The Essence Of The Nursing Practice Essay

The Essence of the Nursing Practice

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The Conundrum of Caring in Nursing
Caring is the quality that constitutes our very
nature of being human. It is a basic human
attribute that people demonstrate toward
each other (Boykin & Dunphy, 2002). Beare
and Myers (1990) add that it is the altruistic
act or feeling of concern for another human
being. While caring is the most common,
authentic criteria of humanness (Roach,
1992), that has dawned civilization, its theme
has threaded the profession of nursing. As
caring has become one of the greatest
fundamentals in nursing, introduced by
Florence Nightingale as being the essence of
nursing (Chitty, 1993), some nursing
proponents fear that it is no longer a central
theme to the nursing profession and has
become only second nature to the busy,
overworked nurse in a technologically
dominated setting. Nursing has struggled at
length to clarify, accept and articulate the
essence of caring in a way that would satisfy
all nursing roles and embody all nursing
knowledge and practice. In spite of it proven
and recognized value in nursing, the
construct of caring has met much opposition
as well. Ironically, some suggest that caring
is not essential to the nursing profession
(Barker, 1995). It is the purpose of this paper
to explore the phenomenon of caring and to
highlight why it is still fundamental to
nursing. To achieve this, the philosophy of
caring, the role and benefits of caring as well
as the challenges encountered will be
explored for how they impact the presence of
caring in nursing today, and current clinical
expectations/experiences that would either
support or oppose such an inquiry.The Essence Of The Nursing Practice Essay
Philosophy of Caring in Nursing
First to be clear, caring in nursing occurs
through two primary domains, one as a noun
or the act of caring for another person when
s/he are unable to care for themselves.
Second, and the context of concern here, is
the adjective of being a caring nurse such as
occurs when a nurse displays actions of
compassion, kindness and concern. By its
very definition, caring is felt to be the central
theme underlying nursing. Derived from the
Latin word, nutricius (meaning nourishing),
it is synonymous with caring (Chitty, 1993).
International Journal of Caring Sciences January – April 2016 Volume 9 | Issue 1| Page 2
While caring is not unique to nursing, it
subsumes all the attributes descriptive of
nursing, a human, helping profession (Roach,
1992). Caring in such a manner reflects trust,
intimacy and responsibility, elements
deemed essential to professional
relationships (Brilowski & Wendler, 2005).
The abstractness of caring transcends the
material and phenomenal world, making it an
increasingly complex issue for enquiry that
stems from the historical developments of
nursing and society at large. As a historical
review of caring unfolds in this paper, it
should become increasingly apparent how
the abstract concept of caring is complex and
how it is perceived by many to illustrate an
ontology and epistemology of nursing, but
yet, notoriously ambiguous (Brilowski &
Wendler, 2005; Eriksson, 2002). Gadamer
(1988) advocated that to understand caring
one needs to delve deeper into reality and
into the world of the patient, one that can be
best achieved in a hermeneutical sense, to
penetrate the core of nursing (Eriksson,
2002). Watson (2005) adds that it moves
humans towards a deeper ethic of human
belonging that affects all.
As nursing is a helping profession, the onus
lays with individual nurses in the extent to
which they perform their nursing
responsibilities in a caring manner. This
focus reflects what Newman, Sime, and
Corcoran-Perry (1991) suggest, that caring in
the discipline of nursing is one of a human
health experience. This is achieved through
the nurses’ experiences as she turns inward
to herself as a source of values and strength
that further exemplifies the caring experience
(Watson, 1979). The nurse who is cognizant
of him/herself and others through selfreflection of personal experiences is one who
is able to enhance his/her caring in a more
holistic dimension (Davis, 2005).
The overall theme behind many a philosophy
of nursing is caring. Lukose (2011) writes,
“nursing is a caring science…human beings
are connected to each other in the caring
process; a nurse’s humanity embraces the
humanity of others to preserve the dignity of
self and others” (p. 27). Caring involves
being there for the patient or family in
whatever way is needed at the time. This
might involve being there to help medically
stabilize the patient’s illness and work
through to recovery, and preparing the
individual and family for discharge by
tailoring care to fit the situation and
supporting the family through this transition.
Sadly, this may also involve being there to
help the patient die with dignity and comfort,
respecting the needs and beliefs of the
family, and being there to provide them with
emotional support. As nurses work through
the care of their patients, their focus shifts
based on the patient’s needs; however, the
aim is always to deliver nursing care with a
caring attitude as care and caring are
intertwined in nursing and impacts the one
being cared for (Como, 2007).The Essence Of The Nursing Practice Essay
As an epistemology, Watson (1990) calls for
the inclusion of caring knowledge into
nursings’ meta-paradigm of person,
environment, health, and nursing. She
suggests that caring knowledge cannot be
created in a void; it is to exhibit a soul
enriching connectedness with nursing metaparadigm in order to be relevant to the
discipline of nursing, as an aesthetic décor,
so to speak. She further adds that “nursing is
a caring science with ethical and
philosophical implications.
Although Nightingale formally started what
is now called the profession of nursing,
whose artistic inclination was the essence of
caring (Chitty, 1993), many biblical writings
that pre-date Nightingale and nursing make
reference to caring for the needy, sick and
hungry in a general sense (Callahan, 2014).
While caring in nursing grew to be perceived
primarily as an art, it has since taken on a
science basis as well (Eriksson, 2002;
Watson, 2005), but in any event remains
fundamental to the practice of nursing
(Roach, 1992; Schattsneider, 1992), as a
combined entity of art and science (Watson,
The blending of the empirical research with
an aesthetic learning opportunity is vitally
important in the development of caring
among humanistic professionals (Pardue,
2004). Caring allows for a delicate balance
between the scientific knowledge base that
nurses hold and their humanistic practice
behaviors (Watson, 1979).
International Journal of Caring Sciences January – April 2016 Volume 9 | Issue 1| Page 3
The Value of Caring
Through caring, a nurse employs an
authentic genuine practice that is all
encompassing and meaningful to the
patient/family. Caring reflects a high regard
for them as a human being (Roach, 1992);
one worthy of utmost respect and dignity
(Eriksson, 2002). The nurse portrays and
stays genuine to him/herself as a concerned,
committed and devoted health care
professional who assumes an acceptable and
unconditional stance to create an
environment conducive to patient growth and
healing (Lewis, 2003). His/her caring mirrors
an inner connectedness, presence and
genuineness inherent in such a giving
profession as nursing (Watson, 1990). Such
attributes have captured the very essence of
how nurses effectively implement their
practice to contribute significantly to a
patient’s perceived health and illness (Smith
& Godfrey, 2002).The Essence Of The Nursing Practice Essay
Another underlying assumption of caring is
that it contributed immensely to the nurse’s
knowledge base. Such knowledge arose
from an interpersonal relationship formed
between the nurse and patient, a rich
resource from which to learn, enhance one’s
already existing knowledge and engages the
patient in a meaningful way (Watson, 1979),
as the nurse sets out on a lifelong journey to
deal with human life and needs to
complement people’s own accompanying
historical and philosophical experiences
(Eriksson, 2002). As the nurse uses his/her
caring repertoire to employ both the
scientific principles of nursing (Watson,
1979), as well as the qualitative esthetic
patterns of knowing (Carper, 1978); s/he
holistically addressees all aspects of caring
pertinent to her patients’ healing that exhibits
a deeper and richer meaning and
understanding (Nelms, 1996). Such
knowledge is not only a requirement of the
nurse (Newman, Sime, & Corcoran-Perry,
1991), but is utilized to lend guidance to the
ethics, values and morals the nurse uses in
how s/he thinks, feels and acts in her practice
(McIntyre, 1995).
Viewpoints of Caring
Through the initial works of Florence
Nightingale (Chitty, 1993), Madelaine
Leininger (Leininger, 1984), Jean Watson
(2005) and Martha Rogers (Fawcett, 1984),
caring became historically rooted in and
threaded through as the essence of nursing.
While it became perceived as a necessity in
how nurses assist patients on the continuum
of illness to wellness, it became an
interwoven theme and even synonymous
with nursing itself. Watson and Leininger The Essence Of The Nursing Practice Essay
perhaps wrote at the greatest depth for how
important caring is to the nursing profession,
particularly, when considering one’s cultural
origins. Leininger for example, asserted that
it’s the one central, unifying domain that
characterizes nursing for all persons
(Leininger, 1984). However, at present, even
Leininger grapples with the notion that
caring seems to be fading in today’s nursing
and is minimized in importance, not only in
the practice of nurses, but in nursing school
curriculum where the emphasis on medical
diagnostics and treatment regimens
overshadow the importance of it (Leininger,
1984). She hence questions how faculty will
instill in our nurses of tomorrow, the
importance of caring in their profession. In
today’s recent literature, Leininger’s notion
of caring and its crucial importance in
nursing is supported (Kenny, 1999; McEwen
& Wills, 2002), in spite of opposition that
suggests it is now submerged in a nurse’s
ritualistic and technological day that is of no
value to one’s healing (Farmer, 1992).
These opposing views to the importance of
caring in nursing have in some cases been
supported by nurse theorists who previously
advocated for caring’s rightful place in
nursing. Such views have contributed
immensely to today’s caring elusiveness and
perceived uncertainty in the profession and
challenged the very reasons why caring is
perceived as important. Musk (2004) and
Clark (2004) however, surmise that such
polarized views can and should be reconciled
where all aspects of nursing are anchored in
caring (Clark, 2004; Musk, 2004). While
caring may not be unique to nursing it is
certainly essential to it (Lewis, 2003).
Watson’s work on her Theory of
Interpersonal Caring is one theory that
became embedded into nursing curriculum
around the world. Caring, she suggests, is
both an art and a science. “Nurses practice
International Journal of Caring Sciences January – April 2016 Volume 9 | Issue 1| Page 4
the art of caring when they reflect on their
practice, not simply focusing on signs and
symptoms but on the richer, deeper spiritual
connections resulting from protecting,
enhancing, and preserving a person’s health”
(Vandenhouten et al., 2012). Further, Watson
adds that “caring science is the essence of
nursing and the foundational disciplinary
core of the profession” (Watson, 2008, p.17).
In essence, it was Watson’s Theory of
Transpersonal Caring that helped identify
caring as the core of nursing (Vandenhouten
et al., 2012). Watson’s Theory of
Interpersonal Caring suggests that “nursing
is a caring science with ethical and
philosophical implications. With human
beings connected to each other in the caring
process; a nurse’s humanity embraces the
humanity of others to preserve the dignity of
self and others. A holistic approach is used in
the transpersonal caring relationship”
(Lukose, 2011, p.27). Nursing researchers
have used it again and again to prove and
illustrate that the foundation of caring can be
effectively incorporated into and beneficial
for the nursing curriculums of many colleges
and universities as well as hospitals and
health care authorities (Burtson & Stichler,
2010; Porter, Cortese, Vezina, & Fitzpatrick,
2014; Spence Laschinger & Leiter, 2006).
The Threat
As the focus of nursing practice changes
with the introduction of technological
advances, increased workloads, and higher
acuity patients, it is feared that the
philosophy of caring in nursing will fade.
The value placed on the medical model of
caring as well, only reinforced the distance
between the nurse and the patient because
the emphasis was on the disease process
itself, not the person or their needs (Clifford,
1989). The sanctioned definition of the
American Nurses Association which
included no notion on the importance of
caring, only for nurses to diagnose and treat
actual or potential health problems
(Schlotfeldt, 1986), did not help maintain the
focus of caring in nursing either. What
perhaps initiated and contributed to this fear
of a downward focus of caring and a shift of
emphasis in nursing was the opposing stance
taken later by many nurse theorists. A loss to
nursing now thought to be potentially
recaptured only through post-modernism
thought (Fry, 1992; Watson, 1999), as a
restoration and re-connectedness with the
human condition is attempted.
The Opposition
Nightingale’s work and effort began the
notion of caring as fundamental in nursing as
she exhibited herself as a very caring being.
Her voluntary visitations to the sick in the
local hospital/community intrigued her to do
more in caring for the sick, even at the
dismay of her family and friends (Chitty,
1993). In an ontological sense, she portrayed
herself as a very caring being, doing good for
others and their poor health (MarrinerTomey, 1994).
However, perhaps Nightingale lost sight of
this caring notion, as it became only
implicitly noted in her writings.
Nightingale’s emphasis on personal
observation as being most important in
nursing, as opposed to caring, became the
impetus for such an assumption (MarrinerTomey, 1994). Hilton (1997) similarly
recalls how she posited nursing empirically,
only as an addendum to medicine. Again, an
effect of the medical model beliefs and
influence. Her treatment to the Irish sisters,
as well, during the Crimea war as they
offered themselves to help the sick and
wounded, dismissed any notions of caring
she initially advocated for in nursing and cast
the altruistic work of the Sisters of Mercy in
the worst possible light (Doona, 1995). One
of Nightingale’s followers, Hildegard
Peplau, later said that caring was not the
essence of nursing and that as long as it is
perceived to be, this female dominated trait
will block men from entering nursing The Essence Of The Nursing Practice Essay
(Kenny, 1999). Barker et al. (1995) go as far
as to suggest that caring reflects a selfishness
of nurses that is conditional upon getting
their own needs met first. Barker further adds
that it is not the basis for the development of
a profession.
Martha Rogers’ humanistic theory on the
Unitary Human Being was perceived to
imply the importance of caring for others.
With a focus on patients as whole beings and
interacting entities, nursing was a humanistic
science dedicated to compassionate concern,
International Journal of Caring Sciences January – April 2016 Volume 9 | Issue 1| Page 5
for maintaining or promoting good health of
all people (Marriner-Tomey, 1994). Davis
(2005) similarly advocated for a more caring
presence of a nurse as being key in
humanistic nursing. However, Rogers’
implication of nursing as a caring,
compassionate profession was,
unfortunately, short lived, where she later
expressed it was time to bury the whole idea
of caring as the essence of nursing and
nurses should begin to look at some
substance in nursing instead, for it was
“foolish” to think that caring is an
identifying characteristic of nursing (Kenny,
1999). This fuelled support to the beliefs
held by Thorne et al., (1998) who felt that
caring is perhaps an unnecessary distraction
in nursing. Is it any wonder then, that nursing
students and nurses have encountered a
caring crisis? (Ma, Li, Zhu, Bai & Song,
While some of nursing’s leading theorists,
Nightingale, Rogers and Peplau discovered
the essence of caring in nursing but later
opposed it, only Watson and Leininger held
true to nursing’s focus around caring. It
remains unclear in history as to why their
values and beliefs of caring being central to
nursing were later self-contradicted, which
left the philosophy of caring in nursing in
turmoil and issues of non-caring behaviours
such as those found in workplace bullying
can breed (Adams, 2015).The Essence Of The Nursing Practice Essay
Caring in Nursing Today
In light of caring’s turbulent journey through
time, it is of no surprise why its ambiguity in
nursing persists. The self conflicting
expressions of early nurse theorists created
an uncertainty for their followers which
further increased this ambiguity. Although
caring today seems apparent in most clinical
settings, it is perceived as something that has
to be worked on. As nurses’ workloads,
increased use of machinery and fast paced
work environment burden the boundaries of
caring (Farmer, 1992; Barker et al., 1995;
Thorne et al., 1998), Watson (1999) and Fry
(1992) anticipate a resurgence of caring in
nursing and its research. Watson (1999)
suggests that as we move into an era of postmodern thinking, the simple act of caring in
nursing will emerge in importance for how it
benefits the sick and compromised. This
contrasts previously identified views that
nurses submerged caring themselves in a sea
of tasks, rituals and mechanical tasks.
Today, in spite of the ambiguity of caring in
nursing, much evidence abounds to illustrate
how the concept of caring in nursing has
positively impacted clinical nursing practice.
Sumner (2005) suggests that while nurses
require a higher level of skill and knowledge
for technologically advanced machinery and
tests, the hands-on approach is still needed,
for nothing can replace this humanism
aspect. The practice of advanced nursing,
she suggests is wholly based upon the
fundamental moral of caring. Technology
can only do so much for the patient,
physically and physiologically, not
emotionally, spiritually or psychologically,
as is needed (Roach, 1992). Hagedorn
(2004) similarly suggests that while a
fragmented healthcare system taxes the
nurses’ attention to one’s emotional needs,
the focus of the 21st century will be on the art
of caring in nursing. As a profession, we
have now witnessed this, as research into the
effectiveness of caring surfaces (Burtson &
Stichler, 2010; Porter et al., 2014). Hagedorn
further adds that aesthetics, as a pattern of
knowing will help promote the holistic view
of the human and add strategically to
prioritizing and promoting health care.
Pragmatically, Thornton (2005) notes how
the concept of caring is advantageously used
today to increase patient and staff
satisfaction and to decrease the patient’s
length of stay in hospital.
Clinically, Hagedorn (2005) and FalkRaphael (2005) have found that caring
remains at the forefront of advanced nursing
practice roles in a variety of settings. As
Newman et al. (1991) have stated, if we just
develop a unified focused statement about
caring and nursing, then it would help
constitute nursing as a professional discipline
and help eliminate ambiguity about nursings’
identity as a discipline, as is sometimes
perceived. Furthermore, by having one
unified focus, this could possibly open up
avenues for nursing to advance in its practice
even more and with increased accompanying
credibility. The presence of caring in
nursing’s advanced practice roles is
International Journal of Caring Sciences January – April 2016 Volume 9 | Issue 1| Page 6 The Essence Of The Nursing Practice Essay
reassuring to the nursing profession, where
new and emerging roles of nurse
practitioners incorporate caring into their
everyday practice with patients, whose
competencies reflect the core caring
dimensions of respect, compassion and
dignity (Hagedorn & Quinn, 2004).
From a patient perspective, the caring
presence that emanates from nurses,
positively impacts patients’ hospital
experience (Davis, 2005). Such
overwhelming evidence of the positive
effects of caring in nursing minimizes Barker
et al’s. (1995) claim that caring is not
important to nursing due to its changing
needs, social structure, and the profession
itself. To nurses of today, it has become
increasingly obvious how caring contributes
to nursing’s ontology and epistemology,
unlike the confusion created by Thorne et al.
(1998), Farmer (1992), Barker et al. (1995),
and the nurse theorists themselves (MarrinerTomey, 1994; Kenny, 1999).
While the ambiguity and elusiveness of
caring in nursing has brought increased
attention to its presence so much so as to
break it off into a science of its own (Smith
& Godfrey, 2002), nowhere is it assumed
that it would be lost from nursing either
artistically or scientifically; but simply just a
renewal of the notion itself from a research,
practical and societal perspective, posing no
threat to nursing as a discipline. The
acceptance and utilization of caring in
nursing as both an art and science to reflect
the underlying importance of caring in
nursing is advocated by many (Hagedorn,
2004; Pardue, 2004).
Both positions have in fact become very
much formalized through nursing theories
and research and enhanced by scholarship in
other related fields (Watson & Smith, 2002).
While the importance of the field of caring
continues to grow into an art and science of
its own, or as a philosophical-ethicalepistemic field of study (Watson & Smith, The Essence Of The Nursing Practice Essay
2002), where if scientific medicine and
technology says nothing more can be done
for the patient, the nurse can still care to give
strength to the patient’s perceived
inadequacies and vulnerabilities (Watson,
1979; Gaut, 1992), the growth of nursing
would be void without it. Caring from both
an art and science perspective would
complement one another, ensuring that all
issues and ambiguities in nursing could
potentially be accounted for and explained
(Pardue, 2004; Hagedorn, 2004; Watson &
Smith, 2002), while holistically addressing a
patient’s need (Eriksson, 2002). Hence,
permitting the discipline of nursing to
proceed in a manner that is in keeping with
their identified codes of ethics and standards
of practice (Canadian Nurses Association,
In spite of the fact that Bishop and Scudder
(1991) imply that caring would not be
missed because of society’s prevailing belief
system based on Cartesian dualism, where
the body is viewed separately from the mind,
such a large global assumption for all people
of all cultures reflects only a minimal
snapshot, with unpromising potential to
surpass the overwhelming evidence
suggesting otherwise (Bishop & Scudder,
Finally, for the nurse theorists who
contradicted caring as no longer essential to
nursing (Kenny, 1999), no known research to
support those assumptions seems to exist,
making them only isolated statements with
minimal foundation for validity.
Caring has remained the art and science of
nursing’s essence through time and into
today’s practice, in spite of some perceived
fears of its loss. It seems somewhat ironic
that the very proponents of caring in nursing
later came to dispute its necessity and
presence. This belief gained momentum on
the premise that nurses were now too
focused on technology, workloads and acuity
issues and the lost sight of the value and
ethic of caring, which clinical research
illustrated it was not so. On its turbulent
journey through time the ontology and
epistemology of caring remains. The
anticipated resurgence of caring in nursing
through postmodern thought brings even
more optimism for caring to continue to be
the central focus of nursing now and in the
future in spite of perceived barriers to its
International Journal of Caring Sciences January – April 2016 Volume 9 | Issu The Essence Of The Nursing Practice Essay

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