selection of faculty. Although many prospective faculty have a fairly
traditional lens for the study of nursing (that is, the lens of medical
science or frameworks borrowed from other disciplines), this actually
becomes an insignificant factor in the process of selection. At the
heart of choosing new faculty is knowing their passion for and love of
nursing. A focus of the interview process is discerning the person's
devotion to the discipline. It is our belief that this attitude, this
love of nursing, is the music for the dancers in the circle. One way
to know if prospective faculty love nursing is to ask them to share
a significant story from practice. Having faculty share a story
illuminates their conceptualization of the discipline. Many faculty who
have not had the opportunity to teach nursing through an articulated
nursing lens, can yet communicate nursing clearly through story.
Faculty are supported in their struggles to conceptualize nursing in
a new way. Forums in which faculty come together and aesthetically
re-present and share their nursing story is one strategy that
effectively engages self and other in the knowing of nursing. It is also
a wonderful way to orient faculty as to how to use nursing situations to
teach nursing. Faculty support each other as colleagues in learning
to teach nursing in a new way, in becoming expert in the practice of
nursing education, and in living out the basic assumptions of this
theory. This need for support holds true not only for faculty-faculty
relationships but for all relationships. The comfort of faculty teaching
nursing from the perspective of Nursing as Caring is enhanced as the
value of knowing other as caring, as living our histories and as having
special nursing stories to share is appreciated.
The administrator, faculty, and staff assist in fostering an environment
that furthers the development of the students' capacity to care.
Competency in caring is a goal of the educational process. Students are
continually guided to know self and other as caring person as faculty
and administrators model actions that reflect respect for person as
person. Each student is known as caring person, as special and unique.
Policies allow for consideration of individual situations and diverse
possibilities. In this culture, the dean and faculty attempt to know the
student as caring person and student of the discipline. The intention of
the dean to know students in this way can be evident through invitations
for regularly scheduled dialogue in which students share openly their
conceptions about nursing. The administrator is truly with students to
know them as caring persons and to hear from them their understanding of
nursing as caring.
Externally, the dean "ministers" to faculty, students, and staff through
securing resources necessary to accomplish program goals. The dean
articulates to persons in the academic and broader community their
role in the dance of nursing. The role of these persons is to provide
resources such as scholarships, faculty development possibilities,
learning resources, and research monies. Although this may be a primary
responsibility of the dean by nature of the role, all persons in the
circle share in this process by virtue of their commitment to nursing.
The administrator brings to the circle a skillful use of the caring
ingredients. Alternating rhythms are used to understand and appreciate
each person's unique contributions that support the achievement of
program goals. For example, the budgetary process is essential to
creating an environment that reflects the valuing of nursing. Commitment
of the dean to securing resources necessary to accomplish the program
goals drives the budget rather than the budget driving the commitment.
The administrator's devotion to the discipline and to the basic
assumptions of the theory direct all activities. The administrator makes
decisions that reflect the basic beliefs of this theory. All decisions
would ultimately be made from this standpoint: "What action should
I take as administrator which would support the study of nursing as
nurturing persons living in caring and growing in caring?"
What we have tried to suggest here is that every aspect of nursing
education is grounded in the values and assumptions inherent in this
theoretical focus. Thus, not only is the curriculum a direct expression
of Nursing as Caring, but all aspects of program are similarly grounded.
REFERENCES
Boykin, A., & Schoenhofer, S. (1990). Caring in nursing: Analysis of extant theory. Nursing Science Quarterly, 4, 149-155.
Carper, B. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1, 13-24.
Carr, S. (1991). Intensive Care. Nightingale Songs, PO. Box 057563, West Palm Beach, FL 33405-7563, 2 (1).
Guralnik, D. (1976). Webster's new world dictionary of the American language. Cleveland: William Collings + World Publishing Co.
Mayeroff, M. (1971). On caring. New York: Harper & Row.
Nodding, N. (1988). An ethic of caring and its implications for institutional arrangement. American Journal of Education, 97, 215-230.
Roble, M. (1991). Ave Maria and Therapeutic Touch for David. Nightingale Songs, P.O. Box 057563, West Palm Beach, FL 33405-7563, 1 (3).
[Illustration: Button]
CHAPTER VI -- THEORY DEVELOPMENT AND RESEARCH
In this chapter, we will address our conception of nursing as human
science and suggest directions and strategies for further development of
the theory of Nursing as Caring. We initially introduced our perspective
of nursing as discipline and profession in Chapter 1 and as a grounding
context for the theory. As a discipline, nursing is a way of knowing,
being, valuing, a way of living humanely, connected in oneness with
others, living caring and growing in caring. The unity nursing offers
is known in human experience through personal, empirical, ethical, and
aesthetic realms.
Science has to do with knowing and that which is known. Philosophers of
science are concerned with valid ways of knowing and ways of validating
that which is known. Human science is described by scholars in various
ways, each emphasizing particular values but all connecting to a common
understanding that human science is concerned with knowing the world
of human experience. A committed inquiry into human experience seems to
call forth certain values related to the meaning of being human.
Herein lies the fundamental difference between formal science and human
science, as we perceive it. Formal science, that which is practiced in
the natural sciences and other sciences that emulate them, is modeled
on the structure of mathematics. Mathematics is a highly lawful science
that has contributed enormous social benefits over time. However,
formal science grounded in mathematics and languaged as calculus is an
inappropriate approach to the study of person-as-person. A perspective
that addresses the phenomenon of person-as-person is grounded in central
values such as caring, freedom, and creativity. Methods to study person
must be similarly grounded.
We have come to understand that valid ways of knowing nursing and
legitimate warrants for nursing knowledge are discovered from within
the study of nursing itself; that is, within the study of the nursing
situation. The manner in which certain disciplines are conceptualized,
especially those dealing in normative contexts, calls for a dialectical
form of sciencing, comparing, and contrasting. However, coming to know
nursing is a dialogical process--direct engagement with the "word of
nursing." Nursing science must be contextual; the decontextualized
methodology of formal science, while essential for certain disciplines,
cannot reveal direct knowledge of nursing. Because of the nature
of nursing, nursing science must permit intentionality, intimacy,
mutuality, and particularity.
Human science has understanding as its goal, with the definite
expectation that understanding is in the moment only (Watson, 1988; Van
Manen, 1990). In addition, the nature of nursing praxis does not
require knowledge for the purpose of control, but for enlightenment,
moment-to-moment and reflectively. The nurse seeks knowledge neither to
control one's own behavior or that of the nursed. If it were otherwise,
the nurse would become his or her own prisoner, and would relate to
the other as dominator rather than caring nurse. The concept of the
hermeneutic circle informs our understanding of the nature of nursing as
a human science. This circle of understanding, really a sphere more
than a uni-dimensional circle, is a heuristic device which directs our
attention. As attention pauses at any aspect of the nursing situation,
we must attend to other aspects and to the whole of the nursing
situation to create useful understanding. One hermeneutist has pointed
out that the circle brings us further along, not the issue at hand
(Droysen, 1988). This distinction points to the human science position
that understanding is not constituted through analysis of facts but
through dialogue with text and context. That is, what moves within the
circle is the seeker, rather than that which is sought, so that many
aspects are illuminated in context, and understanding grows. The
hermeneutic circle requires that what we note in our inquiry remains
contextualized, developing "new and ever new circles" (Boeckh, 1988).
This is in contrast to normal science that requires an external referent
for objects of study in order to avoid circular thinking. Heidegger
(1988), for example, contrasts the vicious circle of normal science
(tautology) with the circle of hermeneutic: " . . . in the circle is
hidden a positive possibility of the most primordial kind of knowing"
(p. 225). We would propose that valid knowing in nursing is that which
is known from within the circle.
While the work of several scholars has influenced our understanding
(e.g., Gadamer, 1989; Van Manen, 1990; Ray, 1994; Reeder, 1988),
Macdonald's (1975) interpretation from the field of humanistic
education is especially meaningful. He explains hermeneutic knowing
methodologically as "circular rather than linear in that the
interpretation of meaning in hermeneutic understanding depends on a
reciprocal relation" (p. 286) rather than on a fixed normative reference
point. The hermeneutic circle models the idea of reciprocal relation,
but Macdonald goes further to call for a self-reflective science that
will "transcend problems of monological and hermeneutic meaning" (p.
287). The nature of nursing as expressed in the Nursing as Caring theory
is a reciprocal relation, one characterized by its grounding in person
as caring, and as persons connected in oneness in caring. Sciencing in
nursing from this perspective must go beyond linearity to encompass the
dialogic circling involved in the nursing situation. This places the
discipline of nursing among the human sciences, and calls for methods
of inquiry that assure the circle or dialogue, and further, fully
accommodate that which can be known of nursing.
Nursing is properly catalogued as one of the human sciences for
many reasons. The most basic reason is that the discipline and the
disciplined practice of nursing directly involve persons in the fullness
of their humanness. From our perspective, this means person as caring.
Person as caring implies person in community, connected in oneness
with others and with the universe, person freely choosing the living of
values which are expressions of caring. This nursing ontology requires
an epistemology consonant with human science values and methods. To know
of, through and with nursing necessitates methods and techniques that
honor freedom, creativity, and interconnectedness.
In Chapter 4, we asserted that nursing knowledge is created and
discovered within and from within the nursing situation. (Nursing
situation, you may recall, is understood as a shared lived experience
in which the caring between the nurse and the one nursed enhances
personhood.) Therefore, because the locus of nursing inquiry is the
nursing situation, the systematic study of nursing calls for a new
methodology that recognizes that fact.
Certainly, we acknowledge that something useful for nursing can be
learned through existing methodologies, from both natural and human
science traditions. For example, an experimental design can produce
information about the effectiveness of a given clinical technique within
a specified range of use (e.g., placement of an oral thermometer). Such
information can be important and useful to the work of the nurse and
useful to the client of nursing. It tells us nothing, however, of
nursing. In fact, the central tenet underlying measurement in normal
science directly contradicts the central tenet of human science: created
versus creating. Thus, the fullness of the nursing situation is not
amenable to study by measurement techniques. Yet, aspects of the nursing
situation can be abstracted and studied as variables in relation to
other variables. This does not, however, yield knowledge of the nursing
situation in its fullest. At best, measurement approaches can call
attention to an aspect so that it can be considered within the
unfolding.
Phenomenology, on the other hand, offers an example of an orientation
and methodology that more closely approximates what is needed in a
nursing method of inquiry. Phenomenology is an orientation toward
inquiry that may be actualized through any one of a number of generic
approaches, but is generally understood as the study of lived experience
(e.g., Van Manen, 1990; Oiler, 1986). When the phenomenon conceptualized
for study is representative of the nursing situation, nursing may be
known. That is, new nursing knowledge may eventuate. New understanding
of the meaning of the shared lived experience of caring between nurse
and nursed enhancing personhood can be created.
Yet, for the purposes of nursing, phenomenology also has its limits.
For example, when phenomena which have been abstracted from a nursing
situation are selected for study (that is, when phenomena are taken out
of context), results of the inquiry cannot generate knowledge of nursing
proper. For example, the understanding that comes in developing a
description of the essential structure of what it is like for a nurse
to be called to nurse informs us about nurses, but not about nursing
directly. Similarly, an exquisite phenomenological description of what
it is like for a person to live grieving is helpful in understanding the
person. However, it should not be mistaken for knowledge of nursing, but
knowledge which illuminates the study of nursing when taken back to
the full context of the nursing situation. Further, the various
phenomenologies in the literature come from frames of reference that are
not nursing (e.g., existential psychology or educational psychology),
and thus impose a "silent" borrowed framework when used to study
nursing.
Is this drawing too fine a line? And is it really important to press
the issue of nursing knowledge versus knowledge of and for nurses?
The answers to these questions are probably found in one's concept
of nursing as a field of knowledge (discipline) and a human service
(profession). It seems that nursing and nurses have suffered
significantly over the years with this dilemma. Is it possible to have
a sense of self as nurse without a concomitant sense of nursing as
a discipline which is more than tacit and to which one is committed?
Students of nursing and practitioners alike have abundant opportunities
to acquire a sense of self as nurse. Yet why is it that many programs of
nursing education (at all levels) do not convey a sense of nursing as
a discipline? The answer may lie in those conducting the programs, who
have experienced training for practice and education in disciplines
other than nursing and without explicit education in the discipline of
nursing.
From the perspective of Nursing as Caring, with its grounding in person
as caring and nursing as discipline, the distinctions implied in this
question of "does it really matter" are of central importance. Nurses
in practice, education, and administration continue to address nursing
primarily in terms of "what nurses do," (e.g., nursing "interventions")
and most nursing research seems to derive from that perspective as
well. Without a clearly articulated understanding of the focus of the
discipline, it has been extremely difficult to organize and structure
nursing knowledge in ways that facilitate the development of the
discipline. In this book, we have offered a theory, Nursing as Caring,
as one expression of that focus, languaged in terms that communicate the
essence of nursing.
Nursing knowledge is knowledge of nurturing persons living caring and
growing in caring within shared lived experiences in which the caring
between nurse and nursed enhances personhood. Furthering nursing
knowledge requires methods that can illuminate the central phenomenon of
the discipline. The development of such a methodology is, as we see it,
the next major effort to be undertaken in the development of the theory.
In this regard, we envision a fully adequate methodology that would
include a phenomenological aspect which goes beyond description to a
hermeneutical process, within an action research orientation. That is,
what seems to be needed is a methodology that would permit the study of
nursing meaning as it is being co-created in the lived experience of
the nursing situation. Supplemental methods could continue to include
traditional phenomenological and hermeneutic work with texts describing
particular nursing situations. Nurses who are interested in developing
knowledge of techniques or modes of expressing caring would continue to
use traditional methods of formal and human science for these kinds of
nursing-related questions.
The development of methods of nursing inquiry appropriate to the study
of the theory, Nursing as Caring, is in a formative stage. We understand
to a considerable extent the limitations of existing modes of inquiry,
and have a growing sense of what will be required of a new methodology.
Nursing scholars are working to develop methods to illuminate the
fullness of nursing. Examples of that work which has encouraged our
efforts include that by Parker (1993), Swanson-Kauffman (1986), Parse
(1990), and Ray (Wallace, 1992). The work of these scholars demonstrates
that the development of nursing ways of inquiry is important and that
a search has begun. As we have come to understand the concept of human
science, our understanding of nursing has been enriched. Like most
of our contemporaries in nursing, we were trained in the
often-unarticulated assumptions of natural science. And we have traveled
the road familiar to many nursing scholars, the road of expertise in
objectification and quantification. Along that road, we began to notice
the trivialization of cherished nursing ideas like presence, touch,
relationship, knowing, and caring. Resisting the temptation to abandon
the journey, we each persevered in a commitment to nursing as something
which mattered, something involving intimate, personal, caring
relationships. Discovering, inventing, and creating a new methodology
is an important dream and we are committed to continuing this aspect of
theory development.
Nursing as Caring is a transformational model for all arenas. Nursing
practice, nursing service organization, nursing education, and nursing
inquiry require a full understanding of nursing as nurturing persons
living caring and growing in caring, and these underlying assumptions:
* Persons are caring by virtue of their humanness.
* Persons are caring, moment to moment.
* Persons are whole or complete in the moment.
* Personhood is a process of living grounded in caring.
* Personhood is enhanced through participating in nurturing relationships with caring others.
* Nursing is both a discipline and profession.
With these transformations, the fullness of nursing will be realized and
we will grow in our understanding of self and other as caring persons
connected in oneness.
REFERENCES
Boeckh, P. (1988). Theory of criticism. In K. Mueller-Vollmer (Ed.), The hermeneutics reader. New York: Continuum.
Droysen, J. (1988). The investigation of origins. In K. Mueller-Vollmer (Ed.). The hermeneutics reader. New York: Continuum, pp. 124-126.
Gadamer, H. (1989). Truth and method. New York: Crossroad Publishers.
Heidegger, M. (1988). Understanding and interpretation. In K. Mueller-Vollmer (Ed.), The hermeneutics reader. New York: Continuum, pp. 221-228.
Macdonald, J. (1975). Curriculum and human interests. In W. Pinar, Curriculum theorizing: The reconceptualists. Berkeley: McCutchan Publishers.
Oiler, C. (1986). Phenomenology: The method. In P. Munhall & C. Oiler (Eds.), Nursing research: A qualitative perspective. Norwalk, CT: Appleton-Century-Crofts.
Parker, M. (1993). Living nursing values in nursing practice. Paper presented at 7th Annual Conference of the Southern Research Association, Birmingham, AL, February 18,1993.
Parse, R. (1990). Parse's research methodology with an illustration of the lived experience of hope. Nursing Science Quarterly, 3,9-17.
Ray, M.A. (1994). The richness of phenomenology: Philosophic, Theoretic and Methodologic Concerns. In J. Morse (Ed.), Critical issues in qualitative research. A contemporary dialogue. Newbury Park, CA: Sage, Ch. 7.
Reeder, F. (1988). Hermeneutics. In B. Sarter (Ed.), Paths to Knowledge. New York: National League for Nursing.
Swanson-Kauffman, K. (1986). A combined qualitative methodology for nursing research. Advances in Nursing Science, 8 (3), 58-69.
Van Manen, M. (1990). Researching lived experience. London, Ontario: State University of New York Press.
Wallace, C. (1992). A conspiracy of caring: The meaning of the client's experience of nursing as the promotion of well-being. Unpublished master's thesis, College of Nursing, Florida Atlantic University.
Watson, J. (1988). Nursing: Human science and human care. A theory of nursing. New York: National League for Nursing.
[Illustration: Button]
EPILOGUE
The Theory of Nursing as Caring was initially presented in its entirety
at the South Florida Nursing Theories Conference in 1992. The theory
was explicated in the original release of Nursing as Caring: A Model for
Transforming Practice in 1993 (Boykin & Schoenhofer, 1993). As work has
progressed to develop the theory for use in nursing practice, research
and education, the underlying assumptions introduced in Chapter 1 have
been affirmed as central to the integrity of the theory. This epilogue
highlights ongoing development of the theory by its authors and by other
nurses. Developmental efforts include clarification of the concept of
personhood, expansion of the understanding of enhancing per-sonhood as
the general "outcome" of nursing, research innovations, and use of
the theory in middle range theory work and in the critical analysis of
caring.
CLARIFICATION OF THE CONCEPT OF PERSONHOOD
In Chapter 1, personhood was described as a process of living grounded
in caring. In an effort to clarify the meaning of "a process" in
the context of the theory of Nursing as Caring, we explained
that personhood, understood as living grounded in caring, is
processual--ongoing, experienced moment to moment, evolutionary,
transformative--rather than a generalized sequence of steps or
operations. In subsequent publications, personhood was described as
"living grounded in caring," eliminating the problematic use of the term
"process" entirely (Schoenhofer & Boykin, 1998a; Boykin & Schoenhofer,
2000).
RESEARCH DEVELOPMENT OF THE FOUNDATIONAL CONCEPTS OF PERSON AS CARING AND PERSONHOOD
Nursing as Caring guides nurses to enter into the world of the other
and allows them to come to know the nursed as living caring uniquely in
situation. In consulting with nurses using Nursing as Caring as their
framework for practice, we found that nurses could easily recognize
expressions of caring when caring was lived in ways familiar to their
own lifeworlds. However, in nursing situations where personal ways of
caring were outside the experience of the nurse, there seemed to be
difficulties in knowing and thus affirming the nursed as person uniquely
living caring in the moment. Without this situated knowing, we saw
that nurses tended to lose the focus of recognizing the other as living
caring uniquely in the moment, and instead, to concentrate on ways in
which persons "were not living caring" and "should grow in caring." This
tendency to return to a normative practice framework in difficult times
is easily understood as nurses struggle to transcend a familiar paradigm
characterized by terms such as "nursing process," "nursing diagnosis,"
"nursing intervention" and to evolve toward what has been called a
simultaneity paradigm (Parse, 1987).
Because knowing the other as caring is the basic act of nursing,
it became clear to us that knowledge expansion would be helpful in
enhancing nurses' ability to recognize uniquely personal ways their
patients live the value of caring. Schoenhofer conducted a series
of studies over several years to develop knowledge of personal lived
meaning of everyday caring. In one unpublished study, adolescents shared
stories of personal caring. Their stories were found to center around
the theme of "helping out." Adolescents described everyday caring in
terms such as "cheering up someone you love," "helping another get what
they need," "work as caring," "caring by physical presence." The stories
illustrated situations where caring was expressed as "helping out when
you don't really want to, but doing it anyway," "helping without being
asked," "filling in where caring is missing." One teenage boy told of
caring for a former girlfriend who was angry about their breakup; he
made deliberate efforts to remain active as a friend, as a way to
help the girl deal with the loss of their romantic relationship. He
characterized his caring as "keeping on showing care even though it
doesn't seem to change things."
In another similar study, 4th grade students told stories of caring in
which they acted as advocates for other children and offered help to
others, both adults and children, who were perceived as less fortunate
and in need of care (Schoenhofer, Bingham & Hutchins, 1998). Adults,
too, have unique and personal ways of living their everyday caring.
One father related an example of caring for his young daughter by
restricting her activities because of poor school performance, and
then engaging in a dialogue with her that resulted in a compromise. The
father saw willingness to discipline as an act of caring and felt that
his willingness to listen to the child's perspective was also part of
his caring (Schoenhofer, Bingham & Hutchins, 1998). Several adults whose
parents had become disabled told stories of caring for parents in ways
that preserved cherished role relationships. These adults understood
that their caring required extra effort to avoid infantalization of the
parent but felt that without that extra effort, attention would be given
to certain needs but adequate caring would not be given.
Research into everyday caring was conducted in a group discussion
format, with persons invited to relate a story that illustrated how they
lived their caring in everyday situations. The ease with which these
research participants understood what was being asked of them, their
willingness to respond and the clarity of the exemplars they shared have
the potential to inform nursing practice. When nurse colleagues learned
of this research effort, they often expressed doubt that people could
and would describe their everyday caring ways. Based on the experience
of the researchers and research participants in this series of studies,
however, it became clear that persons do understand their unique ways of
caring, and do recognize the importance of sharing that understanding.
Nurses committed to practice guided by the tenets of Nursing as Caring
can and should incorporate direct invitation as part of their coming to
know other as caring person, A number of important benefits are possible
with a direct approach to knowing the other as caring. One benefit is
that as the nurse raises the issue of caring, patients are helped
to understand that caring is of immediate importance to nurses,
thus clarifying the service and value of nursing among the health
disciplines. A second benefit is that as nurses address caring directly
with their patients, nurses themselves gain affirmation of nursing as
a caring service and of themselves as persons committed to caring.
However, the most immediate benefit of a direct approach to caring is
the opening of a line of communication that clearly establishes the
"caring between," that space, that relationship within which and
through which all that is important in nursing occurs. The patient is
given the opportunity to recognize self as caring person and to join
in mutual affirmation and celebration with the nurse. Nurses who are
reluctant to engage patients in dialogues about caring ways may think
the topic is "too intimate." It is true that caring is intimate and
personal, but caring is also very visible, just as many of the topics
introduced in the nursing situation are personal and intimate and have
visible referents. As nurses have the courage to raise the topic of
caring, the central importance of caring in human living can become not
only recognized but openly and publicly valued.
RESEARCH DEVELOPMENT OF NURSING OUTCOMES-VALUES EXPERIENCED IN THE NURSING SITUATION
Another research thread has focused on the development of an approach to
identifying and languaging outcomes of nursing guided by the theory of
Nursing as Caring (Boykin & Schoenhofer, 1997; Schoenhofer & Boykin,
1998a, 1998b). Within the context of the theory, the idea of outcomes
has been reconceptualized as "values experienced in the nursing
situation." Several case studies illuminated a dialogical form of praxis
involving nurse, patient and researcher that revealed values experienced
by patients and their nurses. Values experienced by families, health
care administrators and systems were also uncovered as the caring
created in the nursing situation was found to resonate beyond the
immediate nurse-patient relationship. This line of research has
demonstrated that while traditional economic valuation can be
calculated, the value of caring in nursing can and must be more clearly
explicated in human terms. For example, one case study of home health
nursing found that the economic value of six nursing visits produced a
health care cost savings of $5,709, primarily by obviating the necessity
of trips to the emergency department of the local hospital. Through
this unique research approach, the human value of the six visits was
identified and languaged in terms that clearly demonstrate the direct,
unmediated worth of nursing care--to the one nursed, the family, the
nurse and the larger circle of health care systems. The patient and
family gained the important value of confidence through the caring
of the home health nurse; with the nurse's commitment to caring,
they gained faith in themselves, their ability to deal with new
health-related situations as they arose, faith that they wouldn't be
left alone, faith that they were known as persons valuable in their
own right and worthy of care. This is the value of nursing, the reason
nursing exists as a distinguishable social and human service. Nurses
can learn to assert the human value of nursing, and in fact, nurses must
accept the responsibility for bringing the human value of care to the
forefront. Re-establishing the primary position of care in the health
care arena depends on nurses speaking out in clearly human terms about
the meaning and value of care, using the language of caring knowledgably
and without apology.
In May, 2000, Boykin launched a funded study to examine the potential
of the theory of Nursing as Caring to enhance the achievement of quality
outcomes in acute care settings. This two-year demonstration project and
evaluation study involves specifying quality indicators and targeting
benchmarks prior to introducing the theory as the nursing practice
framework in the acute care division of a community hospital. On-site
guidance and consultation in the use of the theory will be available
during the course of the project. Post-program evaluation will focus
on quality indicators and benchmarks relating to patient and staff
satisfaction, family and community support, and cost-benefit care
ratios.
THE THEORY OF NURSING AS CARING AS A CONCEPTUAL FRAME FOR MIDDLE-RANGE THEORIES
A theory that describes or explains a limited range of situations.
Locsin (1995) developed a model of the harmonious relation between
technology and caring in nursing. Further development of the model
led to a theory of technological competence as caring in critical care
nursing (Locsin, 1998). The mediating factors between application of
technology and caring in nursing are posited as intentionality and
authentic presence. The underlying theoretical framework draws on the
theory of Nursing as Caring, and particularly the focus of nursing as
knowing and thus nurturing the other as caring person. The intention to
know the other as caring person is actualized through direct knowing
as well as through the medium of technologically produced data. The
intention to care, to nurture the other as caring, is expressed in
interpersonal ways as well as in technological competence.
Dunphy (1998) drew on aspects of the theory of Nursing as Caring,
particularly the idea of knowing the other as caring person, in the
development of a model for advanced practice nursing, "the circle of
caring." Dunphy was concerned with clarifying the disciplinary identify
of advanced practice nursing as nursing. In an effort to transcend
perspectives of advanced practice nursing based on the traditional
reductionist medical science and nursing process models, processes of
care are superimposed on a traditional medical model (Dunphy, 1998). The
circle of care "incorporates individual strengths of both nursing and
medicine but reformulates them in a new model of care... rooted in the
lived experience of the patient" (p. 11). Caring quality indicators
suffuse the entire model, and include courage, authentic presence,
advocacy, knowing, commitment and patience. Elements formerly termed
diagnosis and treatment are termed caring processes in the new model,
in an attempt to ground advanced practice in nursing values. The core
component of the model, caring processes, focuses on ways of knowing the
person as caring and of truly being with the person in advanced practice
nursing situations. It is this core that provides the crucial link of
caring as the central focus of both traditional nursing and advanced
practice nursing.
CRITICAL ANALYSIS OF THE THEORY OF NURSING AS CARING
There is evidence that the theory of Nursing as Caring has entered the
mainstream of nursing thought. Nursing as Caring is included in several
collected and/or edited works on nursing theories (George, 1995; Parker,
1993; Parker, 2000). In George's (1995) compendium of general nursing
theories, Nursing as Caring is described and the structures of nursing
process and the metaparadigm concepts of Fawcett are used as a
framework for analysis and evaluation. Parker's books, Patterns of
Nursing Theories in Practice (1993) and Nursing Theories and Nursing
Practice (2000) are collections of original chapters authored by the
various nurse theorists and by nurses using the particular theory in
practice.
Nursing as Caring is represented in both these books by original
chapters authored by the theory's originators (Schoenhofer & Boykin,
1993; Boykin & Schoenhofer, 2000) as well as by chapters written by
nurses describing their practice which is guided by the theory (Kearney
&Yeager, 1993; Linden, 2000).
Nursing as Caring was one of four caring theories included in a
comparative analysis reported by McCance, McKenna and Boore (1999). That
analysis was based on a number of factors, including origin, scope
and key concepts of the theory, definition of caring, description of
nursing, the goal or outcome of nursing from the perspective of the
theory, and simplicity of the internal structure. Findings of the
analysis were developed in terms of utility of the theory in practice.
Smith (1999) analyzed concepts from the literature on caring in nursing
in an effort to uncover points of congruence between that literature and
the theoretical perspective of the Science of Unitary Human Beings.
The theory of Nursing as Caring figured prominently in Smith's concept
clarification, contributing to four of the five synthesized constitutive
meanings of caring: manifesting intentions, appreciating pattern,
attuning to dynamic flow and inviting creative emergence (Smith, 1999).
RESEARCH METHOD DEVELOPMENT
In Chapter 6, Theory Development and Research, we envisioned an
approach that "would include a phenomenological aspect which goes beyond
description to an hermeneutical process, within an action research
orientation" (Boykin & Schoenhofer, 1993, p. 97). Two research
approaches have been developed within the context of studying Nursing as
Caring, one focusing on discovering the lived meaning of everyday caring
and the second directed toward understanding the value experienced in
nursing situations.
There is relatively little literature that deliberately sets out to
describe the multitude of ways of human caring. However, most if not
all human text does reflect uniquely personal ways of caring, and
can profitably be studied for this purpose. In an effort to provide a
knowledge base of the variety of human caring ways, one of the authors
(Schoenhofer) innovated a group phenomenology approach in which research
participants not only generated data in group settings, but also led the
synthesis of meaning (Schoenhofer, Bingham, & Hutchins, 1997). The
group approach to data generation was chosen for several reasons--one
was efficiency, but the primary reason was a belief in the synergistic
potential of the group process experience. The group approach to data
synthesis was added to the design based on the assumption that persons
living the phenomenon being studied and generating the data may be most
well qualified to intuit meaning across examples. The series of studies
of everyday caring may best be understood as general foundational human
science, rather than as nursing science per se. Results of the studies
produced knowledge that has potential to enlighten nursing practice,
rather than producing direct knowledge of nursing practice.
While initiated for research purposes, the group phenomenology
approach became a form of nursing praxis. Early in the project,
groups spontaneously shared a sense of pleasure and gratitude for the
experience of celebrating themselves and each other as caring persons.
This opportunity for reflection was then added as closure for the
subsequent groups as it was recognized by the primary researchers that
the tenets of Nursing as Caring were being lived: persons were known,
acknowledged, affirmed and celebrated as caring; per-sonhood was
enhanced as group members recapitulated, clarified and reaffirmed
the meaning and value of caring in their lives; caring between nurse
(researchers) and nursed in the nursing (research) situation was created
and persons were nurtured in their uniquely personal ways of caring.
A second research approach was designed to study values experienced in
nursing situations (Schoenhofer & Boykin, 1998a; 1998b). The design of
this approach was based on several considerations: 1) the tenet that all
that can be known of nursing is known through the nursing situation, the
shared lived experience of caring between nurse and nursed; and, 2)
the blurred lines between research and practice, between roles of
researcher, practitioner and even patient. A mode of inquiry into
outcomes of caring in nursing, from the perspective of Nursing as
Caring, must necessarily be centered within the nursing situation. In
earlier phases of this research, only the nurse participated in the
research dialogue (Boykin & Schoenhofer, 1997). While this approach was
fruitful, two important qualities were missing: 1) the synergism that
brought a wealth of rich data when both nurse and nursed were present;
and, 2) the intersubjective confirmation provided by having both the
nurse and the nursed as research participants. Once again, the mutuality
of the dialogue about the value of caring experienced went beyond
simple data production for research purposes. The dialogue itself was an
extension of the nursing relationship and the caring between nurse and
nursed, with the research nurse now included in the unfolding nursing
situation.
[Illustration: Button]
CONCLUSION
This epilogue has been written to bring the reader up to date on the
development of the theory of Nursing as Caring. Developmental efforts
projected in Chapter 6 are still needed, and efforts in progress hold
promise for further development. As the cadre of nurses interested in
working within the theory grows, development will accelerate, in both
projected and novel directions.
Anne Boykin, PhD, RN Professor and Dean College of Nursing Florida
Atlantic University
Boca Raton, Florida
October, 2000
Savina O. Schoenhofer, PhD, RN Professor of Graduate Nursing Alcorn
State University
Natchez, Mississippi
REFERENCES
Boykin, A., & Schoenhofer, S. 0. (1993). Nursing as caring: A model for transforming practice. New York: National League for Nursing Press.
Boykin, A., & Schoenhofer, S. 0. (2000). Nursing as caring: An overview of a general theory of nursing. In Parker. M. E., Ed., Nursing theories and nursing practice. Philadelphia: F. A. Davis Co.
Boykin, A., & Schoenhofer, S. 0. (1997). Reframing nursing outcomes. Advanced Practice Nursing Quarterly, 1(3), 60-65.
Dunphy, L. H. (1998). The circle of caring: A transformative model of advanced practice nursing. 20th Research Conference of the International Association for Human Caring, Philadelphia, Pa.
George, J. B. (1995). Nursing theories: The base for nursing practice. (4th ed.). Norwalk: CT: Appleton & Lange.
Kearney, C. & Yeager, V. (1993). Practical Applications of Nursing as Caring theory. In Parker, M. E., Ed. Patterns of nursing theories in practice. New York: National League for Nursing Press, Ch. 8.
Linden, D. (2000). Application of Nursing as Caring in practice. In Parker, M. E., Ed., Nursing theories and nursing practice. Philadelphia: F. A. Davis Co., 1993.
Locsin, R. C. (1995). Machine technologies and caring in nursing. Image, 27, 201-203.
Locsin, R. C. (1998). Technological competence as caring in critical care nursing. Holistic Nursing Practice, 12(4), 50-56.
McCance, T. V., McKenna, H. P., & Boore, J. R. P (1999). Caring: Theoretical perspectives of relevance to nursing. Journal of Advanced Nursing, 30, 1388-1395.
Parker, M. E. (Ed.). (2000). Nursing theories and nursing practice. Philadelphia: F. A. Davis Co.
Parker, M. E. (Ed.). (1993). Patterns of nursing theories in practice. New York: National League for Nursing.
Parse, R. R. (1987). Nursing science: Major paradigms, theories and critiques. Philadelphia: Saunders.
Schoenhofer, S. 0., Bingham, V., & Hutchins, G. C. (1998). Giving of oneself on an-other's behalf: The phenomenology of everyday caring. International Journal for Human Caring, 2(2), 23-29.
Schoenhofer, S. 0., & Boykin, A. (1993). Nursing as Caring: Issues for practice. In
Parker, M. E., (Ed). Patterns of Nursing Theories in Practice. New York: National League for Publications, pp. 83-92.
Schoenhofer, S. 0., & Boykin, A. (1998a). The value of caring experienced in nursing. International Journal for Human Caring, 2(4), 9-15.
Schoenhofer, S. 0., & Boykin, A. (1998b). Discovering the value of nursing in high tech environments: Outcomes revisited. Holistic Nursing Practice, 12(4), 31-39.
Smith, M. C. (1999). Caring and the Science of Unitary Human Beings. Advances in Nursing Science, 21(4), 14-28.
[Illustration: Button]
INDEX
Adaptation Model (Roy), 15, 16 Administration, nursing education, 41, 48-50
Administration, nursing service, 32-38 Advanced practice, 61
Aesthetic knowing, 6, 9, 14, 20, 24, 46, 75, 77, 79, 91
Aesthetic project, 46
Allen, D.G.
"Nursing research and social control: Alternative models of science that emphasize understanding and emancipation," 7
"The social policy statement: A reappraisal," 7
"The American Nurses' Association position statement on nursing and social policy: Philosophical and ethical dimensions" (Silva), 7
American Nursing Association
Nursing: A social policy statement, 7 Analysis and evaluation of conceptual models of nursing (Fawcett), 8
Andrews, H.
The Roy Adaptation Model: The definitive statement, 15-16
"Application of nursing as caring in practice" (Linden), 62
The Art of Administration (Tead), 32 Authentic presence, 3-4, 17-19, 25, 61 Avant, K.
Strategies for theory construction in nursing, 8 "Ave Maria and Therapeutic touch for David" (Stobie), 46-47
"The behavioral system model of nursing" Johnson), 15-16
Benner, P.
The primacy of caring: Stress and coping in health and illness, 35
Bingham, V.
"Giving of oneself on another's behalf:
The phenomenology of everyday
caring," 58, 62
Boeckh, P.
Theory of criticism, 52
Bohm, D.
"On dialogue," 35
Boore, J. R. P.
"Caring: Theoretical perspectives of
relevance to nursing," 62
Boykin, A.
"Caring in nursing: Analysis of extant
theory," 9, 19, 47-48
"Creating a caring environment:
Moral obligations in role of
dean," 36
"Discovering the value of nursing in
high tech environments," 59, 63
"Nursing as caring: Issues for practice,"
62
Nursing as caring: A model for transforming
practice, 57, 62
Nursing as caring: An overview of a general
theory of nursing, 57, 62
"Reframing nursing outcomes," 59, 63
"Story as link between nursing
practice, ontology, epistemology,"
14, 17, 19, 20
"The value of caring experienced in
nursing," 57, 59, 63
Brownell, J.
The Curriculum and the Disciplines of
Knowledge, xiv, 6
Budget decisions, 34
Calls for nursing, 13, 14, 15
administrator, nursing, 32-35 dance of caring persons, 36-37 and education, nursing, 44, 4
nursing situation, 17,18,21-22,33,34, 39-40
study of, 53
Caring and technology, 61
"Caring and the science of unitary human beings" (Smith), 62
Caring and advanced practice, 61 Caring theories compared, 62
"Caring between" phenomenon, 14 "Caring for life and death: Nursing in a
hospital-based hospice" (Samarel),
27
"Caring from a human science perspective" (Parse), 3
"Caring in nursing: Analysis of extant theory" (Boykin & Schoenhofer), 9, 19,47-48
"Caring in the instance of unexpected early pregnancy loss" (Swanson-Kauffman), 24
Caring In the moment, 11
Caring ingredients (Mayeroff), 4-5,23, 31,46,48
Caring: The Human Mode of Being, Implications for Nursing (Roach), 2,19
"Caring: Theoretical perspectives of relevance to nursing" (McCance, McKenna, and Boore), 62
Carper, B.
"Fundamental patterns of knowing in nursing," 8-9,11,42-45
Carr, S.
"Intensive care," 42-43,45
Cassarrea, K.
"Improving service through patient surveys in a multihospital organization," 35
Chinn, P.
Theory and Nursing, 8
"The circle of caring: A transformatic model of advanced practice nursing" (Dunphy), 61
"A combined qualitative methodology
for nursing research" (Swanson-Kauffman), 24,55
Concept Formalization in Nursing: Process and
Product (Nursing Development Conference Group), 6,8
"Connectedness: A concept for nursing" (Kronk), 28-30
"Connections" (Maxwell), 20-21 Cooper, M.C.
"Covenantal relationships: Grounding for the nursing ethic," 7
Cost containment, 35
Covenantal relationship, 7, 27
"Covenantal relationships: Grounding for the nursing ethic" (Cooper), 7 "Creating a caring environment: Moral obligations in role of dean" (Boykin), 36
"A critique of the ANA Social Policy
Statement population and
environment focused nursing" (White), 7
"Curriculum and human interests" (Macdonald), 52
The Curriculum and the Disciplines of
Knowledge (King and Brownell), 6
Dance of caring persons, 36-37 illus. 37
and faculty selection, 48 and nursing education, 41-42,49 Deceased patient, 18,19
"Deconstructing the dogma in nursing knowledge and practice: (Rodgers), 7 Deviant/evil patient, 18,19
Dialogue, use of in education, 44-45 Difficult to care situation, 25
"The dilemma of nursing: Current
quandaries and lack of direction"
(Packard and Polifroni), 7 Discipline, nursing as, 6-9
and education, 54
nursing situation, 18-19 and phenomenology, 53-54
and theory development, 53-54 "Discovering the value of nursing in high tech environments" (Boykin and Schoenhofer), 59,63
Droysen, J.
"The investigation of origins," 52 Duffy, J.
"The impact of nurse caring on patient outcomes," 35
Dunphy, L. H.
"The circle of caring: A transformatic model of advanced practice nursing," 61
The Dynamic Nurse-Patient Relationship (Orlando), 27-28
Education, nursing, 24,41-50 administration, 41,48-50 dance of caring persons, 41-42 dialogue, 44-45
faculty selection, 48
knowing, patterns of, 42-45 and nursing situation, 42
Empathic paradigm, 5
Empirical knowing, 9, 24, 42, 43, 45, 51 Essay examination, 46
"The essential structure of a caring interaction: Doing phenomenology" (Riemen), 24
Ethical knowing, 9, 24, 42, 44, 45, 51 everyday caring, 58, 59
"Existential advocacy: Philosophical foundations of nursing" (Gadow), 3
Faculty, selection of, 48
Fawcett, T.
Analysis and evaluation of conceptual models
of nursing, 8
Flexner, A.
Medical education in the United States and
Canada, 7
"Fundamental patterns of knowing in
nursing" (Carper), 9, 42-44
Gadamer, H.
Truth and Method, 52
Gadow, S.
"Existential advocacy: Philosophical foundations of nursing," 3
"Touch and technology: Two
paradigms of patient care," 5, 12, 28
George, J. B.
Nursing theories: The base for nursing practice, 61
"Giving of oneself on another's behalf: The phenomenology of everyday caring" (Schoenhofer, Bingham, and Hutchins), 58, 62
Guralnik, D.
Webster's New World Dictionary of the American Language, 41
"Healing-HIV+" (Wheeler), 32
Health services discussion, nursing's contribution to, 30
Heidegger, M.
"Understanding and interpretation," 52
Nelson's adaptation level theory, 28 Hermeneutic circle, 52, 55 "Hermeneutics" (Reeder), 52
Hologram and view on relationships, 5 Home nursing, 28
"Honestly" (Little), 25-27
The Human Act of Caring (Roach), 2
Human Care, theory of (Watson), 3 Human science, nursing as, 5, 8-9, 51-53 Humanistic Nursing (Paterson & Zderad), 34 Hutchins, G. C.
"Giving of oneself on another's behalf: The phenomenology of everyday caring," 58, 62
"The impact of nurse caring on patient outcomes" (Duffy), 35
"Improving service through patient surveys in a multihospital organization" (Cassarrea, Mills, & Plant), 35
"Intensive Care" (Carr), 42-43, 45 intentionality, 61
"The investigation of origins" (Droysen), 52
Jacobs, M.
Theory and Nursing, 8
Johnson, D.E.
"The behavioral system model of
nursing", 15, 16
Journaling, 46
Kearney, C.
"Practical applications of nursing as
caring theory," 62
King, A., ix
The Curriculum and the Disciplines of
Knowledge, 6
Knowing
aesthetic, 6, 9, 14, 20, 24, 51
as caring ingredient, 58-59, 8081
empirical, 9, 24, 42, 43, 45, 51
four patterns of, 9, 24, 42-44
personal, 9, 23-25, 37-38, 42-43,
45-46, 51
Knowlden, V.
"The meaning of caring in the nursing
role," 24
Knowledge, nursing, 17, 20, 54-55, 96-97
Kronk, P.
"Connectedness: A Concept for
Nursing," 28-30
Languages of the Brain: Experimental
Paradoxes and Principles (Pibram), 5 "Last rights" (Yelland-Marino), 34 Leininger, M.M., xiv
"Leininger's theory of nursing: Cultural care diversity and universality," 15
68 Index
Little, D.
"Honesty," 25-27
Linden, D.
"Application of nursing as caring in practice," 62
Living caring, 1-2,11-13,23,25,30,42, 45
"Living nursing values in nursing practice" (Parker), 55
Locsin, R. C.
"Machine technologies and caring in nursing," 61
"Technological competence as caring in critical care nursing," 61 "Love, beauty and truth: Fundamental nursing values" (Schoenhofer), 20
Macdonald, J.
"Curriculum and human interests," 52
"Machine technologies and caring in
nursing" (Locsin), 61
Maxwell, G.
"Connections," 20-21
Mayeroff, M., ix
On Caring, 2-3,4-5,23,31,46,48
McCance, T. V.
"Caring: Theoretical perspectives of
relevance to nursing," 62
McKenna, H. P.
"Caring: Theoretical perspectives of
relevance to nursing," 62
"The meaning of caring in the nursing
role" (Knowlden), 24
The Meaning of Persons (Tournier), 35
Medical Education in the United States and
Canada (Flexner), 7
Meleis, A.
Theoretical Nursing: Development and
Progress, 15
Mentally disabled child, 19
Middle range theory, 60-61
Mills, J.
"Improving service through patient
surveys in a multihospital
organization," 35
Neuman, B.
The Neuman Systems Model, 16 "Noncaring and caring in the clinical setting: Patient's descriptions" (Riemen), 24
Nurse administrator, 32-35
budget decisions, 34
and calls for nursing, 33,38
nursing situation, 34-35
relationship to direct care, 32-33 Nursed as caring person, 12
Nursing as caring: A model for transforming practice (Boykin and Schoenhofer), 57,62
Nursing as caring: An overview of a general theory of nursing (Boykin and Schoenhofer), 57,62
"Nursing as caring: Issues for practice"
(Boykin and Schoenhofer), 62 Nursing: A Social Policy Statement (American
Nurses Association), 7
Nursing as Caring
as stabilizer of organization, 35-36 discipline and profession, nursing as, 6-9
educational program grounded in, 46 ideas related to, 1-9 ideologies/cognitive frameworks not congruent with, 27
nurse administrator decisions, 35 persons as caring, perspective of, 1-5
transformational model, 55
theory, ix-x, 11-16
Nursing Development Conference Group, ix
Concept Formalization in Nursing: Process and Product, 6-8
Nursing Diagnosis movement, 27-28,30, 31
Nursing: Human Science and Human Care. A Theory of Nursing (Watson), 3,15,52
"Nursing on the caring edge; Metaphorical vignettes" (Watson), 19
"Nursing Process" (Orlando), 27-28,30
"Nursing research and social control: Alternative models of science that emphasize understanding and emancipation (Allen), 7
"Nursing science, major paradigms, theories and critiques" (Parse), 58 Nursing situation, 8-9,12,13-16,46 and administration, nursing, 34-35 education, nursing, 42-45
persons with altered levels of
consciousness, 18-19 re-presentation of via art forms, 20 shared lived experience, 18,20-22,25,
30
study of, 44-45
theory development, 53
Nursing theories: The base for nursing practice
(George), 61
"Nursing theories and nursing practice
(Parker), 61
Oiler, C.
"Phenomenology: The method," 53 On Caring (Mayeroff), 2-3, 4-5, 23, 31, 46, 48
"On dialogue" (Bohm), 35
Orem, D.E.
Nursing: Concepts of Practice, 15, 16 Self-Care Deficit Theory of Nursing, 15, 16
Organization
hierarchical model of, 36-37
stabilizer, Nursing as Caring as, 35-36 Orlando, L
The Dynamic Nurse-Patient Relationship, 27-28
Nursing Process approach, 27-28, 30 Outcomes of caring, 59-60
Packard, S.A.
"The dilemma of nursing science: Current quandaries and lack of direction," 7
Parenthood, nursing profession as, 15 Parker, M.
"Living nursing values in nursing practice," 55
Nursing theories and nursing practice, 61 Patterns of nursing theories in practice, 61 Parse, R.
"Caring from a human science perspective," 3
"Nursing science, major paradigms, theories and critiques," 58 "Parse's research methodology with an illustration of the lived experience of hope", 55
Parson's theory of Social System Analysis, 15
Paterson, J., ix
Humanistic Nursing, 34
Patient satisfaction, 35
Patterns of nursing theories in practice (Parker), 61
Person as caring, 1-5, 11-13, 17, 19-20 discipline and profession, nursing as, 11-12
Person as complete/whole, 5, 12-13 Personal knowing, 6, 9, 14, 23-25 Personhood, 4, 9, 11, 13, 14, 17, 57 Phenix, P., ix
Realms of Meaning, 6, 18, 20, 22 Phenomenology, 53-55
Phenomenology: The Method (Oiler), 53 Philanthropic paradigm, 3, 5, 12, 28 Plant, M.
"Improving service through patient surveys in a multihospital organization," 35
Polifroni, E.C.
"The dilemma of nursing science: Current quandaries and lack of direction," 7
Post-anesthesia patient, 19
Postmortem care, 18, 19
"Practical applications of nursing as caring theory" (Kearney and Yeager), 62
Practice of nursing, 23-32 communicating caring in, 24 and interface with health care system, 31
Pribram, K.H.
Languages of the Brain: Experimental Paradoxes and Principles, in Neuropsychology, 5
The Primacy of Caring: Stress and Coping in Health and Illness (Benner & Wrubel), 25
Problem Oriented Medical Records, 27 Processual, nursing as, 30
Profession, nursing as, 6-9, 11-13, 15, 19, 54
as caring, 30-31
contribution to health policy planning, 30-31
covenantal relationships, 7 and nursing inquiry, 53
social contract, 7
Ray, M.A., xiv
"The richness of phenomenology:
Phenomenologic-hermeneutic
approaches," ix, 52, 55
Realms of Meaning (Phenix), 6
Reason and Commitment (Trigg), 3
Reeder, E
"Hermeneutics," 52
"Reframing nursing outcomes,"
(Boykin and Schoenhofer), 59, 63
70 Index
Re-presentation of nursing situation, 20 Research methods, 62-63
Researching Lived Experience (Van Manen), 52, 53
"The richness of phenomenology:
Phenomenologic-hermeneutic approaches" (Ray), 52
Riemen, D.
"The essential structure of a caring interaction: doing phenomenology," 24
"Noncaring an caring in the clinical setting: Patients' descriptions," 24 Roach, S., ix
Caring: The Human Mode of Being,
Implications for Nursing, 2, 19
The Human Act of Caring, 2
Rodgers, B.L.
"Deconstructing the dogma in nursing knowledge and practice," 7 Roy Adaptation Model, 15
Roy, C.
The Roy Adaptation Model: The Definitive Statement, 15, 16
Samarel, N.
"Caring for life and death: Nursing in a
hospital-based hospice," 27 Schoenhofer, S.
"Caring in nursing: Analysis of extant theory," 9, 19, 47-48
"Discovering the value of nursing in high tech environments," 59, 63
"Giving of oneself on another's behalf: The phenomenology of everyday caring," 58, 62
"Love, beauty and truth: Fundamental nursing values," 20
"Nursing as caring; Issues for practice," 62
Nursing as caring: A model for transforming practice, 57, 62
Nursing as caring: An overview of a general theory of nursing, 57, 62
"Reframing nursing outcomes," 59, 63 research data, unpublished, 27 "Story as link between nursing
practice, ontology, epistemology,"
14, 17, 19, 20
"The value of caring experienced in nursing," 57, 59, 63
Science, movement toward, 24
Self as caring person, 3-4, 12-13, 17, 19, 25, 27
Self-Care Deficit Theory of Nursing (Orem), 15, 16
Shared lived experience, 20-22
Silva, M.C.
"The American Nurses' Association position statement on nursing, and social policy: Philosophical and ethical dimensions," 7
Smith, M. C.
"Caring and the science of unitary human beings," 62
Social contract, 6, 7
"The social policy statement: A reappraisal" (Allen), 7
Stobie, M.
"Ave Maria and Therapeutic Touch for David," 46-47
"Story as link between nursing practice, ontology, epistemology" (Boykin & Schoenhofer), 14, 17, 19, 20
Story, use of, 45
difference from nursing case report, 31 in education, 45, 49
Strategies for Theory Construction in Nursing (Walker & Avant), 8 Swanson-Kauffman, K.
"A combined qualitative methodology
for nursing research," 24, 55
"Caring in the instance of unexpected
early pregnancy loss," 24
Tead, 0.
The Art of Administration, 32 "Technological competence as caring in critical care nursing" (Locsin), 61 Technology, 61
Technology movement, 24
Theoretical Nursing: Development and Progress (Meleis), 15
Theory and Nursing (Chinn and Jacobs), 8 Theory development and research, Nursing as Caring, vii--viii, 51-55 levels of, 8
middle range, 60-61
model development, history of, 15
phenomenology orientation, 53 "Theory of criticism" (Boeckh), 52 Theory of Nursing as Caring, 11-16 Time allocation, 34-35
"Touch and technology: Two paradigms of patient care" (Gadow), 5, 12, 28
Tournier, P.
The Meaning of Persons, 35
Trigg, R.
Reason and Commitment, 3
Truth and Method (Gadamer), 52
Unconscious patient, 18, 19 "Understanding and interpretation" (Heidegger), 52
"Untraining" of nurses, 23-24
"Value of caring experienced in nursing, the" (Boykin and Schoenhofer), 57, 59, 63
Van Manen, M.
Researching Lived Experience, 52, 53 von Bertalanffy's general systems theory, 15
Walker, L.
Strategies for Theory Construction in Nursing, 8
Watson, J., ix
Nursing: Human science and Human Care.
A Theory of Nursing, 3, 15, 52 "Nursing on the caring edge:
Metaphorical vignettes," 19
Webster's New World Dictionary of the
American Language (Guralnik), 41 Wheeler, L.
"Healing-H1V+ ," 32
White, C.M.
"A critique of the ANA Social Policy Statement ... population and environment focused nursing," 7 Winland-Brown, J.
unpublished research data, 27 Wrubel, J.
The Primacy of Caring: Stress and Coping in Health and Illness, 35
Yeager, V.
"Practical applications of nursing as caring theory," 62
Yelland-Marino, T. "Last Rights," 34
Zderad, L., ix
Humanistic Nursing, 34
NURSING AS CARING
A MODEL FOR TRANSFORMING PRACTICE
Anne Boykin,
Savina O. Schoenhofer
Caring is one of the first words that comes to mind when talking about
the practice of nursing. Caring is an essential value in the personal
and professional lives of nurses. However, the formal recognition of
caring in nursing as an area of study is relatively new. Nursing As
Caring sets forth a different order of nursing theory.
This new nursing theory is personal, not abstract. The focus of the
Nursing As Caring theory is not toward an end product such as health or
wellness; it is about a unique way of nurses living caring in the world.
This theory provides a view that can be lived in all nursing situations
and can be practiced alone or in combination with other theories. This
is perhaps the most basic, bedrock, and therefore radical, of nursing
theories and is essential to all that is truly nursing.
EXPERIENCE