Caring is the central focus in nursing, as a discipline and profession. However, caring can be agreed as a multidimensional concept in the framework of practice and perception. There appears to be a conflicting definition of what is caring really. As such, the development of a middle range theory was realized as anchored on the unitary-transformative paradigm. It is important that caring is defined in various context which should establish a common underpinnings and bases. In the context of this theory, human beings remains in constant mutual relationship with the environment, which is considered an extension of the entire Universe, thus, we participate consciously in various orders, patters, and dynamics as how we perceive it. As such, caring becomes a mutual concept of the individual to his or her immediate surroundings following an established set of guidelines and protocols. More so, this theory asserts that caring is also a process which involves the holistic nature of the human person that helps derive the potentialities and possibilities ascribes to it. Adding to that, caring is a concept brought about by affirming our minuscule existence in the entirety of the pan-dimensional Universe.
Assumptions of the unitary theory of caring come from Rogers’s science of unitary human beings (1970, 1994), Newman’s theory of health as expanding consciousness (1994, 2008), and Watson’s Theory of Transpersonal Caring (1985, 2005; Watson & Smith, 2002). To fully understand the meaning of the theory, readers will beneﬁt from studying these sources.
· Human beings are unitary or irreducible, in mutual process with an environment that is coextensive with the Universe, participating knowingly in patterning, and ever-evolving through expanding consciousness (Barrett, 1989; Newman, 1994; Rogers, 1992).
· Caring is a quality of participating knowingly in human–environmental ﬁeld patterning (M. C. Smith, 1999).
· Caring is the process through which human wholeness is aﬃrmed and that potentiates the emergence of innovative patterning and possibilities (Cowling et al., 2008, E44).
· Caring is a manifestation and reﬂection of expanding consciousness potentiating greater meaning, insight, and transformative ways of relating to self and others (Cowling et al., Smith, & Watson, 2008).
· Caring consciousness is resonating with the pandimensional universe (Rogers, 1994; Watson, 2005; Watson & Smith, 2002).
Concepts After establishing the theoretical linkages to the unitary-transformative paradigm, the ﬁve concepts of this theory are explicated. The ﬁve concepts were developed from an analysis of literature on caring and similar concepts described by unitary scholars. The theoretical concepts have their underpinnings in each of the assumptions.
· Manifesting intentions is the ﬁrst concept in the unitary theory of caring; it was originally deﬁned as creating, holding, and expressing thoughts, feelings, images, beliefs, desires, will, purpose and actions that aﬃrm possibilities for human health and healing (Smith, 1999).
· Appreciating pattern is the second concept in this theory. It is apprehending and understanding the mysteries of human wholeness and diversity with awe.
· Attuning to dynamic ﬂow is the third concept in this unitary theory of caring. Attuning to dynamic ﬂow is sensing of where to place focus and attention in mutual process. It was originally described as “dancing to the rhythms within continuous mutual process” (M. C. Smith, 1999, p. 23).
· Experiencing the infinite this concept is defined as “pandimensional awareness of coextensiveness with the universe occurring in the context of human relating” (M. C. Smith, 1999, p. 24).
· Inviting creative emergence it is attending the birth of innovative, emergent patterning through aﬃrming the potential for change, nurturing the awareness of possibilities, imagining new directions, and clarifying hopes and dreams.
The following are propositional statements that further clarify concepts of the theory. Manifesting intention is:
•Preparing self to participate knowingly in cocreating an environment for healing.
•Focusing images, thoughts and intentions for health and healing.
•Expressing intentions in actions that support health and healing.
Appreciating pattern is:
•Seeing wholeness in perceived fragmentation. •Valuing uniqueness and diversity of patterning with wonder. •Acknowledging what is without attempting to change or ﬁx. •Exploring what is meaningful in the moment. •Coming to know by listening to the other’s story.
Attuning to dynamic ﬂow is:
•Being truly present in the ﬂow of relating. •Attending to the subtleties of meaning. •Synchronizing rhythms of self with other. •Trusting intuition in the mutual process.
Experiencing the inﬁnite is:
•Acknowledging the sacred in human relating. •Believing in limitless possibilities. •Igniting hope in despair. •Connecting to a pandimensional universe.
Inviting creative emergence is:
•Honoring the unique timing, pace and direction of change. •Calling attention to possibilities and potentialities hidden from view. •Inspiring new life to emerge in the moment. •Trusting in the wisdom of knowing one’s own way.
The theory focuses holistic knowing from the unitary perspective. There exist two main functional components for the unitary caring theory.1. Human beings.The humans make manifest of the capabilities it can project relative to caring and establishing this linkage requires a satisfactory level of interaction with one another to attain the overall goal of nursing and the health care system. 2. Pan-dimensional environment (Universe) Humans are merely a miniscule partition of the entire Universe. The perceivable and knowing environment, as we know it, is the extension of the pan-dimensional Un
Relationship between Structure and Function
Assumptions of the unitary theory of caring come from Rogers’s science of unitary human beings (1970, 1994), Newman’s theory of health as expanding consciousness (1994, 2008), and Watson’s Theory of Transpersonal Caring (1985, 2005; Watson & Smith, 2002). To fully understand the meaning of the theory, readers will beneﬁt from studying these sources. Concepts are explained clearly one by one, are consistent, well contained in the theory and do not differentiated into sub concepts, a very Complex to other areas packed with great information and requires vast amount of time. It Gave so many information but the ideas in different parts of the theory does not decrease the clarity. Watson and Smith5 refer to a unitary caring science that evolves from frameworks fitting within the unitary-transformative paradigm. They also differentiate between transformation and transcendence in their description of a caring moment as potentiating a new human-environmental field pattern arising from a mutual process. They depict humankindastransformativeinnatureandaunitary caring science that transcends all duality
Diagram of the Theory
Concepts were developed from an analysis of literature on caring and similar concepts described by unitary scholars. Watson and Smith5 place the frameworks of both transpersonal caring science and the science of unitary human beings under the umbrellaofaunitary-transformativeparadigm reflecting the “universal oneness and connectedness of all.”(p459) Although they do not refer to wholeness in their explication of a synthesized view, they refer to the unitary nature of the universe, which is congruent, if not synonymous, with wholeness. They acknowledge “the unitary, transpersonal, evolving nature of humankind, both immanent and transcendent with the evolving universe.”(p459) They speak of a unitary caring science that is deeply relational, transcending duality and invoking the infinite. In addition, they refer to a type of consciousness—transcending time, space, and physicality—that is “open and continuous with the evolving unitary consciousness of the universe.”(p459) The theory is not Visually presented and there was no original diagram for the theory alone.
Circle of Contagiousness
The concept was developed on the basis of reviewing the philosophical and theoretical literature on caring in nursing, identifying meanings from this body of literature, and classifying and naming them within a unitary perspective. A decade later, it is important to reflect on this anew and begin to develop theory-practice connections for unitary caring. If we embrace a model of caring from a unitary perspective, we need to delineate the essential ontological competencies19 that emerge from it. The term ontological competencies has been used by Watson,26 who refers to ontological artistry as the creative work in nursing that reflects the sacred acts ofcaring and healing.
The unitary theory of caring developed while studying the literature on caring in nursing, and then analyzing this literature through the theoretical lens of the science of unitary human beings. Some hospitals are slowly beginning to adopt caring philosophies. Certain hospitals such as Saint Anne’s Hospital, have adopted caring theories and applied it to their hospital practices, and especially in their nursing practice.
By positing unity of wholeness, consciousness, and caring as both higher order and deeper order concepts, it moves nursing closer to its ethical and ontological foundations. Embedded within these unitary concepts are new horizons for unitary caring practices, informed by the 5 constituent meanings of caring that Smith4 gleaned from a unitary lens, that is, manifesting intentions, attuning to dynamic flow, appreciating pattern, experiencing the infinite, and inviting creative emergence. By positing unity of wholeness, consciousness, and caring as both higher order and deeper order concepts, it moves nursing closer to its ethical and ontological foundations. Embedded within these unitary concepts are new horizons for unitary caring practices, informed by the 5 constituent meanings of caring that Smith4 gleaned from a unitary lens, that is, manifesting intentions, attuning to dynamic flow, appreciating pattern, experiencing the infinite, and inviting creative emergence. Provides individual clinicians, teams of health professionals, educators, and leaders with a relationship-centric approach to health care.
According to her “we can never know the whole person and the whole picture of human health through analytical, reductionist processes of knowing”. She has studied, written about, and conducted research related to Rogers’s science of unitary human beings, Parse’s man-living-health (now humanbecoming), Watson’s theory of transpersonal caring, and Newman’s health as expanding consciousness, and has written many commentaries on issues related to nursing theory development. She bridges together the divide between caring theorists and the opposition, such as the Rogerians. Her work can be used by other theorists to put greater emphasis on the aspect of caring and how it pertains to nursing practice. Ideals and ideas for “ontological literacy” can lead in time to “ontological design practices.” These practices see differently—they see and honor the whole person in a way that affirms the possibilities for individuals and humanity; they offer new energetic heartfelt blueprints for transformation and new fields of mutuality, whereby the nurse becomes the healing environment, the creator of sacred space, holding self and other in their wholeness.
Nursing Theories & Nursing Practice Fourth Edition Marlaine C. Smith, PhD, RN, AHN-BC, FAAN Marilyn E. Parker, PhD, RN, FAAN
Parker, M. E., & Smith, M. C. (2010). Nursing theories and nursing practice. Philadelphia: F.A. Davis Co.
Smith, M. C. (2013). Caring in nursing: Analysis of extant theory. In M. C. Smith, M. C. Turkel, & Z. R. Wolf (Eds.), Caring and
the science of unitary human beings (pp. 43-57). New York, NY: Springer.
Smith, M. J., & Liehr, P. R. (2008). Middle range theory for nursing. (2nd ed.). New York: Springer Publishing Company.
Smith MC. Caring and the science of unitary human beings. Adv Nurs Sci. 1999;21(4):14–28. 5. Watson J, Smith MC. Caring science and the science of unitary human beings. J Adv Nurs. 2002;37(5):452–461.
Smith MJ, Liehr P. Attentively embracing story: a middle-range theory with practice and research implications…includingcommentarybyReedPG.Sch Inq Nurs Pract. 1999;13(3):187–210.
Quinn JF. Holding sacred space: the nurse as healing environment. Holist Nurs Pract. 1992;6(4):26– 36. 28. WatsonJ.CaringScienceasSacredScience.Philadelphia, PA: FA Davis; 2004
Advances in Nursing Science Vol. 31, No. 1, pp. E41–E51 Copyright c 2008 Wolters Kluwer Health|Lippincott Williams & Wilkins The Power of Wholeness, Consciousness, and Caring A Dialogue on Nursing Science, Art, and Healing
W. Richard Cowling, III, PhD, RN, APRN-BC, AHN-BC; Marlaine C. Smith, PhD, RN, AHN-BC, FAAN; Jean Watson, PhD, RN, AHN-BC, FAAN
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