Concept Analysis for Caring- Overview PDF

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Concept Analysis for Caring Rachel Corbin Chamberlain University NR501NP: Theoretical Basis for Advanced Nursing Practice Dr. Diana O'Connor November 17, 2019

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Concept Analysis for Caring Concept analysis is an in-depth process that involves choosing a specific topic, defining and researching the topic, and then incorporating or applying it into a theory. This process allows the chosen concept to be further researched and developed into a related theory (Bergdahl & Berterö, 2016). Caring is the concept that will be discussed in this paper in the terms of a nurse caring for a patient. Kristen Swanson’s theory of caring and healing is the theory that will be addressed in correlation to the topic of caring. The purpose of this paper is to define caring, review literature, list attributes of a caring nurse, an antecedent, a consequence, empirical referents, construct cases, and apply it to Kristen Swanson’s theory of caring and healing, by using the conceptual analysis process. Definition/Explanation of Caring Caring is a basic, yet complex term that commonly defines the art of nursing. According to Merriam-Webster (2019), caring is typically used as an adjective and can be defined as “feeling or showing concern for or kindness to others”. According to Drahošová and Jarošová (2016), caring is a way of connecting to people who need help, assistance, or support in an empathetic and judgement-free way. Because caring is an innate characteristic that most humans possess, it is safe to assume that nurses and NPs should have this trait in order to provide highquality, empathetic, and holistic patient care. It has been seen that when caring is incorporated into patient care it has a positive effect on patients’ unsettled mood, decreased their anger, and improves depressive states (Butts & Rich, 2018). It is important for nurses and NPs to apply caring into their practice so that their patients can not only benefit from these improved outcomes, but to also provide patient-centered care. Literature Review

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As previously stated above, the concept of caring is a topic that has been researched and discussed for many years. The description of caring being discussed depends greatly on the context in which it is being used. This literature review will cover the context of caring in multiple different ways: the way nurses, patients, and physicians view caring. It seems fitting to address where caring should begin, so the first article written by Kuntarti, Yetti, and Novieastari (2018) addresses how caring is a core nursing value that should be established and initiated during nursing education. It states how nursing caring behaviors need to be incorporated into the nursing curriculum through lectures, case studies, role play, discussion and reflective thinking. Not only do these behaviors need to be taught, but educators are to train students how to incorporate caring techniques into their daily behavior in order to promote an overall caring culture (Kuntarti et al., 2018). In the article written by Compton, Glidemeyer, Mason, Hartranft, and Sutton (2018), they state how the concept of nursing care is interpreted differently by every patient depending on their culture, socioeconomic status, gender, race, or age. It further explains that it is important to understand the patients’ perceptions of caring first so that nurses can provide care based on what the patients’ view caring as and not what the nurses view. They proved that doing this will improve nurse-patient relationships and the patients’ hospital stay (Compton et al., 2018). In the next article, Gillespie et al. (2018) discusses different ways doctors can incorporate caring behaviors into their practice. It shows that patients are overall more satisfied when their doctor was genuine by; showing their own individuality to connect with the patients’ individuality, took time to listen, encouraged patients to express emotion, smiled, shook hands, and recognized them as human beings not just a disease. In return, these left patients feeling empowered to be active participants in their own plan of care (Gillespie et al., 2018).

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In the article written by King et al. (2019), they discuss barriers that get in the way of nurses providing caring behaviors and a simple way to adapt to the barriers so that caring can take place. They stated that barriers such as increased patient load, high patient acuity, and understaffing are inevitable, but how a simple 1-minute mindfulness activity can leave nurses more focused, willing to set a good example, and improve the overall work environment. It showed that when nurses participated in mindfulness activities it also improved nurses caring techniques, decreased incivility, and reduced their stress. This mindfulness activity proved that when in use, it promotes caring behaviors by resetting one’s personal attitude so that they can enhance their kindness and protect their patients’ dignity (King et al., 2019). The next research article written by Calong, Kathyrine, and Soriano (2018), focuses on specific caring characteristics and traits that patients rate as the most important for nurses to possess. In this study, patients rated that: patient education, trusted nurse-patient relationships, and competent nursing care were the most important caring behaviors to obtain. Patients even stated actions that mirrored caring behaviors: hugging, attention, a greeting, prevalence, preparedness, listening, laughing with, and silence modeled a caring nurse. Overall, patients felt that when nurses applied these characteristics into their practice, it allowed a trusted nursepatient relationship to form, which boosted their confidence and loyalty to their care providers (Calong et al., 2018). In the study done by Hayter and Brewer (2018), they suggest that implementing the Watson Caritas Patient Score (WCPS) into healthcare organizations embeds the human caring philosophy into their culture and influences patients’ perceptions of caring. Their studies showed that when they incorporated caring-based initiatives into their organization, patient satisfaction scores increased immensely. Their results proved that these caring initiatives improved the nurse-

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patient relationships allowing patients to have a more positive overall hospital experience compared to before the WCPS was in place (Hayter & Brewer, 2018). Defining Attributes Caring can be viewed differently depending on the person, however, we are looking specifically at caring attributes of a nurse. Offering scientific knowledge to the patient is seen as a caring attribute. This attribute focuses on engaging the patient and their family into their care by informing them on their current health state and teaching them ways to improve their health. Explaining, educating, and updating the patient of their health status, new medications, test results, etc., allows the patient to understand their plan of care, and therefore, feel like an active participant. A partnership develops between the nurse and the patient by placing responsibility on the patient to be the center of their decision making (Welch & Fournier, 2018). Being emotionally and physically present to the patient is another caring attribute. Physical presence is something that is required of a nurse when providing direct care with patients. Being emotionally present involves active listening, meaningful sharing, comforting/consoling and thoughtful responding (Welch & Fournier, 2018). When a nurse utilizes this attribute, it demonstrates to the patient that they matter, they are not alone, and forms a trusting rapport with them. (Welch & Fournier, 2018). A third caring attribute is recognizing that every human life has an individual purpose and meaning. This attribute focuses on treating the patient with dignity and respect in regards to their own perspective. Acknowledging this truth allows the nurse to view the patient as a unique individual with distinct morals and values and incorporating those into their care (Welch & Fournier, 2018). Antecedent and Consequence

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An antecedent seen prior to caring is when a nurse possesses compassion and the natural want to help others. This portrays that caring can be an innate trait that a nurse possesses without effort. It is also imperative that because caring is the core foundation of the nursing field, it should be taught and incorporated into the nursing education curriculum. According to Kuntarti et al. (2018), it is the responsibility of nursing institutions to develop caring behaviors in their students in order to promote competence in caring and therefore lead to a caring culture. Class lectures, case studies, role play, and reflective thinking are learning techniques that institutions can use in order to support caring behaviors. It is not simply enough to just teach caring behaviors to students, but to also train them how to incorporate them into their daily behavior so that it is a lasting, innate habit (Kuntarti et al., 2018). A consequence that is seen in patients after caring takes place is decreased stress and worry. According to Wei, Wei, Brown, Buck, and Mill (2018), when nurses take the time to talk to the patient and their family about their illness and allow questions, patients’ stress and worry decreases. Being a resource of information, addressing patients’ concerns, and comforts patients when they receive difficult information has also proven to alleviate patients’ anxiety (Wei et al., 2018). Butts and Rich (2018) stated that when caring techniques were applied into patient care, that patients experienced a decrease in depression and anger and their overall mood improved. Empirical Referents It is imperative for one to recognize that the exact definition of caring resides in the eye of the beholder (Ackerman, 2019). That is why it is significant to understand both the patients’ and the nurses’ perceptions of caring behaviors. One can measure whether or not nurses are providing caring techniques in their practice by having them take a caring self-assessment survey. In this survey the nurse will be required to answer the following statements with an

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“agree”, “disagree”, or “neutral” response: Overall the care I give is provided with loving kindness; I help support the hope and faith of the patients I care for; I establish a trusting relationship with my patients; I encourage patients to speak honestly about their feelings; and I am responsive to my patients’ readiness to learn when I teach them something new (Ackerman, 2019). Answering this survey, allows nurses to be aware of their strengths and weaknesses in their caring behaviors and allows room for improvement. Another way to measure whether caring is being enacted, is to ask patients to take a patient satisfaction survey. In this survey, the patients will be required to answer the following statements with an “agree”, “disagree”, or “neutral” response: My nurse- delivered care with loving-kindness; met my basic human needs with dignity; initiated trusting relationships with me; created a caring environment that helps me to heal; and valued my personal beliefs allowing for hope (Hayter & Brewer, 2018). This survey gives feedback to whether nurses are providing care that aligns with the patients’ perceptions of caring. Construct Cases Model A model case is either a real-life or hypothetical example of a chosen concept that displays every defining attribute mentioned in the concept analysis (Kroeker, Widdifield, Muthukumarana, Depeng, & Lix, 2017). In this model case, Jen is an experienced NP that has been working for 15 years. Jen works in a family practice where she has established patients. Jen has a patient named Kate that was just diagnosed with a new illness. Jen is passionate about educating and teaching Kate about her diagnosis and all that is involved with it. Jen is both physically and emotionally present for Kate by allowing her to express her feelings, concerns

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and questions about her new illness. Jen recognizes that Kate is a unique individual with specific needs and takes into account her individuality when planning her plan of care. Borderline Jen is an experienced NP that has been working for 15 years. Jen works in a family practice where she has established patients. Jen has a patient named Kate that was just diagnosed with a new illness. Jen is passionate about educating and teaching Kate about her diagnosis and all that is involved with it. However, Jen is extremely busy and has another patient waiting for her. She is unable to be emotionally present for Kate and does not allow her to express her feelings, concerns, or questions. She did not take into account Kate’s individuality and that she has unique needs. Contrary Jen is an experienced NP that has been working for 15 years. Jen works in a family practice where she has established patients. Jen has a patient named Kate that was just diagnosed with a new illness. After telling Kate that she was diagnosed, she does not educate Kate about the illness, does not allow time for Kate to express her feelings, and does not recognize that Kate is a unique person with specific needs. Theoretical Applications The overall purpose of a concept analysis is to distinctly explain concepts that are within a theory and to provide a concise definition that correlates with that theory (Bergdahl & Berterö, 2016). Because caring is a broad, yet complex concept, it is important to state that in this paper we are discussing the concept of caring in relation to the nurse. Kristen Swanson’s theory of caring and healing corresponds directly to caring behaviors that nurses should possess. Her theory describes caring as a comforting, responsible way to value a person by relating and

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committing to that individual. In her theory, Swanson illustrates that caring is comprised of 5 characteristics: maintaining belief, knowing, being with, doing for, and enabling, all of which are to be provided by from a nurse (Welch & Fournier, 2018). Maintaining belief is described as having faith for others in the midst of difficulties. Knowing is the understanding that everyone has meaning to life by avoiding assumptions and judgement. Being with involves being physically and emotionally present with the patient. Doing for includes: comforting, protecting, maintaining dignity, supporting, and validating the patient’s reality. Enabling allows the nurse to encourage the patient and assist them with healthy behaviors (Welch & Fournier, 2018). She reveals in her theory that when nurses incorporate these caring characteristics into patient care, they can ultimately improve patients’ overall moods, decrease their anger, and lessen their depressive states (Butts & Rich, 2018). Conclusion The concept of caring is defined as showing kindness and concern for other people. The theory of caring and healing by Kristen Swanson relates directly to caring behaviors that nurses should possess. It describes how caring is comprised of 5 characteristics: maintaining belief, knowing, being with, doing for, and enabling. As a future NP, I will be sure to use the techniques Swanson set in place in her theory when providing patient care. Overall, the term caring is identified differently depending on the unique individual defining it. Understanding the way each patient views caring is important for nurses to understand when taking initiative to promote a caring environment. I will be sure to take into account that every patient is different and has their own unique views of what caring looks like. Addressing these specific needs will not only promote high quality care, but will also leave me satisfied with my job as a RN and future NP.

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References Ackerman, L. (2019). Caring science education: Measuring nurses’ caring behaviors. International Journal of Caring Sciences, 12, 572–583. Retrieved from https://eds-bebscohost-com.chamberlainuniversity.idm.oclc.org/eds/pdfviewer/pdfviewer? vid=7&sid=2a346e2e-ca22-443d-8fe0-d65ef64f30b7%40sessionmgr103 Bergdahl, E., & Berterö, C. M. (2016). Concept analysis and the building blocks of theory: Misconceptions regarding theory development. Journal of Advanced Nursing (John Wiley & Sons, Inc), 72, 2558–2566. Retrieved from https://onlinelibrary-wileycom.chamberlainuniversity.idm.oclc.org/doi/full/10.1111/jan.13002 Butts, B. J., & Rich, L. K. (2018). Philosophies and theories for advanced nursing practice (3rd ed.). Burlington, MA: Jones & Bartlett Learning. Calong, C., Kathyrine, A., & Soriano, G. P. (2018). Caring behavior and patient satisfaction: Merging for satisfaction. International Journal of Caring Sciences, 11, 697–703. Compton, E. K., Glidemeyer, K., Mason, T. M., Hartranft, S. R., & Sutton, S. K. (2018). Nurses’ caring behaviors: The perception of patients with cancer at the time of discharge after surgery. Clinical Journal of Oncology Nursing, 22, 169–174. Drahošová, L., & Jarošová, D. (2016). Concept caring in nursing. Central European Journal of Nursing & Midwifery, 7, 453–460. Retrieved from https://eds-a-ebscohostcom.chamberlainuniversity.idm.oclc.org/eds/detail/detail?vid=36&sid=981254ff-9c4742f9-a5eb-201a0f98684a%40sdc-vsessmgr02&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d %3d#AN=116597474&db=ccm

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Gillespie, H., Kelly, M., Gormley, G., King, N., Gilliland, D., & Dornan, T. (2018). How can tomorrow’s doctors be more caring? A phenomenological investigation. Medical Education, 52, 1052–1063. Hayter, K. L., & Brewer, B. B. (2018). Patient perceptions of caring in a midwestern hospital. International Journal for Human Caring, 22, 147–152. Retrieved from https://eds-aebscohost-com.chamberlainuniversity.idm.oclc.org/eds/pdfviewer/pdfviewer? vid=2&sid=7f499597-af65-4ab8-b354-4d6e364796da%40sessionmgr4007 King, C., Rossetti, J., Smith, T. J., Raison, M., Gallegos, D., Gorman, R., ... Watson, J. (2019). Effects of a mindfulness activity on nursing service staff perceptions of caring behaviors in the workplace. Journal of Psychological Nursing & Mental Health Services, 57, 28– 36. Kroeker, K., Widdifield, J., Muthukumarana, S., Depeng, J., & Lix, L. M. (2017). Model-based methods for case definitions from administrative health data: Application to rheumatoid arthritis. BMJ Open, 7, 1–9. Retrieved from https://search-proquestcom.chamberlainuniversity.idm.oclc.org/docview/1912892407?accountid=147674 Kuntarti, K., Yetti, K., & Novieastari, E. (2018). The contributing individuals in developing caring behaviors of nursing students: The focus group finding. International Journal for Human Caring, 22, 169–178. Merriam-Webster. (2019). Retrieved from https://www.merriam-webster.com/dictionary/caring Wei, H., Wei, T., Brown, K. J., Buck, S. H., & Mill, M. R. (2018). Parents’ perceptions of caring characteristics of physicians and nurses. International Journal for Human Caring, 22, 1–7. Retrieved from https://eds-a-ebscohost-

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