Building Knowledge: The Concept of Care

Aim and Objectives: The aim of this article is to explore whether the specific levels of caring described in Swanson’s Middle Range Caring Theory which include characteristics of caring, people’s concerns and commitments underlying caring, conditions that enhance/inhibit caring and consequences of caring and non-caring could be used in categorizing findings from two literature reviews investigating the concept of care. Background: Nursing has a long legacy as a caring/healing profession where caring is increasingly posited as one of the core concepts in modern nursing science. However, the meanings given to the concept of care remain elusive, ambiguous and unclear. Design: Two systematic literature reviews. Method: Twenty-nine articles based on strategic inclusion and exclusion criteria were synthesized. Data was retrieved from CINAHL, Medline, Embase and PsycInfo covering the period 2003-2016. The literature search used the key words care, concept analysis, systematic review, meta-synthesis, meta-analysis and narrative review. Results: Major themes found were related to the following characteristics of caring persons: compassionate, knowledgeable, positive and reflective. Concerns and commitments underlying caring were doing the right thing, connecting, focusing on the others’ experience, acknowledging individual dignity and worth and being present. Conditions that enhanced/inhibited caring were situational constraints, personality traits, communication skills, health problems and organizational features. Consequences of caring and non-caring actions included both positive and negative emotional, spiritual, physical, and social outcomes for patients, families and nurses. Conclusion: The specific levels of caring described in Swanson’s Middle Range Caring Theory are highly suitable for categorizing the findings from three literature reviews on the concept of care. Relevance to Clinical Practice: Swanson’s Middle Range Caring Theory can be used to guide clinical practice and encourage an individual approach to care. It has been shown to contain clear, comprehensible language in its theoretical basis;this encourages use in clinical practice.

Empirical Verification of Swanson’s Caring Processes Found in Nursing Actions: Systematic Review

Caring has long been recognized as central to nursing and is increasingly posited as a core concept although developing a theoretical description of caring which is adequate in the 21st. century continues to be a difficult task for nursing scholars. Consequently, verifying existing theoretical structures of caring remains an ongoing challenge. The aim of this article is to provide empirical verification of the caring processes of “knowing,” “being with,” “doing for,” “enabling” and “maintaining belief” from Swanson’s Middle Range Caring Theory based on the categorization of nursing actions from a systematic literature review on care. Methods: A systematic literature review was conducted in the fields of nursing sciences, medicine and psychology. Purposeful sampling was carried out covering a period from 2003-2013. The final sample included 25 articles. Results: Major themes of nursing actions included “knowing” which consisted of centering, nurturing, informed understanding, assessment skills, communication and respect for individual differences. “Being with” was characterized by intimate relationship, connecting, presencing, emotional adaptability awareness of self/other and decentering. “Doing for” included competence, knowledge, professional/technical skills, helping actions, anticipatory, multidisciplinary and preserving dignity. “Enabling” was characterized by self care, commitment, complexity of care, appropriate communication, information/education, sharing power, enabling choice and ongoing validation. Finally, “maintaining belief” was characterized by spiritual being, humanistic view, harmonious balance, hope, love, and compassion, meaning, and religious and spiritual orientation. Conclusion: Empirical verification was shown for the caring processes described in Swanson’s Caring Theory grounded in concrete nursing actions.

Identity Processes, Depression, and the Aging Self<br/>—A Norwegian Study

The Identity Process Theory is a theory of how people adapt to aging. According to this theory, older people attribute their physical functioning to a more variable state of health or to their age. Health attributions per se help older people avoid negative thoughts and feelings about themselves and their own process of aging. We explored health versus age attributions, and their effects upon depressive symptoms and negativity toward aging among 359 older Norwegians (age range = 60 - 91 years of age). Aging pertained to psychosocial loss, physical change, and psychological growth. Data collected in the 2004 WHOQOL-OLD Norwegian Field Study were analyzed by using a MANOVA and a validatory path analysis. Our findings consistently supported health attributions in relation to psychosocial loss (X2 = 20.37, df = 10, p = 0.03;GFI = 0.98, AGFI = 0.95, RMSEA = 0.05), physical change (X2 = 35.03, df = 14, p = 0.000;GFI = 0.97, AGFI = 0.94, RMSEA = 0.06), and psychological growth (X2 = 22.22, df = 13, p = 0.05;GFI = 0.98, AGFI = 0.96, RMSEA = 0.04). Health attributions increased participants’ depressive symptoms and negativity toward aging, especially toward psychosocial loss (β= -?0.45, p = 0.000) and physical change (β= - 0.48, p = 0.000). We relate these theoretically contradictory findings to Norwegian cultural beliefs and values. We make recommendations for research, including normalizing depressive symptoms and cross-cultural investigations.

Student’s Perception of Missed Care: Focus Group Results

Background: With the inflation of economic constraints on health care and demand to increase care quality, there is an increasing need to develop a clear understanding of what actions by health professionals are perceived as threatening quality care. Objective: To explore graduate nursing and pastoral care student’s perceptions of missed care in Norway. Research design: A qualitative study was employed with the formation of six focus groups. Data was analyzed via a thematic content of the discussions. Participants and research context: Thirty-one students attending a University College in Oslo participated. Findings: Five major themes and thirty subthemes were identified. Major themes included labor constraints, organizational contraints, professional constraints, communication constaints and emotional strain. Discussion: Findings of this study resonate with other research as well as with studies on missed nursing care. Findings also lend support to the definition of missed nursing care actions as required care that is omitted, either in part or whole, or delayed. Conclusion: The findings from this study extend understanding of what barriers health professionals perceive as inhibiting them from offering quality care. The focus groups provided a valuable flora for discussion regarding what participants perceived as missed.

Meanings Given to Professional Care: Focus Group Results

Background: Many studies have focused on exploring the concept of care from patient and nurse perspectives, but knowledge is limited regarding student perceptions. Objective: To explore the meanings given to the concept of professional care from the perspective of graduate students in nursing and pastoral care. Research design: A qualitative study was employed with the formation of six focus groups. Data were analyzed via a thematic content analysis of the discussions. Participants and research context: Thirty-one students attending a University College in Oslo participated. Findings: Seven main themes and forty-four subthemes were identified. Major themes included reverence and respect for the dignity and value of human life, bonding, sensitive to self and other, communication, competence, willfulness and deep caring. Discussion: Different levels of intentionality, professional comportment and caring consciousness were revealed in the discussions. Findings also lend support to major beliefs and values in Watson’s Human Caring Theory. Conclusion: The focus groups generated valuable detail of complex experiences behind student’s perceptions, attitudes, beliefs and actions. Focus group methodology can enhance holistic nursing practice by providing opportunities to explore and clarify holistic care values, create opportunities for self-awareness and transformative learning in education, clinical practice, administration and research.

Gender Differences in Attitudes to Ageing among Norwegian Older Adults

Increased life expectancy has led to policy interest in adding quality to years of life and in related concepts such as attitudes to ageing. Improving attitudes to ageing is regarded as one means of improving the participation and contribution of older people within society. In considering age- related attitudes in the dynamic nature of social identity, age is not just one social category that may or may not constitute a part of one’s identity. Other identities such as gender may be more salient in attitudes to ageing. The purpose of this study was to explore Norwegian gender differences in attitudes to ageing among 282 females and 200 males living in the community. Attitudes to ageing were measured using the Attitudes to Ageing Questionnaire (AAQ;Laidlaw, Power, Schmidt, & the WHOQOL-OLD Group, 2007). Both genders in this study had positive attitudes toward their ageing, in spite of acknowledging loss with problems of exclusion, making friends and talking about difficult feelings. Compared to men, women perceived ageing as a time of greater loss, however, they felt more strongly that ageing brought wisdom and that their life had made a difference. On the other hand, men felt more strongly that physical problems did not hold them back from doing what they wanted to do and believed more strongly that they passed on their experiences to others. Both genders felt that their identity was not defined by age, they didn’t feel old, aging was a privilege, and appraised the importance of exercising. Attitudes to ageing are becoming increasingly important in ageing societies. Such positive attitudes should be regarded with importance to health professionals, leaders and policy makers in planning interventions to buffer the detrimental aspects of ageing.