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Caring Concept Analysis
Introduction
A concept can be said to be a mental construction or ideal with several meanings, definitions and uses that are often described in words. Concepts elaborate phenomena and are therefore useful in the creation of theories and development of research (McEwen and Wills, 2017). Concept analysis enables identification of unique characteristics within a theory which gives researchers precise operational definitions and refinement of vague definitions in theories. Caring has for a long time been recognized as essential in nursing and has increasingly gained ground as a core concept of an evolved nursing science. Theory plays an essential part in understanding behavior, and in the concept of caring, Swanson’s theory of caring provides insight and theoretical structure into the concept of caring. This paper presents a concept analysis of caring and the theory that was developed by Swanson.
Definition/Explanation of the selected nursing concept
The American Heritage Dictionary (2015) defines caring as an expression of concern, feeling, and empathy to another. The Miller Keane dictionary and encyclopedia of nursing, medicine, and health define it as an expression of morals and an interaction containing willingness and commitment to do something that benefits a person of importance. Swanson who developed the theory of caring defines caring as interacting with someone significant in a way that is nurturing with a sense of responsibility and commitment. It involves five processes of maintaining belief, being with and enabling, knowing, advocating for equality in health and promoting of respect and dignity in individuality (Kalfoss and Owe, 2015). Caring is one concept that is vital in nursing as it plays a key role in defining the profession. As a concept, the term caring is ambiguous and is often used without a clear understanding or meaning of the term as different people define it differently based on their interpretation. In knowing, one strives to understand events as they have meant in the life of another and here the caregiver tries to avoid making assumptions or drawing conclusions about the meaning of an event. Instead, the caregiver concentrates on the one being cared for and conducts a thorough and ongoing assessment seeking clarity on the experiences of the individual. An important part of knowing is the personhood philosophy, and the care provider has to be willing to recognize the other person as a significant being. The selves of both the recipient and the provider become engaged when knowing occurs (Kalfoss and Owe, 2015). Being with refers to being present emotionally for the other person. It conveys the notion of being there or the presence of ongoing availability and the sharing of feelings whether they are painful or joyful. Sharing here is also monitored responsibly, so the person providing care does not burden the one they are caring for. Being with extends beyond knowing as it involves being open emotionally to the reality of the other person where their experiences and feelings matter to the one providing care. Doing for involves doing for another person what he or she would do for themselves if were possible. In the provision of care, doing for entails being comforting and protective of the needs of the other person and doing it skillfully and competently while preserving the other person’s dignity. Enabling refers to making it easy for the other person to pass through unfamiliar events and transitions in life. The aim is to give the other person the capacity to actualize and grow themselves, to practice self-care or to heal. In enabling, various actions are suggested like informing, placing focus on the event, explaining, validating feelings, supporting, giving alternatives, providing feedback and thinking things through. Maintaining belief involves having faith that the other person can go through a transition or event and face the future with hope. It involves believing in them and maintaining an attitude filled with hope with the caregiver aiming to assist the other in maintaining, attaining and regaining meaning from their experiences.
Literature Review
General ideas and meanings of the caring concept have been described by different authors and research studies that show various themes of nursing actions that are based on the different processes of caring. Studies have shown that knowing as part of the concept of knowing involves centering on the other with a humanistic view of the person and being mindful of their experiences and values (Zolnierek, 2014). Through knowing, the caregiver can gain insight and understanding of the other person’s situation through interpretation, empathy, inference, intuition, and imagination. It also emphasizes on a nurturing way of relating to others that are valued where patients are treated as unique persons through respectful attitudes and no judgment. It also includes an informed understanding of the other and carrying out individual assessments that are comprehensive with consideration to the patients’ beliefs, wishes, values, and perceptions. In a study to identify elements of end of life care that patients and their families ranked as important, an authentic presence of the care provider was among the top qualities (Virdun et al., 2015). This reflects on the process of being with which is part of the caring concept that calls for an intimate caregiving relationship with the patient. It involves interpersonal sensitivity by being intuitive and empathetic to the suffering of the other and encourages caregivers to place themselves in the shoes of the patient to gain an understanding of the patients’ feelings and thoughts. The care provider needs to show interest, engagement, and concern while also being sincere, compassionate and honest. In surveys carried out to determine levels of patient satisfaction in dental school clinics, professional competence was identified as a major influence to the perceptions of the patients about the care provided (Ahmady et al., 2015). It involves doing for the patient which is part of the caring concept and for the provider to do what is clinically required by the patient, they have to have the relevant training and education, clinical knowledge, self-confidence and collective skills for appropriate care provision. Doing for the patient involves detecting of unwanted or harmful situations like cavities in the dental clinic’s survey, prevention, educating of the patient like advising them to brush their teeth daily as well as listening to the patient. It also involves giving reassurance to the patient, comfort, support, acceptance, promoting healing, reducing suffering or injury while also catering to the emotional needs of the patient. In a study to determine patients trust in nurses among hospitalized cancer patients, enabling of the patient by the caregiver was found to be important in influencing health status and care quality (Charalambous et al., 2016). Enabling which is part of the caring concept involves willingness by the provider to share responsibility and power with the patient especially in decision making. It consists of partnerships between the provider and the patient that empowers them and their families and recognizes them as important sources of information. It makes it possible for mutual commitment to develop as both the patient and provider engage in the process of healing towards shared goals and objectives. In a qualitative study to identify factors that are effective in the provision of holistic care, promoting encouragement and religiousness were found to be important in inducing nurses to provide holistic care that improves care quality (Zamanzadeh et al., 2015). This relates to maintaining belief which is part of the caring concept and is based on recognizing the person as a spiritual being who believes in God and therefore a humanistic view has to be used to respect individual differences with a consideration for the whole patient. Maintaining belief in care provision involves giving hope, compassion, and love and basing care on the person’s spiritual orientation and religion as they seek to discover meaning with themselves and life especially about suffering. In another study to determine the extent of patient ratings on person-centeredness and caring in an acute hospital, it was highlighted that caring concepts need to be in cooperated in nursing for the improvement of healthcare quality (Edvardsson et al., 2017). The findings from the study point out that the perspective of the patient and their experiences with the quality of care is influenced by more than just guidelines and standards or a reduction of adverse events. Perceived caring behaviors of nurses and other staff accounted for a huge percentage of the ratings by the patients when pointing out the level of quality of care.
Defining Attributes
Attributes of caring can be derived from Swanson’s definition of caring as interacting with someone significant in a way that is nurturing with a sense of responsibility and commitment (Kalfoss and Owe, 2015). The attributes can, therefore, be nurturing, commitment and responsibility. Nurturing can be described as focusing attention on another and monitoring their responses to promote growth or health. The focus of others in nurturing is the basis of nursing and is important when trying to establish relationships that are therapeutic. Nurturing qualities include compassion, respect and value for others, being an active listener, encouraging others and being a role model (Boykin and Schoenhofer, 2015). Commitment as an attribute of caring refers to the convergence of one’s obligations and their desires to produce dedication that shapes the identity of the nurse as a caring person. It involves not sacrificing care to patients despite challenging situations and always aiming to put the best foot forward when providing care. Responsibility as a caring attribute refers to being dutiful and accountable to practice methods while upholding ethical standards that call for the respect of the values and dignity of patients while also advocating for their rights. In the context of caring, respecting of the patients right to self-determination shows that the nurse cares about the input and beliefs of the patient and this promotes a mutually beneficial relationship with common goals.
Antecedent and Consequence
Antecedents take place before the occurrence of the concept. An example of an antecedent that can occur before the caring concept is the awareness of the need for help where a cognitive and moral motivation drives an individual to help others. Many nurses are driven to the profession by their compassionate nature where they desire to help others and are determined to give. This can, therefore, be termed as an antecedent that eventually fosters caring in the nurses. Consequences are incidents that happen as a result of the occurrence of the concept and consequences of caring in nursing include growth, the satisfaction of the patients and healing. Consequences can happen to both the patient and caregiver by enabling satisfaction or healing of the patient and job satisfaction for the caregiver who is proud of what they have accomplished.
Empirical Referents
Empirical referents refer to categories of actual phenomena through which their presence demonstrates that the concept has occurred. These referents are required to make the concept measurable since the defining attributes of caring are abstract. The Caring Assessment Report Evaluation Questionnaire (CARE-Q) is a quantitative tool that can be used to measure caring in hospital or care provision settings (Orii and Jeong, 2017). It measures the patient’s contentment with the care they have received from the nurses. Surveys that measure patient satisfaction can also be used as empirical references since they can show the levels of satisfaction that patients have to the caring behaviors of nurses.
Model Case
Ann is a reputed nurse working in the emergency department of one of the biggest hospitals in town. On one evening the hospital receives fifteen accident victims who are injured. She was ready to leave in ten minutes time, but the nurse manager orders all available nurses to respond immediately. With no hesitation, she wears her uniform and rushes to the emergency room to offer assistance. She asks each victim few basic questions and listens to their versions of what happened while consoling them. She uses her skill and expertise to determine who requires urgent attention and ensures they all have beds and are comfortable. The incident takes around four hours after which she heads home. This case shows the various attributes of caring that Ann possesses. She shows nurturing by listening to the patients and giving them consolation for the terrible event. She also demonstrates commitment as she responds swiftly to the emergency and goes back to work despite being ready to leave. She also demonstrates responsibility by using her expertise to determine who is in urgent need of care.
Related Case
Ann and Jane are nurses in the same department hospital. Jane expresses her love for patients through words but in many cases does not apply it in real life. Although she talks as if she cares, she often does not extend a helping hand when it is needed. When Ann narrated the incident of the previous week where the fifteen accident victims were brought in, Jane expresses concern but ultimately states that she was glad that she was on leave. She, however, follows all guidelines of care provision and attentively listens to patients and their needs although she rarely adjusts her method of practice to suit them. In this scenario, Jane only articulates the notion of care with words but does not follow through with actions. This shows a lack of commitment to the patient and therefore does not amount to caring. She, however, shows attributes of responsibility by following all care guidelines and also shows nurturing by listening to her patient’s needs.
Contrary Case
Mary is another nurse who works in the same hospital as Ann and Jane. She welcomes patients and proceeds to take them to respective wards after which she does not concern herself with them as she deems that to be the responsibility of the attending physician. After admission, she does not even give first aid or inquire about their needs and states that it is upon the doctor to take action and she will only help if required. In this case, the attributes of caring are deficient since the nurse is not committed to the patients at all. She is also not nurturing as she does not question or inquire about the needs of the patients. She is also not responsible to them as she states that the doctor has to provide care.
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