The spirit in which the nurse does her work makes all the difference. Invested as she should with the dignity of her profession and the cloak of love for suffering humanity, she can ennoble anything her hand may be called upon to do.

Isabel Hampton Robb, Nursing Ethics, 1900
Founder of American Nurses Association

Is nursing at risk of losing the centrality of caring? As our culture continues to embrace a post-modern relativism that challenges long held moral assumptions, the value of caring and compassion could soon be a casualty of this paradigm shift.

Caring and compassion matter. It has been the historical and unifying virtue ethic of the nursing profession for over 2,000 years of caregiving. I believe that unless nursing education is intentional in integrating this emphasis in our curriculum, we could see a further erosion of this ethic in our generation. In order to keep caring central to our profession, as educators we must not only practically integrate caring into the curriculum, but also model it as educators in all that we do.

In Primacy of Caring, Patricia Benner and Judith Wrubel say it best:
The essence of caring as a nurse is that you recognize the value and worth of those you care for and that the patient and their experience matter to you.  

Recognizing the relevance of this quote to all of nursing practice, I have derived 2 questions that I use in my clinical reasoning case studies as well as my template of clinical reasoning questions (FREE download) to develop the “art” of nursing in students. I encourage you to ask these same questions of your students in the clinical setting as well!

1. What is the patient likely experiencing/feeling right now in this situation?
2. What can I do to engage myself with this patient’s experience, and show that he/she matters to me as a person?

Can Caring Be Taught?

Is caring something you either have or don’t have or can it be taught? Though this could be endlessly debated, I have seen student growth in caring behaviors when it has been intentionalized in my clinical teaching by having a “plan of caring” in addition to a traditional care plan or asking how my students the caring questions above.

Kristen Swanson’s Middle Range Theory of Caring is the framework I have used with my students to develop caring behaviors and identify practical caring interventions as tools they can use with any patient they care for. The strength of Swanson’s caring theory is that it builds on the caring work of Jean Watson and Patricia Benner. It was also derived from the practice setting from women who experienced infant death or gave birth to a critically ill infant.

She identified qualitative themes of what the mother perceived as caring behaviors from nurses. I have found these themes of caring universal despite the specialty practice setting they were derived from.

If you would like to trial this approach in your clinical, I have made all of the resources I’ve developed. This includes a brief PowerPoint to explain the importance of caring to nursing, highlights of Swanson’s caring theory as well as templates for the “plan of caring.” I have also written an article “Care Like a Nurse” ($5 download for this and 20 other resources) that is a practical guide on this topic.

To practically implement Swanson’s caring theory application in the clinical setting, the following practical steps were first completed:

A presentation in theory on the historical legacy and relevance of caring was done. Swanson’s caring framework and the five processes were then explained.  A summary of Swanson’s caring framework, and an article/interview, Caring Made Visible (Swanson, 1998) where she personally explained her framework was distributed and posted online. The first clinical of our nursing program was in a long-term care or rehab setting and consisted of 5 weeks of clinical experiences.  This allowed for 1 caring process and its related caring interventions to be applied each week.  A 1 page blank template that included each weeks process, the definition of that process and the 3 to 5 caring interventions were created and given to each student.

Students chose at least 2 caring interventions they would implement in clinical. They would put in their own words how they would apply it as part of their preparation the day before. Each intervention was evaluated and how their patient responded. Student’s had a “plan of caring” in addition to a care plan. This written “plan of caring” was submitted each week for faculty to note and provide feedback. At the end of the semester a written summative survey of students’ perspectives of applying this framework was performed.

If you are looking for a NEED TO KNOW “skinny” to quickly and efficiently present this caring content as a clinical instructor in the clinical setting for example, I have some suggestions that I have found beneficial. Discuss the importance and relevance of caring to nursing practice. The Student Handout-Relevance of Caring to Nursing can be used to show the historical emphasis of caring in our profession. Post this online or hand out in orientation to the clinical setting:  Summary of Swanson’s Caring Theory as well as the Caring Made Visible article/interview where she personally explained her framework.

As the foundation for this brief approach, I handed out the five most common caring interventions that were identified by my students in past research and explained these in additional detail to provide context. They had space to put in their own words how they would practically implement. In my clinical paperwork I made space available where students would identify each clinical week what caring intervention(s) they applied that week with a brief example. This was found to be meaningful by most of my students!

Article: Empiricle Development of a Middle Range Theory of Caring Kristen Swanson’s caring theory published in Nursing Research, 1991.
Article: Caring Made Visible Interview with Kristen Swanson discussing and explaining her caring theory
Book: Primacy of Caring: Stress and Coping in Health and Illness by Patricia Benner and Judith Wrubel. A classic work on caring and nurse engagement that belongs in every nurse educator’s library!

What others are saying

I believe that overall the Swanson caring process really made me “check myself” before entering the patient’s room…but Swanson helps me remember to do them each and every time I enter a patient’s room.

I grew a lot professionally–I am so much more comfortable talking with patients and expressing compassion than before.

I realized that, no matter how defensive or solitary some patients are, they all have a common need to feel truly loved and cared for. I think the application of true caring is so crucial to being an effective and healing nurse.