Importance of Nursing Theory for the Nursing Profession

 Nursing theory is essential to the profession of nursing on many levels. Theories help to define the discipline and play an important role in research and  concept development helping to discover more facets of nursing for research (Im and Chung, 2012). Generating theory consolidates the nursing profession and ensures new roles are created and founded on “critically appraised science base” (Power, 2016, p.42) Nursing is never static; roles are expanding providing care once done by doctors. Nursing theory ensures a close linkage to research making implementation at the practice level more practical as well as providing the evidence base needed for further theoretical development (Warelow, 2013). Theory is crucial in propelling the profession of nursing and to “protect and preserve the focus and clarity of nursing’s distinct contribution to health care” (Wilson et al. 2015, p.146). In today’s multidisciplinary setting of healthcare, the nursing profession continues to strive to define and maintain its professional boundaries as well as expand its body of knowledge (Warelow, 2013).
The study of nursing theory aids in application of theory to everyday practice and patient/client interactions. Through study of nursing theory, graduate students reflect upon experiences from their practice and how application of theory aided in treatment of patients or how the lack of knowledge in theory hindered the person-nurse relationship. According to Hatlevik (2011), the teaching of nursing student in using reflective skills directly influences coherence of theoretical knowledge to practice.
Swanson’s Theory of Caring
Kristen Swanson first introduced the Theory of Caring with the introduction of Five Caring Processes in 1991 with the publishing Empirical Development of a Middle Range Theory of Caring, later expanding and reorganizing the caring processes in 1993 and 1998 (Wands, 2011;  Amendolair,2012). The five caring processes identified are maintaining belief, knowing, being with, doing for, and enabling.
The process of maintaining belief is a “fundamental belief in persons and their capacity to make it through events and transitions and face a future with meaning” (Wands, 2011 p.182). Nurses who maintain belief in their patients help patients find belief in themselves that they can get through whatever circumstance, by offering hope to them. “Knowing is the anchor that moors the beliefs of nursing/nursing to the lived realities of those served (Swanson, 1991, p.164)” (Amendolair, 2012, p.15). Knowing is learning and attempting to understand events and how they affect the person (Wands, 2011). Swanson’s third caring process is being with;  be with the patient, giving time to the patient and offering presence. Offering of one’s self and time conveys a message to the patient that they matter (Wands, 2011). Preserving life and dignity through caring actions is the fourth process of doing for (Amendolair, 2012). Doing for is not just the action, but predicting what the person would do if they could do it for themselves. Lastly, Swanson defines enabling as “to facilitate the other’s capacity to grow, heal, and/or practice self-care (p.164)” (Wands, 2011, p.184). Enabling equips the patients with the tools and empowerment to care and provide for themselves. These processes provide the foundation of Swanson’s Theory of Caring as well as the research of caring (Wands, 2011).
Theory of Caring and the Nursing Metaparadigm
The widely accepted metaparadigm concepts introduced by Fawcett are person, nurse, environment, and health (Alimohammadi, Taleghani, Mohammadi & Akbarian, 2014). Swanson’s five processes presented in the theory of caring meets all facets of the metaparadigm; person and health, person and environment, health and nurse, and person, environment and health. Maintaining belief and being with fulfills the person-environment-health metaparadigm, knowing is the person-environment, health-nurse can easily be related to doing for, and enabling fulfills the person-health concept of Fawcett’s nursing metaparadigm.
Maintaining belief and being with is a fundamental process in the person-environment-health relationship. Maintaining belief in the person is to encourage and give hope that the person can and will transition out of the current situation (Amendolair, 2012). Being with is arguably the most misunderstood process for nurses but is the most important (Wands, 2011). Spending one-on-one time by being emotionally present with the patient builds a trusting relationship encouraging the patient and nurse’s reception and giving of information from the other (Wands, 2011). These concepts lend to the metaparadigm by acknowledging the person, establishing trust, providing hope and being emotionally present helping to enhance the interaction the nurse has with the person-health-environment. These two processes are holistic in nature by maintaining belief and being with recognizing the person as a whole and all the facets of; the person, their health and their environment. This relationship is always interacting; one affects the other and so on.
Knowing is learning and appreciating the lived experiences of the patient. Knowing relates to the person-environment through subcategories Swanson describes in 1998. These subcategories are avoiding making assumptions, thoroughly assessing, seeking cues, centering on the person who is receiving care and engaging personhood (Wands, 2011). Avoiding assumptions relies on the nurse to have a good understanding of self and their own beliefs as to not make assumptions of the person but rather “knowing the other from place of meaning and deliberate intention” (Wands, 2011). The nurse needs to thoroughly assess and seek cues that can help the nurse understand the person-environment relationship. How does the patient present? Does the body language match verbal cues? These are just a sample that can lead the nurse to examine deeper the person-environment metaparadigm and understand the patient and their life events. Through this investigation and knowing, the nurse can better understand how to empower the patient to manipulate the environment to meet their immediate health and wellness needs.
Doing for is the most recognized process by nurses (Wands, 2011). The health and nurse metaparadigm is relatable in the process of doing for. This is the tasks of nursing, the act of doing for the patient when they cannot do it for themselves leading to a better state of health. Doing for requires more than just technical skills, it requires experience and scientific evidence-based knowledge to support the decisions and actions taken. “Care that is, doing for is comforting, anticipatory, protective of the other’s needs, and performed competently and skillfully (Swanson, 1991, p.164)” (Wands, 2011).
Enabling as defined by Swanson is empowering the patient to cope with their illness by teaching, explaining, supporting, and providing feedback about the illness in turn enabling them to make decisions about their care (Amendolair, 2012). The person is then educated about resources and empowered to make changes that are necessary to improve health and promote wellness. Empowerment through enabling supports the person and helps them find meaning and strength to move forward with their decisions, no matter what that decision may be.
Caring, being the central phenomena of nursing, is supported by Swanson’s theory of caring (Ahern, Corless, Davis & Kwong, 2011). Theory can feel abstract and not easily translated to practice, leading to practitioners to experience a disconnect from caring science theory and caring practice (Ranheim, Karner & Bertero, 2012). Swanson’s theory of caring, being a middle-range theory, lends itself to easy implementation and application to the interaction of nurse practitioners and their patients.
Application of Swanson’s Theory of Caring for Nurse Practitioners
Understanding caring as the central phenomena of nursing is an integral part of becoming a successful nurse practitioner. By using Swanson’s five caring processes a nurse practitioner (NP) practices patient-centered care. Patient-centered care ultimately enables and empowers the patient to make necessary decisions and actions that will promote well-being. Establishing a trusting, respectful relationship through maintaining belief, knowing, being with, doing for, and enabling is an important part of the patient-NP relationship. The NP-patient relationship is characterized by the willingness of NPs to talk with patients and to attentively listen(knowing and being with) to create treatment regimens (doing for) while providing teaching and health promotion (enabling) all the while maintaining belief in the patient.
In my own professional experience I have used the five processes of Swanson’s theory of caring. In 2004, I was the nurse taking care of a new mother that had suffered with HELLP that ultimately led to fetal demise. She was transferred into our ICU after the birth of her stillborn baby. Knowing I had recently experienced this myself, I was assigned to the mother. I could connect with her in ways others felt they could not. I was able to offer her and her family hope through maintaining belief that she will get through this. Knowing her by learning what her fears were, her dreams for the baby were and what she wanted in the future. Being with was simply holding her hand or a hug and crying with her. Doing for her the things she could not at the time due to IV lines and weakness. Enabling her, by providing resources to help with child loss and grief and a journal to express her anger, sadness, and hopelessness. Through all of this, I was able to help her not bring closure, as I believe there is no closure when losing a child, but I rather equipped her with tools to help her to try to make sense of what happened.
Ahern et al. (2011) cared for a 38-year old Caribbean woman that had undergone several invasive and diagnostic procedures relating to a neoplasia. While suffering depression and the recent loss of her parents, she received a diagnosis of high-grade dysplasia. After missing two appointments she arrived at the clinic and expressed her fears and anxiety related to the diagnosis and pain of the procedure. The procedure was explained in depth to her hoping to ease her fears. Unfortunately, she was unable to finish the procedure. The authors surmise that if a holistic advanced nurse practice model had been utilized, there may potentially been a different clinical outcome. Swanson’s theory of caring and its five care processes: maintaining belief, knowing, being with, doing for, and enabling became part of the clinics holistic approach for their advanced practice nurse model.
Conclusion
Theory can feel abstract and not easily applied to everyday practice. The graduate prepared nurse offers patients care through full understanding of theory and its implications in caring for the person. McCrae (2012) states the ability to generate and apply theory is what lends to a legitimate profession. Swanson’s theory of caring, being middle-range, is evidence based through interactions of patients and professional nurses. Offering empirical evidence, in today’s evidence-based health care system her theory lends itself to easy application.  “Theory is central in developing nursing knowledge and to asserting nursing as a professional occupation” (Power,2016, p.45).
Nurse practitioners implement caring theory by maintaining belief, knowing, being with, doing for, and enabling resulting in a holistic approach to patient-centered care. Upon reflection and examination of the five processes of Swanson’s theory of caring and the nursing metaparadigm, the author acknowledges that all five processes are related to each of the four metaparadigms. Not unlike the nursing metaparadigm, all five processes build upon each other; no process is independent of the other.
References
Ahern, R. L., Corless, I. B., Davis, S. M., & Kwong, J. J. (2011). Infusing Swanson’s Theory of caring into an advanced practice nursing model for an infectious diseases anal dysplasia clinic. The Journal Of The Association Of Nurses In AIDS Care: JANAC, 22(6), 478-488. doi:10.1016/j.jana.2011.06.010
Alimohammadi,N., Taleghani, F., Mohammadi,E., & Akbarian,R. (2014). The nursing metaparadigm concept of human being in Islamic thought. Nursing Inquiry 21(2), 121-129. doi:10.1111/nin.12040