The spirit in which she does her work makes all the difference. Invested as she should with the dignity of her profession and the cloak of love for suffering humanity, she can ennoble anything her hand may be called upon to do, and for work done in this spirit there will ever come to her a recompense far outweighing that of silver and gold.

Swanson definesCaring is a nurturing way of relating to a valued other toward whom one feels a personal sense of commitment and responsibility

Practicing in a caring manner leads to the nurses well being, both personally and professionally. Personal outcomes of caring include feeling important, accomplished, and whole. Professionally practicing caring leads to enhanced intuition, empathy, clinical judgment and work satisfaction. Kristen Swanson RN, PhD, FAAN

Kristen Swanson RN, PhD, FAAN

Kristen M. Swanson, RN, PhD, FAAN, is the Dean of the School of Nursing, Alumni Distinguished Professor at the University of North Carolina at Chapel Hill, and Associate Chief Nursing Officer for Academic Affairs at UNC Hospitals. She earned her bachelor degree in nursing from the University of Rhode Island in 1975, her masters in adult health and illness nursing from the University of Pennsylvania in 1978, and a PhD in psycho-social nursing from the University of Colorado, completing her postdoctoral work at the University of Washington (University of North Carolina, 2012; Ray, 2011).Her theory was empirically developed out of three phenomenological studies in separate perinatal contexts carried out in the late eighties and was further developed and refined during the early nineties. Numerous hospitals and health care facilities have since adopted Swansons theory of care as a guide to their own nursing services (Ray, 2011) and Swanson continues to consult internationally on implementation of caring theory in clinical practice, research, and education (University of North Carolina, 2012).

Theory DescriptionFoundation and Historical EvolutionSwanson started out with a deep interest in understanding what is was like for women to miscarry (Swanson, 1998) and her caring theory was initially founded through her doctoral work into exploring what caring meant from the perception of women who had miscarried. As a result of her own personal experience with her second newborn child in a NICU setting, her subsequent post-doctoral research led Swanson into the study of nursing care within a NICU environment, and her third study focused on high risk mothers within a public health setting.

Initial concepts were formulated during her early studies, and as her research progressed Swanson further clarified and honed the five theoretical categories of caring. As the theory has been further referenced, applied to practice, validated, and tested in several different environments over the last two decades, it has without doubt matured and developed, but the five key categories remain inherently the same.

I. 20 women who miscarriedWhat constituted caring in the instance of miscarriage?

II. 19 careproviders in the NICUWhat is it like to be provider of care in the NICU

III. 8 high risk young mothers who received LT public health nursing interventionHow did you recall and describe your nurse-patient relationship after intervention?

The proposed structure of the theory depicts caring as grounded in maintenance of a basic belief in persons, anchored by knowing the others reality, conveyed through being with, and enacted through doing for, and enabling (Swanson, 1993, p. 354).

Knowing (Empathetic Understanding)Striving to understand an event as it has meaning in the life of the otherAvoiding assumptionsCentering on the one cared forAssessing thoroughlySeeking cuesEngaging the self

Being With (Emotionally Present)Being emotionally present to the otherBeing thereConveying availabilitySharing feelingsNot burdening

Doing For (Enact For)Doing for the other as he/she would do for oneselfbut no moreAnticipating their needsPerforming competently/skillfullyPreserving dignity

Enabling (Empowering)Facilitating the others passage through life transitions and face a future with meaningInforming/explainingpatient educationValidating-giving feedbackGenerating alternatives-thinking it through

Maintaining Belief (Esteem)Sustaining faith in the others capacity to get through an event/transition and face a future with meaningBelieve in/holding in esteemMaintaining a hope filled attitudeOffering realistic optimism

CLINICAL WEEK #1I.Knowing (Empathetic Understanding) Striving to understand an event as it has meaning in the life of the other

Choose at least 2 to implementNursing Caring Interventions Evaluation (Client Response)1. Avoiding Assumptions2. Centering on the one cared for*Did my cares when time was best for client*Allowed client quiet time with minimal interruptions*Always verbalized to client what I was coming in for next and told him if there was anything more I could help him with to feel free to ask*Allowed client to maintain sleep/rest*Client did not feel like a burden when using call light*Felt that this conveyed trust between client and nursing student3. Assessing thoroughly4. Seeking cues5. Engaging of self*After surgery I was conveying availability-this was important for the client who was experiencing pain*I was able to get warm blankets and ice water for my client to ensure comfort*I ensured the client that I was there and could help him with anything he needed*Client felt as if I really cared for him and that he was not alone*He felt that he could trust me and was a little more relaxed to know someone was there*Non-verbal cues-client was less anxious and was able to remain comfortable to rest

II. Being With (Emotionally present) Being emotionally present to the other

Choose at least 2 to implementNursing Caring Interventions Evaluation (Client Response)1. Being there*Talking to client and sitting at eye level*Placing a hand on the clients shoulder to let them know that you care and are present*Taking time to explain what you are doing and answer questions and make sure client fully understands*Allow pt. to express feelings without putting judgements on them*Client was able to talk to me on a more personal level*Putting hand on shoulder was comforting and caring-helped client realize I was there*Client ws able to put trust in me and know what to expect and let him know what was next*Client expressed sensitive topics with me about being overweight and was able to not worry about feeling judged2. Conveying availability*Stating, is there anything else I can do for youI have time?*Do not approach client in a rushed nature*Periodically assessing client and asking how they are doing without making them put on their call light and feel like they are a burden *Client gets needs met immediately and does not feel rushed*Client does not feel like they are being a pain because they know that they are not bugging you when you are busy*Does not feel rushed and they feel that they have time to ask questions or review personal nature of self more readily3. Sharing feelings4. Not burdening

Swanson states that the five caring processes are not suggested to be unique to nursing, but are proposed as common features of caring relationships. However, in the context of nursing practice, the theory provides broad guidance for what are considered central caring behaviors that a nurse may undertake in his/her relationship with self, client, and nurse colleagues. The theory helps to facilitate the incorporation of these caring behaviors into daily nursing practice, ensuring that the mainstay of attention remains on the one cared for during all nursing interactions.Furthermore, the theory embodies the notion that the nurse and the one cared for are relating to each other and engaged in the process of caring together, culminating in a meaningful relationship and fostering a mutually beneficial desired outcome.

An exemplar of Swansons theory in research guidance and practice can be found in Amendolairs (2011) recent study Caring Model: Putting Research into Practice. This study clearly demonstrates the application of Swansons theory through the successful design and implementation of an institutional care model that reflects staff nurse perceptions of what nursing means to them. The author concludes that Swansons model is a demonstration of the link between theory and practice, and that the theory constructs provide a clear description of what caring means and how nurses exhibit caring in their everyday practice. As concern grows about clinical relevance of theory and research within practice settings (Chinn and Kramer, 2011), these types of qualitative studies are imperative in demonstrating the powerful link between theoretical constructs and evidence-based nursing practice.

Chinn and Kramer (2011) designate theory importance as forward looking; useable in practice, education, and research; and valuable for creating a desired future (p. 204). Since the Theory of Carings conception in 1991, Swanson, and other notable nursing scholars have continued to make strides in advancing the theory within a variety of nursing contexts, and continuously engage in and encourage the theorys adaptation and growth within contemporary nursing practice. Cited within more than 120 published articles and featured in numerous nursing science, scholarship, clinical, and research journals, the theory more than meets the criteria for being usable in practice, education and research.

Perhaps one of the most versatile middle-range nurse caring theories to come out of the twentieth century, Swansons Theory of Caring is an exemplar model of a substantive middle-range theory that can inform practice and lead to new practice approaches as well as investigate factors that influence the outcomes that are desired in nursing practice (Chinn & Kramer, 20011, p. 48). Utilized within multiple clinical settings across the globe, the theory is proven to be a highly valuable and clinically relevant theory for modern day nursing practice and research.

*Is caring the primary virtue ethic in nursing?Define caring???Can caring be taught???*Isabel Hampton Robb- 1860-1910-one of the most important leaders in early American nursing and nursing educationFirst to implement a grading policy for nursing students so students needed to prove their competency in order to graduate1889 appointed head of Johns Hopkins nursing schoolServed as president of what is currently known as the National League for nursing and the American Nurses Association and founded the American Journal of Nursing

Recognized the importance of not only doing nursing well with high standards of competency but the PRE-EMINENCE of ones MOTIVATION for serving in the nursing profession.love and care for suffering humanity and recognizing that anything can be dignified by serving with this spiritThough old school this ethic remains valid and essential to holistic care today

*Chair of Family and Child Nursing University of WashingtonEmpirical Development of a Middle Range Theory of Caring 1991Framework of caring is used nationwide as First TouchFirst Touch-Hello-relate to pt as a person RetouchFinal Goodbye

How caring benefits nurses

*Chair of Family and Child Nursing University of WashingtonEmpirical Development of a Middle Range Theory of Caring 1991Framework of caring is used nationwide as First TouchFirst Touch-Hello-relate to pt as a person RetouchFinal Goodbye

How caring benefits nurses

**Subcategories are the nursing interventionsDESIRE TO UNDERSTAND THE PERSONAL REALITY OF THE ONE BEING CARED FORRECOGNIZE THE OTHER PERSON AS SIGNIFICANT AND HAVING INHERENT VALUEWHEN KNOWING OCCURS, BOTH CAREGIVER AND CLIENT ARE ENGAGED

Avoiding assumptions-dont assume how the person may be feeling if dx with CA for exampleWhat is this like for you?Center on the one cared for-client is the center and they know itAssess thoroughly-look at NV Seeking cues-NICUEngaging self-when you begin to understand whats going on for another person-cant help but get yourself engagedone human being to anotherAs this becomes evident moves to next level..BEING WITH*Subcategories are the nursing interventionsDESIRE TO UNDERSTAND THE PERSONAL REALITY OF THE ONE BEING CARED FORRECOGNIZE THE OTHER PERSON AS SIGNIFICANT AND HAVING INHERENT VALUEWHEN KNOWING OCCURS, BOTH CAREGIVER AND CLIENT ARE ENGAGED

Avoiding assumptions-dont assume how the person may be feeling if dx with CA for exampleWhat is this like for you?Center on the one cared for-client is the center and they know itAssess thoroughly-look at NV Seeking cues-NICUEngaging self-when you begin to understand whats going on for another person-cant help but get yourself engagedone human being to anotherAs this becomes evident moves to next level..BEING WITH*Presence and sharing are done in such a way that the one caring does not burden the clientBeing with goes one small step beyond knowing-it is more than understanding anothers situation, it is becoming emotionally open to the others current realityTHE MESSAGE CONVEYED WITH BEING WITH IS THAT THEIR EXPERIENCE MATTERS TO THE CAREGIVERExample of women who miscarried and had D&C- the nurse tried to comfort me as much as possible-he tried to be gentle as possible-he even became teary eyed. He made me feel like he cared. As it became painful he kept saying its just a matter of time. You know he was so sorry.

Being there-client senses that they really matter-no matter how bad things may beGive them time and give of yourselfConvey availablity-heres the call light I am always here for youSharing feelings-you are right there with your client what is happeningNot burdening-when sharing feelingsdo not burden with your experience of their experienceOCCUPATIONAL HAZARD-GETTING TOO CLOSE-NEED TO KNOW YOUR LIMITS

*When the client is dependant it can be very embarassingtherefore the caregiver must consciously act to preserve the dignity of the otherDependance upon another for care of the body constitutes an indignity only when the person being cared for becomes an object for the caregiver

Anticipating their needs-pain controlPerform competently-when asked what demonstrates caring 95% pts choose this-90% nurses think it is listening spending time with pt.

*AN ENABLING CAREGIVER IS ONE WHO USES THEIR EXPERT KNOWLEDGE TO THE BETTERMENT OF THE OTHERPURPOSE OF ENABLING IS TO FACILITATE THE CLIENTS CAPACITY TO GROW, HEAL AND PRACTICE SELF CAREINCLUDES PROVIDING EXPLANATIONS AS WELL AS EMOTIONAL SUPPORT BY VALIDATING THE CLIENTS FEELINGS

*CARING THAT MAINTAINS BELIEF IS THE SUBCATEGORIESNURSES SEEK TO ASSIST CLIENTS TO ATTAIN, MAINTAIN OR REGAIN MEANING IN THEIR HOSPITAL EXPERIENCE**