Human Caring & Role Theories

Application to Clinical Practice

Stephanie Thompson, RNTheory in NursingUniversity of Arkansas for Medical Sciences

IntroductionHuman Caring Theory: To practice the art of caring, to

provide compassion to ease patients’ and families’ suffering, and to promote their healing and dignity. The major elements of this theory are the carative factors, the transpersonal caring relationship, and the caring occasion/caring moment.

Role Theory: A conceptual framework that defines how individuals behave in social situations and how these behaviors are perceived by observers.

These theories were chosen based on my interest in learning more about each theory. I am a very caring person and wanted to explore how these theories relate to my nursing practice.

(Watson, 2009)(Role Theory, 2009)

Origins

Human Caring Theory: Developed by Jean Watson between 1975-1979, while teaching at the University of Colorado, published in 1979

Role Theory: The first significant contributions were published in the 1930s by Ralph Linton (1893–1953), Jacob Moreno (1889–1974), and George Herbert Mead (1863–1931). Starting in the 1950s-1960s, was associated mostly with Talcott Parsons (1902–1979).

(Watson, 2009)(Role Theory, 2009)

Comparison of Two Theories

Theory ComparisonTheory Person Environmen

t Health Nursing

Human Caring

“….. a valued person in and

of him or herself to be

cared for, respected, nurtured,

understood and assisted.”

Caring has existed in

every society. Transmitted by culture of the profession.

A high level of overall

physical, mental and

social functioning

“Nursing is concerned with

promoting health,

preventing illness, caring

for the sick and restoring

health.”

Role

roles are socially

specified based on

situation or job duty

expected social roles

based on the current

environment

maintaining or achieving health and well-being

through role assignment

nursing management

roles, and role

development

(Current Nursing, 2012) (Role Theory, 2009)

Application to PracticeHuman Caring Theory Key Concepts

“Caring begins with being present, open to compassion, mercy, gentleness, loving-kindness, and equanimity toward and with self before one can offer compassionate care to others.”

Framework using Ten Caritas Processes

• Practicing loving-kindness self and other• Being authentically present• Cultivating one’s own spiritual practices; deepening self-awareness• Developing and sustaining a helping-trusting, authentic caring relationship• Being supportive of the expression of positive and negative feelings• Creative use of self and all ways of knowing as part of the caring process• Engaging in genuine teaching-learning experiences within context of caring relationship –

attend to whole person• Creating healing environment at all levels• Reverentially and respectfully assisting with basic needs• Attending to spiritual, mysterious, unknown dimensions of life-death-suffering; “allowing for a

miracle”

Application to Family Nurse PractitionerThis theory shows us why nurses become nurses and not doctors. It is because of the caring aspect of nursing and the relationship that is built between patients and nurses. Nurse practitioners work with others and their patients thru caring moments. This involves an action and choice for the two to come together and decide what to do with the situation and the moment. It is through the combination of caring moments that the nurse may accomplish healing at its most holistic form.

(Watson, 2009)

Application to PracticeRole Theory Key Concepts

Typical roles include the role of teacher, child, mother, father—or nurse! Roles exist independently and serve as a connection between the individual and society. Roles may represent relationships or functions.

Types of Roles• Role Set – all the roles that one person plays at a given time Ex: father, worker, husband, brother, and

friend.

• Role Complementarity - When roles are complementary, partners in a relationship identify self and

others correctly, accurately assume expected roles. For example Each person on the team has a particular

role to play

• Role Reciprocity expected pairing of role positions, such as husband/wife, mother/child, worker/client,

teacher/student. Both roles must be present to complete the function

• Role Status – the position in society from which a role is enacted.

• Role-Making - Roles are not static, people shape the roles they play.

• Role Conflict or Role Strain – conflicting demands made by several roles held simultaneously by one

person.   Role Incongruity - differing perceptions of the same role.

• Role Reversal - one person assumes the behaviors of the other person in a reciprocal role Individuals have many roles they manage on a daily basis. Roles contain a set of rules to guide behavior. Roles specify what goals, tasks and performances are required for that type of role.

(McEwen, 2011, pp. 258-260)

Application to PracticeClient Situation

In this scenario, both theories are used by the nurse. Patient is admitted to the hospital with abdominal pain and vomiting. He has a history of alcoholism and diabetes. According to the nurse report, he asks for pain medications frequently. Since he was your patient yesterday you know he often requires a higher level of pain meds and you are responsive to his suffering by contacting the provider for a change in the order. The provider is reluctant to increase the dose of morphine and, in order to avoid causing harm to the patient, the nurse advocates for her patient by engaging in conflict resolution with the physician. The result was an increase in the morphine dose for the patient.

(Lachman, 2012)

Nursing Diagnosis for Human Caring TheoryApplication to Practice

Interventions based on Human Caring Theory are determined by using the key concepts of the theory. Practicing loving kindness, being present and being supportive is the main focus. Respectfully assisting with basic needs and attending to the patient practice the human caring theory.

• Assess ability to carry out ADLs

• Identify preferences for personal care items, ex soap, shampoo.

• Encourage independence, but intervene when patient cannot perform.

• Maintain privacy during bathing as appropriate.

• Keep the temperature warm bath; make sure the preferred water

temperature of the individual

• Keep all toiletries in a convenient basket

• Safety measures in bathroom

Bathing self-care deficit

(Gradishar, 2012)

Nursing Diagnosis for Role Theory Application to Practice

Ineffective self-health management

Interventions for this diagnosis are based on Role Theory and are determined by using the role of the nurse in a patient relationship situation. Teaching, educating and chronic disease management are the main focus for this nursing diagnosis and interventions. Respectfully assisting with educational needs regarding the patient illness and patient self management practice the human caring theory.

• Promote change through behavior modification

• Set and Follow SMART Goals

• Keep logs

• Be the patient coach

• Teach about chronic illness

• Evaluate logs and journals(Gradishar, 2012)

Application to PracticeResearch Needed

Human Caring Theory:

There needs to be more research completed on the relationship aspect when using the Human Caring theory. There must be boundaries set on how far a nurse should go to care for a patient. There should also be boundaries on how engaged the nurse is in a relationship with a patient. In other words, what is the ethical boundary of assisting a patient with their needs.

Role Theory:

The Role Theory has had a lot of research completed on how roles are perceived in society. There needs to be more research on how the role of an individual affects others in their immediate circle. For example, by being a nurse, how does that affect my husband and children?

Human Caring Theory Model Diagram

Role Theory Model Diagram

NURSE

Caregiver

Commnuicator

Teacher

Advocate

Counselor

Researcher

Case Manager

Assessments

Team Player

Exams

Motivator

Delegater

Synthesis of Human Caring Theory and Application

By applying the Human Caring Theory to my practice I have been able to see where I have already been doing these things. Human caring to me is second nature and comes naturally to me. Researching this project, I have learned how, when, and where I have applied the human caring theory to my practice. Everyday I use the key concepts of this theory. Care, compassion, being present, aware, supportive, trust, and healing are used everyday in some way or another.

Synthesis of Role Theoryand Application

Researching the Role Theory has been fun and interesting. I came across several different articles and studies about roles in society. I found it interesting when reading older material and the difference in today’s perception of roles. I myself have many roles and have found the role of nurse to be one of the most rewarding roles I fill. Applying the theory to my practice has allowed me to see how people may perceive the role of nurse in different generations.

SummaryIn summary, the application of theory to nursing practice is very important and critical to a successful career in nursing. By applying theories to nursing, you are better able to understand the processes behind why things happen a certain way and the relationship between nurses and patients. The Human Caring Theory and Role Theory were fun to research and write about. I learned a lot about how these two theories apply to myself as a nurse. My favorite theory is the Human Caring Theory. The art of caring and providing compassion to others is my calling in life.

ReferencesGradishar, D., & Gleason,M. (2014). EHS: Nursing Diagnosis Care Plans, 4/e - Self-Care

Deficit. EHS: Nursing Diagnosis Care Plans, 4/e - Self-Care Deficit. Retrieved July 22,

2014, from

http://www1.us.elsevierhealth.com/MERLIN/Gulanick/archive/Constructor/gulanick42

.

html

Lachman, V. (2012). Applying the Ethics of Care to Your Nursing Practice. MedSurg

Nursing, 21(2). Retrieved July 22, 2014, from

http://www.nursingworld.org/mainmenucategories/ethicsstandards/resources/applyi

ng-the-ethics-of-care-to-your-nursing-

practice.pdf

McEwen, M., & Wills, E. M. (2011). Theories From the Sociologic Sciences. Theoretical basis for

nursing (3rd ed., pp. 258-260). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins

Health.

Role Theory. International Encyclopedia of the Social Sciences. 2009. Retrieved July 06,

2014 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3045302300.

html

Watson J. Nursing: The Philosophy and Science of Caring.(2009) Boulder, CO: University

Press of Colorado.

The Human Caring & Role Theories

Application to Clinical Practice

Stephanie ThompsonTheory in NursingUniversity of Arkansas for Medical Sciences