Running head: APPLICATION OF THEORY TO THE PRACTICE PROBLEM OF
Application of Theory to the Practice Problem of Nurse Staffing
Marialena Murphy
Grand Canyon University
August 10, 2011
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APPLICATION OF THEORY TO THE PRACTICE PROBLEM OF
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Application of Theory to the Practice Problem of Nurse Staffing
Nursing theory influences the practice of nursing in a multitude of ways that can have a
profound impact. Theory provides a framework to support and define nursing practice, support
quality of patient care, and can be implemented in practice situations to provide solutions to
nursing practice problems. Applying theory to resolve nursing challenges can be utilized in
educational and research settings, direct patient care situations, as well as in administration and
management of nursing care services. The benefits of applying theory to address a practice
dilemma can be demonstrated by applying Jean Watson’s theory of human caring, and Ken
Wilbur’s integral theory and examining how these theories impact the problems surrounding
nurse staffing situations in an acute care hospital setting.
Practice Problem Identification and Importance
A review of the nursing literature demonstrates that supporting nurse staffing ensures
quality nursing care for patients and has been an ongoing challenge for nurse managers and
administrators. Failure to ensure sufficient numbers and compassionate nurse staff has been
demonstrated to negatively impact patient satisfaction and outcomes. The nurse staffing problem
is not limited only to ensure adequate numbers of staff that are being lost in the acute care
settings due to overwork, burnout, compassion fatigue and injuries; the nurse staffing problem
also includes the impact to patient care and to the nursing work force when compassion and
caring is absent and the negative effects this has on both the patient and the nurse (Douglas,
2010). Traditional methods of addressing nurse staffing issues with financially based
recruitment and retention plans have not resolved these issues; however, applying the theory of
human caring to the issue of nurse staffing provides important insight and solutions that can
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assist managers, administrators and organizations to improve the delivery of care, support nurses
as a valuable resource and improve patient outcomes.
Theorist Biography
Jean Watson, PHD, RN, AHC-BC, FAAN is a distinguished professor of nursing, and
recipient of the Murchinson-Scoville Endowed Chair in Caring Science, at the University of
Colorado in Denver, Colorado. She is a scholar, author, teacher, and founder of the Watson
Caring Science Institute, an international, non-profit foundation that is dedicated to supporting,
expanding and extending the theories and practices of human caring in healthcare (Watson
Caring Science Institute, n.d). Jean Watson has six honorary doctorates and has traveled
throughout the world cultivating, teaching and operationalizing the theory of human caring in the
work of nurses and health care. Jean Watson was born in West Virginia in July of 1940. She
graduated from nursing school in 1961 in Virginia and then went to the University of Colorado
to complete her BS, and MS in nursing and her Ph.D. in 1973.
Concepts and Propositions of the Theory
The major concepts of the theory of human caring are based on the assumption that the
essence and foundation of nursing resides in caring science as the crux of the discipline of
nursing (Watson, 2008). Interpersonal interactions are the primary expression of caring,
however caring is not necessarily limited by physical, space or time limitations and this
relational connection provides a reflection of our humanity in each other (Watson, 2008). Caring
can be described in ten carative factors or processes that promote wholeness, healing, health and
the process of evolving and growth for the individual and family. Caring harmonizes with curing
and medical science while providing authentic relationships that encourage the “emergence of
human spirit” (Watson, 2008, p. 17). Caring and the practice of caring is central to the
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profession of nursing (Watson, 2008) and relational caring is viewed as an ethical, moral,
philosophical, and values guided foundation.
The ten carative factors/caritas processes outlined in Jean Watson’s theory of human
caring can be viewed as nursing interventions that describe and express the connection between
caring and love. “Caritas comes from the Latin word meaning to cherish” (Watson, 2008, p. 39)
and summons compassion, caring, love, forgiveness and equanimity into the relations between
self and other in the practice of nursing. The ten caritas processes include:
1. Practicing loving kindness toward self and others.
2. Instill faith and hope in others.
3. Nurture individual beliefs and practices for self and others.
4. Promote helping and trusting relationships.
5. Acceptance of positive and negative feelings.
6. Creative solution-seeking using scientific methods and all ways of knowing.
7. Genuine teaching and learning that supports individual needs.
8. Creation of a healing environment that attends to physical, societal and spiritual
needs.
9. Providing acts of healing by attending to basic human needs.
10. Remaining open to mystery and the unknowns of existence. (Watson, 2008)
These assumptions of the theory of human caring and the caritas processes apply at the
level of self, other and also in a societal and leadership sense. The theory and processes are
specific enough to be interventions that apply in nurse patient or interpersonal relationships but
have a breadth and universality that can also be applied as leadership principles.
Theory Applied in Practice
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An example of how the theory of human caring has been applied in nursing leadership
and administration is described in “A caring approach in nursing administration” (Nyberg, 1998),
which demonstrates how a foundation of caring provides an ethical framework for nursing
management, quality management and organizational effectiveness. The theory provides a
framework that leaders can use to restore “nursing’s value-guided vision of care” (Watson, 2000,
p. 2) that allows leaders to care for the nurses and patients and promote wholeness, healing and
allow nurse leaders to regain their true vocation. Utilizing the theory, nurse leaders can provide
an ethical and moral support to address a variety of practice problems in the administration and
delivery of patient care.
Nurse staffing is vital to the delivery of patient care (Douglas, 2010). Although many
resources are spent attempting to manage the workflow, optimize staff hours and improve
through-put, there is still much to be learned about the caring side of nursing and how that
impacts nurse retention, patient satisfaction and the economics of the delivery of care (Douglas,
2010 p.416). Compassion fatigue in nursing results in a situation where “too many nurses leave
acute care where they are so needed” and can have detrimental effects on the health of the nurse,
the delivery of care, and also the patient’s feelings of being cared for as well as patient outcomes.
Practice Change Hypothesis with Theory Implementation
Nurse leaders who utilize the theory of human caring in their practice can address nurse
staffing issues in a variety of ways. One example of implementing a caritas process to impact
nurse staffing would be for nurse managers to support staff nurses to engage in self-care
activities and practice loving kindness for self and others. Developing and implementing policies
that ensure healthy work practices, limiting work/call hours and providing healing support space
and time for nurses to rest and rejuvenate can help to operationalize this practice. This one
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example illustrates how incorporating the theory of human caring in even one small way could
have a large impact on the nurses work environment as well as impact their own perception of
being cared for. Demonstrating the theory as a nurse leader, opens the door for staff nurses to
begin to incorporate caring in a more thoughtful way in their own practice to impact their
interactions with patients. The impact and connectedness between management, nurses and
patients is more deeply understood by examining Ken Wilbur’s Integrated Theory. This theory
examines consciousness and connectedness in human psychology and relationships and has been
borrowed to support nursing theory related to human caring.
Borrowed Theorist Biography
Ken Wilbur was born in 1949 in Oklahoma City, Oklahoma, graduated from high school
in Lincoln, Nebraska and attended Duke University to study medicine. After his first year at
Duke he became interested in eastern and western psychology and philosophy and pursued the
study of consciousness and writing. He has been termed “the Einstein of consciousness
research” (Spirituality & Practice, n.d, para. 2) due to the original and revolutionary concepts
that he developed and has incorporated into Integrated Theory. In 2000 Wilbur founded the
Integral Institute, whose mission is to awaken humanity to full self-awareness (Integral Institute,
2009, para. 1). Wilbur’s work has been referenced as support for Jean Watson’s theory of
human caring in several of her books, including “Nursing: The philosophy and science of caring”
and “Caring science as sacred science”.
Theory Applied in Practice
Integral theory synthesizes Western and non-Western understanding of consciousness
and has been applied to business, politics, art, ecology, spirituality, education, medicine and
psychology and researchers have developed applications in leadership, coaching and
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organizational development (Integral Institute, 2009). In leadership, this theory provides a
blending of available leadership theories and applies them from a variety of perspectives. The
holistic model described by Wilbur focuses on a fundamental interconnectedness (Reams, 2005),
which is described in a four quadrant model that examines self and collective aspects as well as
internal and external aspects. Integral leadership theory has been applied at West Point with
cadets and instructors and at Notre Dame University’s Mendoza College of Business (Reams,
2005).
Practice Change Hypothesis with Theory Implementation
Implementation of integral theory in the leadership of nurse managers challenged with
nurse staffing shortages can be a positive method to promote a more holistic approach to remedy
the root causes of staffing issues. By utilizing the four quadrant model Wilbur has developed
(Reams, 2005, p. 120) leaders can benefit from understanding the interconnectedness of
decisions made by organizations and leaders and the impact on nurse staffing and patients.
Attaining an understanding and consciousness of the leader’s self-development and the impact of
this level on the strengths and weakness of the leader is also important (Reams, 2005).
Potential Challenges with Application of Theory to Practice
Application of theory to the practice challenge of staffing is fraught with some potential
challenges. Some potential objections to using these theories to address nurse staffing and
leadership development are that it requires significant education and change. It does not rely on
old familiar methods for recruitment and retention, which although unsuccessful in resolving
issues long term, continue to be popular in hospitals and healthcare institutions. Another
potential challenge is that theory may be seen as too abstract by leaders not familiar with
grounding practice on a theoretical framework.
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Summary
Nurse staffing challenges are most commonly addressed with short-sighted, reactionary
methods such as recruitment bonuses or additional pay incentives that do not address the root
cause of the problem. Applying the theory of human caring and integral theory to address the
practice problem of nurse staffing offers the opportunity to make real and lasting long term
changes that will shape more caring leaders and patient care environments. Utilizing a theoretical
framework to transform nursing leadership and organizations will improve nurse staffing and
improve quality outcomes.
References
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Boykin, A., Schoenhofer, S., Smith, N., St. Jean, J., & Aleman, D. (2003). Transforming practice
using a caring-based nursing model. Nursing Administration Quarterly, 27(3), 223-230.
Burtson, P., & Stichler, J. (2010). Nursing work environment and nurse caring: relationship
among motivational factors. Journal of Advanced Nursing, 66(8), 1819-1831.
Douglas, K. (2010). When caring stops, staffing doesn't really matter. Nursing Economic$, 28(6),
415-419.
Douglas, K. (2011). When caring stops, staffing doesn't matter: Part II. Nursing Economic$,
29(3), 145-147.
Integral Institute. (2009). http://www.integralinstitute.org/?q=node/1
Nyberg, J. (1998). A caring approach in nursing administration. Retrieved from
http://books.google.com/books?hl=en&lr=&id=mrpHtbI2EY4C&oi=fnd&pg=PP7&dq=j
an+Nyberg+nursing+leadership&ots=BZeOp82bnm&sig=R9MbTfkvCi1PCI4kbQBeDd
7mU8M#v=onepage&q=jan%20Nyberg%20nursing%20leadership&f=false
Reams, J. (2005). What’s integral about leadership?A reflection on leadership and integral
theory. Retrieved from http://integralreview.org/documents/Whats%20Integral%20About%20Leadership%201,%202005.pdf
Spirituality & Practice. (n.d).
http://www.spiritualityandpractice.com/teachers/teachers.php?id=310
Wade, G., Osgood, B., Avino, K., Bucher, G., Bucher, L., Foraker, T., & ... Sirkowski, C.
(2008). Influence of organizational characteristics and caring attributes of managers on
nurses' job enjoyment. Journal of Advanced Nursing, 64(4), 344-353.
Watson Caring Science Institute. (n.d). http://www.watsoncaringscience.org
APPLICATION OF THEORY TO THE PRACTICE PROBLEM OF
Watson, J. (2008). Nursing The philosophy and science of caring (Revised ed.). Boulder, CO:
University Press of Colorado.
Watson, J. (2000). Leading via caring-healing: the fourfold way toward transformative
leadership. Nursing Administration Quarterly, 25(1), 1-6.
Watson, J. (2008). Nursing: The philosophy and science of caring (Revised ed.). Boulder, CO:
University Press of Colorado.
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