Concept of Caring: Nature of Nursing Practice

The concept of caring is frequently put under study, via analytical and phenomenological methods, in order to provide the researchers with an understanding of human nature. The concept of caring has been applied in nursing, whereby the attitude of a nurse is evaluated by observing the moral, cognitive and emotional factors. When looking the concept of caring as it pertains to nursing, it is important to look at the awareness of basic moral values like respect for individuals. Nursing care is often associated with affection for a particular client, or even the empathy and appreciation resulting from the association between a patient and the nurse, whereby they both benefit from understanding one another. It is important to identity and understand this relationship that is often long-term and unusual due to challenges posed by both the institutions and the economy.

Caring is identified as the essence of nursing. As a result, there has been a need to study and extend research in this field, in order to fully understand the perspectives of caring. In addition to this, research in the area of caring as it pertains to nursing, is aimed at evaluating the strengths and weaknesses of the concept, as well as its application in nursing practise. The concept of caring looks at “caring as a human state, caring as a moral imperative or ideal, caring as an affect, caring as an interpersonal relationship, and caring as a nursing intervention”. Previous research in caring in nursing has identified two concepts, namely the physiologic response in patients, and the subjective experience. The main limitations to adequate research in this area has been attributed to “the lack of refinement of caring theory, the lack of definitions of caring attributes, the neglect to examine caring from the dialectic perspective, and the focus of theorists and researchers on the nurse to the exclusion of the patient”.

Caring is not regarded as one of the core concepts in the discipline of nursing. However, some nursing scholars assert that caring is central to the science and art of nursing, as no other profession is so totally concerned with caring behaviours, caring processes and caring relationships. Nursing is not caring, but it cannot exist without caring. Many researchers have identified a close association between caring and the practise of nursing, stating that they are nearly synonymous. Caring is a central and core element of nursing practise, which makes it the essence of nursing (Crowden 1106). Crowden further stresses that caring cannot be described as a paradigm that is particular to nursing. He defines nursing as something that constitutes a fraction of nursing, however minimal, as well as a concept that is payable outside the profession (Crowden). Scott (78) identifies caring as an integral part of medical competence in the field of medicine, just as skills and knowledge are in that field.

Scott’s definition of caring implies performing activities for, to, and with another person thought beneficial for that person. Most people think of this when they say, nursing care. This nursing care usually involves two people whose connection is mainly governed by the responsibility of one person to respond to and meet the needs of the other. Unlike relationships of family members or friends, these relationships are usually between strangers who often lack a shared history and occur within the context of professional norms and sanctions (Scott, Aikem and Mechanic).

According to Phillips (1556), the use of the word caring as synonymous with nursing is insidious. Warelow (658), also shares in this opinion, stating that “considering caring and nursing as synonymous is damaging” (Warelow). According to Webb (962), caring and nursing defy precise description, which results in the challenges posed when assessing the relationship between them. Webb continues to emphasize the lack of consensus about the definition of care, stating that the definition of care and caring can be termed as confusing and ambiguous (Webb). This makes nursing literature an arena for considerable debate on the association between caring and nursing and on the ways in which caring in nursing can be defined.

The debate on the concept of caring is characterized by diametrically opposed points of view that meaningful measurement of aspects of caring in nursing can be made with an intermediate range of conceptualizations (Larson 47). Morse (125) observes nursing as pertaining to time spent with a patient, as opposed to the behavioural tasks towards the patient (Morse, Botorff and Neander). Radsma (444) identifies caring in nursing as any activity that can be seen to portray compassion, commitment, respect, concern, healing and solicitude. According to Gaut (78), caring is exhibited in the actions of nurses, which can be operationalized and investigated. He identifies the taxonomy of caring to include both existential aspects of caring and nursing actions.

The scale of epistemological discussion regarding the nature of caring in nursing is expressed in the research methods that are applied in its study. The researchers who view caring in nursing as existential mainly use qualitative methods, since they observe the likelihood of measuring and evaluating it in a meaningful manner (Leninger 6). On the other hand, there are some researchers who are not averse to operationalizing caring variables in order to study them by means, such as direct observation or questionnaire surveys, including those who view nursing from a largely existential point of view (Gaut 82).

One general definition of caring in nursing can be coined from the various interpretations of the word. Caring can be considered as the behaviours, actions, and attributes of nurses. Caring nurses listen to and are empathetic with clients’ points of views. Generally, caring requires identification of patients as distinctive persons whose goals nurses facilitate. Clients’ ideals and choices are of primary consideration when planning and providing care and the nurses’ own personal values must never interfere with clients’ right to receive care (College of Nurses of Ontario 3-4).

There are some common themes in the study of caring in nursing, in spite of the varying epistemological and methodological approaches used in the study. It is believed that caring is not a lone entity that is quantifiable. “Caring is not only a series of actions, but also a way of acting that is both contextually dependent and value bound” (Fealy 1136). Clifford (39) identifies two elements of caring in nursing, namely an instrumental element, which implies the physical component of caring in nursing, and an expressive element, which focuses on the affective aspect of giving care. Care can also be categorized into physical and emotional labor, with organization as a key component of the care (Clifford).

The roles of a researcher and developer in nursing take on a particular focus when guided by the Theory of Nursing as Caring. Research questions lead to exploration and illumination of patterns of living caring personally and in nursing practice. Dialogue, description, and innovations in interpretative approaches characterize research methods. Development of systems and structures, including policy formulation, information management, nursing delivery, and reimbursement, to support nursing necessitates sustained efforts in reframing and refocusing familiar systems as well as creating novel configurations (Morse, Botorff and Neander).

There has been numerous research into caring in nursing, which is mainly concerned with identifying the elements or concepts such as components of factors that are used in the literature that appear to lack a precise definition, which constitute the process. Researchers have been faced with difficulties of identifying the most appropriate methods to employ in their studies, to identify the elements of caring in nursing. There have been debates between qualitative and quantitative approaches, though the researchers believe that the latter is more effective, if they are well designed, using adequate sample sizes. A broad range of samples allows for the use of various analytical techniques including factor analysis. These techniques are employed in the identification of latent constructs or factors within multivariate data.

According to Valentine (100), nursing research in nursing is supposed to advance the empirical measurement of caring in a way that withstands the scrutiny of the scientific community. Taking into consideration the requirement to clarify the elements of caring in nursing and the acceptability of quantitative methods in this regard, there is a need for a study that will develop and administer an instrument to an adequate sample of nurses, in order for a meaningful multivariate analysis to be carried out, while possibly relying on one conceptualization of caring. The overall aim of nursing is to preserve and promote the health and wellbeing of the patient/person. The nurse identifies a need for care and chooses and implements an action intended to serve as a mean for positive change in the patient.

In nursing practice, the caring nurse is guided by the moral motivation to do good for the patient. Whether an action is caring or not is to be judged solely by the person being cared for (26). Valentine (32) has explored the relationship between caring and cost and concludes that caring is related to satisfaction with the hospital, health outcomes, readiness to leave the hospital, satisfaction with nurses and rating of the hospital. Quality of caring also predicts patients’ knowledge of medications at the time of discharge, clinical condition, and length of stay (Valentine).

In the nursing practice, nurses embrace as foundational to client centred care various values and beliefs, which include: respect; human dignity; clients are experts for their own lives; clients as leaders; clients’ goals coordinate care of the heath care team; continuity and consistency of care and caregiver; timeliness; and responsiveness and universal access to care. These values and beliefs must be incorporated into, and demonstrated throughout, every aspect of client care and services.

The responsibilities and workload of the nurses has been stepped up on a global scale, owing to the numerous changes in the health care delivery systems. Nowadays, nurses are required to handle patients with more keenness and intricacy, in view of their health care circumstances. In spite of these challenges, nurses have sought ways of preserving their caring practice. Watson is observed to support this endeavour, as is seen in the Jean Watson’s caring theory.

My definition for caring involves the consideration of the behaviours, actions and attributes of nurses. Caring nurses listen to and are empathetic with clients’ points of views. Generally, caring requires the recognition of clients as unique individuals whose goals nurses facilitate. Clients’ values and choices are of primary consideration when planning and providing care, and a nurse’s own personal values must never interfere with the clients’ right to receive care. Caring is not the unique province of nursing. However, as a discipline and a profession, nursing uniquely focuses on caring as its central value, its primary interest, and the direct intention of its practice. The full meaning of caring cannot be restricted to a definition, but is illuminated in the experience of caring and in reflection on that experience.

The “caring between” is the source and ground of nursing. It is the loving relation into which the nurse and the nursed enter and correlate by living the intention to care. Without the loving relation of the caring between, unidirectional activity or reciprocal exchange can occur, but nursing in its fullest sense does not occur. It is in the context of the caring between that personhood is enhanced, each expressing self and recognizing the other as caring person

It is not easy to measure care. Care requires attending to relationships, experiences, values, ethics, and emotions, the study of which runs counter to much of Western scientific tradition (Fealy). Instead researchers rely on indicators or proxies that are measurable through psychological, economic, or nutritional instruments. Often these fail to capture the context within which caring relationships develop. These indicators include the time it takes the caregiver to respond to crying (distress signal), the proximity of the caregiver to the infant, caregiver availability, and breastfeeding rates as measures of care. Just as it would be difficult to find adequate indicators for spiritual values, there are few indicators that capture the complexity of care. Psychologists have identified some possible scales. A working definition identifies caring capacity as “the ability to perform care behaviours, to use human, economic, and organizational resources to the benefit of infants and young children” (Clifford).

The commitment of the nurse practicing nursing as caring is to nurture persons living caring and growing in caring. This implies that the nurse comes to know the other as a caring person in the moment. Difficult to care situations are those that show the extent of knowledge and commitment needed to nurse effectively. An understanding of the meaning of caring is challenged when the nurse is presented with someone for whom it is difficult to care. In these extreme situations, a task-oriented, non–discipline-based concept of nursing may be adequate to assure the completion of certain treatment and surveillance techniques. Though this is an insufficient response it is not the nursing we advocate.

The aspect of caring in nursing is a vital ingredient in the practice, since it makes the process of providing care gratifying, as opposed to just another occupation, with earnings on a monthly basis. Watson’s theory provides the nurses with an opportunity to exercise caring, to show empathy in order to relieve the patients and families that are sorrowful, and to enhance their therapeutic and decorum duties. The theory is also helpful in increasing the nurses’ sense of self-actualization. Watson’s theory looks at the caring values, with regard to both the patients and nurses. The application of caring values in provision of health care is important for nurses since it gives meaning to their work, and it provides them with good health.

“The Theory of Nursing as Caring calls upon the nurse to reach deep within a well-developed knowledge base that has been structured using all available patterns of knowing, grounded in the obligations inherent in the commitment to know persons as caring” (Phillips).

These patterns of knowing may develop knowledge as intuition; scientifically quantifiable data emerging from research; and related knowledge from a variety of disciplines, ethical beliefs, and many other types of knowing. All knowledge held by the nurse that may be relevant to understanding the situation at hand is drawn forward and integrated into practice in particular nursing situations. Although the degree of challenge presented from situation to situation varies, the commitment to know self and other as caring persons is steadfast.

The Nursing as Caring theory, grounded in the assumption that all persons are caring, has as its focus a general call to nurture persons as they live caring uniquely and grow as caring persons. The challenge for nursing is therefore, not to discover what is missing, weakened, or needed in another, but to come to know the other as caring person and to nurture that person based on the particular situation presented.

Nursing is not a “process” in the sense of a complex sequence of predictable acts resulting in some predetermined desirable end product. Instead, it is inherently a process, in the sense that it is always unfolding and guided by intention (Valentine). The nurse practicing within the caring context described here will most often be interfacing with the health-care system in two ways: first, communicating nursing so that it can be understood; and second, articulating nursing service as a unique contribution within the system in such a way that the system itself grows to support nursing (Fealy).

In summary, nurses who understand and value the practice of culturally competent care are able to effect positive changes in healthcare practices for clients of designated cultures. Sharing a cultural identity requires knowledge of trans-cultural nursing concepts and principles, along with an awareness of current research findings. Culturally competent nursing care can only occur when client beliefs and values are thoughtfully and skilfully incorporated into nursing care plans (Leininger).

Caring is the core of nursing. Culturally competent nursing guides the nurse to provide optimal holistic, culturally based care. These practices also help the client to care for himself and others within a familiar, supportive, and meaningful cultural context. Continual improvement and expansion of modern technologies and other nursing and general science knowledge are integrated into practice if they are appropriate. Today nurses are faced daily with unprecedented cultural diversity because of the increasing number of immigrants and refugees. Commitment to learning and practicing culturally competent care offers great satisfaction and many other rewards to those who can provide holistic supportive care to all patients (Leininger 20).

In these caring situations, connectedness between the patient and the nurse is established. The caregiver participates in the patient’s struggling with suffering and when the patient’s suffering evokes the caregiver’s compassion, the patient is invited into a caring relationship. Several other studies have revealed the necessity of creating such caring encounters in order to protect humanistic values and prevent humiliation within the health care system (Radsma).

In conclusion, research confirms the importance of caring and its significance for human life and existence. Caring is needed in all relationships between human beings. In general, caring is a concern for all health care professionals in asymmetrical health care encounters. In nursing, the characteristics of caring encounters from the nurses’ perspective are relatively well described. The meaning and outcome of caring encounters from the patients’ and nurses’ perspectives do, however, require further investigation (Leininger).

Works Cited

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Scott, Alfred R., et al. “Organizational aspect of caring.” Milibank Quaterly (1995): 73, 77-95. Print.

Valentine, Lumpur K. Nurse-patient caring: challenging our conventional wisdom. In Caring: the conventional healer. New York: national League for nursing, 1991.

Warelow, James P. “Is caring the ethical ideal?” Journal of Advanced Nursing (1996): 655-661. Print.

Webb, Christine. “Caring, curing, coping: towards and integrated model.” Journal of Advanced Nursing (1996): 23, 960-968. Print.