Page 71 - Encyclopedia of Nursing Research

38 n CARInG

nursing practice can result in positive eco- down. Haldorsdottir’s (1991) research led to a
nomic outcomes. Theoretical and empirical classification of levels of caring relationships
C work in caring is expanding. Grand theories related to a continuum of health or vitality;
(Boykin and Schoenhofer, 2001; Leininger & abusive relationships were classified as bio-
McFarland, 2006; Watson, 2008a, 2008b) and cidic, cold and detached as biostatic, apa-
middle-range theories (Duffy & Hoskins, thetic ones as biopassive, benevolence and
2003; Locsin, 2001; Ray, 1989; Smith, 2010; kindness as bioactive, and transpersonal car-
Swanson, 1991) are focused on explicating ing relationships as biogenic or life giving.
the nature and dynamics of care and caring. Sherwood’s (1997) meta-synthesis of 16
Three reviews of the research literature qualitative studies revealed four patterns
on caring have been published. Swanson of nurse caring: interaction, knowledge,
(1999) summarized and categorized the intentional response, and therapeutic out-
research related to caring in nursing science, comes. Caring was defined within content,
and Sherwood (1997) reported a meta-syn- context, process, and therapeutic or healing
thesis of the qualitative research on caring. outcomes. Two types of caring knowledge
Smith (2004) reviewed the research related and skills were identified as person-centered
to Watson’s theory of human caring. Many and technical-physical.
different designs and methods have been Smith (2004) reviewed 40 studies pub-
used to investigate caring, including descrip- lished between 1988 and 2003 that focused
tive qualitative designs, surveys, phenom- specifically on Watson’s theory of transper-
enology, and quasi-experimental designs sonal caring. Four major categories of research
using standardized scales and physiological were identified: nature of nurse caring, nurse
measurement. caring behaviors as perceived by clients and
Swanson (1999) reviewed 130 data-based nurses, human experiences and caring needs,
articles, chapters, and books on caring pub- and evaluating outcomes of caring in nursing
lished between 1980 and 1996. The studies practice and education. The largest number
were categorized into five levels: capacity for of studies focused on nurse caring behaviors
caring (characteristics of caring persons), con- as perceived by clients or nurses. An expand-
cerns and commitments (beliefs or values that ing area of research related to evaluating
underlie nursing caring), conditions (what outcomes of caring. Research supports that
affects, enhances, or inhibits the occurrence of caring-based activities impact mood follow-
caring), caring actions (what caring means to ing miscarriage, patient satisfaction, pain
nurses and clients and what it looks like), and and symptom distress in patients with can-
caring consequences (outcomes of caring). In cer, well-being, and even blood pressure.
her summary of 30 qualitative studies that Watson’s (2008a, 2008b) compendium
described outcomes of caring and noncaring of instruments to assess and measure car-
relationships, Swanson found that outcomes ing is an important contribution toward the
of caring for the recipients of care were emo- advancement of research. This text provides
tional and spiritual well-being (dignity, self- background on more than 20 instruments,
control, and personhood), enhanced healing, citations of work in which they were used,
and enhanced relationships. Consequences and a copy of them. Some of these tools are as
of noncaring were humiliation, fear, and feel- follows: (a) Larson’s CARE-Q to measure per-
ing out of control, desperate, helpless, alien- ceptions of nurse caring behavior, (b) Wolf’s
ated, and vulnerable. nurses who care report Caring Behaviors Inventory to measure the
a sense of personal and professional satisfac- process of caring, (c) Cronin and Harrison’s
tion and fulfillment, whereas noncaring is Caring Behavior Assessment Tool and
related to outcomes of becoming hardened, Duffy’s Caring Assessment Tool to measure
oblivious, depressed, frightened, and worn patient perceptions of nurse caring behaviors,