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694 UNIT V Middle Range Nursing Theories

The Structure of Caring

( )

Client
Maintaining Knowing Being Doing Enabling well-
belief with for being

Philosophical attitudes Informed understanding Message Therapeutic Intended
towards persons (in of the clinical condition (in conveyed actions outcome
general) and the desig- general) and the situation to client
nated client (in specific) and client (in specific)
FIGURE 35-1 The structure of caring as linked to the nurse’s philosophical attitude, informed under-
standings, message conveyed, therapeutic actions, and intended outcome. (From Swanson, K. M. [1993].
Nursing as informed caring for the well-being of others. Image: The Journal of Nursing Scholarship, 25[4],
352–357.)

structure of caring (Figure 35–1). Swanson (1993) who received long-term care from master’s-prepared
has noted that the repertoire of caring therapeutics nurses. Swanson claims that her in-depth meta-
of novice nurses might be limited and restricted by analysis of research on caring has supported the
inexperience. Conversely, the techniques and knowl- generality of her theory beyond a perinatal context
edge imbedded in caring of experienced nurses are (Swanson, 1999c).
elaborate and subtle, so caring might go unnoticed
by an uninformed observer. Yet, Swanson (1993) Acceptance by the Nursing Community
asserts that, regardless of the years of nursing experi-
ence, caring is delivered as a set of sequential pro- Practice
cesses (subconcepts) created by the nurse’s own The usefulness of Swanson’s Theory of Caring has
philosophical attitude (maintaining belief), under- been demonstrated in research, education, and clini-
standing (knowing), verbal and nonverbal messages cal practice. The proposition that caring is central to
conveyed to the client (being with), therapeutic ac- nursing practice had its beginning in the theorist’s
tions (doing for and enabling), and the consequences own insights into the importance of caring in profes-
of caring (intended client outcome). sional nursing practice and in findings from Swanson’s
phenomenological investigations. Her subsequent in-
vestigations demonstrated applicability of the Theory
Logical Form of Caring in clinical nursing practice, education, and
Swanson’s middle-range Theory of Caring was devel- research. Swanson’s theory has been embraced as a
oped empirically using an inductive approach. Chinn framework for professional nursing practice in the
and Kramer (2011) note, “With induction people United States, Canada, and Sweden. An example is the
induce hypotheses and relationships by observing or Dalhousie University School of Nursing in Halifax,
experiencing an empiric reality and reaching some Nova Scotia, Canada, which selected Swanson’s
conclusion” (p. 182). Swanson’s theory was generated Theory of Caring to guide the development of future
from phenomenological investigations with women generations of nurses as caring professionals. Likewise,
who experienced unexpected pregnancy loss, caregiv- nurses at IWK (Isaac Walton Killam) Health Centre,
ers of premature and ill babies in the newborn inten- a tertiary care hospital for women, children, and
sive care unit (NICU), and socially at-risk mothers families in Halifax, Nova Scotia, have recognized the