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692 UNIT V Middle Range Nursing Theories

from women’s perspective and investigated the context Researchers concluded that applying the Theory of
and evolution of women’s responses to miscarriage Caring in clinical practice is an effective strategy to
during the first year after loss (Swanson, Connor, promote healing after unexpected pregnancy loss for
Jolley, et al., 2007). In 2009, Swanson and her women and men as individuals and as couples.
research team published results of a funded inter- Swanson continues to contribute to research of
vention study called Couples Miscarriage Healing other scholars. In 2006, Wojnar and Swanson ex-
Project. The purpose was to better understand the plored why lesbian mothers should deserve special
effects of miscarriage on men and women as indi- consideration when it comes to healing after miscar-
viduals and as couples, to explore the effects of mis- riage. As a result, Wojnar, Swanson, and Adolfsson
carriage on couple relationships, and to identify best (2011) offered a revised conceptual model of miscar-
ways of helping men and women heal as individuals riage inclusive of lesbian population for clinical
and as couples after unexpected pregnancy loss. practice and research. Swanson coauthored findings
Study participants (341 heterosexual couples) were from an investigation that explored soldiers’ experi-
randomly assigned to control or one of the follow- ences with military health care (Jennings, Loan,
ing three treatment groups: (1) nurse caring, which Heiner, et al., 2005). Findings suggest that quality of
entailed attending three counseling sessions with a care for soldiers is improved by narrowing the gap
nurse, (2) self-caring, which involved completing between what is offered for them as consumers and
three videos and workbooks, or (3) combined caring, what they experience when they seek care. Most
which involved attending one nurse caring session recently, Swanson coauthored results from a study
and completion of three videos and workbooks, that explored the experiences of parents following
to determine the most effective way of supporting moderate to severe traumatic brain injury of their
couples after miscarriage. Interventions, based on child (Roscigno & Swanson, 2011) as well as the
Swanson’s Theory of Caring and Meaning of Miscar- quality of life for children following traumatic brain
riage Model, were offered at 1, 5, and 11 weeks after injury (Roscigno, Swanson, Solchany, et al., 2011),
enrollment. Outcomes included depression (CES-D) where participants described health and cultural
and grief, pure grief (PG), and grief-related emo- barriers leading to misunderstandings that could be
tions (GRE). Differences in rates of recovery were easily avoided.
estimated via multilevel modeling conducted in a Swanson’s Theory of Caring has been validated for
Bayesian framework. Bayesian odds (BO) ranging a wide range of usage in research, education, and
from 3.0 to 7.9 showed that nurse caring was most clinical practice.
effective for accelerating women’s resolution of de-
pression. BO of 3.2 to 6.6 favored nurse caring inter-
vention and no treatment over self, and combined Major Assumptions
caring for resolving men’s depression. BO of 3.1 to In 1993, Swanson further developed her theory of
7.0 favored all three interventions over no treatment informed caring by making her major assumptions
for accelerating women’s grief resolution, and BO of explicit about the four main phenomena of concern
18.7 to 22.6 favored nurse caring and combined car- to the nursing discipline: nursing, person/client, health,
ing over self-caring or no treatment for resolving and environment.
men’s grief. BO ranging from 2.4 to 6.1 favored
nurse-caring and self caring over combined caring Nursing
or no treatment for promoting women’s resolution of Swanson (1991, 1993) defines nursing as informed
grief-related emotions. BO from 3.5 to 17.9 favored caring for the well-being of others. She asserts that the
nurse caring, combined caring, and control over nursing discipline is informed by empirical knowledge
self-caring for resolving men’s grief emotions. Nurse- from nursing and other related disciplines, as well as
caring had the overall most positive impact on cou- “ethical, personal and aesthetic knowledge derived
ples’ resolution of grief and depression. In addition, from the humanities, clinical experience, and personal
grief resolution was accelerated by self-caring for and societal values and expectations” (Swanson, 1993,
women and combined caring intervention for men. p. 352).