NR 501 Week 5 Discussion: Analysis and Application of a Nursing Model

Chamberlain College of Nursing

Analysis and Application of the Person-Centered Nursing Framework

Dr. Drake and Class,

For this week’s analysis and application of a nursing model discussion assignment, I have chosen the Person-Centered Nursing Framework. Developed by McCormack and McCance in 2006, this model was a response to the evolving healthcare practices transitioning from treatment-driven plans to more holistic approaches (McCormack & McCance, 2017). The person-centered model addresses patients comprehensively, not just as diagnoses, fostering therapeutic relationships among care providers, patients, and their support systems. This model integrates care plans involving the patient, family, and community alongside the healthcare team. The focus is on healthcare being relationship-oriented, encompassing all relationships and contexts within the healthcare environment. The framework identifies four components: prerequisites for the nurse, the care environment in which care is delivered, person-centered processes, and expected outcomes.

Importance of Nursing Theory

Nursing theory was largely neglected after Florence Nightingale first defined nursing in 1860 with her seminal work, “Notes on Nursing: What It Is, What It Is Not” (Zborowsky, 2014). However, the development of nursing theory and models grew exponentially starting in the 1950s (McCrae, 2012). Early nurse theorists recognized the need to distinguish the profession from medicine and the traditional “handmaiden status.” The development of nursing theory was pivotal in establishing nursing as a “thinking profession” (McCrae, 2012). Continuing to develop nursing theory is essential for protecting and defining nursing as a profession rather than a discipline.

The purpose of this paper is to explore the importance of nursing theory for the nursing profession, discuss Kristen Swanson’s Theory of Caring, and explain how this theory meets all four recognized relationships of the nursing metaparadigm and its application to the role of nurse practitioner.

Importance of Nursing Theory for the Nursing Profession

Nursing theory is essential to the profession on many levels. Theories help define the discipline, play a significant role in research, and facilitate concept development, leading to the discovery of more facets of nursing for research (Im & Chung, 2012). Generating theory consolidates the nursing profession and ensures new roles are based on critically appraised science (Power, 2016). Nursing roles are expanding, often encompassing care previously provided by doctors. Nursing theory ensures a close linkage to research, making implementation at the practice level more practical and providing the evidence base needed for further theoretical development (Warelow, 2013). Theory is crucial in advancing the nursing profession and maintaining its distinct contribution to healthcare (Wilson et al., 2015). In today’s multidisciplinary healthcare environment, nursing continues to define and expand its professional boundaries and body of knowledge (Warelow, 2013).

Studying nursing theory aids in the application of theory to everyday practice and patient/client interactions. Graduate students reflect on their practice experiences and how applying theory has aided in patient care or how the lack of theoretical knowledge hindered the person-nurse relationship. According to Hatlevik (2011), teaching nursing students reflective skills directly influences the coherence of theoretical knowledge with practice.

Swanson’s Theory of Caring

Kristen Swanson first introduced the Theory of Caring with the Five Caring Processes in 1991, later expanding and reorganizing them in 1993 and 1998 (Wands, 2011; Amendolair, 2012). The five caring processes are maintaining belief, knowing, being with, doing for, and enabling.

• Maintaining Belief: This process involves a fundamental belief in persons and their capacity to overcome events and transitions, facing the future with meaning (Wands, 2011). Nurses help patients find belief in themselves by offering hope.
• Knowing: Knowing anchors nursing to the lived realities of those served, involving learning and understanding how events affect the person (Wands, 2011; Amendolair, 2012).
• Being With: This process involves giving time and presence to the patient, conveying that they matter (Wands, 2011).
• Doing For: This process includes preserving life and dignity through caring actions, anticipating and addressing needs that the patient would do if able (Amendolair, 2012).
• Enabling: Enabling involves facilitating the patient’s capacity to grow, heal, and practice self-care by providing the necessary tools and empowerment (Wands, 2011).

Theory of Caring and the Nursing Metaparadigm

Fawcett’s widely accepted metaparadigm concepts include person, nurse, environment, and health (Alimohammadi et al., 2014). Swanson’s Theory of Caring addresses all facets of the metaparadigm:

• Person-Environment-Health: Maintaining belief and being with acknowledge the person and their environment, providing hope and emotional presence.
• Person-Environment: Knowing involves understanding the patient’s lived experiences and avoiding assumptions.
• Health-Nurse: Doing for relates to the nurse’s actions to improve patient health.
• Person-Health: Enabling empowers patients to make decisions about their care.

Application of Swanson’s Theory of Caring for Nurse Practitioners

Understanding caring as the central phenomenon of nursing is integral for successful nurse practitioners. Swanson’s five caring processes facilitate patient-centered care, enabling and empowering patients to make necessary decisions and actions for their well-being. Establishing trusting, respectful relationships through maintaining belief, knowing, being with, doing for, and enabling is crucial in the NP-patient relationship.

In my professional experience, I have utilized Swanson’s five processes. In 2004, I cared for a new mother who had suffered from HELLP syndrome, leading to fetal demise. I could connect with her, offer hope, understand her fears, be present with her, assist her physically, and enable her by providing resources for grief. This experience underscored the practical application of Swanson’s Theory of Caring.

Ahern et al. (2011) describe a case of a 38-year-old Caribbean woman with high-grade dysplasia, who struggled with depression and anxiety. By integrating Swanson’s caring processes, the clinic aimed to improve clinical outcomes and provide holistic care.

Conclusion

Theory may seem abstract, but it is essential for practical application in nursing. Swanson’s middle-range Theory of Caring provides empirical evidence for its application in evidence-based healthcare. Understanding and applying this theory ensures holistic, patient-centered care. Reflecting on Swanson’s processes, it is evident that they are interconnected and integral to the nursing metaparadigm, enhancing the nurse-patient relationship.

References

Ahern, R. L., Corless, I. B., Davis, S. M., & Kwong, J. J. (2011). Infusing Swanson’s Theory of Caring into an advanced practice nursing model for an infectious diseases anal dysplasia clinic. Journal of the Association of Nurses in AIDS Care, 22(6), 478-488. doi:10.1016/j.jana.2011.06.010

Alimohammadi, N., Taleghani, F., Mohammadi, E., & Akbarian, R. (2014). The nursing metaparadigm concept of human being in Islamic thought. Nursing Inquiry, 21(2), 121-129. doi:10.1111/nin.12040

Amendolair, D. (2012). Caring model: putting research into practice. International Journal for Human Caring, 16(4), 14-21.

Im, E. & Chang, S. J. (2012). Current trends in nursing theories. Journal of Nursing Scholarship, 44(2), 156-164. doi:10.1111/j.1547-5069.2012.01440.x

Hatlevik, I. K. R. (2011). The theory-practice relationship: reflective skills and theoretical knowledge as key factors in bridging the gap between theory and practice in initial nursing education. Journal of Advanced Nursing, 68(4), 868-877. doi:10.1111/j.1365-2648.2011.05789.x

McCrae, N. (2012). Whither nursing models? The value of nursing theory in the context of evidence-based practice and multidisciplinary healthcare. Journal of Advanced Nursing, 68(1), 222-229. doi:10.11111/j.1365-2648.2011.05821.x

Power, L. (2016). Nursing theory and the delivery of compassionate care. Nursing Standard, 30(24), 41-46.

Ranheim, A., Karner, A., & Bertero, C. (2012). Caring theory and practice-entering a simultaneous concept analysis. Nursing Forum, 47(2), 78-90. doi:10.1111/j.1744-6198.2012.00263.x

Wands, L. M. (2011). Caring for veterans returning home from middle eastern wars. Nursing Science Quarterly, 24(2), 180-186. doi:10.1177/0894318411399450

Warelow, P. J. (2013). Changing philosophies: a paradigmatic nursing shift from Nightingale. Australian Journal of Advanced Nursing, 31(1), 36-45.

Wilson, R., Godfrey, C. M., Sears, K., Medves, J., Ross-White, A., & Lambert, N. (2015). Exploring conceptual and theoretical frameworks for nurse practitioner education: a scoping review protocol. JBI Database of Systemic Reviews and Implementation Reports, 13(10), 146-155. doi:10.11124/jbisrir-2015-2150

Zborowsky, T. (2014). The legacy of Florence Nightingale’s environmental theory: nursing research focusing on the impact of healthcare environments. Health Environments Research and Design Journal, 7(4), 19-34.