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Why this theory
Kristen Swanson developed her middle-range theory of caring from three perinatal studies: women who had miscarried, parents and professionals in a newborn intensive care unit, and socially at-risk mothers who received long-term public health nursing support (Swanson, 1991). Because the theory grew partly out of women's own accounts of miscarriage, it fits this patient closely.
Swanson describes caring as a nurturing way of relating to someone the nurse values and feels personally committed to and responsible for (Swanson, 1991). She later placed the five caring processes within a wider structure: the nurse's maintained belief in the person, knowing the person's experience, the processes of caring, and the intended outcome of the person's well-being (Swanson, 1993).
The patient
The patient is illustrative. Ms. L., 31, comes to the emergency department at 9 weeks' gestation with bleeding and cramping, and an ultrasound confirms a miscarriage. It was her first pregnancy. She is quiet, keeps apologizing for "making a fuss" and asks whether lifting boxes at work caused it.
The five caring processes in practice
| Process | What it means | What the nurse does for Ms. L. |
|---|---|---|
| Knowing | Striving to understand an event as it has meaning in the life of the other | Asks what this pregnancy meant to her rather than assuming; learns she had already told her family |
| Being with | Being emotionally present | Sits down, stays after the ultrasound result, and allows silence and tears without hurrying her |
| Doing for | Doing for the other what she would do for herself if she could | Manages pain, offers a private room away from the labor and delivery unit, and arranges for her partner to come in |
| Enabling | Helping the other through an unfamiliar transition | Explains what physical recovery will feel like, which bleeding is normal, and which warning signs need a call; answers her question about lifting with accurate, gentle information that early miscarriage is most often caused by problems with the pregnancy itself, not by ordinary activity |
| Maintaining belief | Sustaining faith in the other's ability to get through the event and face a future with meaning | Tells her that grief after an early loss is normal and real, and gives her information about a pregnancy-loss support group |
Evaluating the theory
The theory is clear, and its five processes are easy to remember and teach. It is also testable, because each process describes nurse behaviors that can be observed and measured. One limitation is that the theory describes the nurse–patient relationship but says little about the system around it, such as staffing or time pressure in a busy emergency department, which can make "being with" hard to achieve.
Conclusion
Swanson's theory turns caring from a vague value into specific actions. For Ms. L., it guides the nurse to treat the miscarriage as a loss, correct her self-blame, and prepare her for the days ahead.
References
Swanson, K. M. (1991). Empirical development of a middle range theory of caring. Nursing Research, 40(3), 161–165. https://doi.org/10.1097/00006199-199105000-00008
Swanson, K. M. (1993). Nursing as informed caring for the well-being of others. Image: The Journal of Nursing Scholarship, 25(4), 352–357. https://doi.org/10.1111/j.1547-5069.1993.tb00271.x
