Caring in Nursing: Theory, Practice Gap, and Bahrain

Introduction to Caring in Nursing

Over time, nursing and caring have largely been regarded as synonymous. With that in mind, it is important to note that a number of caring theories have been developed with caring as a central concept. Some of these theories include the Cultural Care theory by Leininger and the Human Caring theory by Jean Watson, both of which were developed in the 1970s. This paper is concerned with caring as a concept in nursing, and offers a detailed evaluation of the nature of the theory-practice gap, most particularly in Bahrain as it relates to nursing.

Defining Caring in Nursing

Caring behaviors in the context of nursing can be understood as those approaches and practices evidenced by nurses as they seek to care for individuals or patients in a nursing setting. There exist a number of caring behaviors — ten, to be precise — as outlined by Taber's. According to Eyles (2004), these behaviors include addressing patients by their own names, touch, respect, sensitivity, provision of relevant information so that patients can make well-founded decisions, patience, comforting, responsibility, honesty, and listening.

It can be noted that apart from nursing, other professions also have well-developed and concise caring behaviors. These professions include, but are not limited to, law enforcement — where the most evident caring behaviors include respect and honesty — and the teaching profession, where responsibility, sensitivity, active listening, and patience constitute the top caring behaviors.

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 assertion is supported by Watson's theory. To achieve this key need, caring transactions must be invoked, and thus the relevance of caring to nursing cannot be overstated. According to Wallace and Fitzpatrick (2005), nursing is essentially a caring profession, and caring impacts positively on the well-being of a patient.

Based on literature from patients' perspectives, being a caring nurse has a significant effect on patient care. For instance, in a study on caring from the patient's perspective conducted by Brown in 1986, it was found that the nurse's ability to provide the required treatment and care, and the confidence patients had in that care, was critical to the experience of care (Nyberg, 1998). Others who have carried out similar studies include Mayer and Riemen. Mayer concerned himself with patients suffering from cancer and the perceptions their families had of nurses' caring behaviors, while Riemen undertook a phenomenological study that sought to chart patients' descriptions of caring interactions with nurses.

Key Caring Theories: Watson and Leininger

Some of nursing's most prominent caring theories include Jean Watson's Human Caring theory and the Cultural Care theory developed by Leininger. Caring is viewed by Watson as a science. In her own words, Watson (2008) notes that "caring encompasses a humanitarian, human science orientation to human caring processes, phenomena and experiences." It can also be noted, however, that caring as a science cannot be looked at from a purely scientific perspective, as it also encompasses humanities and arts. Therefore, it is accurate to state that today, the concept of caring in nursing is being examined from an interdisciplinary perspective, and its relevance to professionals across the health spectrum cannot be overstated.

Madeleine Leininger notes in her own words 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 exercising caring behavior. As the only nursing theory that comprehensively addresses the issue of culture, Leininger's theory of cultural care identifies caring as largely unique and essential to nursing.

Defining the Theory-Practice Gap

A theory is primarily a collection of related concepts whose main goal is to guide practice through action. According to Freshwater (2002), it is well recognized that gaps exist in nursing between theory and practice. When it comes to guiding nursing practice, there is insufficient systematic utilization of theories, even though the benefits of theory-informed nursing practice are considerable in terms of enhancing the level of care offered to patients. A theory-practice gap is essentially the nurses' inherent inability to utilize nursing and associated theories in clinical practice settings. This definition is also supported by Larsen and Lubkin (2006), who describe the theory-practice gap in nursing as the inability of nurses to utilize various nursing theories and related frameworks in real-world scenarios. Freshwater (2002) further notes that the disparity between theory and practice can be summarized by the fact that researchers and educators are seldom found in the practicing nurse's environment.

Though practice and theory are in some ways separate in nursing, nursing students are highly likely to encounter the theory-practice disparity. There are a number of reasons why this gap exists, beyond Freshwater's observation about the absence of researchers and educators. To begin with, nurses may fail to utilize theories because they either do not understand them or have insufficient information about them. It is also possible that some nurses do not believe in certain theories and therefore fail to apply them in practice. Additionally, the theory-practice gap is sometimes brought about by circumstances or scenarios that do not allow nurses to utilize theories and conceptual models. According to Barker (2009), the organizational or medical model of care is what professional nursing more often applies, rather than relevant nursing theories and models. It is also worth noting that some hold the opinion that theories and conceptual models cannot be applied in nursing practice due to their abstract nature — the argument being that such theories provide insufficient information to guide judgments in a nursing setting. According to Barker (2009), there are also those who consider nursing theories and conceptual models as largely incomplete and lacking in terms of refinement and adequate testing, which aligns with the view of them as thinking stimulants rather than practical guides.

Barker (2009) argues that measures should be designed to ensure that nursing models and theories retain their relevance in nursing practice. She notes that for theories and nursing models to produce predictable client outcomes, they should be consistent with other validated theories and should provide clear and concise rationale and consequences for nursing actions. There is also the question of whether, given that nursing is an applied science, the only appropriate theories and models are those derived from within the scope of nursing itself. A wide range of theories from other disciplines — including developmental theories, family theories, and systems theories — have been suggested for incorporation into clinical and nursing practice to enhance nurses' medical and nursing knowledge. Most nursing theories already borrow concepts from various other disciplines, and these concepts must be adapted to fit the nursing context. Barker (2009) notes that over time, a number of scholars have argued that theories and models should form the basis of nursing practice, as they align with human science from a nursing perspective. However, the introduction of theory-based practice should be handled with care, as it initially brings a real possibility of disrupting the prevailing stability of current nursing practice (Barker, 2009).

According to Kramer, new graduates consistently face a reality shock when called upon to perform in practical nursing scenarios (Chitty, 2005). This reality shock is characterized by feelings of ineffectiveness and powerlessness when confronting practical situations. Kramer's findings indicate that the psychological stresses brought about by reality shock greatly reduce new graduates' ability to cope effectively with new role demands (Chitty, 2005). In the 1970s, high nursing staff turnover was partially attributable to reality shock, as the expectations of new nurses failed to match the experiential reality of the nursing environment (Barker, 2009).

Students continue to face a reality shock once immersed in practical nursing scenarios, where their theoretical knowledge and application of nursing concepts encounters significant challenges. This is largely because no deliberate measures are taken at the training level to enhance the integration of theoretical knowledge with practical experience. This is perhaps the reason why Callara (2008) insists on the need to teach students how to apply qualitative reasoning in real-world scenarios by drawing on ideas from both their everyday living and from experts well versed in the realities of the profession.

References

Barker, A.M. (2009). Advanced Practice Nursing: Essential Knowledge for the Profession. Jones and Bartlett Learning.

Callara, L.E. (2008). Nursing Education Challenges in the 21st Century. Nova Publishers.

Chitty, K.K. (2005). Professional Nursing: Concepts and Challenges. Elsevier Health Sciences.

Cody, W.K. (2006). Philosophical and Theoretical Perspectives for Advanced Nursing Practice. Jones & Bartlett Learning.

Eyles, M.O. (2004). Mosby's Comprehensive Review of Practical Nursing for the NCLEX-PN Examination. Mosby.

Freshwater, D. (2002). Therapeutic Nursing: Improving Patient Care through Self-Awareness and Reflection. Sage.

Larsen, P.D. (2006). Chronic Illness: Impact and Interventions. Jones & Bartlett.

Leininger, M.M. (1988). Care, the Essence of Nursing and Health. Wayne State University Press.

McKenna, H. (1997). Nursing Theories and Models. Routledge.

Nyberg, J.J. (1998). A Caring Approach in Nursing Administration. University Press of Colorado.

Wallace, M. & Fitzpatrick (2005). Encyclopedia of Nursing Research. Springer Publishing Company.

Watson, J. (2008). Nursing: The Philosophy and Science of Caring. University Press of Colorado.