The caring concept in nursing: evaluating theory-practice gaps in Bahrain

¶ … Caring in Nursing

Over time, nursing and caring have largely been regarded synonymous. With that in mind, it is important to note that quite a number of caring theories have been developed based on caring as a central concept. Some of these theories include the Cultural Care theory by Leininger as well as the Human Caring theory by Jean Watson whose development took place in 1970's. In this text, I will concern myself with caring as a concept in nursing. In so doing, I shall come up with a detailed evaluation of the nature of the practice theory gap most particularly in Bahrain as far as nursing is concerned.

Caring in Nursing: A Definition

To begin with, it is important to note that caring behaviors in the context of nursing can be taken to be those approaches as well as practices that are evidenced by nurses as they seek to care for individuals or patients in a nursing setup. In that regard, there exists a number of caring behaviors (ten to be precise) as outlined by Taber's. According to Eyles (2004), these behaviors include calling out patients by their own names, touch, respect, sensitivity, provision of relevant information so that patients can come up with well founded decisions, patience, patience, comforting, responsibility, honesty and last but not least, listening. It can be noted that apart from nursing, we also have other professions with well developed and concise caring behaviors. These professions include but of course are not limited to law enforcement where the most evident caring behaviors include respect and honesty. Further, in the teaching profession, responsibility, sensitivity, active listening as well as patience can be said to constitute the top caring behaviors.

In my own opinion, nursing is essentially founded on the key need of ensuring that a patient attains an enhanced level of harmony not only within the body but also within the soul and mind. This is an assertion supported by Watson's theory. However, to achieve this key need, caring transactions may have to be invoked. Hence in that regard, the relevance of caring to nursing cannot be overstated. According to Wallace and Fitzpatrick (2005), nursing is essentially a caring profession and based on that; it is my submission that caring impacts positively on the well being of a patient. Further, based on literature from patients' perspectives, being a caring nurse has a significant effect or impact on patient care. For instance, in a 'caring from the patient's perspective' study done by Brown sometimes in 1986, it was found out that the nurse's ability to avail the required treatment as well as care and the confidence patients had on the same was critical to the experience of care (Nyberg, 1998). Others who have carried out similar studies include Mayer and Riemen. Meyer concerned himself with patients suffering from cancer and the perceptions their families had on the caring behaviors of nurses while Riemen undertook a study (phenomenological) that sought to chart what descriptions patients had when it came to interactions (caring) with nurses.

As I have already noted in the introductory section; some of nursing's most popular caring theories include Jean Watson's well-known Human Caring theory and the Cultural care theory developed by Leininger. Caring is viewed by Watson as being a science. In that regard, Watson (2008) in her own words notes that "caring encompasses a humanitarian, human science orientation to human caring processes, phenomena and experiences." However, it can also be noted that caring as a science cannot only be looked at from a scientific perspective as also contained therein are humanities and arts. Therefore, it is quite in order to state that today; the concept of caring as far as nursing is concerned is being looked at from an interdisciplinary perspective and hence its relevance to professionals across the health spectrum cannot be overstated.

Magdalene Leininger in her own words notes that "care in the context of nursing can be taken to be a focus that is not only unifying but also dominant and central" (Leininger, 1988). According to Leininger's theory of cultural care, it is essential to take culture into consideration when it comes to exercising the caring behavior. Being the only theory in nursing that comprehensively takes into consideration the issue of culture, Leininger's theory of cultural care identifies caring as largely unique as well as essential to nursing.

A Definition of the Practice Theory Gap

Primarily, a theory is a collection of concepts that are in one way or the other related and whose main goal is to guide practice through action. According to Freshwater (2002), it is a well-known fact that gaps exist in nursing in relation to theory and practice. With this in mind, it follows that when it comes to guiding nursing practice, there is insufficient systematic utilization of theories though the benefits of the use of theories to inform nursing practice cannot be overstated as far as enhancing the level of care offered to patients is concerned. A theory-practice gap is essentially the nurses' inherent inability to utilize nursing as well as associated theories in the setting of clinical practice. This is a definition also supported by Larsen and Lubkin (2006) who note a theory practice gap as far as nursing is concerned is the inability of nurses to utilize the various nursing theories as well as related frameworks in real world scenarios. Freshwater (2002) further notes that the disparity existing between theory and practice can be summarized by the fact that; seldom are researchers and educators found in the practicing nurses environment.

It can be noted that though practice and theory are in one way or the other separate as far as nursing is concerned, it is highly likely that nursing students will face the practice-theory disparity. There are a number of reasons which can be invoked to explain why theory-practice gap exists in nursing apart from Freshwater's assertion that seldom are researchers and educators found in the practicing nurses environment. To begin with, there is a possibility that nurses fail to utilize theories because they either don't understand the theories or have insufficient information regarding the same. However, it is also possible that some nurses may not believe in some theories and hence in the light of that, fail to utilize the same in practice. However, there is also the likelihood that theory-practice gap is at times brought about by circumstances or scenarios that do not allow nurses to utilize theories and conceptual models. For instance, according to Barker (2009), the organizational model or medical model of care is what is more often than not brought out by professional nursing as opposed to the application or the actual utilization of theories as well as nursing models which can be taken to be relevant. It is also worthwhile to note that there are those who are of the opinion that theories as well as conceptual models cannot be applied or utilized in nursing practice due to their abstract nature. Here, the assertion is that the information provided or availed by such theories as well as conceptual models is insufficient to inform judgments in the nursing setup. Further, according to Barker (2009), there are those who consider nursing theories as well as conceptual models as largely incomplete and lacking in terms of refinement and testing adequacy. This reasoning is in line with the view of nursing theories as well as conceptual models as rather abstract and hence entirely meant to act as thinking stimulants.

Barker (2009) is of the opinion that there should be measures designed to ensure that nursing models as well as theories retain their relevance in nursing practice. She goes ahead to note that for theories as well as nursing models to inform client outcomes (predictable), they should not only be consistent with other theories which are validated but they should also provide nursing actions consequences and rationale in a clear and concise manner. There is however the other issue of nursing being an applied science which raises the question of whether the only appropriate theories as well as models are those derived from the scope of nursing. It is important to note that there exists a wide range of theories from a number of other disciplines and in some instances; there are suggestions that they be incorporated into the clinical and nursing practice so as to enhance not only the medical but also the nursing knowledge of nurses. These theories include but are not limited to developmental theories, family theories, systems theories etc. As a matter of fact, most nursing theories have a concept or two borrowed from a wide range of other disciplines and so as to fit the nursing context; these theories have to be transmuted. Barker (2009) notes that over time, quite a number of scholars have argued that theories and models should form the basis of nursing practice as they are largely in line with human science from the nursing point-of-view. However, the introduction of a theory-based practice should be handled with great care as initially; the introduction of the same brings about a real possibility of disrupting the current nursing practice's prevailing stability (Barker, 2009).

According to Kramer, new graduates consistently face or encounter a reality shock of sorts when called upon to deliver in practical nursing scenarios (Chitty, 2005). It is important to note that in this case, the reality shock experienced by students/new graduates is characterized by feelings of ineffectiveness as well as powerlessness when confronting practical scenarios. According to the findings availed by Kramer, the ability of new graduates to cope with new role demands effectively is greatly reduced by the generation of stresses (psychological) brought about by reality shock (Chitty, 2005). Indeed, it can be noted in this case that in the 1970s, the high nursing staff turnover was partially informed by reality shock as the expectations of new nurses who were beneficiaries of nursing scholarships failed to match with the nursing scenario's experiential reality (Barker, 2009).

Currently, students continue to face a reality shock of sorts once they are immersed into practical nursing scenarios and it is here that their theoretical knowledge as well as application of nursing concepts faces significant challenges. This is essentially because there are no deliberate measures taken at the training level to enhance the integration of knowledge at a theoretical level with practical experience. This is perhaps the reason why Callara (2008) insists on the need to ensure that students are taught how to apply qualitative reasoning in real world scenarios by applying ideas derived from both their everyday living and those sourced from experts who are well versed with reality or practicalities of the profession.

Based on my own analysis of facts and supporting evidence, there exists a theory practice gap as far as nursing is concerned in Bahrain. This is more so the case in the schizophrenics needs care. Over time, Bahrain has just like other parts of the world shifted its education of nurses into HEIs, that is, Higher Education Institutions in addition to increasingly embracing androgenic principles which emphasize on the need of students to become reflective, critical as well as self-directed thinkers. What this means is that instead of the undertaking of training nurses being focused on the 'product', it is instead becoming more and more focused on the 'process.' However, as I have already noted, this approach is taking root not only in Bahrain but across many other locations of the world as well. However, in Bahrain, the situation is aggravated by the apparent overreliance on academia at the expense of practice when it comes to the training of nurses. Further, it can be argued that in the case of Bahrain, the theory-practice mismatch is also informed by the very nature of the two environments' underpinning philosophies and their conflicting nature. The two environments in this case are theory and practice. As I have already noted, an example of an issue in my area that can be said to bring out the disparity between theory and practice in nursing is schizophrenic need care. Here, it has been inappropriate to rely on theoretical aspects as well as research in for instance prescribing different counseling models for different patients. This is essentially because each and every person happens to be unique and in that regard; the number of variables to be taken into consideration so as to come up with each groups account are quite a significant number. It therefore follows that even a single patient can be said to constitute a unit treatment group. Hence in the case of Bahrain, practitioners fresh from college have encountered quite a number of challenges in regard to coming up with a diagnosis for the best treatment of individual patients as the ability to do so is largely rooted in the application of judgment (professional) as opposed to research findings as well as other theoretical aspects that are largely generalized.

It is important to note that in comparison to other disciplines, nursing seems to be most affected by issues that relate to the theory-practice gap. Indeed, in other disciplines, the technical rationality paradigm seems to be largely efficient. For instance, in civil engineering, it is hard to encounter gaps between theory and practice. Here, if the design of a certain bridge (in theoretical terms) is developed to withstand ten thousand tones, the same bridge will most likely be able to withstand such weight in reality, that is, in practice. To seal the existing disparity as far as theory and practice is concerned; there is a need to come up with deliberate measures as well as approaches which are both acceptable and applicable to nursing and clinical practice. With that in mind; I conclude this text with a summary of the measures that should be undertaken, in my view, so as to seal the gap which essentially exists between theory and practice in the nursing profession. One of those in appreciation of the need as well as urgency of closing the theory practice gap is Cody (2006) who is of the opinion that a nurse's ability to utilize theory appropriately in nursing practice is critical as far as the provision of quality healthcare services is concerned. However, there are those who hold the opinion that it is impossible to entirely seal the gap that exists as far as theory and practice is concerned in nursing. Indeed, (McKenna, 1997) is convinced that in nursing; the gap existing between practice and theory could go a long way to stimulate innovation in the profession.