Kristen M.

Swanson
Theory of Caring

By:
Peñaranda, Joelleen “Future Nurse”/”Future Patient”
Tiu, Kit Anthony “Future Patient”
“Caring is a nurturing way of relating to a valued
other toward whom one feels a personal sense of
commitment and responsibility.”

(Swanson, 1991)
 BACKGROUND
Born on 1953 in Providence, Rhode Island, USA.
Earned her baccalaureate degree (magna cum laude) from the
University of Rhode Island, College of Nursing in 1975.
Began her career as a nurse at the University of Massachusetts
Medical Center in Worcester.
Pursued graduate studies in Adult Health and Illness Nursing at the
University of Pennsylvania School of Nursing in Philadelphia.
After receiving a master’s degree in 1978, she worked briefly as a
clinical instructor of medical-surgical nursing at the University of
Pennsylvania.
 BACKGROUND
Subsequently enrolled in the Ph.D. in Nursing program at the University
of Colorado in Denver.
Studied Psychosocial Nursing in University of Colorado in Denver.
Caring and miscarriage became the focus of her doctoral dissertation
and subsequently her program of research.
Received an individually awarded National Research Service
postdoctoral fellowship form the National Center of Nursing Research
Board of Trustees of Swedish Health System in Seattle
Board of Directors for the American Association of Colleges of
Nursing (AACN)
 Theoretical Sources
Swanson has drawn on various theoretical sources while developing her theory of caring.
She credits several nursing scholars for insights that shaped her beliefs about the nursing
discipline and influenced her program of research.
She acknowledges Dr. Jacqueline Fawcett’s course on the conceptual basis of nursing
practice, which led her to understand the difference between the goals of nursing and
other health disciplines.
Swanson chose Dr. Jean Watson as her mentor during her doctoral studies. She
attributes the emphasis on exploring the concept of caring in her doctoral dissertation to
Dr. Watson’s influence.
 Theoretical Sources
However, despite the close working relationship and emphasis on caring and miscarriage is
not an application of Watson’s Theory of human caring. Rather, Swanson and Watson
each assert that compatibility of findings on caring in their individual programs of
research adds credibility to their theoretical assertations.
Rather, Swanson, and Watson each assert that the compatibililty of their findings on
caring in their individual programs of research adds credibility to their theoretical
assertions.
Watson's Theory of Human Caring and Swanson's Theory of Caring is somehow the
same but they differ in some areas. For example, where they derive their nursing theory.
 Theoretical Sources
Swanson's theory is considered to be middle range, meaning her approach is specific and not
general. Her theory focuses first on women who experienced miscarriages (a very specific
population). While Watson's was generic and broad.
Although they differ in some areas, their similarities stem from the actions of their
nursing care plan they are still the same. You care for the person physically, spiritually, and
emotionally.
Swanson acknowledges Dr. Kathryn E. Barnard for encouraging her transition from the
interpretive to a contemporary empirical paradigm and for transferring caring knowledge
from her phenomenological investigations to intervention research and clinical practice with
women who have miscarried.
 Use of Empirical Evidence
Swanson formulated her theory of caring inductively, as a result
of several investigations.
Swanson proposed two models:

1) The Caring Model 2) The Human Experience of

Knowing Miscarriage Model
Being with
Doing for
Enabling
Maintaining belief
 Use of Empirical Evidence
Swanson (1990) discovered that the caring process she identified with women
who miscarried was also applicable to mothers, fathers, physicians, and nurses
who were responsible for the care of infants in the NICU.
Hence, she retained the wording that described the acts of caring and
proposed that all-inclusive care in a complex environment embraces balance
among caring, attaching, managing responsibilities, and avoiding bad outcomes.
Researchers concluded that applying the theory of caring in clinical practices is
an effective strategy to promote healing after unexpected pregnancy loss for
women and men as individuals and as couples.
 Major Concepts
1. Caring - Is a nurturing way of relating to a valued other toward
whom one feels a personal sense of commitment and responsibility.

2. Maintaining Belief - Maintaining belief is sustaining faith in the

other’s capacity to get through an event or transition and face a
future with meaning, believing in other’s capacity and holding him or
her in high esteem, maintaining a hope-filled attitude, offering realistic
optimism, helping to find meaning, and standing by the one cared for no
matter what the situation.
 Major Concepts
3. Knowing - Is striving to understand the meaning of an event in the
life of the other, avoiding assumptions, focusing on the person cared
for, seeking cues, assessing meticulously, and engaging both the one
caring and the one cared for in the process of knowing.

4. Being With - Means being emotionally present to the other, It

includes being there in person, conveying availability, and sharing
feelings without burdening the one cared for.
 Major Concepts
5. Doing For - Doing for means to do for others what one would do for
self if at all possible, including anticipating needs, comforting,
performing skillfully and competently, and protecting the one cared
for while preserving his or her dignity.

6. Enabling - is facilitating the other’s passage through life transitions

and unfamiliar events by focusing on the event, informing, explaining,
supporting, validating feelings, generating alternatives, thinking things
through, and giving feedback.
Structure of Caring
 Five Hierarchical Domains

Swanson proposed that knowledge about

caring may be categorized into five
hierarchal domains (levels).
 Five Hierarchical Domains
1st Domain
-Refers to the person’s capacities to deliver caring.
Empathy, Training, Experience
2nd Domain
-Refers to individuals' concerns and commitments that lead to caring
actions.
Faith in Others, Commitment to Support
 Five Hierarchical Domains
3rd Domain
-Refers to the conditions (nurse, client, organizational) that enhance
or diminish the likelihood of delivering caring.
Knowledge and Skills, Receptiveness to Care, Workplace
Environment
4th Domain
-Refers to actions of caring.
Compassionate, Intentional
 Five Hierarchical Domains
5th Domain
-Refers to the consequences or the intentional and unintentional outcomes of
caring for both the client and the provider.
Client intentional consequences: Enhanced Well-being, Trust and Connection
Client unintentional consequences: Dependency, Unmet Expectations
Provider intentional consequences: Personal Fulfillment, Professional Growth
Provider unintentional consequences: Emotional Impact, Role
Strain
 MAJOR ASSUMPTIONS
(Metaparadigm)
NURSING

Swanson defines nursing as informed caring for the well-

being of others. She asserts that the nursing discipline is
informed by empirical knowledge from nursing and other
related disciplines, as well as “ethical, personal and
aesthetic knowledge derived from the humanities, clinical
experience, and personal and societal values and
expectations”.
 MAJOR ASSUMPTIONS
(Metaparadigm)
PERSON

Swanson defines persons as “unique beings who are in the

midst of becoming and whose wholeness is made manifest in
thoughts, feelings, and behaviors”. She posits that the life
experiences of each individual are influenced by a complex
interplay of “a genetic heritage, spiritual endowment and
the capacity to exercise free will”. Hence, persons both
shape and are shaped by the environment in which they live.
 MAJOR ASSUMPTIONS
(Metaparadigm)
HEALTH
According to Swanson, to experience health and well-being is:
"to live the subjective, meaning-filled experience of wholeness.
Wholeness involves a sense of integration and becoming
wherein all facets of being are free to be expressed. The
facets of being include the many selves that make us a
human: our spirituality, thoughts, feelings, intelligence,
creativity, elatedness, femininity, masculinity, and sexuality,
to name just a few."
 MAJOR ASSUMPTIONS
(Metaparadigm)
HEALTH

Thus, Swanson reestablishes well-being as a complex process of

curing and healing that includes "releasing inner pain,
establishing new meanings, restoring integration, and emerging
into a sense of renewed wholeness."
 MAJOR ASSUMPTIONS
(Metaparadigm)
ENVIRONMENT

Swanson defines environment as situational. She maintains

that for nursing it is "any context that influences or is
influenced by the designated client." Swanson states there
are many influences on environment, such as the cultural,
social, biophysical, political, and economic realms, to name
only a few.
 You For List
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That in all things, God may be glorified!