Caring Defined by a Nursing Student

A nursing student has the unique task of learning how to professionally care for another human being. But what does it mean to ‘care’? By evaluating the publications of nursing professionals trying to answer that very question, one can begin to understand that caring is a very complex action that requires several different interpretations in order to make sense. In this essay, the articles of Kapborg & Berterö, Swanson, and Merrill, Hayes, Clukey, & Curtis each highlight and explain caring. Together, they can help explain what it means to care as a nurse so that nursing students can form their own thoughts and opinions on the concept of caring.

Article Summary One

In Kapborg & Berterö’s article, they state that caring can be illustrated as “the hand (doing), heart (being) , and the brain (professionalism)” (2003). The aim of the study was to identify what Swedish novice nursing students define the nature of caring as. The study obtained their results using a questionnaire where 127 Swedish nursing students responded along with writing an essay of their own image of caring (Kapborg & Berterö, 2003). Their reasoning for using nursing students in the study was to establish what students thought caring was before they worked in healthcare.

The article also compared other literature from nursing articles and theorists to observe the many different aspects of caring in the nursing profession. They found that their research corresponded to the literature of the field, in that while it is a universal concept, caring can not be singularly defined (Kapborg & Berterö, 2003). Through their appraisal of nursing literature, they discovered that caring is the core of human expertise alongside nursing.

The three categories of doing, being, and professionalism can all be subdivided into other subcategories to further understand what entails caring. The first portion of doing, means providing care in the form of actions to patients, and can be divided further into three subcategories: treatment, assistance, and caring for (Kapborg & Berterö, 2003). An example of doing would be giving a patient a breathing treatment. A lot of the activities in the doing category are physical actions in caring for the patient. The second aspect of being, entails that the nurse is mentally present (Kapborg & Berterö, 2003). This could be seen in a nurse listening to their patients and communicating with them. Being can further be divided into the nurse being there and being with the patient. Being there represents how the nurse expresses concern and provides security to the patient (Kapborg & Berterö, 2003). Being with is how well the patients feel the nurse exhibits these qualities of protectiveness and how they show kindness. When the nurse understands and empathizes with the patient, they make the patient feel that their nurse is present and invested in their care (Kapborg & Berterö, 2003). The final category is professionalism where nurses should be competent in their field. The four subcategories are: “knowledge, rules and regulations, ethics, and prevention” (Kapborg & Berterö, 2003). All while nurses are caring for patients, they must have professional knowledge and skills, along with practicing preventative care for themselves and their patients. While being a caregiver, they must understand the laws and guidelines of their practice and know ethical boundaries (Kapborg & Berterö, 2003). All these categories and subcategories show that caring is a very vast concept and requires more than just being able to perform the physical aspects of nursing. Interestingly, by comparing this research to other studies they found that nursing students relate caring by doing, the physical aspect, the most (Kapborg & Berterö, 2003). Other research indicates that actual registered nurses find that doing and being together are the best classification of caring (Kapborg & Berterö, 2003). Nursing students understand that caring is a lot of physical work, but registered nurses know that while the activities of nursing are important, it is just as critical to provide psychological care to patients as well.

Kapborg and Berterö’s overall concluding definition of caring was “to take care of the entire human being both physically, emotionally, and intellectually” (2003). By using this definition and the body part visual of caring, nursing programs can provide a framework thus allowing students to follow their own commitments to their profession and to their patients.

Article One Critique

Relating Kapborg’s & Berterö’s (2003) findings to other works of literature allowed them to recognize patterns, along with establishing their own thought process regarding the relationship of nurses to caring. Also, by visualizing the aspects of caring into body parts, the overall process of caring and the many different aspects it entails is more accessible to an understanding caring from inside of the profession. The article stated in its limitations that their method of research (questionnaires and essays) could be too ambiguous and that their interpretation of the student’s answers could have influenced the results. They also found by comparing the research to other studies, that nursing students relate caring by ‘doing’, the physical aspect the most (Kapborg & Berterö, 2003). This is helpful in showing what the base level of understanding what care is for nursing students. This article helped the understanding of caring by using a visualization of the three main aspects of caring, and then comparing it to other thought processes of other nursing professionals.

Article Two Summary

In Kristen Swanson’s piece caring is defined as a “nurturing way of relating to a valued other toward whom one feels a personal sense of commitment and responsibility” (1993). All caring relationships including nurses to their patients, coworkers, or to themselves, should follow this definition regarding care. Persons that are receiving care, are molded by their environment, genetic heritage, spiritual endowment, and free will (Swanson, 1993). Each of these influences relates experiences of the self and how people are affected by their care provider. The environment is the context manipulated by the client in a situation, contained within their own realms of influence. Swanson also notes that it’s important to consider the resources, demands, and constraints of the client that effect the situation, and ultimately their environment (1993).

As a nurse, the focus is not on illness as much as it is helping clients regain their well-being. Well-being is “living in such a state that one feels integrated and engaged with living and dying” (Swanson, 1993). Well-being is then derived from wholeness, where everything that makes us human is expressed through our ‘facets of being’ which include but are not limited to: a person’s thoughts, feelings, sexuality, intelligence, spirituality, etc. (Swanson, 1993). To achieve this well-being, a person must go through the process of healing where pain is released, and wholeness is renewed (Swanson, 1993). Health is a social phenomenon and can be affected by those around someone (and their environment) in the healing process. Nurses provide informed care to clients of all situations, in all environments. An expert nurse must care not only about the current predicaments and problems of a client, but the overarching and lasting health effects of a public and future generations (Swanson,1993).

Sometimes, it may be difficult for the work of nurses to be understood and appreciated by those outside of healthcare. Even then, the acts can be diminished as ‘women’s work’ and become undervalued by society. Outside of other nurses, the clients of nursing care are the only others who can truly understand and appreciate the healing power of a good nurse (Swanson, 1993). It is very important to convey that even though care is vital to nursing, this “does not mean that only nurses are caring, and that all nursing practice situations may be characterized as caring” (Swanson, 1993). The therapeutic practices of nursing and the overall goal of well-being for clients is what makes nursing unique.

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The overall framework of nursing according to Swanson can be defined in her structure of caring where everything is based on maintaining belief—that is the “fundamental belief in persons and their capacity to make it through events and transitions and face a future with meaning” (1993). This is where the nurse learns where to address care and figure out what matters to the client. The next portion of her model is knowing, and that is the informed understanding of the condition and situation of the client (Swanson, 1993). Knowing anchors the maintenance of belief and strives to understand and translate everything to the human condition (Swanson, 1993). The next stage is being with, and that is being emotionally available and conveying to clients that they and their opinions matter to the nurse. The way this is done is through conversations, and sharing of these experiences (Swanson,1993). Being with also means being there physically along with also being available; to be with another according to Swanson means “to give time, authentic presence, attentive listening, and contingent reflective response” (1993). It is also vital under the condition of being there during times of vulnerability, that the nurse remains aware that they are the provider, and not the recipient. It is important to empathize, but not at the cost of becoming highly involved in the reality of the client. There needs to remain a professional boundary between caregiver and client (Swanson, 1993). The last two portions go hand in hand with ‘doing for’ and ‘enabling’. Doing for comes from Henderson’s idea that nursing is helping the patient do things that they would otherwise do themselves if they were able to do so. Doing for can refer to the physical aspect of helping a client (ambulating), or to psychosocial assistance (outreach programs) (Swanson, 1993). Enabling, can sometimes be construed as the allowance of unhealthy behavior when in fact it entails the nurse serving in the role of educator, coach, and guide for the client to develop their own understanding and long-term well-being (Swanson, 1993). To reiterate, Swanson’s structure for nursing care depicts the “maintenance of a basic belief in persons, anchored by knowing the other’s reality, conveyed through being with, and enacted through doing for and enabling” (1993). Altogether, this structure focuses on the well-being and wholeness of the individual, nurse or client, and their need to be understood and cared for.

Article Two Critique

Overall, this article depicts caring as a process that encompasses the multiple aspects that make us human, and the role of the nurse in reforming and helping the client achieve well-being and wholeness. This article falls out of the typical range for current information, but there is still something to be learned with how previous theories of care impact the current climate of the nursing profession. The article was not difficult to understand, and the description of caring was stated several times and enforced through examples and applications. This structure betters the understanding of holistic nursing care, and how every action by the nurse contributes or detracts from a patient’s overall well-being.

Article Three Summary

The final article discusses caring relative to how trauma patients perceive caring behaviors from their nurses. Authors Merrill, Hayes, Clukey, and Curtis (2012) examined how the turbulent trauma nursing field contributes to how patients feel they have been cared for. The purpose of the study “was to assess how trauma patients with multiple injuries requiring hospitalization perceive caring behaviors in their nurses” (Merrill et al., 2012). Research was found lacking for how patients under critical health circumstances perceive the care they have been given. While it’s important for a nurse to have technical skills in the trauma unit, that nurse must also be able to attend to the psychological needs of their patients. This article defined caring as “the heart and artistry of nursing so understanding what actions, attitudes, and behaviors convey caring is essential to good practice” (Merrill et al., 2012). By properly setting examples of good care in trauma, it can easily be appropriated to other fields of nursing.

This study used the Caring Behavior Inventory (CBI4) to assess moderate to severe trauma patients in the hospital at a level II trauma center (Merrill et al., 2012). This inventory determines the five dimensions of caring: “respectful deference to others, assurance of human presence, positive connectedness, professional knowledge and skill, and attentiveness to the experiences of others” (Merrill et al., 2012). These aspects are all related into a survey of 42 questions, that researchers then used to determine how patients thought their nurses showed care to them. Research has concluded that patients and staff both may see caring in different manners, but “nurses tend to underestimate things that family members consider most important… family members place higher value on information, proximity to the patient, and assurance (Merrill et al., 2012). Nurses tend to think that comfort and support are more important to the patient’s care. Other studies have been conducted that show how certain nursing behaviors show caring, but in order to successfully create a healing environment for trauma patients, nurses need to understand what attitudes and actions, along with behaviors will be the most therapeutic in their recovery (Merrill et al., 2012).

At a 136-bed regional hospital in Colorado, using a descriptive study in an interview format, researchers questioned 103 patients in total, that had trauma scores greater than 15, that were chosen by the trauma nurse coordinators (Merrill et al., 2012). Using the 42-item questionnaire of the CBI4, researchers read the questions to the patient and had them score their response about the nurses’ caring behaviors from 1-6, never to always. Participants were all over the age of 18, spoke English, and gave their informed consent to participate in the study (Merrill et al., 2012). The CBI4 was shown to be an efficient and satisfactory tool to provide valid results in this study.

Overall, the study found that the caring behaviors of trauma nurses were rated very highly. The most important factor found by the study were items of “helping the patient, being cheerful with the patient, giving the patient’s treatments and medications on time, and making the patient physically or emotionally comfortable” (Merrill et al., 2012). These behaviors can be combined into the category of Attentive Nursing and further relate to the overarching behaviors of assurance of human presence and positive connectedness (Merrill et al., 2012). Patients value competence and confidence in their nurses. Patients also value being cared for and heard. It is especially vital when they are in a critical health moment and rely on their nurse for a lot of their needs.

The study did find differences based on gender and ethnicity in their participants. The biggest differences came from the answers of Latino and White patients (Merrill et al., 2012). Latino patients placed “being sensitive to the patient” and “including the patient in planning his or her care as important factors (Merrill et al., 2012). White patients placed “meeting the patient’s stated and unstated needs” and “being confident with the patient” as important items (Merrill et al., 2012). However, they both ranked “giving the patient’s treatments and medications on time” as an important item (Merrill et al., 2012). The researchers concluded that based on this information, more testing needs to be done with a larger sample size to determine further indications of both gender and ethnicity (Merrill et al., 2012). In order to provide the best possible care, a nurse must consider cultural backgrounds to effectively care for their patients.

Article Three Critique

Overall, the study provided a lot of insight in regards to caring for patients in the trauma field and how those actions are perceived by the patients. While the article was easy to understand, and their results were clear, it did not go into depth on what the subfields of caring (respectful deference to others, assurance of human presence, positive connectedness, professional knowledge and skill, and attentiveness to the experiences of others) were as much as it explained what the patients thought of their care in the items of the CBI4. It gave a general summarization of the results of the most significance but failed to show how other aspects of care were ranked by the patients. The results portion of the article only explained in great depth the part of care that was found most important to the patient. The conclusion did provide an interesting perspective on the basis of gender and ethnicity, which then geared the article towards the reader to think of the cultural impact of the results, and how different cultures view care. The article also did not focus on the definition of caring as much as it explained how caring behaviors of the nurse can be perceived by patients.

Conclusion

This paper discussed the topic of caring using articles published by health professionals. The work of Kapborg and Berterö discussed how nursing students in Sweden defined and visualized caring. Kristen Swanson’s piece related well-being and wholeness, and provided a structure based on maintaining belief in the patient that establishes a caring relationship. The study of how trauma patients perceived the care of their nurses was created by Merrill, Hayes, Clukey, and Curtis, and showed that caring is individualized to each patient, and can be seen differently by different genders and ethnicities. Each of these establish that caring is a vast subject, with multiple facets and variables. All of these articles contribute to the understanding that caring is subjective to each nurse and patient and requires a firm understanding of what caring behaviors are and how they are shown to patients. Caring can be seen in a lot of different ways and exhibited in multiple ways too-- even if they are not always obvious. Caring is relative to each individual patient and nurse, and yet the overarching concept can be seen as simply helping another human being in their time of need.

References

1. Kapborg, I., & Berterö, C. (2003). The phenomenon of caring from the novice student nurse’s perspective: A qualitative content analysis: International Nursing Review, 50, 183-192.
2. Merrill, A. S., Hayes, J. S., Clukey, L., & Curtis, D. (2012). Do they really care? How trauma patients perceive nurses’ caring behaviors: Journal of Trauma Nursing, 19(1), 33-37.
3. Swanson, K. M., (1993). Nursing as informed caring of the well-being of others: IMAGE: Journal of Nursing Scholarship, 25(4), 352-357.