Nurses are as follows: maintain belief, knowing,

Nurses are
known for being natural caregivers and Dr. Kristen Swanson’s Theory of Caring
focuses on interrelated caring processes that are essential to the well-being
of the patient. Swanson’s mid-range Theory of Caring was proposed in 1991
branching off from The Human Caring Theory, a grand theory, that was developed
by Watson in the 1970’s. As defined by Walker and Avant (2011), “Middle-range
theories not only share conceptual economy of grand theories but also provide
the specificity needed for usefulness in research and practice” (p. 16). McEwen
(2014) goes on to say that middle range theories encompass limited aspects of relatively
concrete concepts and propositions that may be empirically tested (p. 37-38). Swanson’s
middle range theory was developed based on three studies in perinatal settings.
Her theory is structured based on five caring processes which are used to
provide therapeutic education and interventions to positively affect the patient’s
well-being. Swanson (1993) describes nursing as “the informed caring for the
well-being of others” (p. 352). The five caring processes are as follows:
maintain belief, knowing, being with, doing for, and enabling. Maintaining
belief is the sustaining faith in the capacity of others to transition and have
meaningful lives.  Knowing is the striving
to understand events. Being with is being emotionally present. Doing for is
where you do for the patient what they would normally do for themselves. Lastly,
enabling is facilitating the patient through life transitions (Swanson, 1993,
p. 355).

            The development of Swanson’s Theory
of Caring being based off studies in the perinatal setting goes hand in hand with
my clinical practice in labor and delivery. Much of the time, the overall outcomes
of my job are joyous ones, the delivery of a viable infant! But at times, I
have patients who are going through miscarriages or who deliver stillborn
babies. It is in situations like the later, that I incorporate all five of Swanson’s
caring processes. For example, I had a young mother who was term and at her 40-week
routine appointment was informed that the baby no longer had a heartbeat. She
was sent over from the clinic for an induction and I was the nurse providing her
care. My goal in situations like this is to provide empathy and attempt to
understand the patient’s and family’s grief. Many times, space and support are
what the patient initially needs and I am there to simply listen and help her
understand what has happened until she is ready to talk. I want the patient to
know I am emotionally connected whether that be by touching her arm or just
being a presence in the room. By providing privacy, peri-care, nutrition, and
comfort, I do for my patient what she would normally be doing for herself. I
also educated and provided support for the patient and her spouse by presenting
them with literature on grieving, funeral home information, and support groups.
 Following the delivery if the stillborn
baby, I encouraged my patient to hold her baby. This particular patient was
hesitant at first but after seeing her baby in the warmer, decided to hold her.
I also presented the family with a memory box that contained the infant’s
footprints, a lock of her hair, pictures, and special notes from the nursing
staff. The bonding of holding her infant and the keepsakes the patient could
take home allowed for a sense of closure.

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“Theories make nursing practice more overtly purposeful by
stating not only the focus of practice but also specific goals and outcomes” (McEwen,
2014, p. 25). The objective of Swanson’s Theory of Caring is to deliver care
that promotes dignity, respect, empowerment, and the overall well-being of the
patient. According to Swanson (1993), “This theory delineates five overlapping
processes that are best discussed as dimension of one over-arching phenomenon: caring”
(p. 357). Swanson’s theory can be applied in many situations and contribute to
nursing knowledge. In this situation, the theory gives insight on how patients
and healthcare providers deal with miscarriages/stillbirths and the healing
process. As a nurse who has dealt with multiple miscarriages and stillbirth
events, they never get “easier.”  After
further exploring Swanson’s Theory of Caring, I can now purposefully apply the five
caring processes and adaptive methods to help not only my patient and patient’s
family through the healing process, but myself as well.


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