient’s feel like family but we also care for and support their families in any way
we can. We have recently been looking at ways to improve patient care to include not only the
physical aspect but the mental, emotional, psychosocial well-being of each and every patient. We
provide many alternatives to traditional medicine in order to achieve this. An example would be
what we call “comfort touch” which is basically a very simple and or foot massage to help
improve comfort from pain, anxiety etc. We have also developed a “Friends for Fifteen” program
that allows non-traditional staff members to spend 15 minutes a day with patient’s to allow them
time to talk about things of their choice, read, sing, play a card game, get a massage, or anything
else of interest. This allows both parties to build a relationship and shows patients that everyone
in our facility cares about them and will be there to help them along the way. This is also a very
beneficial program for those unresponsive patients to get some one on one time doing things that
are not in the daily routine. I think that there is always room for improvement to increase patient
comfort so I hope to take what I have learned from this theory to my day to day practice to see
what we can develop and change to make things even better.
While there are multiple research examples out there to conclude that Swanson’s caring
theory is effective, I will briefly describe one. Swanson tested her theory many times with the
funding help of the National Institutes of Health (NIH) and the National Institutes of Nursing
Research. In one intervention study comprised of 242 women who had miscarried, Swanson
evaluated the effects of caring based counseling sessions to reveal how those women processed
their loss one year after the event, and she also looked at the passage of time and what effects it
had on the women’s healing. “The main findings of the investigation were that caring was
effective in decreasing the participants’ overall disturbed mood, depression and anger. Delayed
measurement (with or without treatment) alone affected increased anger and decreased likeliness
Running head: Nursing Theory Evaluation Paper
that the participants would say that they had lost a baby. All study participants (treat or not)
assigned less personal significance to miscarrying and had higher levels of self-esteem and less
anxiety, anger and confusion” (Peterson and Bredow, 2009, pg. 196). The study found that while
time helped woman heal, caring behaviors helped increase their self-esteem and decrease
symptoms of depression.
Conclusion
Caring is a fundamental part of nursing that has been around for many years. Nursing as a
whole strives to improve patient comfort on a daily basis and will continue to grow as a
profession and organization to be the best. I feel that in every stage of nursing education there is
some part of education based on caring and as we continue to advance our technologies and
practices the education will also change and evolve.
References:
Masters, K. (2012). Nursing Theories: A framework for Professional Practice.
(pp. 365-369) Sudbury, MA: Jones and Bartlett Learning, LLC.
Peterson, S. and Bredow, T. (2009) Middle Range Theories: Application to Nursing
Research. (2nd Ed. pp. 196). Philadelphia, PA: Wolters Klower Health/Lippincott
Willimams & Wilkins