Nursing as Caring Theory

Introduction

The Nursing as Caring Theory is a middle-range nursing theory developed by nursing theorists Anne Boykin and Savina Schoenhofer. First introduced in the early 1990s and fully explicated in their 1993 book Nursing as Caring: A Model for Transforming Practice, this theory offers a distinct perspective on the discipline of nursing. Unlike many traditional theories that focus on problem-solving, pathology, or deficit-based approaches to healthcare, the Nursing as Caring theory posits that nursing is fundamentally a relationship between the nurse and the nursed, centered on the idea that all persons are caring.

At its core, the theory suggests that the distinctive nature of nursing is not found in medical tasks or procedures, but in the act of nurturing and responding to the personhood of others. It shifts the focus from "doing things to" patients to "being with" patients, emphasizing that the ideal of nursing is to authentically care for others as they live their unique lives.

Philosophical Underpinnings

To fully understand this theory, one must grasp the foundational philosophical assumption that drives it. Boykin and Schoenhofer assert that all persons, by their very nature, are caring. This is not merely a trait that some possess and others lack; it is an essential characteristic of being human. Because every human being is inherently caring, nursing is not about instilling caring into a patient, but rather about coming to know and support the caring that already exists within them.

This perspective radically changes the nurse-patient dynamic. The nurse enters the relationship not as an expert fixing a broken machine, but as a fellow human being seeking to understand the unique expression of caring in the other. The relationship is therefore democratic. The nurse brings knowledge and skill, but the patient brings knowledge of their own life and self. The goal is to grow the caring relationship, thereby nurturing the patient's wholeness.

Major Concepts and Definitions

The theory is structured around four major concepts that are common to nursing frameworks: Nursing, Person, Health, and Environment. However, Boykin and Schoenhofer define these in specific, non-traditional ways that align with their philosophy.

Nursing

Nursing is defined as the nurturing of wholeness relative to well-being. It is a discipline and a profession that is both a science and an art. In this theory, nursing is essentially "caring." It is not something you do *to* someone, but something you live *with* them. The act of nursing is entering into and sustaining the caring relationship.

Person

A person is defined as a unique caring being. Every individual is viewed as a complete whole, not a collection of parts or a set of symptoms. A person is constantly growing, changing, and living their caring in the world. This concept emphasizes that the patient is more than their diagnosis; they are a being with a history, a future, and an inherent capacity to care.

Health

Health is conceptualized as unity of mind, body, and soul. It is a sense of wholeness and well-being that is subjectively defined by the person. It is not merely the absence of disease, but a state of being that allows the person to live out their potential. Because health is subjective, the nurse must seek to understand what health and healing mean to the specific individual they are caring for.

Environment

Environment is described as the universe of personhood. It is everything that is not the person, yet it is the context in which the person lives and expresses their caring. The environment includes physical space, social interactions, cultural context, and the immediate situation of the nursing encounter. The environment provides the setting for the nursing situation to unfold.

The Five Assumptions

Boykin and Schoenhofer formulated five foundational assumptions that serve as the bedrock of the theory. These assumptions guide the nurse's mindset when approaching a patient:

• 1. All persons are caring by virtue of their humanness. This is the non-negotiable starting point. Caring is the essence of what it means to be human.
• 2. Persons are whole, and caring is the intentional focus in the moment-to-moment lived experience. We treat the whole person, recognizing that caring happens in the immediate, present interactions.
• 3. Personhood is a process of living grounded in caring. We are constantly developing, and this development is fueled by our capacity to care for ourselves and others.
• 4. Nursing is both a discipline and a profession. As a discipline, it creates new knowledge about caring; as a profession, it delivers that knowledge to others to nurture their well-being.
• 5. The practice of nursing is the concrete expression of this discipline and profession. When a nurse practices, they are actualizing the theoretical concepts of caring in the real world.

The Nursing Process: Knowing and Being

In the Nursing as Caring theory, the traditional nursing process (assessment, diagnosis, planning, implementation, evaluation) is reframed. While these steps may still occur technically, the theoretical focus is on the process of "knowing" the patient.

Direct Conscious Inquiry

This is the method by which the nurse comes to know the patient. It involves suspending one's own assumptions and engaging deeply with the other. It requires the nurse to ask: "Who is this person?" and "How does this person express their caring?"

"Going-Be-Doeing"

The theorists use this unique phrase to describe the unitary action of nursing. It blends "being" and "doing." In nursing, you cannot simply "do" tasks without "being" present, nor can you simply "be" present without taking action to nurture. The nurse goes toward the other, is fully present with them, and does the work of nurturing.

Responding to the Call

The nursing situation is seen as a "call" from the patient to the nurse. The patient calls out for care, explicitly or implicitly, and the nurse responds with authentic presence and action. The theory emphasizes that the nurse must be open to recognize the call in its many formssometimes it is a request for pain medication, but other times it is a silent need for comfort or presence.

Implications for Practice

Adopting the Nursing as Caring Theory has profound implications for how nursing is practiced on a daily basis. It transforms the nursing environment from a factory of efficiency into a community of care.

• Focus on Relationship: The charting, medication administration, and procedures are secondary to the relationship formed with the patient. The nurse views the time spent as "caring moments" rather than tasks to be checked off.
• Respect for Dignity: Because every person is viewed as inherently caring and whole, the nurse treats the patient with ultimate dignity, regardless of their physical condition.
• Presence: The most powerful tool a nurse has is their presence. Being fully attentivelistening, eye contact, touchis more therapeutic than technology.
• Self-Care for Nurses: The theory implies that because the nurse is a person, they too are caring and whole. To care for others effectively, the nurse must nurture their own sense of personhood and caring. Burnout is mitigated when the nurse feels aligned with the deep meaning of their work.

Conclusion

The Nursing as Caring Theory serves as a reminder that amidst the high-tech complexity of modern healthcare, the heart of the profession remains human connection. It challenges nurses to look beyond the diagnosis and see the person. By defining nursing as the nurturing of wholeness, Boykin and Schoenhofer provide a framework that not only guides patient care but also sustains the nurse's spirit. It validates that nursing is not just a job, but a profound expression of human solidarity and love.