Blasdell, Int J Nurs Clin Pract 2017, 4: 238

https://doi.org/10.15344/2394-4978/2017/238

International Journal of
Nursing & Clinical Practices
Mini Review Open Access

The Meaning of Caring in Nursing Practice

Nancy D. Blasdell
Rhode Island College School of Nursing, 600 Mt. Pleasant Avenue, Providence, RI 02908-1991, USA
Introduction Publication History:
The dynamic essence of nursing is due to caring. Unfortunately, Received: December 16, 2016
many different terms such as care, care-giving, care receiving, Accepted: May 22, 2017
nursing care, etc. are used interchangeably which promotes
confusion. Thus, the concept of care can be considered one of the Published: May 24, 2017
least understood parts of nursing. It is important to note that because
there are multiple ways to define caring from different paradigms, Keywords:
the frame of reference is Nursing practice, Caring, knowledge
imperative to understand the definition.

The purpose of this paper is to: analyze three conceptualizations

of caring and discuss the relevance of incorporating theory into Analytical Dialectical, philosophical,
metaphysical
practice.
Science as product Science as creative process of
discovery
Watson’s Theory of Caring
Human = mind/body/spirit gestalt
Human = sum of parts ex. of whole being (not only more
Watson [1] defines caring as: “the moral ideal of nursing (bio-psycho-socio-cultural- than sum of parts, but different)
whereby the end is protection, enhancement, and preservation of spiritual-being) ‘Real’ is abstract, largely subjective
human dignity. Human caring involves values, a will and a as well as objective, but is may
‘Real’ is that which is
commitment to care, knowledge, caring actions, and measurable, observable, and or may not ever be fully known,
consequences. All of human caring is related to inter subjective knowable observable, fully measured, what
human response to health-illness; environmental-personal is ‘real’ holds mystery and
interaction; a knowledge of the nurse caring process; self unknowns yet to be discovered
knowledge, knowledge of one’s power and transaction
limitations” (p. 901). Moreover, Watson
posits that “the essence of the value of human care and caring may A nurse is required to perform certain acts for her patient which
be futile unless it contributes to a philosophy of action. . . The are legally and ethically binding. Watson [1] posits that the value of
actual concrete action of caring can transcend the value (and pass human care and caring is more than the mere action of performance.
it on). . . The value of caring is grounded in the self-transcending Caring involves a sense of self identity and spirit of the person. It
creative nurse” (p. 32). She further believes that human-to- involves a pure sense of dedication and commitment to the patient.
human caring interactions of nursing cannot be validated or A specific action of caring may transcend the value because it is
understood using a “positivistic, deterministic, materialistic “grounded in the self-transcending creative nurse” [1].
mind set” [1.
The following are Watson’s [1] eleven assumptions related to
Watson [1] acknowledges the differences between traditional Human Care Values in Nursing:
science and human science. They are as follows:

Traditional Science
Nursing Human Science for Caring
1. Care and love are the most universal, the most
Context tremendous, and the most mysterious of cosmic forces:
Normative they comprise the primal and universal psychic energy.
Ipsative 2. Often these needs are overlooked; or we know people need
Reductionistic
Transactional each other in loving and caring ways, but often we do not
Mechanistic
Metaphysical; Humanistic-contextual behave well toward each other. If our humaness is to survive,
Method centered however, we need to become more caring and loving to
Disease centered Phenomena centered nourish our humanity and evolve as a civilization and live
on Person-experience centered together.
Pathology-physiology, the Human responses to illness and 3. Since nursing is a caring profession, its ability to sustain
physical body personal meanings of human its caring ideal and ideology in practice will affect the human
condition development of civilization and determine nursing’s
Ethics of ‘science’ contribution to society.
Human-social ethics- morality
More quantitative
More qualitative *
Corresponding Author: Dr. Nancy D. Blasdell , Rhode Island College School
Absolutes, givens,
Relativism, probabilism of Nursing, 600 Mt. Pleasant Avenue, Providence, RI 02908-1991, USA ; E-
laws Human as object mail: [email protected]
Human as subject
Objective experiences
Subjective-intersubjective experiences Citation: Blasdell ND (2017) The Meaning of Caring in Nursing Practice. Int J
Facts Nurs Clin Pract 4: 238. doi: https://doi.org/10.15344/2394-4978/2017/238
Experience, meaning
Nomothetic
Idiographic +/ nomethic Copyright: © 2017 Blasdell. This is an open-access article distributed under the
Concrete-observable
Abstract- may or may not “be seen” terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author
and source are credited.

Int J Nurs Clin Pract IJNCP, an open access journal

ISSN: 2394-4978 Volume 4. 2017. 238
4978/2017/238

Page 2 of 5

1. As a beginning we have to impose our own will to care Watson [3] explains that the carative factors refer to how
and love upon our own behavior and not on others. We interventions are associated to the human care process. As the
have to treat ourselves with gentleness and dignity before nurse has interaction with the patient, the carative factors become
we can respect and care for others with gentleness and actualized. She further explains that higher levels of caring can
dignity. occur between different nurses and different experiences.
2. Nursing has always held a human-care and caring stance in
regard to people with health-illness concerns. The nurse-patient transpersonal dimension is part of the dynamics
of the human caring process [3]. “An event, such as an
3. Caring is the essence of nursing and the most central and actual occasion of human care, is a focal point in space and time
unifying focus for nursing practice. from which experience and perception are taking place, but the
4. Human care, at the individual and group level, has received actual occasion of caring has a field of its own that is greater than
less and less emphasis in the health care delivery system. the occasion itself ” (p.59). The actual caring occasion as it is
5. Caring values of nurses and nursing have been submerged. called, includes action and choice by the patient and the nurse. The
Nursing and society are, therefore, in a critical situation experience of coming together in a caring situation provides the two
today in sustaining human care ideals and a caring people the opportunity to formulate a decision of “how to be in the
ideology in practice. The human care role is threatened by relationship – what to do in the moment” [3].
increased medical technology, bureaucratic-managerial
institutional constraints in a nuclear age society. At the Watson’s Theory of Human Care involves three major areas:
same time there has been a proliferation of curing and
radical treatment cure techniques often without regard to 1. Nursing within the context of human science and art;
costs. 2. Mutuality of person/self of both nurse and patient with mind-
6. Preservation and advancement of human care as both an body-soul gestalt, within a context of intersubjectivity;
epistemic and clinical endeavor is a significant issue for 3. the moral ideal of the human care relationship in nursing
nursing today and in the future. which includes concepts such as phenomenal field, actual
7. Human care can be effectively demonstrated and practiced caring occasion, and transpersonal caring [3].
only interpersonally. The intersubjective human process
keeps alive a common sense of humanity; it teaches us how The actual goals of the theory are related to the mental and
to be human by identifying ourselves with others, whereby spiritual growth for oneself and others, discovering meaning in
the humanity of one is reflected in the other. one’s own existence and experiences, discovering inner power and
8. Nursing’s social, moral, and scientific contributions to control, and enhancing occurrences of transcendence and self-
human- kind and society lie in its commitment to human healing [3]. The actual agent of change is considered the patient.
care ideals in theory, practice, and research (p. 32, 33). However, the nurse can be a co-participant in the change through the
process of human care. The agent of change is the “personal,
internal mental-spiritual mechanisms of the person who allows the
The eleven assumptions to Human Care Values in Nursing self to be healed through various internal or external means, or
provide an understanding of how nursing is connected to caring. without external agents, but through an inter-subjective
The assumptions give a sense of purpose to the concept of caring interdependent process wherein both persons may transcend self and
from Watson’s perspective. usual experiences" [3].
In order to understand nursing as the science of caring, Watson
derived 10 primary carative factors. The carative factors involve the The interventions of Watson’s Human Care Theory are
interpersonal aspects of caring and function as structural guides to associated to the human care process with complete participation
understand care as a phenomenon in an interpersonal relationship of the nurse/ person in conjunction with the patient/person. These
process. The carative factors and processes are linked to basic interventions require an intention, a drive, a relationship, and
human needs, human relationships, and health maintenance [2]. actions. The process requires a commitment to caring as a moral
They are as follows: obligation directed toward the preservation of humanity [3]. The
carative factor, as mentioned earlier, is formulated by a
1. The formation of a humanistic-altruistic system of values knowledge base and clinical competence. It is only when the
nurse is being with the other person can the carative factors
2. The instillation of faith-hope become actualized.
3. The cultivation of sensitivity to one’s self and to others
4. The development of a helping-trust relationship It is important to remember that the perspective of
Watson’s Theory of Human Care is spiritual-existential and
5. The promotion and acceptance of the expression of positive and phenomenological in its orientation. However, it has also been
negative feelings influenced by Eastern Philosophy [3]. The context is humanitarian
6. The systematic use of the scientific problem-solving method for and metaphysical and incorporates the art and science of nursing.
decision making Science is emphasized in the context of human science [3].
7. The promotion of interpersonal teaching-learning
Leininger Theory of Caring
8. The provision for a supportive, protective, and (or) corrective
mental, physical, sociocultural, and spiritual environment
Madeleine Leininger is known world wide as the founder of
9. Assistance with the gratification of human needs transcultural nursing. She developed her thoughts during the middle
10. The allowance for existential-phenomenological forces (p. 9, 1950’s. When she worked as a psychiatric nurse specialist in a
10). child guidance home, she was exposed to children from many
diverse
 Page 3 of 5

cultural backgrounds. She discovered that the staff had a lack of a different picture of caring. Watson concentrates on the philosophic
understanding of how cultural backgrounds affected the behavior (existential-phenomenological) and spiritual foundation of caring
of the children. Therefore, she realized that there was a need to and believes caring to be “the ethical and moral ideal of nursing”
develop strategies in incorporate diversified cultures, patterns, [4]. Whereas Leininger places caring in a cultural context because
and lifestyles [4]. She therefore, pursued her doctoral study with caring patterns can differ transculturally [4].
a concentration on cultural anthropology. While completing her
schooling, she gained an understanding of the importance of Each of the theorists educational background played a
providing care within a cultural context. She began to adapt significant role in their theory development. In 1973, Watson
specific concepts and themes from anthropology in order to completed her doctoral degree in educational psychology from
pursue the Theory of Transcultural Care [4]. Leininger [5] defines the University of Colorado. She had a strong connection with the
caring as “Caring in the generic sense refers to those assistive, humanist Carl Rogers regarding her concentration on the
supportive, or facilitative acts towards or for another individual interpersonal and transpersonal processes in human care.
or group with evident or anticipated needs to ameliorate or
improve a human condition or lifeway…” (p. 900). Leininger Leininger completed her doctoral study at the University of
separates the generic sense of caring from professional caring. Washington in which she concentrated on cultural anthropology.
According to Leininger, professional caring is considered “those For two years she lived with the residents of New Guinea in order
cognitive and culturally learned behaviors, techniques, processes, to conduct an ethno-nursing and ethnographic research study of
or patterns that enable or help an individual, family, or two villages [4]. This work provided an enlightenment for her
community to improve or maintain a favorable healthy condition which showed that “care and beliefs about health and illness are
or lifeway” [6]. imbedded in the values, world views and life patterns of people” (p.
900). This new discovery enabled her to construct the theory of
Leininger [6] has the following assumptions about human caring: transcultural care.
1. Human caring is a universal phenomenon, but the Leininger and Watson differ on whether there is a difference
expressions, processes and patterns vary among cultures. between generic caring and professional caring. Watson [1]
2. Every nursing care situation has transcultural caring behaviours, believes that caring is an interpersonal process between two
needs and implications. people with transpersonal dimensions. “Transpersonal caring,
3. Caring acts and processes are essential for human an important component of caring, occurs when the nurse detects
development, growth and survival. the subjective world of the patient, experiences union with it and
expresses the union in such a way that both experience a freeing
4. Caring should be considered the essence and unifying from isolation. Transpersonal caring, then, is a spiritual space,
intellectual and practice dimension of professional nursing. and life history of each other. This transcendence allows both the
5. Caring has biophysical, psychological, cultural, social and patient and the nurse to enter the phenomenal field of the other”
environmental dimensions which can be studied and [4].
practised to provide holistic care to people.
6. Transcultural caring behaviours, forms and processes have yet Leininger separates generic caring from professional caring. For
to be verified from diverse cultures; when this body of example, she views professional caring as behaviors which are
knowledge is procured, it has the potential to revolutionize learned cognitively and culturally derived, techniques, processes,
present-day nursing practices. or patterns which help an individual, family, or community to
7. To provide therapeutic nursing care, the nurse should have improve or maintain a healthy condition or life pattern [4]. Central to
the knowledge of caring values, beliefs and practices of the Leininger’s Transcultural Theory of Nursing is the key element
client (s). that “human caring is a universal phenomenon, but the expressions,
processes, and patterns vary among cultures… caring has
8. Caring behaviours and functions vary with social structure biophysical, psychological, cultural, social, and environmental
features of any designed culture. dimensions which can be studied and practiced to provide holistic
9. The identification of universal and non-universal folk and care to people” [4]. The anthropological foundation infers that the
professional caring behaviours, beliefs and practices will be social, cultural, and historical context of human beings is included.
important to advance the body of nursing knowledge. Leininger posits that human beings cannot exist away from their
10. Differences exist between the essence and essential features of cultural background and social structures.
caring and curing behaviours and processes.
Another important component of Leininger’s theory is that there
11. There can be no curing without caring but there may be is wide applicability due to the fact that theory generation may occur
caring without curing (p.901). at multiple levels (macro range, middle range, and micro range).
Therefore, the researcher may decide where to enter and leave the
Critical analysis of Watson and Leininger Theories of Caring model. Leininger [6]] classified a number of her constructs into
taxonomy. The purpose of developing the taxonomy was to assist the
Although Watson and Leininger are highly respected for their nurses in conceptualizing, ordering, and studying different types of
theories on caring, they view caring from two different caring phenomena. Leininger’s theory is considered to be the only
perspectives. Only by understanding their philosophical one which combines theory and method and defines different levels
underpinnings, epistemology, and constructs from which they are of abstraction and methodological approaches [4].
coming from can one fully understand and appreciate their
perspectives. Leininger disagrees that nursing should be included in the
metaparadigm of person, environment, health, and nursing.
As a common theme, both Watson and Leininger view nursing Instead, she believes that care should be one of the concepts
“as a humanistic science, with the concept of caring being the because she
central unifying domain of nursing” [4]. However, both theorists
formulated
 Page 4 of 5

thinks it is central and a unifying focus for nursing. She also views Swanson [8] believes that there are assumptions regarding the
nursing as being both humanistic and scientific caring [5]. Although four main phenomena of concern to nursing: persons/clients,
caring is not unique to the nursing discipline, the specificity and health/well- being, environments and nursing. Swanson [8]
goal of nursing focuses around caring for people in a manner that agrees with Watson
is congruent with their culture, values, lifeways and patterns. She [6] in that the way in which nurses identify persons and personhood
defines nursing as a “learned humanistic art and science that plays a role in identifying the clients of nursing and what defines the
focuses upon personalized care behaviors, functions and processes practices, environments, and goals of nursing care. The individual’s
directed toward promoting and maintaining health behaviors or life experience is influenced by the genetic makeup, spiritual
recovery from illness” [4]. She stresses that the focus of nursing enrichment, and the capacity to portray free will. Individuals are not
could be the individual, families, culture or society as a whole. stagnant in regards to their wholeness, but instead are involved in
“becoming, growing, self-reflecting, and seeking to connect with
Watson on the other hand, views nursing as both a human others” [8].
science and an art activity. The context of human science for
nursing is derived from: Environment is defined according to the specific situation [8]. In
nursing, it is considered any particular context which has influence
1. a philosophy of human freedom, choice and responsibility or is influenced by the patient. The amount of influence is
2. a biology and psychology of holism (non-reducible considered multi-faceted which includes; biophysical, psychological,
persons interconnected with other and nature cultural, political, economic, social, and spiritual [8]. It is important
to note that the environment of the patient could perhaps be even
3. an epistemology that allows not only for empirics, but for more specified in which the environment may be considered the
advancement of aesthetics, ethical values, intuition and organs or tissues of the body [8].
process discovery
4. an ontology of time and space Health/Well-being can be present in an individual by experiencing
5. a context of interhuman events, processes and relationships wholeness [8]. Wholeness is “a sense of integration and
6. a scientific world view that is open [4]. becoming wherein all facets of being are free to be expressed. Facets of
being include the many selves that make us human: our spirituality,
thoughts, feelings, intelligence, creativity, relatedness, femininity,
Watson [1] believes that the activity of the art of nursing is masculinity and sexuality to name just a few. Healing, the process of
concentrated of the transpersonal caring relationship. Watson states reestablishing well-being, includes releasing inner pain, establishing
that “It is art when the nurse, having experienced or realized the new meanings, restoring integration and emerging into a sense of
feelings of another, is able to detect and sense those feelings and in renewed wholeness” [8].
turn is able to express them in such a way that the other person is
able to experience them more fully and release the feelings he or she
has been longing to release… Nursing is defined as a human science Nursing is frequently viewed as an extension of medicine
of person and human health-illness experiences that are mediated by focusing on psychomotor skills and a willingness to follow orders
professional, personal, scientific, aesthetic, and ethical human [8]. Unfortunately, our society places a higher priority on stopping
transactions” [1]. “Caring is based on a guiding force and value the disease and circumventing death than on the prevention of
system that affect the encounters between the nurse and other health problems, enhancement of the quality of life, and
persons. Whether or not one is conscious of one’s philosophy maintaining a patient’s dignity [8]. The beauty of nursing can be
and values, they affect one’s caring behavior. Humanistic seen by those who truly have an appreciation for nursing. This can
values and altruistic behavior can be developed through be accomplished by either being a recipient of high quality
consciousness raising and a close examination of one’s views, nursing, receiving formal education, or observing exceptional
beliefs, and values. They can be further developed through clinical practice [8].
experiences with different cultures, early experiences that have
aroused compassion and other emotions, study of the humanities, Swanson [8] believes that nursing includes “therapeutic practices
literary and artistic experiences, value-clarification exercises, and … (in which) the nurses are grounded in knowledge of nursing,
personal growth experiences” [1]. related sciences, and the humanities, as well personal insight and
experiential understanding and that the goal of nurse caring is to
enhance the well-being of its recipients. It is the blend of
Leininger Theory of Caring knowledge/information and the goal of practice that distinguishes
nursing from others whose practices includes caring” (p. 354).
Swanson [7] describes caring as “ a nurturing way of relating to a
valued other toward whom one feels a personal sense of Swanson [8] posits that there are five caring processes which
commitment and responsibility” ( p. 354). It is considered a middle relate to each other. These include: maintaining belief, knowing,
range theory which is empirically succumbed to phenomenological being with, doing for, and enabling. Each of these processes has
inquiry. Although this theory originated from perinatal contexts, a unique function of relating to the theory of caring.
there are citings in nursing and non-nursing literature which
postulate that the theory of caring may have generalizability Maintaining belief is considered to be the fundamental belief in
beyond the context of perinatal and nursing practice [7]. She also which persons have the capability to progress through transitions
identifies five categories which include: maintaining belief, and life events and look towards the future with meaning [8]. Nurses
knowing, being with, doing for, and enabling. Swanson [7] confesses approach the patient with the idea that the medical condition or
that a limitation of her original caring theory was that it did not have developmental challenge has a personal meaning to the patient.
the structure to demonstrate how the five categories related to each Maintaining belief is also the foundation of nursing practice. It
other. Therefore, she worked on correcting this limitation. allows for having faith to progress through life’s events, transitions,
and gives the ability to perceive the future with meaning that starts
or maintains caring [8]. This foundation provides the opportunity
to accelerate
 Page 5 of 5

nursing in serving the humanity through commitment. On the dialog on caring within the nursing community will enable the
societal level, maintaining belief is considered to be involved in nursing profession to grow at its fullest potential by strengthening
the person’s right to get through experiences and focus on a the core of the nurse for his/her fullest potential as a practicing
future with meaning that provides motivation to nurses regarding nurse.
political activism in areas such as access to care and the necessity
for health care reform [8]. On the interpersonal level, the nurse Conclusion
provides her patient and/or family with physical and emotional
safety in order to support them through the stressful experience.
Caring constitutes a variety of meanings. Most scholars view
caring from their own context and therefore, a universal
Swanson [8] believes that “knowing is the anchor that moors the
definition is not possible. The complexity of defining caring
beliefs of nurses/nursing to the lived realities of those served”
should be left up to the individual. It is only when we understand
(p. 355). Knowing tries to provide justification for events because
ourselves that we can formulate our own definition of caring.
it has meaning in life. Only through the enhancement of ethical,
Providing an intellectual dialog on caring within the nursing
aesthetic, and empirical knowledge can the essence of caring be
community will enable the nursing profession to grow at its
known as therapeutic [8]. Nurses must “know thy self ” in order to
fullest potential by strengthening the core of the nurse for his/her
truly understand another person’s reality and to fully appreciate
fullest potential as a practicing nurse.
the capacity one may focus on the patient’s lived reality [8].
Competing Interests
The term “being with” involves emotionally connecting with
the patient. Patients benefit from this term because they feel that
they are appreciated and are connected with their nurses. In addition The authors declare that they have no competing interests.
to physical presence, “being with” also means the ability to
provide availability and the ability to endure with the patient. It is References
the feeling of connectedness that comforts the patient. Nurses
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According to Argyris, Putnam, and Smith [9] “action

science is an inquiry into how human beings design and implement
action in relation to one another… Action science call for basic
research and theory building that are ultimately related to social
intervention” (p. 4). It is through reflecting on our practice and
relating it to other literatures, including those of the philosophy of
science and social inquiry, that we hope to articulate an action
science” [9].

Conclusion

Caring constitutes a variety of meanings. Most scholars view

caring from their own context and therefore, a universal definition
is not possible. The complexity of defining caring should be left up
to the individual. It is only when we understand ourselves that we
can formulate our own definition of caring. Providing an intellectual