Unitary Caring

Contributor: Marlaine Smith
August 28, 2021

Author – Marlaine Smith, RN, PhD, AHN-BC, FAAN

First published –

Published in 1999 as a concept clarification and substantively expanded to a middle range theory in 2010.

Copyright 2021 Marlaine Smith

Major Concepts

  • Manifesting intentions
  • Appreciating pattern
  • Attuning to dynamic flow
  • Experiencing the Infinite
  • Inviting creative emergence


Middle range theory

Brief Description

The middle range theory of Unitary Caring resides in the unitary-transformative paradigm and is derived from Rogers’ (1992) SUHB, Newman’s Theory of Health as Expanding Consciousness (2008), and Watson’s Theory of Transpersonal Caring (2008), currently called Unitary Caring Science (2018). Barrett’s middle range Power theory and Phillips’ concept of wellbecoming are foundational SUHB literature drawn upon as well.


  1. Human beings are pandimensional energy fields, integral and in a mutual process of patterning with pandimensional environmental energy fields.
  2. Human beings knowingly participate in the unitary patterning of their wellbecoming.
  3. Consciousness is the pandimensional awareness (knowing and being) of the human-environment energy fields.
  4. Caring is a quality of consciousness and a way of participating knowingly in human–environment field patterning through which wholeness is affirmed, diversity is appreciated, emergent possibilities are potentiated, and wellbecoming is nurtured.


Manifesting intentions

Manifesting intentions is defined as “creating, holding and expressing thoughts, images, feelings, beliefs, desires, will (purpose), and actions that affirm possibilities” for wellbecoming. (Smith, 1999, p 21). Intentions are powerful in human-environment field patterning and constitute knowing participation in change. Manifesting intentions is creating sacred space characterized by reverence, commitment, authenticity, concern, and presence in in any nursing encounter. (Smith, 1999). The nurse becomes the healing environment.

Appreciating Pattern

Appreciating pattern was described by Cowling. Cowling defined unitary pattern appreciation as “discovery in the service of knowing wholeness and essence” (p. 61). It is “apprehending and understanding the mysteries of human wholeness and diversity with awe.” (Smith, 2020, p. 495). Appreciating pattern is grasping uniqueness and wholeness through sensing, co-exploring experiences and deep listening. This happens through letting go of preconceptions and the need to categorize, classify, label, or judge. (Smith, 2020).

Attuning to Dynamic Flow

Attuning to dynamic flow is defined as “sensing where to place focus and attention in mutual process” (Smith, 2020, p. 496). Unitary caring is tuning into and resonating with another’s vibrational frequency. Newman (2008) describes this phenomenon as resonance, the awareness of spontaneous intuitive insights and feelings. “Attuning to dynamic flow is a heightened sensitivity to the rhythmic patterning of relating. Through this attuning, there is awareness of when and how to move, be still, speak, be silent, laugh, cry, touch or withdraw.” (Smith, 1999, p. 24).

Experiencing the Infinite

Experiencing the Infinite is “pandimensional awareness of coextensiveness with the universe occurring in the context of human relating” (Smith, 1999, p. 24). Watson (1985) calls this as an actual caring occasion, where the spirit of both transcends space, time and physicality. In those moments, there is an experience of connectedness to all-that-is extending beyond space-time boundaries that defies description in ordinary language”. (Smith, 2020, p. 496).

Inviting Creative Emergence

Inviting creative emergence is defined as “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” (Smith, 2010, 2015, 2020). Unitary caring is inspiring wellbecoming by creating safe space for new patterns to emerge through supporting, coaching, offering encouragement.


The propositions in the theory of Unitary Caring are statements that define, clarify and synthesize the theoretical ideas in the assumptions and concepts. These are clearly stated in the circles representing the concepts in the model.

Primary Sources

Smith, M.C. (1999). Caring and the Science of Unitary Human Beings. Advances in Nursing Science, 21(4), 14-28.

Smith, M.C. (2010). Smith’s theory of unitary caring. In Nursing Theories and Nursing Practice 3rd ed. Parker, M. & Smith, M.C. (Eds.). Philadelphia: F.A. Davis.

Smith, M.C. (2015). Marlaine Smith’s theory of unitary caring, In Nursing Theories and Nursing Practice 4th ed. Smith, M.C. & Parker, M. (Eds.). Philadelphia: F.A. Davis.

Smith, M.C. (2020) Marlaine Smith’s theory of unitary caring. In Nursing Theories and Nursing Practice. 5th ed. M.C. Smith (Ed.) Philadelphia: F.A. Davis, 493-502.

Smith, M.C. (In Press). Theory of Unitary Caring. In M.J. Smith & P. Liehr. Middle Range Theory for Nursing. New York: Springer.

Watson, J.& Smith, M.C. (2002). Caring science and the science of unitary human beings: A trans-theoretical discourse for nursing knowledge development. Journal of Advanced Nursing, 37(5), 452-461.

Watson, J., Smith, M.C. & Cowling, R. (2019). Unitary Caring Science: Disciplinary evolution of Nursing. In W. Rosa, J. Watson, & S. Horton-Deutch, Handbook of Caring Science. New York: NY: Springer.

About the Author – Marlaine C. Smith

Marlaine Cappelli Smith is known for her work in metatheory, or the study of nursing theories and theoretical issues, research and theory development related to healing through touch therapies, and advancing Caring Science including the development of the middle range theory of Unitary Caring. She has studied, written about, and conducted research related to Rogers’ Science of Unitary Human Beings (SUHB), Parse’s Humanbecoming theory, Watson’s Theory of Transpersonal Caring, and Newman’s theory of Health as Expanding Consciousness, and has written many commentaries on issues related to nursing knowledge. Marlaine conducted five research studies examining the impact of touch therapies of massage, therapeutic touch, hand massage, and simple touch on pain, symptom distress, quality of life, sleep and other outcomes for persons in acute and long-term care settings. The last completed study, a multisite RCT, was funded by the NIH, National Center for Complementary and Alternative Medicine. She has been interested in transtheoretical work, that is looking across nursing theories for points of convergence. The middle range theory of Unitary Caring was developed while studying the literature on caring in nursing and analyzing this literature through the lens of the SUHB.

Marlaine has held academic appointments at Duquesne University, Penn State, LaRoche College, University of Colorado (CU) and Florida Atlantic University (FAU), including serving as Associate Dean for Academic Affairs at both CU (2001-2006) and FAU (2006-2011), Dean at FAU (2011-2019) and the Director of the Anne Boykin Institute for the Advancement of Caring in Nursing. She retired from her faculty position at FAU as Professor and Helen K. Persson Eminent Scholar in August, 2021. Marlaine has published over 150 journal articles, columns, monographs, abstracts, and book chapters, and is editor, co-editor or associate editor of three editions of Nursing Theories and Nursing Practice, Caring in Nursing Classics, Philosophies and Practices of Emancipatory Nursing: Social Justice as Praxis, and Handbook for Caring Science: Expanding the Paradigm. Over the course of her career she taught 53 different courses, chaired 23 dissertations, and served on an additional 57 dissertation committees. She has significant experience developing curricula for BSN, MSN, DNP and PhD programs, and serves as a “thought leader” in developing Tool Kits for the newly developed AACN Essentials (2021).

Marlaine completed her BSN at Duquesne University, her MPH and MNEd at the University of Pittsburgh, and her PhD in Nursing Science at New York University. Honors include: Fellow of the American Academy of Nursing, Honorary Scholar in the Global Academy of Holistic Nursing, Florida Nurses Association Hall of Fame, DAISY Award, Nurse of the Year – Palm Healthcare Foundation, Florida Nursing Student Association Dean of the Year, Great 100 Nurses of Florida, National League for Nursing’s Martha E. Rogers Award and New York University’s Distinguished Alumna Award. She is certified as an Advanced Holistic Nurse and Integrative Health and Wellness Coach, and has studied and/or completed certificate programs in aromatherapy, mindfulness-based stress reduction, high touch jin shin, guided imagery, meditation, Reiki and yoga.