Concept Analysis Caring
Concept analysis of caring in nursing
Elizabeth Adkison
Chamberlain College of Nursing
Theoretical Basis for Advanced Practice Nursing
NR 501
Dr. Robyn Rice
Aug 3, 2014 Concept analysis of caring in nursing Maya Angelou once said “People may forget what you said, but they will never forget the way you made them feel.("Maya Angelou," 2014, p. 1)” The profession of nursing is often defined as not only a science but also an art. Jean Watson and her Theory of Caring defines nursing as the art of caring. Concept analysis is important in order to define terms and provide clarity of a concept. Caring is so much more than just an emotion in nursing. This concept analysis aims to define caring in the profession of nursing and the healing …show more content…
of patients. By providing a purpose for the analysis, reviewing scholarly literature, providing uses of the concept, defining its attributes, providing examples of two model cases and alternative cases, defining its antecedents and consequences, and explaining two empirical referents; it will become evident how important caring is to the art of nursing.
Aim
The aim of this concept analysis is to identify caring as a core concept in nursing and define caring in relation to the profession of nursing. Watson believes that in nursing practice it is imperative to sustain human caring ideals and she also breaks up the concept of caring using three out of the four metaparadigms in nursing; the human being, health, and nursing (McEwen & Willis, 2010). Watson explains the way in which nurses interact with patients via movements, gestures, touch, sound, verbal expressions, and share scientific information contribute to caring-healing modalities which potentiate the healing process.
Literature Review
A literature review was conducted using CINAHL Plus with full text accessed from the DeVry University library. Three articles were reviewed for themes, ideas, and facts about the concept of caring. Each article reviewed defines caring a little differently and concludes that reaching a common definition in nursing is difficult. Furthermore, each scholarly article reviewed describes an incongruence in the way that nurses and patients perceive the concept of caring. Each article also concludes that caring is an essential component to health care and impacts patient outcomes. However, the articles state that caring in nursing is a difficult concept to measure. Sunderland(2013) notes that relationships between health care professionals, patients, and their families is important to a patient’s health and can result in either suffering or relieved suffering. This study concludes that nurses, patients, and their families perceive caring as an essential component of the healing process.
An interesting concept discussed by Papastaurou, Efstathiou, and Charalambous (2011) in their research is that patients place more emphasis on the technical skills in nursing than nurses do.
The authors describe that the more ill patients are the more important the proficiency of nursing skills is to them than the relationship they have with their nurse. However, the articles reviewed state that more research is needed to emphasize the difference that caring makes related to patient outcomes. Dinapoli, Nelson, and Watson (2010) define caring in nursing using the Latin word, caritas. Caritas is defined as something precious and fragile that should be sustained. Furthermore, Dinapoli, Nelson, and Watson add caring to the metaparadigm of nursing and explain that caritas nursing process involves transpersonal care, caring moments between the nurse and patient, and leads to a spiritual connection (2010). The authors conclude that caring heals patients in ways that both medicine and machines …show more content…
cannot.
All three of the articles reviewed use quantitative studies. Soderlund (2013) uses triangulation methodology to draw conclusions from previous studies. Similar to Soderlund’s research method, Papastaurou, Efstathiou, and Charalambous (2011) use a systemic review of comparative studies to draw conclusions. The two aforementioned methodologies of research are often reliable as they draw conclusions from previous studies and cover a large amount of studies and include a larger sample size then the original study as it incorporates numerous studies to draw conclusions. However, sometimes these types of research methods can involve bias as the author is often the one conducting the research. Dinapoli, Nelson, and Watson (2010) used a more scientific approach in their research as they used exploratory and principal component factor analysis to measure the structure of the caring factor survey. The caring factor survey was originally tested on 89 patients and then tested on 450 patients globally. The results were analyzed using the analysis of variance (ANOVA).
Strengths of the authors’ conclusions in the literature review are that they all define caring as an essential component in nursing and that it does increase patient satisfaction and healing. However, a weakness is that a common definition of caring in nursing does not exist and neither does a definitive way to measure caring in nursing to prove that it leads to increased patient healing. Each author in the literature review explains the importance of needing more research related to the concept of caring in nursing to illustrate how it leads to increased patient outcomes.
Uses of the Concept
Caring is a concept used by nurses in the care of their patients and themselves. Parker and Smith (2010) provide an overview of Watson’s Theory of Caring. Watson explains the ability for the nurse to connect with a patient is translated via movements, gestures, facial expressions, procedures, information, touch, and sound. Watson further explains that the nurse uses caring to potentiate harmony which releases some of the blocked energy which interferes with the natural healing process. Watson states that caring- healing practices are dependent on “critical, reflective practices that must be continuously questioned and critiqued in order to remain dynamic, flexible, and endlessly self-revising and emergent”(Parker & Smith, 2010, p. 356). Furthermore, Watson describes the caring moment/ caring occasion as an action by both the nurse and the patient and that if it is transpersonal each person feels a connection at the spiritual level opening up opportunities for healing and human interaction which affects both the patient and the nurse.
Caring moments teach the nurse how to be human by learning to recognize herself in others, Watson states “it keeps alive our common humanity and avoids reducing self or others to the moral status of an object” (Parker & Smith, 2010, p. 358) Caring is used by nurses not only in the care of their patients but also themselves at the spiritual and soul level in order to enhance and promote wholeness and healing in those they care for.
Defining Attributes
There are several defining attributes of caring in nursing including touch, competence, presence, attitude, and acceptance. However, this concept analysis will discuss two of the defining attributes of caring; touch and acceptance. Touch is a form of nonverbal communication that is often associated with caring behavior. There are numerous studies available which illustrate how therapeutic touch increases patient outcomes related to pain relief and mental illness. Nurses often use touch in practice to illustrate compassion for their patients; it could be the gentle patting of a dying patient’s hand or stroking the forehead of an unconscious patient. Touch often indicates to a patient that they are not alone and are cared for. Watson explains that touch allows nurses to connect with another at the spirit-to-spirit level. Use of therapeutic touch and massage is often used in nursing as a caring healing modality (Parker & Smith, 2010).
Acceptance of another human being is also a defining attribute of caring.
Accepting a person means to acknowledge that they are worthy of dignity and respect. Soderlund (2013) explains that people experience dignity and wellbeing when they are comforted and feel healed in an atmosphere of humanity. Acceptance is at the heart of patient centered care by validating what a patient has to say is important and encouraging them to make decisions and take charge of their own health. Watson describes acceptance as a nurse seeing the person behind the patient (Parker & Smith, 2010). Acceptance truly illustrates the caring qualities that a nurse encompasses as nurses deal with patients with varied life
experiences.
Model Cases
Namaste is a new care program that has emerged throughout the United States which has increased the care of individuals with advanced dementia. Trueland (2012) describes the Namaste program as a program for individuals with a silent voice. Namaste involves individualized one on one care. In the case described by Trueland, each day residents of the nursing home are welcomed individually by name as they enter a room filled with pillows and blankets. Throughout the day residents have their hands massaged with lotion, are offered smoothies and popsicles and are encouraged to reminiscence using memory boards and other aids (2012). The Namaste program of care allows nurses to spend more time with their patients, allowing them to develop a more meaningful transpersonal relationship with them. As a result of Namaste nurses have been able to assess pain more easily, pressure ulcers have been decreased, fluid intake has been increased, and aggression has been more easily managed(Trueland, 2012).
In the second model case Tesfamichael (2011) describes an incident in which an elderly patient experiences bowel incontinence. In this case the nursing instructor and nursing student hear the patient crying outside of her room. The nursing instructor walks into the room and identifies the patient by her last name, which is the way she prefers to be addressed; this illustrates respect for the patient. The nursing instructor then pulls the curtain and asks the nursing student to gather cleaning supplies. The nursing instructor stays with the patient while the student gathers supplies, demonstrating presence, which is a defining attribute of caring. When the student returns the instructor and the student assist the patient in cleaning herself and changing clothing, asking her permission before undressing her and cleaning intimate areas; this illustrates treating the patient with dignity (Tefsamichael, 2011).
Alternative Cases
Two contrary cases are going to be illustrated using the same model cases above. The opposite of a care program like Namaste would be simply sitting residents with advanced dementia in a room with the television on and not providing any interaction. During the day the residents experience no human touch or contact because the nurses caring for them do not think they understand what they are saying so they do not communicate with them. The residents are not being treated with dignity or respect or asked to take an autonomous role in their care. Watson’s carative processes involve providing a supportive, protective, spiritual, and healing environment that encourages comfort and dignity (Parker & Smith, 2010).
In the second contrary case the patient experiences bowel incontinence and is heard crying in the hall. The nursing instructor walks into the room and acknowledges the patient but screams loudly to the student to get supplies because there is a huge mess to clean up. Not only did the instructor not protect the patient’s privacy but she is also not treating her with dignity or respect. Once the student returns the instructor scolds the patient telling her to be more careful next time and make it to the restroom. The student sees an example of a non-caring interaction between the instructor and patient, which may be carried into her own practice one day. Watson’s carative factors include assisting with basic needs and administering human care essentials which encourage body-spirit wholeness and unity of the being in all aspects of care and promoting transpersonal teaching-learning (Parker & Smith, 2010).
Antecedent & Consequence
An antecedent and component of caring is respect. Respect is a basic moral principle and human right. Respect and caring positively impact nurse-patient interactions. Nurses often show care by respecting a patient’s dignity, their autonomy, and accepting their values. Browne (1993) conceptualizes respect and states that it is very important to the concept of caring. Furthermore, Browne explains that respect makes up more specific components within caring such as empathy, support, and acceptance (1993). Respect for individuals leads to caring principles that encompass nursing such as humanized care and shared decision making.
A consequence of caring is that it can lead to moral distress. Shepard (2010) discusses how nurses often experience moral distress related to caring for patients. Shepard further discusses how oncology and critical care nurses often deal with end of life care and experience conflicts between ethical principles and external principles. Nurses often experience moral distress when they have to see the suffering of their patients related to interventions they receive while hospitalized. Nurses often experience moral conflict when aggressive treatment is delivered to dying patients or when they feel patients’ rights are being violated or resources are being allocated. Shepard states that many times nurses ask themselves, “why am I doing this?” and moral distress can negatively impact nurses’ mental health, job satisfaction, and delivery of care (2010).
Empirical Referents
As stated earlier in the paper measuring caring in nursing is often a difficult task but oftentimes caring is measured by giving patients satisfaction surveys about the care they received. Dinapoli, Nelson, and Watson (2010) have developed a ten question survey the Caring Factor Survey (CSF) to measure patient perceptions of the care they received to help improve caring behaviors in nurses.
Several measurement tools are being developed to measure the caring phenomenon that exists in nursing. Watson’s Theory of Caring and her Caritas Factors are often referred to when developing questionnaires for patients to answer. Two assessment tools that exist are CARE-Q and the Caring Behavior Inventory. CARE-Q is a caring assessment evaluation that asks participants to rate 50 caring behaviors from least important (1) to most important (7). The results are then analyzed using statistics. The Caring Behavior Inventory assessment tool asks participants to rate 42 items on the extent that the nurses’ make caring visible to them (Dinapoli, Nelson, & Watson, 2010).
Conclusion
This concept analysis hopefully helped define caring in nursing. By discussing the aim of the analysis, reviewing scholarly literature, uses for the concept, defining attributes, model and alternative cases, antecedents and consequences, and providing empirical referents it should be evident that caring is a very important component of nursing. Caring involves understanding patients on a spiritual level and looking beyond their illness or diagnosis to see the soul that lies within them. Caring can be the gentle touch a nurse gives a patient to reassure them they are not alone. Caring can be a nurse sitting with a patient silent while they cry after receiving tragic news. Caring often means a nurse smiling or nodding to reassure a patient what they have to say matters. Caring entails respect for a patient’s views and culture. Caring is what makes nursing more than science; an art.
Elizabeth Adkison
Chamberlain College of Nursing
Theoretical Basis for Advanced Practice Nursing
NR 501
Dr. Robyn Rice
Aug 3, 2014 Concept analysis of caring in nursing Maya Angelou once said “People may forget what you said, but they will never forget the way you made them feel.("Maya Angelou," 2014, p. 1)” The profession of nursing is often defined as not only a science but also an art. Jean Watson and her Theory of Caring defines nursing as the art of caring. Concept analysis is important in order to define terms and provide clarity of a concept. Caring is so much more than just an emotion in nursing. This concept analysis aims to define caring in the profession of nursing and the healing …show more content…
of patients. By providing a purpose for the analysis, reviewing scholarly literature, providing uses of the concept, defining its attributes, providing examples of two model cases and alternative cases, defining its antecedents and consequences, and explaining two empirical referents; it will become evident how important caring is to the art of nursing.
Aim
The aim of this concept analysis is to identify caring as a core concept in nursing and define caring in relation to the profession of nursing. Watson believes that in nursing practice it is imperative to sustain human caring ideals and she also breaks up the concept of caring using three out of the four metaparadigms in nursing; the human being, health, and nursing (McEwen & Willis, 2010). Watson explains the way in which nurses interact with patients via movements, gestures, touch, sound, verbal expressions, and share scientific information contribute to caring-healing modalities which potentiate the healing process.
Literature Review
A literature review was conducted using CINAHL Plus with full text accessed from the DeVry University library. Three articles were reviewed for themes, ideas, and facts about the concept of caring. Each article reviewed defines caring a little differently and concludes that reaching a common definition in nursing is difficult. Furthermore, each scholarly article reviewed describes an incongruence in the way that nurses and patients perceive the concept of caring. Each article also concludes that caring is an essential component to health care and impacts patient outcomes. However, the articles state that caring in nursing is a difficult concept to measure. Sunderland(2013) notes that relationships between health care professionals, patients, and their families is important to a patient’s health and can result in either suffering or relieved suffering. This study concludes that nurses, patients, and their families perceive caring as an essential component of the healing process.
An interesting concept discussed by Papastaurou, Efstathiou, and Charalambous (2011) in their research is that patients place more emphasis on the technical skills in nursing than nurses do.
The authors describe that the more ill patients are the more important the proficiency of nursing skills is to them than the relationship they have with their nurse. However, the articles reviewed state that more research is needed to emphasize the difference that caring makes related to patient outcomes. Dinapoli, Nelson, and Watson (2010) define caring in nursing using the Latin word, caritas. Caritas is defined as something precious and fragile that should be sustained. Furthermore, Dinapoli, Nelson, and Watson add caring to the metaparadigm of nursing and explain that caritas nursing process involves transpersonal care, caring moments between the nurse and patient, and leads to a spiritual connection (2010). The authors conclude that caring heals patients in ways that both medicine and machines …show more content…
cannot.
All three of the articles reviewed use quantitative studies. Soderlund (2013) uses triangulation methodology to draw conclusions from previous studies. Similar to Soderlund’s research method, Papastaurou, Efstathiou, and Charalambous (2011) use a systemic review of comparative studies to draw conclusions. The two aforementioned methodologies of research are often reliable as they draw conclusions from previous studies and cover a large amount of studies and include a larger sample size then the original study as it incorporates numerous studies to draw conclusions. However, sometimes these types of research methods can involve bias as the author is often the one conducting the research. Dinapoli, Nelson, and Watson (2010) used a more scientific approach in their research as they used exploratory and principal component factor analysis to measure the structure of the caring factor survey. The caring factor survey was originally tested on 89 patients and then tested on 450 patients globally. The results were analyzed using the analysis of variance (ANOVA).
Strengths of the authors’ conclusions in the literature review are that they all define caring as an essential component in nursing and that it does increase patient satisfaction and healing. However, a weakness is that a common definition of caring in nursing does not exist and neither does a definitive way to measure caring in nursing to prove that it leads to increased patient healing. Each author in the literature review explains the importance of needing more research related to the concept of caring in nursing to illustrate how it leads to increased patient outcomes.
Uses of the Concept
Caring is a concept used by nurses in the care of their patients and themselves. Parker and Smith (2010) provide an overview of Watson’s Theory of Caring. Watson explains the ability for the nurse to connect with a patient is translated via movements, gestures, facial expressions, procedures, information, touch, and sound. Watson further explains that the nurse uses caring to potentiate harmony which releases some of the blocked energy which interferes with the natural healing process. Watson states that caring- healing practices are dependent on “critical, reflective practices that must be continuously questioned and critiqued in order to remain dynamic, flexible, and endlessly self-revising and emergent”(Parker & Smith, 2010, p. 356). Furthermore, Watson describes the caring moment/ caring occasion as an action by both the nurse and the patient and that if it is transpersonal each person feels a connection at the spiritual level opening up opportunities for healing and human interaction which affects both the patient and the nurse.
Caring moments teach the nurse how to be human by learning to recognize herself in others, Watson states “it keeps alive our common humanity and avoids reducing self or others to the moral status of an object” (Parker & Smith, 2010, p. 358) Caring is used by nurses not only in the care of their patients but also themselves at the spiritual and soul level in order to enhance and promote wholeness and healing in those they care for.
Defining Attributes
There are several defining attributes of caring in nursing including touch, competence, presence, attitude, and acceptance. However, this concept analysis will discuss two of the defining attributes of caring; touch and acceptance. Touch is a form of nonverbal communication that is often associated with caring behavior. There are numerous studies available which illustrate how therapeutic touch increases patient outcomes related to pain relief and mental illness. Nurses often use touch in practice to illustrate compassion for their patients; it could be the gentle patting of a dying patient’s hand or stroking the forehead of an unconscious patient. Touch often indicates to a patient that they are not alone and are cared for. Watson explains that touch allows nurses to connect with another at the spirit-to-spirit level. Use of therapeutic touch and massage is often used in nursing as a caring healing modality (Parker & Smith, 2010).
Acceptance of another human being is also a defining attribute of caring.
Accepting a person means to acknowledge that they are worthy of dignity and respect. Soderlund (2013) explains that people experience dignity and wellbeing when they are comforted and feel healed in an atmosphere of humanity. Acceptance is at the heart of patient centered care by validating what a patient has to say is important and encouraging them to make decisions and take charge of their own health. Watson describes acceptance as a nurse seeing the person behind the patient (Parker & Smith, 2010). Acceptance truly illustrates the caring qualities that a nurse encompasses as nurses deal with patients with varied life
experiences.
Model Cases
Namaste is a new care program that has emerged throughout the United States which has increased the care of individuals with advanced dementia. Trueland (2012) describes the Namaste program as a program for individuals with a silent voice. Namaste involves individualized one on one care. In the case described by Trueland, each day residents of the nursing home are welcomed individually by name as they enter a room filled with pillows and blankets. Throughout the day residents have their hands massaged with lotion, are offered smoothies and popsicles and are encouraged to reminiscence using memory boards and other aids (2012). The Namaste program of care allows nurses to spend more time with their patients, allowing them to develop a more meaningful transpersonal relationship with them. As a result of Namaste nurses have been able to assess pain more easily, pressure ulcers have been decreased, fluid intake has been increased, and aggression has been more easily managed(Trueland, 2012).
In the second model case Tesfamichael (2011) describes an incident in which an elderly patient experiences bowel incontinence. In this case the nursing instructor and nursing student hear the patient crying outside of her room. The nursing instructor walks into the room and identifies the patient by her last name, which is the way she prefers to be addressed; this illustrates respect for the patient. The nursing instructor then pulls the curtain and asks the nursing student to gather cleaning supplies. The nursing instructor stays with the patient while the student gathers supplies, demonstrating presence, which is a defining attribute of caring. When the student returns the instructor and the student assist the patient in cleaning herself and changing clothing, asking her permission before undressing her and cleaning intimate areas; this illustrates treating the patient with dignity (Tefsamichael, 2011).
Alternative Cases
Two contrary cases are going to be illustrated using the same model cases above. The opposite of a care program like Namaste would be simply sitting residents with advanced dementia in a room with the television on and not providing any interaction. During the day the residents experience no human touch or contact because the nurses caring for them do not think they understand what they are saying so they do not communicate with them. The residents are not being treated with dignity or respect or asked to take an autonomous role in their care. Watson’s carative processes involve providing a supportive, protective, spiritual, and healing environment that encourages comfort and dignity (Parker & Smith, 2010).
In the second contrary case the patient experiences bowel incontinence and is heard crying in the hall. The nursing instructor walks into the room and acknowledges the patient but screams loudly to the student to get supplies because there is a huge mess to clean up. Not only did the instructor not protect the patient’s privacy but she is also not treating her with dignity or respect. Once the student returns the instructor scolds the patient telling her to be more careful next time and make it to the restroom. The student sees an example of a non-caring interaction between the instructor and patient, which may be carried into her own practice one day. Watson’s carative factors include assisting with basic needs and administering human care essentials which encourage body-spirit wholeness and unity of the being in all aspects of care and promoting transpersonal teaching-learning (Parker & Smith, 2010).
Antecedent & Consequence
An antecedent and component of caring is respect. Respect is a basic moral principle and human right. Respect and caring positively impact nurse-patient interactions. Nurses often show care by respecting a patient’s dignity, their autonomy, and accepting their values. Browne (1993) conceptualizes respect and states that it is very important to the concept of caring. Furthermore, Browne explains that respect makes up more specific components within caring such as empathy, support, and acceptance (1993). Respect for individuals leads to caring principles that encompass nursing such as humanized care and shared decision making.
A consequence of caring is that it can lead to moral distress. Shepard (2010) discusses how nurses often experience moral distress related to caring for patients. Shepard further discusses how oncology and critical care nurses often deal with end of life care and experience conflicts between ethical principles and external principles. Nurses often experience moral distress when they have to see the suffering of their patients related to interventions they receive while hospitalized. Nurses often experience moral conflict when aggressive treatment is delivered to dying patients or when they feel patients’ rights are being violated or resources are being allocated. Shepard states that many times nurses ask themselves, “why am I doing this?” and moral distress can negatively impact nurses’ mental health, job satisfaction, and delivery of care (2010).
Empirical Referents
As stated earlier in the paper measuring caring in nursing is often a difficult task but oftentimes caring is measured by giving patients satisfaction surveys about the care they received. Dinapoli, Nelson, and Watson (2010) have developed a ten question survey the Caring Factor Survey (CSF) to measure patient perceptions of the care they received to help improve caring behaviors in nurses.
Several measurement tools are being developed to measure the caring phenomenon that exists in nursing. Watson’s Theory of Caring and her Caritas Factors are often referred to when developing questionnaires for patients to answer. Two assessment tools that exist are CARE-Q and the Caring Behavior Inventory. CARE-Q is a caring assessment evaluation that asks participants to rate 50 caring behaviors from least important (1) to most important (7). The results are then analyzed using statistics. The Caring Behavior Inventory assessment tool asks participants to rate 42 items on the extent that the nurses’ make caring visible to them (Dinapoli, Nelson, & Watson, 2010).
Conclusion
This concept analysis hopefully helped define caring in nursing. By discussing the aim of the analysis, reviewing scholarly literature, uses for the concept, defining attributes, model and alternative cases, antecedents and consequences, and providing empirical referents it should be evident that caring is a very important component of nursing. Caring involves understanding patients on a spiritual level and looking beyond their illness or diagnosis to see the soul that lies within them. Caring can be the gentle touch a nurse gives a patient to reassure them they are not alone. Caring can be a nurse sitting with a patient silent while they cry after receiving tragic news. Caring often means a nurse smiling or nodding to reassure a patient what they have to say matters. Caring entails respect for a patient’s views and culture. Caring is what makes nursing more than science; an art.