Caring Made Visible
Kristen M. Swanson, RN, PhD, FAAN, is associate professor at the Department of Family and Child Nursing, University of Washington. She has developed a theory on the “Five Caring Processes of Nursing,” which she discusses below with Pat Jakobsen, RN, BSN, a member of the CNJ Editorial Advisory Board. Later, Mary Koloroutis, RN, MS, director of Clinical and ProfessionalDevelopment at 910-bed Abbott Northwestern Hospital, shares how her organization has applied the Five Caring Processes. An abbreviated version of this interview was published in Creative Nursing, 4:4.
Jakobsen: Kristen, you have designed a theory that translates caring into five visible actions, or processes. Tell us about your theory and how you came up with it. Swanson: I started with a deep interestin understanding what it was like for women to miscarry. I was a doctoral student and, when I approached my chairperson, Dr. Jean Watson, who founded the Center for Human Caring in Colorado, she told me that she would work with me if I would explore what caring meant from the perception of women who miscarried. At the end of that study, I suggested there were five basic processes — knowing, beingwith, doing for, enabling and maintaining belief. At the time I defined them differently, tied to the context of miscarriage. So for example, I defined “knowing” as “describing the woman’s desire to have others understand the meaning of miscarriage in her life.” That went on to become, “striving to understand an event as it has meaning in the life of the other.” So you see the progress of thedefinitions — from the angle of the one who is cared for to the angle of those caring and of their intent. The second study was a post-doctoral study done at the University of Washington, with Dr. Kathryn Barnard. The intention at that point, I had gone on to have my second child, who was not well at birth and ended up at a newborn intensive care unit. That had actually happened at Denver. I had somenot-too-good experiences while he was in the hospital. Some of the difficult experiences I had were clearly related to his well-being, but the other piece of it was the nursing care I received was not everything I believed nursing could be. Since I have such a love for nursing, that was a painful thing for me to heal from, that maybe nursing wasn’t all of what I thought it could be. Once I healeda little
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from that experience and had a little distance from it, a couple of things hit me. First was how much I wished that I had received the kind of caring that the women who had miscarried had described in my earlier study. Second, I began to reflect on some of the conditionsthat the nurses had been working under during the time my son was born. Some of those conditions included having just switched over to 12-hour shifts, such that they were coming or going to work at 3 a.m. or 3 p.m. Since many of them lived in the mountains, that meant 3 a.m. trips to work. At the same time, they had switched from a Level II to a Level III nursery, which meant that they were nowgetting very sick babies. My little boy, when all was said and done, would probably have been the intensity of a Level II nursery. So in the eyes of the nurses, he was not the sickest child, but in my eyes, the sickest child in the room. So I also thought that discrepancy could have played itself out in me acting as though it was the end of the world and for the nurses, this may have been a fairlyroutine problem. So I left that experience and decided that if I really wanted to understand what caring for vulnerable infants might be like, that maybe I needed to get several sides of the story. So I set out to do a study of what it’s like to provide caring to vulnerable infants. The people I interviewed were the care providers and I translated that to mean professional and parent providers. I...
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