Introduction
The concept analysis of any nursing concept involves the description of the concept in relation to its anatomy. This process should comprise of a definition of the concept being analyzed, characteristics that differentiate it from other concepts, boundaries providing delineation for the concept, preconditions identifying the similar conditions that give rise to the behaviors distinguishing the concept and the outcomes that result from the concept. One of the nursing theories that this paper shall cover is the caring concept. The caring concept is developed from the caring theory by Parker and Smith (2010).
Jean Watson’s Theory of Caring
The concept of nursing cannot be discussed without understanding the role that nurses play in the healthcare system. Defining the role of nurses encompasses an understanding of what caring entails. According to Orem (1991), the focus of caring is best understood as returning the patients to self-care rather than establishing a reciprocal relationship between the nurse and the patient. As such, a nurse must be committed to caring in a sustained and continuous manner so long as the patient needs it. To perform this role, the nurse must be in possession of knowledge and skills necessary for the provision of patient care.
Watson (1979) notes that when the term caring is used in nursing, it represents all factors that nurses must meet to deliver patient care. There are factors that have been singled out by various researchers and which are related to the dynamics of nurse-patient relationship. Some of these factors include: trust and respect useful in interpersonal communication and comfort measures such as compassion, empathy, nurturance, helping and coping measures, touching, stress alleviation measures, health maintenance, protection, restorative and stimulative behaviors, instruction and consultation. Judging from these factors, it is evident that the components of caring are more decentralized and play an important supportive role to the therapeutic interventions administered by doctors.
Identification of all uses of the concept
In this step, we shall identify all possible uses that the concept can be used in (Cutcliffe & McKenna, 2005). According to walker and Avant (1995), the various sources that can be used to get the other uses of the concept are available literatures, dictionaries, thesaurus and discussions among colleagues and friends. From the dictionary, the Concise Oxford Dictionary, care has been described as a noun meaning caution, serious attention or trouble. As a verb, the word has been described as feeling regard, affection or concern for somebody or something. The term care can also be modified to caring and caring can either be a noun or an adverb. As a noun, caring means the profession or practice of providing social or medical care. As an adverb, caring means the act of showing or feeling compassion and care towards a person or an object. In the thesauruses, care has been depicted a noun, a verb and an act. As a noun, care stands for caution, anxiety, guardianship, responsibility and regard among many others. As a verb, it is depicted as love, being attentive or philanthropy. Care for is in form of an act and means looking after, safeguarding or being benevolent. It can also stand for love, protecting, nursing and watching over.
Uses of the word
The word ‘caring’ has been used in many places and many attempts have been to uncover the meaning of the name. The main focus has been on the professional use of the term by the nurses, physicians and the general public. It was discovered that the term was sometimes not defined but was linked as a suffix to nursing. There was no differentiation made between the two words- care and nursing- as they were often used interchangeably (Cutcliffe & McKenna, 2005). One of the researches showed that the term caring was used in two clusters. In the first cluster, the term was located in a continuum that began from interest and attention and moved to consideration, concern, guidance, serving needs and protection. The second cluster featured inclination, wanting to be near someone or the attachment towards an individual. It was also discovered that, though there was not cut- clear meaning for the usage of the term, the three basic meanings that were meant by the use of the concept were; responsibility or providing for; concern for or attention to; fondness, regard or attachment.
Theoretical definitions
Some of the theoretical definitions for the caring concept that have been used by nurses include one of the theories by Leininger, where he defined care as the activities and actions directed towards supporting, assisting or enabling other people with anticipated needs to improve their condition or to face death (Leininger, 1991). Another theory developed to define the concept depicted caring as not simply an attitudinal or emotional response, but as a way of being, relating, acting and engagement in other people’s lives (Roach, 1984). According to Watson (1995), he depicted caring as an attitude or value that has to become an intention, a will, or a commitment that is shows itself in concrete acts.
Defining attributes
According to Watson’s theory, caring lies at the core of nursing and a majority of nursing practitioners are driven by their desire to care for the sick. Jean Watson defines caring as a science that encompasses a humanitarian orientation, human caring, phenomena and experiences. The theory is grounded in a relational ontology that views beings as being in unity and interconnectedness with the world. It espouses transpersonal caring which extends caring from the individual to the community, world, and ultimately universe.
Constructing a model case
Walker and Avant (1995) define a model case as a real world example where the concept is used in a way that incorporates all its core attributes without the inclusion of attributes that are not part of the concept. In essence, a model case is an accurate example of the concept. The following is an example of a model case that aligns with the concept of caring: Mrs. Brown has been diagnosed with congestive heart failure. The doctors have stated that the disease is in its terminal stage. Mrs. Brown lives alone and there are no immediate family members that can provide her with emotional support. Suffice is to say that Mrs. Brown was not doing well but she is under the care of a Senior Nurse Roselyn. She sat close to the patient and reached out to her and began talking to her. Mrs. Brown opened up and began talking about her life, the challenges in her family, and things she wished she should have accomplished in life. Because the unit was very busy at the time, Nurse Roselyn drew the curtains and sat there and just listened to the patient.
This model case represents the concept of caring. Despite the high level of activity in the unit, the nurse continues to show support to the patient who is alone and away from her family even at the most critical time in her life. The model case shows not only the concern but also the measures the nurse has taken to provide comfort by being attentive. As such, the nurse is at a better position to provide wholesome care grounded in love, kindness, and equanimity.
Identification of alternate cases (borderline, related, contrary, invented, and illegitimate cases)
Additional cases serve the purpose of providing other examples of what the concept of caring does not entail hence enhancing a better understanding of the concept.
Borderline cases are those that demonstrate a set of the critical attributes of the concept but do not cover all of them. In other situations, the borderline cases may contain all the attributes of the caring concept, but these examples may be markedly different in terms of intensity of occurrence. The following is a case study that can aid in the understanding of borderline cases.
The patient is a 45 year old male who has been admitted at the cardiopulmonary unit. Doctor assessments show that the patient has a history of slurred speech and blurred vision but these symptoms were absent at the time of his admission. However on the second day, the doctors observed transitory ischaemic arterial spasm. He was treated and allowed to go home, but on the fourth day he presented seizures and was readmitted and further analysis showed that he had metastatic lung cancer. Though the nurse had seen him during the first admission, the second admission occurred when the nurse was on holiday, and so was unaware of how the patient had responded to treatment during the first admission. On seeing the patient a second time she did not go and see or talk to the patient. The nurse was frightened and did not know what to tell the patient. When the patient began communicating to her, she could not relate and therefore could not help him find meaning in his life, unable to understand, and therefore unable to offer holistic care. Related cases refer to those cases that are closely related to the nursing concept but do not contain the core attributes of the concept. An example of related cases is the importance of compassion and empathy when caring for the patient.
Identification of antecedents and consequences
Antecedents are events that must take place before caring happens and consequences are the events that happen as a result of caring. A criterion cannot be both an attribute and an antecedent (Walker and Avant, 1995). It can only be either one of them or the other. From the uses of the caring concept and the illustrations given above, three themes can be said to be antecedents rather than critical attributes. ‘Respect for people’ and the ‘amount of time’ can be described as critical attributes or antecedents. In order for caring to take place, respect for people must happen. The amount of time is sometimes influenced by the extent to which caring can take place. ‘intention to care’ is the third antecedent that stems from the works of Watson (1985), and shows caring as the actions and activities that are directed towards supporting, assisting or helping other individuals. From the models above, we can conclude that the consequences of caring are not easily identified. The case however, shows to some degree, the effects of caring or not caring can have on the patient. One of the effects of caring is wellbeing, both mentally and physically.
Definition of empirical referents'
This is the final step in the concept analysis. According to walker and Avant, the critical attributes are often the empirical referents. The concept being analyzed however is highly nebulous and the critical attributes may be equally nebulous. The critical attributes of caring identified in our cases reinforce the qualitative nature of caring. They also highlight the need to further examine the experience of caring
References
Cutcliffe, J. R., & McKenna, H. P. (2005).The essential concepts of nursing: building blocks for
practice. Edinburgh: Elsevier/Churchill Livingstone.
Parker, M. E., & Smith, M. C. (2010).Nursing theories and nursing practice (3rd ed.).
Philadelphia: F.A. Davis.
Walker, L. O., & Avant, K. C. (1995).Strategies for theory construction in nursing (3rd ed.).
Norwalk, CT: Appleton & Lange.
