Navigating Nursing Theories: A Comparative Analysis of ‘Nursing as Caring’ and ‘Transition Theory’ in Practice- Review Article
Faryal Ghafor1, Salma Rattani2
1MScN Scholar, The Aga Khan University Hospital, Karachi.
2Assistant Professor, The Aga Khan University Hospital, Karachi.
*Corresponding Author E-mail: faryalghafoor123@gmail.com
ABSTRACT:
This comparative analysis explores the theoretical perspectives, assumptions, concepts, and applications of "Nursing as Caring" and "Transition Theory" in practical nursing settings. Founded by Anne Boykin and Savina Schoenhofer, "Nursing as Caring" emphasizes holistic care and nurturing relationships, while "Transition Theory," developed by Dr. Meleis, focuses on facilitating healthy transitions in individuals' lives. The analysis highlights similarities and differences between the two theories in terms of their theoretical foundations, practical applications, and outcomes. Through a detailed examination of scenarios and interventions, the study illustrates how each theory can be effectively applied in nursing practice to enhance patient care and promote positive outcomes. The conclusion emphasizes the essential role of nursing theories in guiding professional practice and maintaining the unique essence of the nursing profession.
KEYWORDS: Nursing as Caring, Transition Theory, Holistic Care, Patient Outcomes, Nursing Theories.
INTRODUCTION:
Theoretical Perspective of “Nursing as Caring”
This theory was founded by Nurse theorists Anne Boykin and Savina Schoenhofer. It was first published in 1990 and 1991. This theory considers caring as the essence of Nursing. Nursing is concerned with the scope of human living, with the aim of "nurturing individuals living caring and growing in caring’’. Caring can be defined with the 6 C’s terms that is commitment, confidence, conscience, competence, compassion, and comportment. Traditionally, a system approach has been used in Nursing. Caring is a holistic approach to providing wholesome care to a person. Most of the time the aim of care provided in the hospital remains in the medical context that remained constricted to medication.
This theory is built on the fundamentals of the caring process1. The theory highlights the importance of "caring between," which enriches the nursing experience and underscores the necessity of understanding patients as whole individuals rather than merely cases to be treated. This perspective aligns with the concept of protecting personhood, which involves recognizing patients as partners in their care and fostering a sense of autonomy and dignity throughout their healthcare journey. Ultimately, the application of these theories in clinical settings reinforces the significance of empathetic interactions and holistic care in promoting better health outcomes for patients.
a. A person is cared for under their humanness.
b. The person is cared for in every unique moment to moment.
c. Person is considered subjectively as a whole part rather than objectively as a part.
d. Personhood is a process of living that is grounded in caring.
e. Personhood enhanced through nurse-to-person relationship.
a. Nursing Situation: The perceptions, thoughts, and ideas that are present in the mind of the Nurse when she intends to Nurse the person. It includes the expression of her values and actions to live a nursing relationship with the person.
b. Call of Nursing: Nurturance is perceived in the mind of the nurse. A nurse responds with deliberate knowledge, it is nursing expression as per a person's needs and demands. It cannot be predicted.
c. Nurturing Response: It involves a unique response created by the Nurse.
d. Direct Invitation: It includes the Nurse's interaction and communication with the person when she asks how she can prove to be more helpful.
e. Dance of Caring person: It is characterized by an egalitarian spirit of caring, that includes the efforts of each dancer, even the one being nursed, are appreciated. The Dance of Caring People is also a model for leading an organization. Every person in the healthcare system lives a meaningful life of caring.
Theoretical Perspectives of "Transition Theory"
This theory was founded by Nurse theorist Dr. Meleis in 1960. The theory aims to assist people in making healthy transitions. This theory deals with the features of transition and experiences of human beings as they move from one state to another. The framework includes the human experiences, responses, and the implications of transition on the well-being of people. This transition theory assists in mastering actions, emotions, and symbols associated with new roles and identities to achieve better results2.
a. Transition is not an easy process; it is complex and multidimensional in nature.
b. There are multiple complex patterns of transition.
c. Transition has a time aspect; it takes place over an extended period.
d. It changes the identity, responsibilities, and behavioral pattern of the affected individual.
e. Transition is not synonymous with change, but transition can be both the outcome and cause of the change.
Concepts:
Types of Transition:
a. Developmental: Developmental transition deals with developmental phases of life; for example, birth, aging, and death.
b. Situational: It involves different situational contexts, for instance one’s professional responsibilities, and quality of relationship with family members.
c. Health illness: Recovery, hospital discharge, and chronic illness diagnosis are all illustrations of health and ailment transitions.
d. Organizational: Includes changing environmental situations, for instance from one unit to another or from one home to hospital.
a. Single Transition
b. Multiple transitions
c. Sequential Transition
d. Simultaneous Transition
e. Related Transition
f. Unrelated event of transitions
a. Awareness: It is the perception, knowledge, and recognition of the transition experience.
b. Engagement: It is the extent to which a person participates in the transition process.
c. Change and difference: Changes that a person experiences in one’s personality to bring a sense of direction.
d. Transition period: A moment when an event comes into the awareness of the individual.
e. Critical time and points: These are marker events- illness, diagnosis of ailment- in one’s life that bring intensifying transition.
a. Process indicators:
These are the processes that direct an individual towards healthy outcomes or vulnerabilities. Nurses conduct assessments to detect the processes in the early stages to ensure healthy outcomes.
b. Outcome indicators:
It is used to assess the quality of transition in person, whether it is healthy or not.
Table 1: Comparison between the theory of nursing as caring: a model for transforming practice and Transition Theory
|
S. No. |
The theory of nursing as caring |
Transition Theory |
|
1 |
The theory is written in simple language utilizing the basic concept of caring. |
Theory is simple to understand, its concepts are logically linked and the relationship among its theoretical assertions is obvious. |
|
2 |
The theory highlights the significance of Nursing care. |
The theory highlights the Nursing care and Nursing role to bring positive outcomes in individuals experiencing different types of transition. |
|
3 |
The theory deals with every person as a subject, not an objective part, Theory used the word “person”. |
The theory states the word “people” and deals with people according to their unique needs. Every subject has its own unique needs. |
|
4 |
The theory is practical in nature and easy to apply to achieve positive outcomes in the health setting. |
The theory is middle range, it addresses the specific phenomenon, which makes it applicable in Nursing practices. |
|
5 |
The theory is person-centered. |
Theory focuses on people in diverse types of transition. |
Table 2: Contrast between the theory of nursing as caring: a model for transforming practice and Transition Theory
|
S. No. |
The theory of nursing as caring |
Transition Theory |
|
1 |
It is a Grand nursing theory; it offers a broad philosophical framework. |
The theory is middle range, it addresses specific phenomena and contains fewer abstract concepts. |
|
2 |
Theory contained limited explanations about person, health, illness, environment |
The theory provides a brief explanation regarding various concepts of Framework. |
|
3 |
Theory application could lead to emotional attachment with the person. |
Theory application fulfills the professional demands of the Nursing Profession. |
|
4 |
The theory provides less insight into nursing education as it is more considerate towards caring as a virtue. |
The theory highlights the significance of a Nurse’s understanding of different aspects of types, patterns, and responses of transition. |
|
5 |
The nurse delivers care based on her characteristics and personhood. |
Nurse delivers care based on the characteristics of the patient’s personality and situation. |
Application of the theory of nursing as caring: a model for transforming practice and Transition Theory
Name: abc, Age: 45 years, Address: Village xyz, Occupation: Village field worker,
Unit: Medical ward of the government hospital, Presenting complaints. c/o body stiffness, shortness of breath, and difficulty swallowing.
Previous history: He had an accident two months ago that caused his right upper limb fracture.
Case Scenario: During a night duty in the medical ward, a nurse observed a patient experiencing severe pain and difficulty expressing his condition, characterized by significant rigidity in his arm and marked deterioration in his facial expressions. Communication was challenging due to the patient's evident struggle to speak, prompting the nurse to consult his daughter, who reported that he had been in good health until a few days prior when he developed abdominal muscle stiffness. Initially treated at a local dispensary, his condition worsened, leading to referral to the government hospital. The daughter also mentioned difficulty moving his jaw, which impeded eating, and heightened sensitivity to noise and light, exacerbating his discomfort. A thorough review of the patient's medical history revealed a right upper limb fracture from two months ago that had only received basic bandaging without tetanus prophylaxis. This information raised suspicion of tetanus, prompting the nurse to collaborate with the head nurse to relocate the patient to a quieter side room, alleviating his distress. Comfort measures were implemented, including adjusting his position and advising on hydration methods to prevent aspiration. This scenario highlights the critical role of nursing assessment and intervention in identifying serious conditions like tetanus while applying theoretical frameworks such as "Nursing as Caring" and "Transition Theory" to ensure holistic, patient-centered care that enhances outcomes.
Table 3: Potential outcomes and rationale for selection of theory
|
S. No. |
Scenario |
Intervention and Rationale |
Outcomes |
|
1 |
The patient's Facial expression indicated extreme distress. |
Conversation with the patient to explore the reason for distress to enhance his comfort level. (Nursing is caring) |
The patient demonstrates a sense of relief after the detailed conversation. |
|
2 |
The patient had an accident two months ago. |
Inquire about treatment after that accident to connect the previous history with the present complaint of the patient (Transition Theory- Process indicators) |
Timely diagnosis of Tetanus. |
|
3 |
The patient experiencing discomfort due to noise and lighting in the ward. |
Shifted the patient into the side room to Provide comfort to the patient. (Organizational Transition) |
The patient expressed relief after shifting into noise noise-free environment. |
|
4 |
The patient complained about thirst but unable to swallow. |
Restrict his oral intake to avoid Aspiration pneumonia. (Transition theory) |
Other dietary measures were explored successfully. |
|
5 |
The patient was unable to move his body, he was experiencing extreme pain. |
Asked the patient to inform whenever he needs assistance. (Nursing is caring) |
Patient’s comfort and satisfaction level enhanced with the care provided. |
|
6 |
The Patient was diagnosed with Tetanus. |
Explain to the patient the disease process and strategies that could provide relief to the patient, for instance darkness in the room, and a noise-free environment. (Transition theory Critical time and point) |
The patient demonstrates adaptive behavior. |
Reflection:
Through the process of analyzing and applying nursing theories, I found "Nursing as Caring" and "Transition Theory" to be particularly relevant to the scenario involving a patient facing significant health challenges. These theories underscore the fundamental role of the nurse in providing compassionate care and supporting patients as they navigate significant health changes with resilience and courage. The practical relevance of these theories became evident, as they offer valuable insights into the expectations that patients have from nursing professionals. Patients often prioritize the caring and empathetic behavior of nurses over other services provided. This understanding deepened my appreciation for the unique needs of individual patients, especially during their transitions through health challenges. Caring is not just an aspect of nursing; it is its essence, while transition represents a universal experience in life that all individuals encounter. Integrating these theoretical frameworks into practice is crucial for delivering high-quality, patient-centered care.
CONCLUSION:
Throughout history, nursing theories played a pivotal role in the development of Nursing as a unique profession. Nursing theories are the base of nursing practices. Without Nursing theories, Nursing becomes a merely task-oriented profession; however, nursing theories are the essence of the profession. In context to the theory of Nursing as caring and Transition theory, these theories provide the framework for nursing practices and help the Nursing profession to maintain its uniqueness. It enables Nurses to provide care to patients as per their unique transition. Moreover, it helps nurses to formulate appropriate nursing care plans to achieve the best possible outcome. It is inevitable to say that these theories are the soul of the nursing profession.
REFERENCES:
1. A.A B, Schoenhofer S. Nursing as Caring: A Model for Transforming Practice. NLN publications. 1993: i-xxxii, 1.
2. Im E-O. Afaf Ibrahim Meleis: Transitions theory. Nursing Theorists and Their Work. 2021: 306.
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Received on 13.02.2024 Revised on 12.07.2024 Accepted on 25.10.2024 Published on 20.11.2024 Available online on December 28, 2024 Int. J. of Advances in Nursing Management. 2024;12(4):207-210. DOI: 10.52711/2454-2652.2024.00046 ©A and V Publications All right reserved
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