KRISTEN M. SWANSON

Five Process

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1. Maintaining Belief

• Orientation to caring begins with a fundamental beliefin persons and their capacity to make it through events and transitions and face a future with meaning.

• It is foundation to the practice of nursecaring.

• It fuels nursing and nurses to a commitment to serve humanity (in general) and each client (in specific).

• On the societal level, it is belief in the rights of all people that motivates nurses to political activism around such matters as access to care and the need for health care reform.

2. Knowing

• It is the anchor that moors the beliefs of nurses/nursing to the lived realities of those served.

• It is striving to understand events as they have meaning in the life of the other.

• It translates the idealism of belief maintenance into the realism of the human condition. It involves avoiding assumptions, centering on the one(s) cared for, thoroughly assessing all aspects of the client's condition and reality, and ultimately engaging the self or personhood of the nurse and client in acaring transaction.

• In effect, nurse knowing sets the potential for the nursing therapeutics of being with, doing for and enabling to be perceived as relevant and, ultimately, effective in promoting client well-being.

• The efficiency and efficacy of knowing as a caring therapeutic is enhanced by empirical, ethical and aesthetic knowledge ofthe range of responses humans have to actual and potential health problems.

• Formal nursing education, experience with clients with similar conditions, or a given client under differing conditions, hones a nurse's capacity to know the meaning of an event in a given client's life. 

3. Being With

• Being with, being emotionally present to other is the caring category that conveys to clients that they and their experiences matter to the nurse.

•  Being with assures clients that their reality is appreciated and that the nurse is ready and willing to be there for them. It includes not just the side-by-side physical presencebut also the clearly conveyed message of availability and ability to endure with the other.

• To be with another is to give time, authentic presence, attentive listening and contingent reflective responses and the one cared for realizes the commitment, concern and personal attentiveness of the one caring.

• It is done with sense of responsibility toward both the client and self, remaining ever aware of who is provider and who is recipient in any given clinical situation.

• There is a fine line between sharing the other's reality and taking on that reality as your own. When such boundaries are crossed, painful outcomes are bound to ensue. It can ultimately diminish the nurse's personal and professional relationships and role performance 

4. Doing for

• The unique function of the nurse is to assist the individual, sick or well in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessarystrength, will, or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible.(Henderson, 1966).

• Doing for involves actions on the part of the nurse that are performed on behalf of the client's long term well-being. There is efficaciousness to these actions, wherein the nurse actsultimately to preserve the other's wholeness.

• Doing for includes comforting the other, anticipating their needs, performing competently and skillfully, protecting the other from harm and ultimately preserving the dignity of the one done for.

5. Enabling

• Enabling is defined "as facilitating the other's passage through life transitions and unfamiliar events" (I991).

• It includes: coaching, informing and explaining to the other; supporting the other and allowing her/him to have her/his experience; assisting the other to focus in on important issues; helping her/him to generate alternatives; guiding her/him to think issues through; offering feedback; and validating the other's reality.

• The goal is to assure the other's long-term well-being.

• It has negative meaning in mental health community in which the provider sets up or maintains a situation in which the other may sustain an unhealthy way of being. The provider may actually act as co-dependent to the other's pathological choices whereas this was never the intention of Swanson's labeling of this category.

• It highlights the two sides of the caring coin: one in which the self of both caregiver and recipient are enhanced by the care provider's actions and the opposite in which the self of provider and recipient are diminished by the provider's misdirected actions.

• Any discussion of caring in nursing must begin and end with the awareness of where professional responsibilities lie (to self and other); what constitutes nurturance versus diminishment (of self and other); how the boundaries of personal and professional roles are delineated; and when and where to seek support for the demands of caring.

• As Orem (1980), it substitutive care (doing for the other what they are unable to do for themselves) but doing no more than is necessary to conserve the client's energy or preserve the client's dignity.

• It is creating an environment in which self-healing can occur similar to Nightingale's I8591 notions of providing an environment in which the body's inherent healing tendencies can operate.

• It is client's internal environment (e.g. self concept, knowledge or skills level) that is altered in order to enable healing; at other times it is the external environment that is manipulated (i.e., provision of safety devices, removal of physical, social or emotional threats orobstacles).