Caring+Theory

Primary author: Kim Stewart

The history of caring theory is largely found in its evolution as a central foundation of nursing practice but it can also be extended to clinicians in settings ranging from traditional acute care hospitals to outpatient ambulatory clinics and public health arenas. Formulated in the 1970s, Jean Watson’s Theory of Human Caring seems to be the most referenced in literature and the foundation of many studies on caring as it relates to both health care and health behaviors. Compared to the traditional practice of medicine from a physician perspective, nursing practice focuses on the patient in a holistic manner. Sitzman (2002) reflects on Watson’s delineation of “core” versus “trim” functions of nursing. Caring behaviors emanate from the core of nursing practice and are used to facilitate healing processes and relationships while the tasks required to clinically treat disease are found in the trim or periphery. Although both components are required for holistic care the core function of caring is essential to the process as a whole. Cowling and Taliaferro (2004) also stress the healing-caring perspective, expressing concern that the expanded clinical role of nursing has “embraced the ideals of medicine at the expense of nursing ideals” (p. 54).

McCance, McKenna, and Boore (1999) similarly describe the origin of Watson’s theory as a combination of human science and metaphysics, with the goal to “protect, enhance, and preserve humanity by helping a person find meaning in illness, suffering, pain, and existence” (p. 1390). Foster (2006) highlights the major tenets of Watson’s theory as consciousness, intentionality, and the caring moment. More specifically, the key concepts originally defined by Watson are known as the following ten “carative factors” (McCance et. al, 1999):

1. Humanistic-altruistic system of values 2. Faith-hope 3. Sensitivity to self and others 4. Helping-trusting, human care relationship 5. Expressing positive and negative feelings 6. Creative problem-solving caring process 7. Transpersonal teaching-learning 8. Supportive, protective, and / or corrective mental, physical, societal, and spiritual environment 9. Human needs assistance 10. Existential-phenomenological-spiritual forces

Three additional caring theories presented by McCance, McKenna, and Boore (1999) include Madeleine Leininger’s Theory of Culture Care, Simone Roach’s Conceptualization of Caring, and the Theory of Nursing as Caring developed by Anne Boykin and Savina Schoenhofer. With its origin in anthropology, key concepts of Leininger’s theory are culture and diversity, with a goal of providing culturally acceptable care that benefits patients and family. In contrast, Roach’s theory is grounded in philosophy and theology and is defined by its “five Cs” key concepts: compassion, competence, confidence, conscience, and commitment (p. 1391). Finally, Boykin and Schoenhofer’s more recently developed and less studied theory has a philosophical and human science foundation, positing that caring is “an essential feature and expression of being human… illustrated by the basic premise that all persons are caring” (p. 1391).

In the context of this course, caring theory is pertinent to effective clinician-patient communication, in part through the functions of fostering healing relationships and responding to emotions. Street and Epstein (2008) define interpersonal communication as a “key source of social influence and a process critical to change in health behavior (p. 238). Historically, descriptive models of physician-patient relationships have evolved from paternalism, with high physician control and low patient control, to consumerism where the roles are effectively reversed. The authors extend these descriptive models in presenting critical indirect and direct pathways to health outcomes that are initiated by communication functions (Figure 11.1, p. 240). Among the many proximal and intermediate outcomes found on the indirect pathway to health outcomes, components of caring theory can be found in mediating effects of proximal outcomes such as trust, rapport, and feeling known, and in intermediate outcomes such as social support and emotional management.

With the aforementioned focus on caring theories in relation to personal clinician-patient relationships, Rafael (2000) addresses the question of how they can be translated to community focused public health practice. The author specifically refers to the applicability of Watson’s theory, stating that its recognition of “the whole in the parts supports a focus on wholeness of a community, aggregate, or population while still attending to the individuals and families within it” (p. 41). The concepts of body-mind-spirit can be viewed from a community context, with the body found in physical environment and demographics, the mind in cultural norms and laws, and the spirit in the community’s value systems.

Practical examples of application of caring theory in the community can also be found in a variety of settings. McCance, McKenna, and Boore (1999) highlighted the Denver Nursing Project in Human Caring’s initiative with an HIV-AIDS clinic. Using Watson’s theory as the foundation for the clinic’s education, clinical practice, and research, it demonstrated improvements in quality of life, decreased hospital length of stay, and prevention of hospital admissions for this patient population. Purnell (2009) stated that “the essentialityof caring nursing in the community becomes very real after traumatic events and disasters” (p. 113), citing an example of nursing school faculty and students who trained as Red Cross volunteers to not only provide basic health needs but also demonstrate caring through listening, empathy, and connections. These examples demonstrate that applied caring theory can truly benefit the both the community as a whole as well as the individuals who are part of the community.

References:

Cowling, III, W. R., & Taliaferro, D. (2004). Emergence of a healing-caring perspective: Contemporary conceptual and theoretical directions. //The Journal of Theory Construction and Testing, 8//(2), 54-59.

Foster, R. L. (2006). A perspective on Watson's Theory of Human Caring. //Nursing Science Quarterly, 19//(4), 332-333.

McCance, T. V., McKenna, H. P., & Boore, J. R. (1999). Caring: Theoretical perspectives of relevance to nursing. //Journal of Advanced Nursing, 30//(6), 1388-1395.

Purnell, M. J. (2009). Gleaning wisdom in the research on caring. //Nursing Science Quarterly, 22//(2), 109-115.

Rafael, A. R. (2000). Watson's philosophy, science, and theory of human caring as a conceptual framework for guiding community health nursing practice. //Advances in Nursing Science, 23//(2), 34-49.

Sitzman, K. L. (2002). Interbeing and mindfulness: A bridge to understanding Jean Watson's Theory of Human Caring. //Nursing Education Perspectives, 23//(3), 118-123.

Street, Jr., R. L., & Epstein, R. M. (2008). Lessons from theory and research on clinician-patient communication. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), //Health Behavior and Health Education: Theory, Research, and Practice// (4th ed., pp. 236-269). San Francisco, California: Jossey-Bass.