Caring theories emerged in the 1980s and were influenced by existential philosophy and by principles of equity in relationships. The questions that guided the development of caring theories are “What do nurses do?” (care for patients), and “How do nurses do what they do?” (by caring for patients). These are somewhat similar to those questions that prompted the development of interaction theories. (Theories that are central to this school of thought are not analyzed in this volume.)
Therefore, caring human/becoming theories have many similarities to interaction theories.
However, caring theories elucidate the act of caring in interactive situations, based on values that honor and respect human capacity, spirituality and dignity, hope, trust, and altruism in giving and receiving care. According to Jean Watson (1979, 1988, 1999, 2002), the very act of caring for oth- ers is considered caring for the self. Rosemarie Parse’s (1981, 1995, 1998) central conception of nursing is the transformation of the nurse and the client during the act of providing and receiving care (Cody, 2000; Cowling, 1989). The process of care is defined as a process of becoming for both clients and nurses; however, transformation is only possible if each is open to it (Baldurs- dottir and Jonsdottir, 2002). Patients and nurses are human beings who are coexisting and coconstituting rhythmic patterns with their environments, and choosing meaning and bearing
TABLE 9-17 OUTCOMES THEORISTS—NURSING PROBLEMS
Theorists Nursing Problems
Johnson Structural functional stress in one subsystem (insufficiency, discrepancy) and between subsystems (incompatibility, dominance)
Levine Response to fear, response to stress, inflammatory response, sensory response Rogers Disruptions in organization and structure of interacting human–environment fields
Roy Ineffective coping mechanisms causing ineffective responses that disrupt the integrity of the person
TABLE 9-18 OUTCOMES THEORISTS—NURSING THERAPEUTICS
Theorists Nursing Therapeutics
Johnson Inhibition, constriction, supplementation, protection, nurturing (supportive/maintenance, teaching, counseling, and behavior modification)
Levine Therapeutic—alter course of adaptation Supportive—maintain course of adaptation
Rogers Repatterning of human environment fields or assistance in mobilizing inner resources Roy Manipulation of focal, residual, and contextual stimuli with patient’s zone of positive coping
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responsibilities for their actions. They are actors and reactors simultaneously, and every caring act transforms both to different levels of being.
Caring human being theories, although evolved from interaction theories, Parse’s in particu- lar, are based on Rogerian views of uniting human beings and on the ideas of energy and connec- tion between people and their environments (Watson and Smith, 2002).
Tables 9-20 to 9-25 present theories of caring. Although these theories address nurse–patient interactions, the process of caring occurs between two independent human beings who connect equally in a relationship that transforms them both.
Caring theories have taught us that:
• The fundamental act of caring is central in processes that bring patients and nurses together.
• Caring is central to the discipline of nursing.
• Nurses giving the care, if done right, emerge out of the relationship transformed because caring for another human being affects them profoundly.
• Meanings of health–illness situations are determined individually and modified collec- tively.
• Choices, values, interpretations, and meanings are rights of both patients and nurses.
Understanding each other’s perspectives is part of the caring act.
• The moment of nurse–patient encounter involves connection and dialogue on how the relationship is formed and what the consequences are.
• Although the nurse and patient have a historical context, it is the current moment that shapes their interaction and the consequences of their interaction.
• Nurses and persons/communities are transformed by their encounters.
TABLE 9-19 OUTCOMES THEORISTS—A SUMMARY
Concepts Defining Properties
Focus Energy
Balance, stability, homeostasis presentation Outcomes of care
Human being Adaptive and developmental being
Patient Lack of adaptation
Systems deficiency Orientation Illness, disease
Role of nurse External regulatory mechanism Decision making Primarily health care provider
TABLE 9-20 CARING THEORISTS—A VIEW OF NURSING
Theorists View of Nursing
Watson Nursing is a human science consisting of knowledge, thought, values, philosophy, commitment, and action with passion in human care transactions.
Parse Nursing helps human beings towards becoming through choosing ways of cocreating their own health and finding meanings in situations.
CHAPTER 9 Nursing Theories Through Mirrors, Microscopes, or Telescopes 173
TABLE 9-21 CARING THEORISTS—FOCUS OF NURSING
Theorists Focus of Nursing
Watson Transpersonal caring relationship. A moral commitment to protect and enhance human dignity.
Allow human beings to determine and find their own meaning.
Parse Unitary being with freedom to choose and decide. Nursing guides unitary human beings in finding meaning in situations, in choosing ways to cocreate their health and to deal with illness. Nursing guides in authentic living in the day and dayness of a human being’s life.
TABLE 9-22 CARING THEORISTS—GOALS OF NURSING
Theorists Goal of Nursing
Watson Mental and spiritual growth for human beings (nurses and clients), finding meaning in one’s own existence and experience.
Parse Cocreating meaning and finding ways of being. Transforming through coconstituting new ways in deliberate ways through the human universe process.
TABLE 9-23 CARING THEORISTS—NURSING PROBLEMS
Theorists Nursing Problem
Watson Imbalance caused by deficit in human transcending; disharmony among the mind, body and soul, between person and world.
Parse A pattern of human–universe rather than a disease or a problem, process related to man-living-health tied to meaning, rhythmicity and contranscendence. Discontinuity and interruption.
TABLE 9-24 CARING THEORISTS—NURSING THERAPEUTICS
Theorists Nursing Therapeutics
Watson Use of entire self in affirming the subjective significance of a person. Detecting and responding to true feelings of human beings.
Parse Practice methodology: illuminating meaning, synchronizing rhythms and mobilizing transcendence through being truly present with a person or a group.
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