Caring

Nursing theory is the backbone of the nursing practice. It structures and upholds the day-to-day ins and outs of life in the nursing profession. It bridges multiple areas of practice, connecting disparate and far-flung specialties of nursing and carrying signals between them. Most of all, nursing theory gives nursing practice the strength without which it would crumble. Grand theories serve these roles on a global level, addressing all of nursing in more general, speculative terms, but practice-level theories are no less useful, providing frameworks in which data can be gathered on actual patient outcomes for particular situations. In between are the mid-level nursing theories, gluing together grand nursing theories and practice-level nursing theories into a cohesive whole that flows from big ideas to minutiae with ease. The more specific the problem is, the more likely it is that one would find the best answer in a practice-level theory. As for broader questions of nursing education, informatics, and other upper-level concerns, however, it is often the case that the grand nursing theories are the easiest to apply, counterintuitive though that idea may seem. When one is not dealing with patients directly, grand nursing theories are most useful, and yet many of the same principles can apply to interactions with colleagues as apply to connections with patients. Therefore, Jean Watson’s grand-level nursing theory of caring is the best theory to address the problem raised herein.

Summary of Chosen Nursing Theory

Watson’s caring theory is based on the principles of human connection. Empathy is vital to this theory because according to Watson (2012), this is the only way in which true caring can take place. Yet despite this obvious importance, it also seems that there must be other important aspects of caring. Indeed, there are, Watson also pointed out how “altruistic” ideas such as faith and hope ought to be a part of patient care. Though this may seem controversial, particularly where the possibility of giving a patient false hope is concerned, in truth, positivity should be part of a nurse’s daily attitude. In her work, Watson also drew attention to the fact that science cannot be ignored simply because one is using caring theory; in fact, she asserted that the problem-solving strategies used must come from science. In this respect, caring theory has preempted some of its critics who might see the word “caring” in the name and assume that this suggests a complete abandonment of the solid empirical and evidence-based practices upon which the field of nursing rests. Overall, caring theory brings many specific reminders on how to bring greater caring into all interactions that a nurse might encounter, whether in a career or life.

Sections of This Paper

The nursing theory under discussion having been summarized, following the conclusion of this introduction, a hypothetical but realistic and relatable problem will be proposed. Following this, the scholarly evidence on the portions of Watson’s caring theory that relates to the problem or issue will be examined in detail. Based on these ideas and their connections to the problem at hand, a strategy with which to approach the issue will be devised. Again, a section on the relationship between this portion and the literature shall follow. Subsequently, legal or ethical issues will be brought in as they relate to the strategy, and from there, the paper will conclude with a reiteration of the new understanding gained through this research into nursing theory and its connection to a problem.

Problem or Issue

The problem or issue chosen should first and foremost be relatable. As all nurses have gone through an educational process to acquire the right to use that label for themselves, it seems sensible to start with education as the locus of interest. One common problem in nursing education is that newer ideas are constantly replacing older ones, yet educators have a tendency to pass along the values, systems, and techniques that were prevalent when they were educated. This can sometimes lead to conflict in which students are told contradictory information by different teachers, and this becomes both confusing and distressing for students. If the teachers are subsequently confronted in the classroom with the information that their doctrines are not the only authoritative source, depending upon temperaments, hostility can arise. Students might be left with both resentment for being put in the situation of being between two opinions and fear that they will not be able to become adequate nurses if the educational system lacks consistency. Usually, this situation is handled simply by being ignored until those involved have mostly forgotten its occurrence, but with the use of caring theory, such an issue could instead become a means to open a forum between concerned parties and bring greater understanding.

Scholarly Evidence

Caring theory may not have explicitly related literature on the topic of nursing education, but it is still valid to invoke the theory as a guiding force for this problem. At times, it is difficult to find indisputable connections between scholarly sources on grand nursing theories and a given problem or issue. This, of course, is merely one of the weaknesses of grand theories at work and does not invalidate the search for the bridge between caring theory and the problem at hand. First, however, it may be helpful to define Watson’s caring theory at greater length. As Watson herself (2012) put it in a retrospective reflecting decades of work in the area, “Both retrospectively and prospectively, [caring theory] can be read as philosophy, ethic, or even paradigm or worldview . . . [H]umans cannot be treated as objects [nor] separated from self, other, nature, and the larger universe” (p. 239). The fact that the theory can be seen as an overarching governing philosophy means that Watson’s caring theory can never be too far divorced from any topic, even when those topics deal more with nursing management issues such as nursing leadership, nursing education, nursing informatics, or health policy. Also, though patients are often at a bit of a remove from these higher-level issues and concerns, Watson’s caring theory still guides because the theory does not refer only to patients but rather to all humans.

Because Watson’s caring theory involves everyone, nursing students and teachers alike can be the objects of the caring approach for which Watson has advocated. It seems likely that Watson finds the application of her caring theory to a conflict between students and teachers to be entirely in keeping with the theory. Alligood (2013) explained Watson’s emphasis on “the interpersonal and transpersonal qualities of congruence, empathy, and warmth . . .” and her belief that “nurses are not here to manipulate and control others but rather to understand” (p. 81). In this summary of Watson’s views, one might just as easily substitute “nursing teachers” for “nurses” and yield an equally valid result; teachers, too, connect better with students in a state of interpersonal congruence when there is no attempt to manipulate or control them. Likewise, even when there is no power differential, as between two nursing teachers who are colleagues, the temptation to try and force a personally desired outcome is rarely useful. Thus, as a keystone of the strategy proposed, a willingness to engage as equals must prevail as the only path to true caring.

Strategy

Once a more transpersonal viewpoint is adopted, the strategy for resolving this hypothetical issue ought to fall into place naturally. Primarily, the strategy should consist of discussions between the teachers who might not ordinarily have much contact with one another, as well as genuine interactions between the teachers and the students that help allay the students’ possible fears. Because those who are newest to a discipline often have the highest desire for a great deal of structure, students’ loss of faith over faculty disagreements on minor issues can at times seem overblown to teachers and more experienced nurses. If caring is invoked, however, it becomes more possible to empathize with the other person’s point of view and to see that students’ uncertainty is just a state of mind and not a poor reflection on the teachers. Hopefully, the two teachers who espoused differing views on a nursing practice might be able to find a way to present one single answer to the students out of a sense of caring for students’ natural need for definitive answers at an early stage in their studies. Even if the answer is not perfect and leaves both faculty members dissatisfied with the compromise, caring theory ought to allow the teachers to transcend this difficulty for the greater benefit of the students. Just as in a hospital, the patients’ needs come before those of the medical staff, so, too, in a school the students’ needs must come first.

Rationale and Evidence from Literature

Watson’s caring theory can be particularly useful in enabling those in positions of greater power to see those beneath them as individuals rather than as faceless crowds or stacks of reports or even as a series of problems to be addressed. This notion of focusing on the person rather than the problem is fundamental to the caring theory strategy for this issue. Indeed, any theory of caring in nursing will, by its very nature, have a close tie to person-centered nursing, although many person-centered concepts seem to be on a middle-level for nursing theory rather than the grand level of Watson’s caring theory. As McCormack and McCance (2011) described person-centered care, “Person-centred care has a long association with nursing, and at a level of principle is well understood as that which is concerned with: treating people as individuals, respecting their rights as a person, building mutual trust and understanding . . .” (p. 1). Mutual trust and understanding are particularly important when the issue is one of trust having been rattled. Yet in this strategy for this problem in particular, due to the power dynamics involved, it is important to fully define mutual trust.

For caring theory to be enacted to the fullest the trust cannot only run uphill in the power differential; teachers, too, must trust their nursing students to know what they need. Sherwood’s (2012) meta-analysis noted a similar absence in the literature on caring theory in that nurses were often called upon to build “mutual trust” with patients, yet the half of this in which the nurse must trust the patient was often ignored. Truly, an attitude of, “Trust me, even though I know I cannot trust you,” is not at all in alignment with caring theory and is detrimental to both nurse-patient and teacher-student interactions. Indeed, when such an attitude goes so far as to become exploitative, there can even be ethical issues involved.

Ethical or Legal Aspects

The issue proposed carries few associated legal aspects, as most nursing-related legal concerns tend to relate to patient care and confidentiality, and this issue does not involve actual patients. However, there are ethical concerns with the strategy suggested, since nursing students must be properly educated to be able to take care of patients appropriately down the road. Though it is exceedingly unlikely that a nursing school could ever be implicated in a malpractice suit if a nurse from that school were to commit acts of malpractice or gross negligence, the ethical tie remains. It is not a school’s responsibility to be held accountable for nurses’ subsequent actions, but at the same time, since the strategy suggested involves choosing one firm answer to give students when debate arises, care must be taken. Though the caring theory approach would be sensitive to students’ needs, it would also incorporate future patients’ needs to have the proper care. Indeed, given how caring theory focuses on “transpersonal” properties such as the interconnectivity of all times as being one, under this concept, there is little distinction between the consequences of one’s actions now and those that might occur at a later time. There is enough about the strategy that works well, however, that this alone is a small concern.

Another ethical point that works in favor of the proposed strategy is that if caring theory’s transpersonal premises are accepted, conflict minimized anywhere leads to greater caring everywhere. This is why the issue should not be allowed to simply sit and simmer in teachers’ and students’ awareness. Ultimately, a nursing school ought to model for students the situation of a well-run work environment so that students can take the behaviors and interpersonal structures they have implicitly learned into their new careers. One would not want to let an inter-staff disagreement go unaddressed when working with actual patients, because, under the ideas of Watson’s caring theory, the strong connection between all people might cause this tension might ripple out to patients and negatively impact their health. Ethically, then, nurses must be caring to themselves and their colleagues as well as patients, because only then will patients best be able to receive the caring that nurses have to offer them in particular.

Conclusion

As has been seen, Jean Watson’s caring theory is a grand-level nursing theory that can be applied not only to nurses’ interactions with patients but also to conflicts that might arise at a nursing school. The proposed problem was a hypothetical take on a common situation in which teachers’ disagreement on a nursing topic began to negatively affect students. By using the precepts and principles of caring theory, it became possible to devise a strategy in which empathy and open communication trumped conflict and divisiveness. Caring theory, it would seem, is much more than merely a nursing theory; it is also a means by which to live one’s life.

References

Alligood, M. R. (Ed.). (2013). Nursing theorists and their work. Philadelphia, PA: Elsevier Health Sciences.

McCormack, B., & McCance, T. (2011). Person-centred nursing: Theory and practice. Hoboken, NJ: John Wiley & Sons.

Sherwood, G. D. (2012). Meta-synthesis of qualitative analyses of caring: Defining a therapeutic model of nursing. In M. C. Smith, M. C. Turkel, & Z. R. Wolf (Eds.), Caring in nursing classics: An essential resource, (357–370). New York, NY: Springer Publishing Co.

Watson, J. (2012). The theory of human caring: Retrospective and prospective. In M. C. Smith, M. C. Turkel, & Z. R. Wolf (Eds.), Caring in nursing classics: An essential resource, (237–241). New York, NY: Springer Publishing Co.