Caring is a core element in nursing even yet it remains elusive to the entire nursing metaparadigm. All nurses as required by their profession must be caring. For it is through caring that nursing derives its uniqueness and contributes significantly to health care (Thorne, Canam, Dahinten, Hall, Henderson, and Kirkham, 2002). This is not only the patient as an individual but the family and community as well. Further as the nursing profession continues to take on some of the roles of physicians, it is important to differentiate the profession from that of physicians. Caring seems an obvious component of nursing yet does not feature in the nursing metaparadigm for a number of possible reasons. First, there is a possibility that caring was perceived to be synonymous to nursing. It is true there is little understanding and agreement on what the term refers to. Again, a focus on caring was perceived to delimit the nursing territory (Thorne, Canam, Dahinten, Hall, Henderson, and Kirkham, 2002). The variability of care makes scientific inquiry almost impossible. It is indeed true that medicinal treatment alone can guarantee healing. This however, becomes tricky with the aged, frail people and those suffering from chronic diseases. These groups of persons need care.
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According research and experiences recorded by nurses; once patients are well taken good care of, it helps boosts their chances of recovery. This is because sickness, even when traced from traditional societies, was perceived to interact with environment, family, community, spirit and the individual persons. The better an individual feels the greater are his or her chances to respond positively to treatment. This good feeling can be provided by the nurse who establishes confidence, a bond and trust with the patient. Caring is therefore an important concept that needs to feature in the nursing metaparadigm. Without this concept nurses may not be well able to execute some of their duties successfully.
Concepts and Metaparadigms
Concept refers to terms that define phenomena occurring either in thought or nature (McEwen and Willis, 2006). Concepts normally contain some attributes which help to distinguish them. Since the formulation of concepts employs the use of words, concepts can be broadly be categorized as either concrete or abstract. The former can be perceived by the common senses and include concepts such as universe, passion, ground, which are symbolic and a representation of phenomena. On the other hand abstract concepts include love, anger, passion etc. All these terms are particular to an entity and for that matter descriptive in nature. Concepts can be formulated using a single word, two words or a phrase (McEwen and Willis, 2006). Examples of single word concepts include death, fear, anxiety etc. The concepts with two words can take the form of mutual agreement, self-fulfillment etc. There are concepts which take the form of a phrase such as user-friendly services, environmental conscious behavior, poor service delivery etc. There are many concepts in different disciplines which help to differentiate one from the other. For the reason purpose of systematic study of nature, it is important to come up with concepts that are clear (Duncan, Cloutier and Bailey, 2007). This becomes a stepping stone that gives researchers and scholars a grasp of reality. It also makes the study of phenomena easier. Also in order to communicate meaning clearly to readers there is need for scholars to avoid ambiguity. This means that every time a term is used in a particular context, scholars must endeavor to define it to ensure proper interpretation.
On the other hand metaparadigms define a discipline and set the boundaries with other disciplines. It gives the discipline a global perspective which is useful for the practitioners of the discipline to observe phenomena within their parameter (Van Wyk, 2005). In most cases it comprises a range of major concepts which act as its defining elements. These concepts within a metaparadigm act as limitations or boundaries of the discipline. Again, metaparadigm not only defines a discipline but also outlines its concerns. For instance in nursing metaparadigm we have four concepts which include environment, person, nursing and health. These concepts in general help to define nursing metaparadigm and set it apart from other disciplines or professions for that matter. A clear line is therefore able to be drawn between nursing and physician practice. This is possible because of the different metaparadigms.
Evidence to Support Position
Historically there are four concepts in the nursing metaparadigm which have been used to describe the context and content of the nursing profession. As much as the four concepts; health, environment, person and nursing continue to be embraced in the nursing fraternity, they have been a number of challenges and proposals being experienced and given as alternatives (Schim, Benkert, Bell, Walker and Danford, 2007). The nursing metaparadigm however, continues to be recognized by all professions in the field. Apart from the four components the concept of caring continues to be a contentious issue. For a long period caring has been ignored since it could not be subjected to scientific inquiry, measured and its impact determined (Thorne, Canam, Dahinten, Hall, Henderson, and Kirkham, 2002). In many instances the ability to cure by use of scientific means through medicinal treatments alone renders the role of caring obsolete. This however, does not apply to those who are weak, aged and suffering from chronic diseases (Castledine, 2009). These ones have to be cared for in order to boost their recovery process.
Even with the many perceptions and definitions there seem to be an agreement on the components of care. The major focuses of these components are the physical, emotional and psychosocial requirements of the patients (Castledine, 2009). The patient needs to be cared for and in this case the staff is concerned primarily with giving care and little attention is given to end results. For this reason there is need to understand care in a far more refined manner compared to the traditional view of the same (Van Wyk, 2005). It is important for the care givers to be compassionate with those receiving care. The level of concern with the health of patients makes nurses not only to experience whatever the patient is going through but give hope and assurances or recovery. The nurse can also offer assistance in areas where the patients is unable to perform. There are also specific conditions and situations which call for care from the nurses. These problems may be social or medical. Most importantly care much aim at the preservation of a patient’s dignity (Castledine, 2009).
According to research carried out to examine how students perceive stories shared by nurses, researchers found out the views of four students which centered on the care as developing of trust (Adamski, Parsons and Hooper, 2009). The stories told by nurses tended to encourage as well as make one student gain confidence to undertake similar experiences. This student in particular went into mimicking the behavior of the nurse such as the use of non-verbal communication thus leading to desirable results. In this way it became apparent to the student that through experimenting with some of the ways demonstrated and practiced by nurses, one could actually make a bond with patients. There is much excitement and one is encouraged to go and try it out with the patients.
The view of another student tended to perceive a great percentage of caring resulting from being open to patients and at the same time listening attentively to what they say (Adamski, Parsons and Hooper, 2009). This student emphasized the need to concentrate on the patient while withholding ones judgment. In this way the student perceived caring as being manifested in a number of ways but most importantly it was channeled towards trust and establishing a bond with the patient (Adamski, Parsons and Hooper, 2009). Similarly, the same student craved for a mentor who would be instrumental to help her gain confidence, learn to care and see to an improvement of her nursing practice (Adamski, Parsons and Hooper, 2009). It is true that the care shown to patients makes them feel good about themselves. The nurse should therefore endeavor to improve these skills in order to be successful in executing duty.
Moreover, it is important for nurses to exhibit confidence, communicate effectively, respect and be available always to attend to a patient’s needs. This is a tall order which requires the nurse to be comfortable in a number of situations (Rayman, Ellison, Holmes, 1999). The only way to achieve this is through experience and to allow exposure to a number of situations. These experiences are gained from a number of places. Similarly, it was noted by the student that caring involves being able to stay current on nursing practices, ability to prioritize and doing what is right (Adamski, Parsons and Hooper, 2009).
The concept of caring comprise of various attributes. These attitudes are essential to nursing as a whole. They include attitude, action, variability, relationship and action (Brilowski and Wendler, 2005). Nursing as a profession pays much attention to relationship between nurse and patient. This relationship is initiated by the former with the intention of taking action. It is a relationship that calls for cooperation and respect from both parties. The patients require such a relationship for assistance as most of them are not able to care for themselves. In some cases the relationship has been perceived to be a form of friendship as there is concern and affection for one another (Rayman, Ellison and Holmes, 1999). The nurse being the initiator and most active in the relationship is a companion in the client’s journey towards recovery. In order for this relationship to be fulfilling there must be intimacy, trust and responsibility. The nurse has the responsibility to develop a trusting relationship which comes with patience, openness, love and sincerity. Proximity to the patient is vital and important for the development of intimacy and trust.
Since the nurse is in a professional relationship with the patient then all responsibilities are at facing to that direction. The person who is receiving care must be assured of well- being through responsible actions shown by the nurse. Professional care givers therefore need to act in the most current and knowledgeable manner towards their clients (Khademian and Vizeshfar, 2008). In this mission there are guided by professional ethical codes. For instance their conduct must be of high standard and also their decision making must be guided by principles of practice.
In conceptual analysis of care there must be action exhibited by the nurse towards the patient. This is not only performing some activities for the patient but also ensuring one’s presence at all times. The care giver sees the need of an individual and more than wiling to respond to these needs in a professional manner (Khademian and Vizeshfar, 2008). It is important for instance for the nurse to be interested in the patient as a human being worthy of respect and dignity. It is from her that the nurse will start to exhibit care for the patient. The most obvious of this kind of care is physical. In this case some actions that would make patients feel good about themselves. These actions may include a rub on the back, assisting the patients in and out of bed, chair, dressing and undressing etc. In some cases the nurses will have to assist female patients to do their hair and even apply make-up (Brilowski and Wendler, 2005). All these ensure that the patients feel good about themselves. They feel their live has not simply stalled due to sickness but someone is more than willing to see them recover and carry on with the day to day life.
A caring nurse must also exhibit a caring touch. As much as the action might seem small, its significance is great. It is a form of non-verbal communication important to establish rapport between the two and changes the perceptions of the patient towards the nurse. Actions such as holding hands, gently stroking the hair are some of the actions that cement the relationship between the nurse and the patient.
The physical presence of the nurse is important just like emotional presence. The nurse must not only shares time and space with patients but also listens actively (Brilowski and Wendler, 2005). There is need to be a part of the family and share their fears, hopes and aspirations. It is important at this time for the family and the patient to be assured that they are not alone. A nurse may seat by the bedside of the patient telling stories and contributing to whatever the family have to offer. It is simply the feeling of togetherness and appearing like one family. This is a holistic and genuine engagement of the two parties that helps build on trust and confidence.
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Caring as a concept varies in different circumstances, people involved and the environment at large (Daniels, 2004). Variability in care is therefore another way to describe the changing nature and fluidity of caring. For this reason the more a nurse practices care giving to patients the more experience gained. It is therefore expected of the nurse to offer care corresponding to environment and nature of the patient. There is need to understand that patients are different and need assorted care and attention.
Importance to Nursing
The introduction of the concept of care in nursing metaparadigm will help reduce emotional labor that always accompanies giving of care among nurses. In the work place nurses normally have emotional regulation which is likely to lead to emotional exhaustion or burn out (Huynh, Alderson and Thompson, 2008). In any organization and in nursing profession in particular it is vital that workers be able to feel their emotions and be aware of the personal costs associated with the services they give to patients. It is important to note that emotional exhaustion of the nurses can come as a result of a number of factors including depersonalization of the patient. As an attribute to care, variability must be taken into consideration such that patients are treated as individuals (Brilowski and Wendler, 2005). This cannot be easily achieved if the nurse has not been oriented on some of the principles of care. His or her individuality must be taken into account.
Caring gives nursing its uniqueness hence the reason for nurses to be directly involved in care giving. In the modern health care however, the role of care giving is remotely executed by the nurse. For instance it is common for support staff to aid in care giving while under the supervision of a nurse (Clifford, 1995). In this case the role of the nurse is reduced to that of a supervisor and therefore contact with the patient is reduced. The all important link between the nurse and the patient is cut. This makes treatment to be a long and complicated experience for both the nurse and the patient.
In defining nursing as a formalized manner of giving care then it becomes easy for the nurses to respond to the needs of patients with compassion. There will be little or no pressure at all for the nurses to fulfill demands that are farfetched from nursing. Their activities as care givers will be guided by the need to respond to health care. The available resources will therefore dictate the activities of the nurses (Clifford, 1995).
Through the experience gained in caring for the patients, nurses feel empowered and become mush tolerant of uncertainty. Since an individual is able to connect with the patients, it becomes easy to respond to their needs (Daniels, 2004). In addition the satisfaction gained through work is increased as the nurse becomes energized and passionate about work. It is for the same reason that the nurse is able to empathize with the patient. The nurse is close to the patient and attends to all demands being made, it quickens the recovery progress. The patient is not ashamed to communicate and share deep feelings. On the other hand the nurses are well able to experience the illnesses thus increase their understanding. In this way it becomes easier to attend to similar cases in future.
Care education is also essential in nursing profession more so preparing nurses for care in their profession. As much as the theory of care differs greatly from the life experiences in the field; still the need to get the education is vital. Once the students have gotten the knowledge in school it will help change their attitude and more importantly give them a clue of what to expect in their work. This knowledge is essential for preparation and also in laying down a framework for the nurses such that they are aware from the onset what is entailed in their profession (Clifford, 1995). In addition the knowledge is important for the sake of contemporary practices in health care and gives insight to the future of nursing.
For a long time nursing as a profession has been misunderstood and portrayed negatively. The inclusion of caring in nursing metaparadigm is important in the creation of a good public image for the nurses and the profession. Once the public has a good image upon a profession it helps boost recruitment and also change the nurses’ attitudes towards work (Takase, Maude and Manias, 2006). The nurses will also improve on their self-image which largely contributes to performance in the job.
Conclusion
There is still much debate on whether or not the concept of caring should be included in the nursing metaparadigm. In the nursing profession this concept continues to be controversial. The reason for this controversy is the fact that nurses continue to give care despite the concept being ignored. This may appear simply as an ignored concept but in reality it has been and remains part and parcel of the nursing profession. In fact there are those who have equated nursing as a whole to caring. In this case caring seems to have been a metaparadigm of nursing alongside health, person, and environment. In the modern health care, nurses have delegated the role of care to subordinate staff while maintaining the role of supervisors. As much as the nurse is still in control, there is lack of attachment with the patient.
The public opinion of nursing is far from impressive as most of the people are ill informed about the profession. The majority tend to think nursing to be synonymous to caring. The nurse is perceived as a subordinate to the physician, receives instructions from the doctors, earns less salary etc. All these are stereotypes most of which emerge from the tradition role of the nurse as a care giver. This caring is understood casually with little understanding of the profession. It is for the same reason that people feel they know quite well the role of the nurses. For this matter they are ready to judge on the delivery of services. It is important for the nurse to be respected, seen to be compassionate, concerned and competent.
The importance of caring is not only confined to the nurses but the family and the patient as well. Most importantly however, is the fact that caring will help increase the rate of healing and health thus lighten the work of the nurses. It is significant to all involved in the entire process of healing as it reduces anxiety and fear for both the family and patients. In this way it helps to empower the patient, give comfort, hope, security and self-esteem. Eventually, nurses are able to enjoy their work. This is as a result of the nurse being perceived differently by the patient thus boosting morale. Caring should therefore be incorporated in the nursing metaparadigm since it will be a major boost to the profession. The nurses will feel good about their profession as they are trained, gained experience and able to develop a relationship with patients.
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