Application of Concepts from Caring Science

Answer

Theory Construction

The solid theory base informing caring science offers nurses a strong foundation for clinical practice as well as the evaluation of outcomes of that practice. Research in this autonomous discipline emphasizes the development of theory and concepts coupled with reflection, which are integral to bridging the gap between practice and theory. This paper develops a clinical nursing theory and relates it to middle-range theory.

For the current exercise, a good point of departure is to identify the main concept informing the theory to be formulated: patient involvement. As is the norm in clinical application research, problematizing the identified concept is key, for it may be possible that often it is taken for granted. Indeed, patient involvement has been emphasized and noted to be of critical significance in healthcare as focusing on the needs of the patient alone is never enough (Bombard et al., 2018). Traditionally, there has been an expectation that all patients need to do is physically present themselves for care and be grateful for that care whose designing and delivery depends on the knowledge, skills, and experience of caregivers. As such, patients are often passive responders as opposed to being active actors. Thus, the problem presently being identified is lack of patient involvement in nursing care, and this is the core concept of the theory. Having identified this concept (A), the next task is to identify another concept (B) so that the two are related by a proposition, making the theory complete. Examining patient outcomes in the context of nursing care can help come up with concept B, which would be affected by patient involvement. Settling for patient outcomes (in a general sense) seems like a better choice than looking for a specific outcome.

With concept A and concept B identified as patient involvement and patient outcomes respectfully, seeking a relationship between them is the next step in this exercise. While the notion of patient involvement features appreciably in literature (for example Agency of Healthcare Research and Quality, 2020), it has not been adequately investigated in terms of how it affects care. Nevertheless, significant research has been done on patient involvement in broader organizational processes involving the designing and planning of care, for instance as concerns quality improvement (QI) and the role of patients in the same regard (Burgerum et al., 2020; Madden & Speed, 2017). By and large, this literature emphasizes the significance of patient involvement in designing and planning care vis a vis quality improvement objective, and merit is found in presently extending the implied significance to the nursing care context, particularly the nurse-patient relationship. An assertion is thereby made that patient involvement (whereby the patient assumes an active role in the care being given) improves patient outcomes as may relate to healing. This gives the theory generated its form: Patient involvement (Concept A) improves (Proposition) patient outcomes as may relate to healing (Concept B).

Literature shows professional dominance in the nurse-patient relationship whereby nurses, enjoying greater power, justify their decisions on all dimensions of care given to the patient (Kwame & Petrucka, 2020; Molina-Mula & Gallo-Estrada, 2020). These researchers found that the involvement of nursing managers in direct patient care was associated with negative patient outcomes. In as much as such decisions are made for the patient’s benefit, the power imbalance places greater autonomy in the hands of caregivers, yet sometimes the opinion/perception of the patient ought to count besides scientific evidence. This point elevates variables of relevance in such a situation, for example the patient decision power, patient perception of care, and nurse perception of care, all which could be measured through surveys in a typical research setting. Rationale for this theory is rooted in the fact that patient involvement affects the nurse-patient relationship; it is also imperative to note that patient outcomes largely depend on the nature of this relationship. In fact, an appreciable body of studies have contextualized that a good nurse-patient relationship is accompanied and characterized by friendship, clones, mutual trust, and empathy just to mention but a few (Rajcan et al., 2020).  Thus, the kind of relationship established between the patient and the nurse directly affects the quality of care delivered. To relate this more precisely with the current theory, a good relationship will result in quality care and better patient outcomes (as may relate to healing).

Importantly, the theory constructed here finds congruence with Watson’s Theory of Human Caring particularly when explored in the context of its range of carative factors. For instance, as concerns the “cultivation of sensitivity to one’s self and to others”, the nurse seeks to promote health as well as higher level function but that is only possible if a genuine person-to-person relationship is cultivated (between the nurse and the patient) (Kandula, 2019: p. 29). Arguably, this relationship becomes more meaningful when both parties are active actors, as opposed to one (the patient) being a passive responder who only physically presents him/herself for care. Similarly, the relationship needs to be a helping-trust one, allowing genuine communication by establishing rapport as well as caring; all these can only be optimally achieved if there is optimal patient involvement. The same line of thinking can be applied to other carative factors captured by Watson’s Theory of Human Caring, including the internal and external variables the nurse needs to manipulate as part of the effort to provide protective, supportive, and/or corrective physical, mental, spiritual, and socio-cultural environment. Greater understanding of what needs to be done will be achieved if there is greater patient involvement in care delivery, hence in the end better patient outcomes. The formulated theory is thus elucidated.

Regarding the clinical application of this theory, its application would be informed by the Synergy Model whose main idea is that “a patient’s needs drive the nurse competencies required for patient care” (AACN, 2021, par. 4).  (2017) explains that this framework emphasizes nursing practice that is based on various nurse competencies and patient characteristics.  Its core is that “the needs and characteristics of patients and families influence and drive the characteristics and competencies of the nurses” (Deodato & Mendes, 2021: p.5). Considering the synergy this model would yield in terms of care designing and delivery, it appears the most suited to act as ‘a launch pad’ for the proposed theory’s implementation.

In a word, the theory formulated here posits that patient involvement improves patient outcomes as may relate to healing. Indeed, it is in the clinical care unit that a patient’s passive role acquires maximum expression, hence the need to find strategies that would help optimize patient involvement hence an opportunity to take part in their own care. By and large, the theory suggests a paradigm shift from a professional-dominated arrangement to one of balanced power, cordiality, mutual trust, friendship, and closeness as to enable an ideal nurse-patient relationship as envisioned by theorists such as Watson. A relationship that lacks patient involvement is not an optimal one because it positions the nurse as a wielder of power by virtue of being an expert and professional, hence a high probability of distancing between the two parties. With such distancing comes conflicts, reduced communication, lack of commitment and dedication to patient needs and concerns, and a focus on the technical aspects of the relationship. Desired patient outcomes are likely to diminish under such circumstances, hence the need to consider this theory in clinical practice. Application would be pegged upon the AACN Synergy, which focuses on nurse competencies vis-à-vis patient characteristics. However, while there may be agreement that patient involvement improves patient outcomes, research is needed to know the terms of such involvement or even to what extent because at the end of the day the core nursing objective of promoting health and improving wellbeing must be met.

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