Concept Analysis on Caring in Nursing Essay paper
Concept Analysis on Caring in Nursing Essay paper
Concept Analysis Paper
Purpose of Assignment:  Discover the process of concept analysis and its importance in theory development.  The student will choose and analyze a concept of importance to nursing by synthesizing literature related to the chosen concept.
Assignment:  Submit a scholarly 10-12 page Paper that clearly and accurately addresses the following:
 

Select a concept
Determine the aims or purpose of analysis? What will be achieved by analyzing the concept you selected?  Why is it important to understand this concept?
Identify all uses of the concept that you can discover. Thoroughly search the literature for how this concept is defined and how it is used in the literature.  A total of four different sources are required and one reference must be from a different discipline other than nursing (sociology, psychology, theology).
Determine the defining attributes of this concept. Concept Analysis on Caring in Nursing Essay paper.
Identify model, borderline, related, and contrary and compare how they differ from the concept you chose.
Identify antecedents and consequences of the concept. Concept Analysis on Caring in Nursing Essay paper.
Give an example of any empirical referents used to measure this concept. (Tools or surveys?)
Describe how the concept will be useful in your nursing practice.

 
Concept Analysis and PowerPoint Grading Rubric
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Criteria
Possible Points

1. The aims of the analysis are clearly identified
10

2. A thorough literature review is completed using at least four different sources with at least one being from a different discipline
10

3. Defining attributes are listed.
15

4.  Model, borderline, related, and contrary cases are listed and compared with the chosen concept
 
10

5. Antecedents and Consequences are listed and explained
10

6. Empirical referent(s) are listed and explained
10

7.  Description of how concept is used in Evidence Based Practice Concept Analysis on Caring in Nursing Essay paper
10

8.  PowerPoint of 10-12 pages submitted with Paper
15

9.  Correct APA and scholarly grammar style
10

10. Timely submission, 5 points are deducted for every day late.

Total points
100

 
 
 
Concept Analysis on Caring in Nursing
Concepts are the foundation of theoretical development (Robert, Tilley & Peterson, 2014).  They represent meaning, experience and/or ideas of a human experience (Watson & Nelson, 2012). The purpose of a concept analysis is to provide clarity on a particular concept as it relates to both theory and practice in the nursing profession. Concept analysis are used greatly in nursing literature to help develop new concepts and refine existing concepts that relate to nursing for the sole purpose of constructing new theory development (Sargent, 2012).  The concept of caring in nursing practice has evolved over the last several decades. Because there are many variations of the definition of caring, it can be difficult for individuals to understand caring specifically in the nursing sense (Lindberg, Fagerström, Sivberg & Willman, 2014). Therefore, I chose to do an analysis on the concept of caring particularly on the care that nurses provide to patients as it relates to Jean Watson’s Theory of Human Caring.  The subsequent sections of this analysis paper are:  definition of the concept of caring, concept comparison, literature review, attributes of caring, antecedent and consequences of caring, empirical referents of caring, model case of caring, alternative cases of caring, and conclusion.
Definition of the Caring Concept
According to Oxford Dictionary, caring can be defined as being an adjective or noun (2016). As an adjective, caring is the act of showing kindness and/or concern for others. As a noun, caring is defined as the practice of looking after others whom are unable to care for themselves.  Caring in the nursing profession consists of doing, knowing, and being (DiNapoli, Turkel, Nelson, & Watson, 2010).  According to Watson’s theory, caring is a central component of nursing and is the basis of the relationship and connection between the nurse and patient (Roussel & Swansburg, 2009).  She defined caring as a state of being.  The act of caring is not about performing specific caring interventions to obtain certain results and treatment of your patient, but rather focuses on all the needs of the patient which include physically, psychologically, and spiritually (Sitzman, 2007).  According to Watson and her Theory of Human Caring, caring fosters understanding, relieves grief and suffering, and enhances the patient’s well-being.  Watson further defines caring as the process of morally committing to protect, enhance and preserve a person’s humanity which in turns fosters healing in that individual (Watson & Nelson, 2012).
Concept Comparison
Parenting can be considered a full-time job.  The definition of parenting is to provide and nurture your offspring in a way that fosters positive growth by attending to their physical health, emotional health, and cognitive functions (Seay, Freysteinson & McFarlane, 2014).  Parents accomplish this by “effectively caring, teaching, leading, communicating and provide for the needs of the child consistently and unconditionally” (Seay, Freysteinson & McFarlane, 2014, p. 7).  This growth is in all aspects much like a nurse has to consider all aspects of their patient when caring for them.  In the nursing profession, caring is more in the sense of promoting healing and health in your patient’s recovery process to their pre-ill state (Watson & Nelson, 2012).  Whereas in parenting, caring is more like providing and loving their offspring. Concept Analysis on Caring in Nursing Essay paper.
Literature Review
According to Dudkiewicz, a caring foundation provides the ethical framework needed to improve patient satisfaction, overall of delivery of care, staff satisfaction, and improve quality measures (2014). Watson’s Theory of Human Caring can be utilized to address specific practice problems and delivery of patient care in healthcare organizations by focusing on the concept of caring.  Caring nursing also provides the foundation for a healing environment where the development of the nurse and patient relationship can be achieved in which it then can promote healing and growth for the patient (Quinn, 2009).
According to Watson’s Theory of Human Caring, Watson defines a valued person as one that should be cared for, respected and nurture (McEwen & Willis, 2014, p. 184).  She defines health for a person as the unity between the mind, body, and soul (McEwen & Willis, 2014).  Therefore, the nurse needs to address the whole person in order to provide or care effectively for their patients’ health.  In order to do this successfully, the nurse would need to consider the patients’ environment as a contributing factor to the patients’ health.  Watson defines the environment as being crucial to the holistic healing of the patient.  The environment contains noise and smells that can affect the patient and nurse’s relationship (Watson, 2008; Bernick, 2004). According to Watson, the caring attitude by nurses allows them to cope with their environment (Watson & Browning, 2012).  According to recent Press Ganey research, there is a direct relationship between staff and patient satisfaction (Dudkiewicz, 2014; Roussel & Swansburg, 2009). Employee satisfaction directly influences the efficiency and quality of work being delivered; which in turn results in better overall outcomes and increased patient satisfaction which can affect the overall delivery of care.
When nurses support one another at their work place in a carative way, they are supporting themselves as well as protecting the rights of their patients by providing the best quality of care. It has been shown that nurses whom engage in self-care and work in an environment that promotes caring have greater job satisfaction, less stress and minimum burnout and fatigue (Aiken, Clarke, Sloane, Lake & Cheney, 2008).  Adequate staffing, schedule flexibility and encouragement of nursing autonomy also affect job satisfaction (Currie, Harvey, West, McKenna, & Keeney, 2005). Adequate staffing directly affects delivery of patient care as well as the quality of the care.  Watson developed a measuring survey called the Caring Factor Survey that can review the quality of care a patient is receiving and is discussed later in this paper.
Defining Attributes
After much research, one can conclude that there are many attributes or characteristics on the concept of caring.  According to Watson and Nelson, there are five core attributes of caring which are:  relationship, action, acceptance, attitude, and variability (2012).  A professional caring relationship is established when the nurse recognizes and addresses the patient having a need from disease, self-care deficit or a pending crisis (Brilowski & Wendler, 2005).  A professional caring relationship places the responsibility on the nurse because the nurse is responsible for the actions directed towards caring for the patient. Concept Analysis on Caring in Nursing Essay paper.
In order to provide professional care, the nurse must perform an action such as either being with the patient or performing a task for the patient (Brilowski & Wendler, 2005).  The four different types of actions are:  nursing care, touch, presence and competence.  Nursing care is the actions and interactions that take place between the nurse and the patient.  A caring touch is performed by the nurse and perceived by the patient.  Instances of touch are most often referred to as ‘the little things that mean the most’. An example of an act of touch is making sure the washcloth is always warm on the patient’s forehead. This simple act, could mean the most to the patient.  Presence is another form of action by the nurse which consists of the nurse actively engaging with the patient by being in the same space with the patient, listening carefully and communicating with the patient and their family members.  Clinical competence by the nurse is crucial in providing quality care especially in life-saving circumstances (Brilowski & Wendler, 2005).
            In order for caring to be therapeutic, nurses whom are providing the care must be strong, confident, and have a positive attitude with themselves and others (Brilowski & Wendler, 2005).  A nurse provides care to a patient by fully accepting the patient as a human being whom deserves to be treated with dignity and respect and acknowledge the patient’s feelings and values.  The saying ‘treat others like you would want to be treated’ would fall under acceptance. Variability is another attribute of caring.  Care is dependent on the environment, the circumstances and the people involved.  Caring nursing will change or evolve as a nurse develops new skills and becomes more proficient in his/her practice. The caring nurse must also recognize that he/she must first care for themselves before providing authentic care to others (Sitzman, 2007).
Antecedents and Consequences of Caring
Watson and Nelson identified that in order to develop a caring relationship between the nurse and patient, they must first have the antecedents of trust and rapport (2012).  Integrity and commitment by the nurse conveys trust within the patient; which, in turns establish rapport and a transpersonal relationship embracing the carative bond between the nurse and patient. Watson and Nelson also identified the consequences of a nurse establishing a caring relationship with his/her patients and those consequences are nurse satisfaction and patient healing.  Increased health and healing are the most important outcomes for the patient resulting from nurse caring (Brilowski & Wendler, 2005).  The nurse benefits from a professional caring relationship with the patient as well.  The nurse will show an ability to tolerate uncertainty and will develop an increase sense of empowerment.  Caring nourishes a nurse’s passion to practice and increases a sense of personal and professional satisfaction for the nurse which contributes to an increase feeling of empowerment.
Empirical Referents
Measuring the concept of caring can be challenging because care is perceived by the person giving it and receiving it (Papastavrou, Efstathiou & Charalambous, 2011). Concept Analysis on Caring in Nursing Essay paper.  “Caring enhances patient perceptions of quality health care delivery” and increases nurse retention (Watson & Nelson, 2012, p. 103).  Patient-centered care is largely based on reports of patient satisfaction and assessments of healing and safety (Lynn, McMillen & Sidani, 2007; Watson & Nelson, 2012). The empirical referents I selected for the analysis on the concept of caring are the Patient’s Assessment of Quality Scale and Caring Factor Survey which are both measurements on the assessment of quality of care. These measurement scales have identified common components that contribute to the quality of care which are: individualization of plan of care, caring holistically and the creation of healing environments staffed by nurses proficient in the Caritas Processes (DiNapoli, Nelson, Turkel, & Watson, 2010; Lynn et al., 2007; Quinn, 2009). These two measurements can then be compared to outcomes to determine if a positive outcome correlates to the perception of quality care given (Papastavrou, Efstathiou & Charalambous, 2011).
The Patient’s Assessment of Quality Scale or PAQS-ACV, focuses on nursing care in the acute care setting and is evaluated by the patients’ perceptions.  The factors assessed in the PAQS-ACV are:  individualization with 17 questions, nurse characteristics with 12 questions, caring with 7 questions, environment with 2 questions and responsiveness with 6 questions.  The PAQS-ACV is a Likert scale with half of the questions worded positively and the other half negatively; the answers being a 5-point balanced scale ranging from strongly disagree to strongly agree. It takes the patient about twenty to twenty-five minutes to complete (Lynn et al., 2007).
The original Caring Factor Survey is a 20-item survey developed from Watson’s Theory of Human Caring. It was designed to assess patients’ perceptions on the care received from nurses who practiced in a caring way (Watson & Nelson, 2012).  The revised 10-item CFS is a refined guide of the survey that incorporates the caritas processes with their assumptions in theory developed by Jean Watson. The ability to accurately measure caring by utilizing the caritas processes helps to establish caring as a metaparadigm concept. Both surveys are accurate in measuring caring (DiNapoli et al., 2010). The CFS is written in first person because it is supposed to be from the respondent’s perception of his or her own caring attributes (Watson & Nelson, 2012, p.66). The CFS is also a Likert 5-point balanced scale ranging from strongly disagree to strongly agree. Scores from each of the 10 items are added together with higher scores indicative of increased attributes of caring.
Model Case
Nurse Jackie walks into room 1 and identifies herself as to her patient and the patient’s family members along with greeting them all with a smile and handshake. She then speaks to the patient directly by maintaining eye contact. She explains about patient privacy and asks the patient’s permission to discuss her plan of care in front of her family members. The patient wishes for her family to step out of the room and doesn’t wish to share her medical information with them. Nurse Jackie politely asks for the family to go to the waiting room and the family leaves the room. Nurse Jackie then explains that the doctor has ordered for a foley catheter to be placed due to the nurse expressing concerns to the doctor about decreased urine output and increased oral intake. Nurse Jackie explains the purpose of the catheter and the doctors’ reasoning for ordering it to be placed. The patient is visibly confused and shocked to hear this. Concept Analysis on Caring in Nursing Essay paper. Nurse Jackie then talks in a comforting and calm tone explaining what a catheter is, shows her printed materials on the step by step process of inserting it and maintaining it. The patient is concerned about the risks from having the catheter placed. Nurse Jackie addresses the patient’s concerns and the patient is accepting of receiving a foley catheter. Nurse Jackie places the catheter, provides post pericare and addresses the patient for any further questions or concerns.  Nurse Jackie can now monitor the patient for urinary retention and accurately monitor urinary output. Nurse Jackie retrieves the patient’s family in the waiting room and explains they can go back to the room.
The nurse utilizes the concept of caring by addressing the five attributes of caring which were discussed earlier in this paper as well as expressing concern for the patient’s health.  All of the defining attributes were covered in this case. Nurse Jackie provided patient education, assessed needs of the patient, monitored the patient, followed through with care, and established a professional relationship with the patient. The nurse possessed a skill set and knowledge base in doing this. The nurse followed up after the procedure for any concerns of the patient.  The antecedents of trust and rapport were accomplished, the consequences of improving health through monitoring urinary output was addressed, and empirical measurements were addressed by the nurse whom asked the patient afterwards if she had any concerns or thoughts of which the patient did not.
Alternative Cases
Borderline Case
The nurse walks into the room and identifies herself as the nurse to her patient. She welcomes her to the unit and states she needs to place a catheter per doctors’ orders due to the patient’s inability to void in the past 12 hours. The patient agrees to the placement of the catheter. The nurses places the catheter and then asks if she could do anything else for the patient before she leaves to pass her 9 o’clock medications. The patient does not have any questions and the nurse leaves the room. The nurse identifies who she is to the patient and establishes a nurse-patient relationship. She expresses concern about the decreased urine output and identifies that there’s a task to be completed.  She does not offer any education on what a catheter is or what the process is to place it. The nurse does ask if the patient has any questions or concerns, but it is not until the end of the case study and after placement of the catheter that she does this.  The nurse does not fully show the concept of caring in this case study, but she does show some of the characteristics of caring. Concept Analysis on Caring in Nursing Essay paper.
Contrary Case
The nurse walks into the patient’s room, pulls back the patient’s bedding, states she’s going to place a foley catheter per doctors’ orders and asks the patient if she has any concerns before proceeding. The nurse does not identify whom she is to the patient, does not give the patient time to think and address any concerns that she might have prior to the nurse stepping into her personal space, and does not give any education on what she is about to do to the patient.  The nurse does not exhibit caring in this case study. She simply is in a rush to complete the task at hand without looking at the patient as whole.
Conclusion
Caring is the foundation for nursing and the main reason why nurses go into the profession. Watson’s Theory of Human Caring can be applied to practice today focusing on the concept of caring and how it affects the nurse-patient relationship, quality of delivery of care, patient’s healing, and patient and nurse satisfaction. There are many ways to measure caring, but one must remember that these measures are based on patients and their perspectives. In order to fully care for someone, one must look at the whole person according to Watson’s theory. I have gained much knowledge on the concept of caring and how it affects nursing practice today through Watson’s theory. Concept Analysis on Caring in Nursing Essay paper.
References
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Bernick, L. (2004). Caring for older adults: Practice guided by Watson’s caring-healing model.                Nursing Science Quarterly, 17(2), 128-134.
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Viewpoint: Caring Science meets Heart Science: A guide to authentic caring practice

Watson, J., & Nelson, J. (2012). Measuring caring: International research on caritas as healing. New York: Springer Publishing Company. Concept Analysis on Caring in Nursing Essay paper.