The spirit in which she does her work makes

all the difference. Invested as she should

with the dignity of her profession and the
cloak of love for suffering humanity, she
can ennoble anything her hand may be
called upon to do, and for work done in this
spirit there will ever come to her a
recompense far outweighing that of silver
and gold.

Swanson definesCaring

is a
nurturing way of relating to a
valued other toward whom one
feels a personal sense of
commitment and responsibility

Practicing in a caring manner leads

to the nurses well being, both
personally and professionally.
Personal outcomes of caring
include feeling important, accomplished, and
whole. Professionally practicing caring leads to
enhanced intuition, empathy, clinical judgment
and work satisfaction.

Kristen Swanson RN, PhD, FAAN

Kristen Swanson RN, PhD, FAAN

Kristen M. Swanson, RN, PhD, FAAN, is the Dean of the School of Nursing,
Alumni Distinguished Professor at the University of North Carolina at
Chapel Hill, and Associate Chief Nursing Officer for Academic Affairs at
UNC Hospitals. She earned her bachelor degree in nursing from the
University of Rhode Island in 1975, her masters in adult health and illness
nursing from the University of Pennsylvania in 1978, and a PhD in psychosocial nursing from the University of Colorado, completing her
postdoctoral work at the University of Washington (University of North
Carolina, 2012; Ray, 2011).
Her theory was empirically developed out of three phenomenological
studies in separate perinatal contexts carried out in the late eighties and
was further developed and refined during the early nineties. Numerous
hospitals and health care facilities have since adopted Swansons theory
of care as a guide to their own nursing services (Ray, 2011) and
Swanson continues to consult internationally on implementation of caring
theory in clinical practice, research, and education (University of North

Theory Description
Foundation and Historical Evolution

Swanson started out with a deep interest in understanding what is

was like for women to miscarry (Swanson, 1998) and her caring theory was
initially founded through her doctoral work into exploring what caring meant
from the perception of women who had miscarried. As a result of her own
personal experience with her second newborn child in a NICU setting, her
subsequent post-doctoral research led Swanson into the study of nursing
care within a NICU environment, and her third study focused on high risk
mothers within a public health setting.
Initial concepts were formulated during her early studies, and as her
research progressed Swanson further clarified and honed the five theoretical
categories of caring. As the theory has been further referenced, applied to
practice, validated, and tested in several different environments over the last
two decades, it has without doubt matured and developed, but the five key
categories remain inherently the same.

I. 20 women who miscarried

What constituted caring in the instance of
miscarriage?

II. 19 careproviders in the NICU

What is it like to be provider of care in the
NICU

III. 8 high risk young mothers who received LT

public health nursing intervention
How did you recall and describe your nursepatient relationship after intervention?

The proposed structure of the theory depicts caring as grounded in

maintenance of a basic belief in persons, anchored by knowing the
others reality, conveyed through being with, and enacted through
doing for, and enabling (Swanson, 1993, p. 354).

Knowing (Empathetic Understanding)

Striving to understand an event as it has

meaning in the life of the other

Avoiding assumptions
Centering on the one cared for
Assessing thoroughly
Seeking cues
Engaging the self

Being With (Emotionally Present)

Being emotionally present to the other

Being there
Conveying availability
Sharing feelings
Not burdening

Doing For (Enact For)

Doing for the other as he/she would do for

oneselfbut no more

Anticipating their needs

Performing competently/skillfully
Preserving dignity

Enabling (Empowering)
Facilitating the others passage through

life transitions and face a future with

meaning

Informing/explaining
patient education
Validating-giving feedback
Generating alternatives-thinking
it through

Maintaining Belief (Esteem)

Sustaining faith in the others capacity to

get through an event/transition and face a

future with meaning

Believe in/holding in esteem

Maintaining a hope filled attitude
Offering realistic optimism

CLINICAL WEEK #1
I.Knowing (Empathetic Understanding) Striving to understand an event as it has meaning in the life of the
other
Choose at least 2 to
implement

Nursing Caring Interventions

Evaluation (Client Response)

1. Avoiding Assumptions

2. Centering on the one cared

for

*Did my cares when time was best for client

*Allowed client quiet time with minimal interruptions
*Always verbalized to client what I was coming in for
next and told him if there was anything more I could
help him with to feel free to ask

*Allowed client to maintain sleep/rest

*Client did not feel like a burden when using
call light
*Felt that this conveyed trust between client
and nursing student

*After surgery I was conveying availability-this was

*Client felt as if I really cared for him and that

he was not alone
*He felt that he could trust me and was a little
more relaxed to know someone was there
*Non-verbal cues-client was less anxious and
was able to remain comfortable to rest

3. Assessing thoroughly

4. Seeking cues

5. Engaging of self

important for the client who was experiencing pain

*I was able to get warm blankets and ice water for my
client to ensure comfort
*I ensured the client that I was there and could help him
with anything he needed

II. Being With (Emotionally present) Being emotionally present to the

other
Choose at least 2 to
implement
1. Being there

2. Conveying availability

3. Sharing feelings
4. Not burdening

Nursing Caring Interventions

Evaluation (Client Response)

*Talking to client and sitting at eye level

*Placing a hand on the clients shoulder to let them
know that you care and are present
*Taking time to explain what you are doing and answer
questions and make sure client fully understands
*Allow pt. to express feelings without putting
judgements on them

*Client was able to talk to me on a more

*Stating, is there anything else I can do for youI

have time?
*Do not approach client in a rushed nature
*Periodically assessing client and asking how they are
doing without making them put on their call light
and feel like they are a burden

*Client gets needs met immediately and

personal level
*Putting hand on shoulder was comforting
and caring-helped client realize I was
there
*Client ws able to put trust in me and know
what to expect and let him know what
was next
*Client expressed sensitive topics with me
about being overweight and was able
to not worry about feeling judged

does not feel rushed

*Client does not feel like they are being a
pain because they know that they are
not bugging you when you are busy
*Does not feel rushed and they feel that they
have time to ask questions or review
personal nature of self more readily

Swanson states that the five caring processes are not

suggested to be unique to nursing, but are proposed as
common features of caring relationships. However, in
the context of nursing practice, the theory provides
broad guidance for what are considered central caring
behaviors that a nurse may undertake in his/her
relationship with self, client, and nurse colleagues. The
theory helps to facilitate the incorporation of these
caring behaviors into daily nursing practice, ensuring
that the mainstay of attention remains on the one
cared
for
during
all
nursing
interactions.
Furthermore, the theory embodies the notion that the
nurse and the one cared for are relating to each other
and engaged in the process of caring together,
culminating in a meaningful relationship and fostering a
mutually beneficial desired outcome.

An exemplar of Swansons theory in research guidance

and practice can be found in Amendolairs (2011) recent
study Caring Model: Putting Research into Practice.
This study clearly demonstrates the application of
Swansons theory through the successful design and
implementation of an institutional care model that
reflects staff nurse perceptions of what nursing means
to them. The author concludes that Swansons model is
a demonstration of the link between theory and
practice, and that the theory constructs provide a clear
description of what caring means and how nurses
exhibit caring in their everyday practice. As concern
grows about clinical relevance of theory and research
within practice settings (Chinn and Kramer, 2011), these
types of qualitative studies are imperative in
demonstrating the powerful link between theoretical
constructs and evidence-based nursing practice.

Chinn and Kramer (2011) designate theory

importance as forward looking; useable in practice,
education, and research; and valuable for creating
a desired future (p. 204). Since the Theory of
Carings conception in 1991, Swanson, and other
notable nursing scholars have continued to make
strides in advancing the theory within a variety of
nursing contexts, and continuously engage in and
encourage the theorys adaptation and growth
within contemporary nursing practice. Cited within
more than 120 published articles and featured in
numerous nursing science, scholarship, clinical,
and research journals, the theory more than meets
the criteria for being usable in practice, education
and research.

Perhaps one of the most versatile middlerange nurse caring theories to come out of
the twentieth century, Swansons Theory of
Caring is an exemplar model of a substantive
middle-range theory that can inform
practice and lead to new practice approaches
as well as investigate factors that influence
the outcomes that are desired in nursing
practice (Chinn & Kramer, 20011, p. 48).
Utilized within multiple clinical settings
across the globe, the theory is proven to be a
highly valuable and clinically relevant theory
for modern day nursing practice and
research.