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Expanding Caring: Theory and Practice intertwined in municipal elderly care
Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The Swedish Agency for Higher Education evaluated in 2007 the nursing programs at Swedish Universities, and confirmed that several programs lacked definition of the main subject of the discipline;- namely caring- and/or nursing. The caring science disciplines showed indications of increasing signs of fragmentation, in that sub-disciplines were evolving. There is a unique foundation of theoretical knowledge that is specific for the caring professions grounded in caring theory and philosophy. For some reason the theoretical foundation and contexture of providing care seems to fade off with time in clinical practice, as well as an explicated theory-practice gap; that theory does not go along with clinical practice. An assumption in this thesis is that caring theory somehow seems to evaporate; as nurses become clinically active- caring theory does not seem to be much reflected upon.The overall aim was to investigate into the meaning of caring to nurses in municipal elderly care, and into their explicit and implicit understanding of caring theory in their daily practice.The theoretical perspective was caring science, while the epistemological frame was of a phenomenological hermeneutical life world approach. Data was gathered by interviews with nurses working in elderly care and analyzed to grasp the structure of the phenomenon of caring in theory and practice. The thesis comprises four studies of which three empirical was consolidated with a Jean Watson’s specific caring theory, ending up in a better understanding of the approach of caring in nursing and the role of theory in practice.

The findings of the studies show that the lived experience of caring as narrated by the participating nurses comprises both implicit and explicit theoretical foundation to existential caring theory. The explicit use of theory or certain theoretical affiliation was not obvious; rather what may be theoretical inputs was expressed as the importance of being present and the necessity of having a health perspective in caring. By illuminating caring and concepts from caring theory, the meaning of caring in their professional lived experience, the primary intention or choice of working as nurses became apparent again. There seems to be different perspectives related to caring theory, but as the empirical findings shows, there is a consensus behind what caring is, both in theory and in practice. As a result from the analysis the aim of caring itself may be more salient and focused if based on existential phenomenological caring concepts and theory, as this corresponds with the nurses understanding of holistic intentional caring with a health perspective.

A gap exists, but is more related to organizational restrictions such as role constraints and time pressure than to the meaning of caring in theory and practice.

Mediating care is a concept that embraces the implications of all the outcome concepts of the analysis and it has the possibility of being the expression of immanent and transcendent dimensions in caring. Mediating care represents the expression of our understanding of life, our values and norms. It is given expression through the insights into, and the ways we connect to one another, our ability as carers (nurses) to reach out to another in his or her being, as well the understanding of ones own being in caring. Theoretical and practical reflection and cultivation of clinical sensibility has the opportunity of inspiring for an expanded caring consciousness, manifested in the mediation of care.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2011. , 63 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1217
Keyword [en]
Caring in theory and practice, municipal elderly care
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-63685ISBN: 978-91-7393-277-6 (print)OAI: oai:DiVA.org:liu-63685DiVA: diva2:382161
Public defence
2011-01-14, Aulan K1, Kåkenhus, Campus Norrköping, Linköpings universitet, Linköping, 09:11 (Swedish)
Opponent
Supervisors
Available from: 2010-12-30 Created: 2010-12-30 Last updated: 2016-08-31Bibliographically approved
List of papers
1. Caring and its ethical aspects-an empirical philosophical dialogue on caring
Open this publication in new window or tab >>Caring and its ethical aspects-an empirical philosophical dialogue on caring
2009 (English)In: INTERNATIONAL JOURNAL OF QUALITATIVE STUDIES ON HEALTH AND WELL-BEING, ISSN 1748-2623, Vol. 4, no 2, 78-85 p.Article in journal (Refereed) Published
Abstract [en]

With a focus on caring ethics, the aim of this study was to see if and how experienced nurses in care for the elderly described caring and whether they included any theoretical basis to their caring acts. Questions that guided the research were: Does ethical caring theory have any relevance in nurses clinical work? How do experienced nurses describe care in general, their intentions and motives in particular? In order to enter into the meanings of caring, a reflective lifeworld research approach based on phenomenology was utilized. Eleven experienced nurses were interviewed and the resulting transcripts were analysed for meaning, The findings revealed caring as a seamless integration of different levels, or embodied moments, of knowledge. In caring that is understood as a practical, aesthetical and ethical field of force, there is room for "being", "becoming" and "doing". Theory and practice can and must intertwine to enable the caring goal of health as well-being. A conclusion that may be drawn from this study is that there is a potential for connecting ethical caring concepts and theories into practical everyday care. Nurses basic intentions for a care-giving profession, as well as hidden/forgotten theory and concepts, are viewed in this study as a possibility of turning from a pre-reflective state to a more conscious level. This study gives new nuances to the understanding that existence affects caring and caring affects existence, and contributes to the more general claim that it now is high time for ethical caring science theory to be visible and make a change in care. Highlighting the experience of existential caring intentionality, and relating the experience to theoretical caring substance, this study may contribute to the development of a more consciously ethical and individualized caring culture.

Keyword
Lifeworld-led care, phenomenological philosophy, theory-practice, embodied care, aesthetics, ethics
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-51475 (URN)10.1080/17482620902727300 (DOI)
Available from: 2009-11-04 Created: 2009-11-04 Last updated: 2014-04-10
2. Embodied reflection in practice-Touching the core of caring
Open this publication in new window or tab >>Embodied reflection in practice-Touching the core of caring
Show others...
2010 (English)In: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 16, no 3, 241-247 p.Article in journal (Refereed) Published
Abstract [en]

A study was performed with the aim of clarifying the integration of the caring act of touch with reflection on caring theory. Seven participant nurses in elderly care volunteered as coresearchers and performed a caring act called Rhythmical Embrocation, together with reflective dialogues on caring theory. The project lasted for 6 months and at the end qualitative interviews with participants were used to evaluate the study. The findings showed an opening of awareness, embodied moments of presence and an extended ability to act creatively in caring. In this study, the movement between theory and practice was the integration of the caring act with reflection on basic caring concepts. Implications for praxis development are that implementation and reflection by teams over certain caring acts might open the door to an expanded view of ones own caring ability that in the long run will benefit the patient.

Place, publisher, year, edition, pages
Blackwell Publishing Ltd, 2010
Keyword
caring, embodied enquiry, reflection, phenomenological hermeneutics
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-57170 (URN)10.1111/j.1440-172X.2010.01836.x (DOI)000278110000003 ()
Note
This is the pre-reviewed version of the following article: Albertine Ranheim, Anita Kärner, Maria Arman, Arne Wilhelm Rehnsfeldt and Carina Berterö, Embodied reflection in practice-Touching the core of caring, 2010, International Journal of Nursing Practice, (16), 3, 241-247. which has been published in final form at: http://dx.doi.org/10.1111/j.1440-172X.2010.01836.x Copyright: Blackwell Publishing Ltd http://eu.wiley.com/WileyCDA/Brand/id-35.html Available from: 2010-06-11 Created: 2010-06-11 Last updated: 2017-12-12
3. Challenge for theory and practice in elderly care: intertwining forces
Open this publication in new window or tab >>Challenge for theory and practice in elderly care: intertwining forces
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Aim: Investigating into the possible disparity between theory and practice in caring by analysing nurses’ lived experience of the understanding of caring theory in practice in the context of municipal elderly care.

Background: Caring theories are the description and conceptualization of the care that is given in caring practise by nurses and other professional caregivers with the aim of verbalizing and communicating caring phenomena. Intermittently, a theory –practice gap is given expression- that theory does not go along with clinical practice in caring.

Method: Hermeneutical phenomenology was the research approach used to explore the lived experience of caring science theories in caring practice from the perspective of 12 nurses working in municipal care for elderly.

Findings: A detachment to caring theory was enunciated, but when describing their caring intentions, the nurses’ relationship to theory became apparent, and even confirmed their practice. As such, a seedbed exists for caring theory to be reflected on and cultivated in caring praxis. However, as the nurses describe, the caring theory must be sensitive enough for the nursing practitioners to accept. The gap revealed itself on an organisational level, as the nurses’ commission in municipal care did not correspond with their caring intention.

Conclusion: We believe it is important to seriously consider what we want to achieve as a caring profession. We have to reflect on our responsibility as culture carriers and knowledge developers. We must make the disparate forces of intention and organisation become one intertwining force.

Keyword
Theory-practice, elderly care, phenomenological hermeneutics
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-63683 (URN)
Available from: 2010-12-30 Created: 2010-12-30 Last updated: 2016-08-31Bibliographically approved
4. Caring Theory and Practice: entering a Simultaneous Concept Analysis
Open this publication in new window or tab >>Caring Theory and Practice: entering a Simultaneous Concept Analysis
(English)Manuscript (preprint) (Other academic)
Abstract [en]

To better understand the approach of caring in nursing and the role of theory in practice, we wanted to consolidate the empirical findings from three studies performed to reveal nurses’ caring intentions, their lived experience of reflecting caring theory in practice, with caring theory by Watson (1979, 2008).

Through a simultaneous concept analysis (SCA) of nine concepts, caring theory was consolidated with the findings of three empirical studies – to reveal the dynamics of caring theory and practice. In conclusion these nine concepts interrelate to the advanced concept mediating care. Mediating care is the visualized outcome or evidence for the intertwining of theory and practice in caring.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-63684 (URN)
Available from: 2010-12-30 Created: 2010-12-30 Last updated: 2016-08-31

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