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CHAPTER 35 Kristen M. Swanson 691

Swanson tested her Theory of Caring with women • The fourth domain refers to actions of caring.
who miscarried in investigations funded by the National • The fifth domain refers to the consequences or the
Institutes of Nursing Research and other funding intentional and unintentional outcomes of caring
sources. Swanson’s (1999a, 1999b) intervention research for both the client and the provider (Swanson,
(N 5 242) examined the effects of caring-based coun- 1999c).
seling sessions on women coming to terms with loss Conducting the literary metaanalysis clarified the
and emotional well-being during the first year after meaning of the concept of caring as it is used in the
miscarrying. Additional aims were examination of the nursing discipline and validated the transferability of
effects of passage of time on healing during that first Swanson’s middle-range Theory of Caring beyond
year and development of strategies to monitor caring perinatal context.
interventions. This study established that passing of Subsequently, Swanson authored or coauthored
time had positive effects on women’s healing after mis- numerous scholarly articles and book chapters on
carriage, however, caring interventions had a positive application of caring-healing relationships in clinical
impact on decreasing the overall disturbed mood, an- practice and education or tested the theory of caring.
ger, and level of depression. The second aim was to Swanson coauthored an article on nursing’s historical
monitor the caring variable and determine if caring was legacy as a caring—healing profession, and the mean-
delivered as intended. To do so, caring was monitored ing, significance, and consequences of optimal healing
in the following three ways: environments for modern nursing practice, education,
1. Approximately 10% of counseling sessions were and research (Swanson & Wojnar, 2004).
transcribed and data were analyzed using inductive The article presented the core foci of nursing as a
and deductive content analysis. discipline: what it means to be a person and experi-
2. Before each caring session, the counselor com- ence personhood; the meaning of health at the indi-
pleted McNair, Lorr, and Droppleman’s (1981) vidual, family, and societal levels; how environments
Profile of Mood States to monitor whether the create or diminish the potential for the promotion,
counselor’s mood was associated with women’s maintenance, or restoration of well-being; and the
ratings of caring after each session, using an inves- caring-healing therapeutics of nursing. A book
tigator-developed Caring Professional Scale. chapter followed toenhance nurses’ capacity for com-
3. After each session, the counselor completed an passionate caring (Swanson, 2007). In it, Swanson
investigator-developed Counselor Rating Scale and explored how caring matters to well-being of every
took narrative notes about her own counseling. person and described conditions that impact quality
The most noteworthy finding of monitoring caring of nurse caring ranging from the interpersonal rela-
was that clients were highly satisfied with caring re- tionships through physical environments, to execu-
ceived during counseling sessions, suggesting caring tive/managerial leadership. Swanson’s coauthored
was delivered and received as intended. works focused on social and economic factors that
Swanson’s (1999c) subsequent investigation was a affect nursing shortage and quality of care (Grant &
literary metaanalysis on caring. An in-depth review of Swanson, 2006) and consumer satisfaction with
130 investigations on caring led Swanson to propose health care (Mowinski-Jennings, Heiner, Loan, et al.,
that knowledge about caring may be categorized into 2005). Swanson and colleagues also explored comple-
five hierarchical domains (levels), and research con- mentary and alternative medicine (CAM) attitudes
ducted in any one domain assumes the presence of all and competencies of nursing students and faculty and
previous domains (Swanson, 1999c). the results of integrating CAM into the nursing cur-
• The first domain refers to the persons’ capacities to riculum as a holistic approach to nursing (Booth-
deliver caring. Laforce, Scott, Heitkemper, et al., 2010).
• The second domain refers to individuals’ concerns In her own program of research, Swanson tested
and commitments that lead to caring actions. the usability of the Theory of Caring. In 2003, Swanson
• The third domain refers to the conditions (nurse, and colleagues published results from an investiga-
client, organizational) that enhance or diminish tion on the miscarriage effects on interpersonal and
the likelihood of delivering caring. sexual relationships during the first year after loss