Swanson Caring Theory

Contributor – Kristen M. Swanson

Author – Kristen M. Swanson

First published – 1986

Major Concepts

I define caring as ‘a nurturing way of relating to a valued other towards whom one feels a personal sense of commitment and responsibility.’ It involves five caring processes that solicit healing responses:

  • Knowing – striving to understand an even as it has meaning in the life of the other. Hence, the recipient feels understood.
  • Being with – being emotionally present to the other. Thusly, the recipient feeling valued.
  • Doing for – doing for the other as they would do for themselves if it were at all possible. Consequently, the recipient feels safe and comforted.
  • Enabling – providing sufficient information, validation, and support that the recipient feels capable of getting through an event or transition.
  • Maintaining belief – sustaining faith in the other’s capacity to come through an event or transition and face a future with meaning. The recipient, thusly, feels hopeful (as opposed to hopeless).

The consequence of knowing, being with, doing for, enabling, and maintaining belief the recipient experiences a sense of healing (wholeness) as manifested through feeling understood, valued, safe and comforted, capable, and hopeful for the future. Lastly, as illustrated below. Although maintaining belief is defined as the fifth process, it is actually the prime process from which all others emanate.

Typology

Middle range theory that was initially developed through three phenomenological studies in the perinatal loss context (Swanson, 1991, 1993, 2019)

Brief Description

The first study from which the theory emerged included interviews with 20 women who had recently miscarried (Swanson, 1986, 1988); the second involved two years of observational study plus interviews with 19 care providers (mothers, fathers, physicians, nurses, and a medical ethicist) in the newborn intensive care unit (NICU) (Swanson, 1990); and the third involved marginalized mothers who had participated in a long term public health intervention with masters prepared nurses charged with helping the women take care of themselves so that they might be better prepared to care for their baby (Swanson, 1991, 1993). Mothers had been enrolled in the public health study at three months gestation through a Women, Infants, and Children Public Health Program. The nurses (n = 5) and mothers (n = 69) worked together for approximately 18 months. Four years after the public health study ended, I interviewed eight of the original 69 mothers. Across all three studies the basic question was ‘what constitutes caring in the context of (1) miscarrying; (2) providing care in the NICU; (3) or receiving care during early motherhood.

I and others further developed the caring theory and its measurement through additional research. In a meta synthesis of the caring literature in 1999, I found considerable empirical evidence for the five caring processes across a variety of nursing and other care related studies. With the support of NIH, NINR funding, my research teams demonstrated the effectiveness of caring-based counseling on women (1999) and couples’ (2009) healing after miscarriage.

Over the years the theory has been translated, applied, measured, and validated for its relevance to practice, education, research, and policy. These studies and applications have involved nurses as well as other professionals.

Primary Sources

Swanson-Kauffman, K. M. (1986). Caring in the instance of unexpected early pregnancy loss. Topics in Clinical Nursing, 8(2), 37-46.https://doi.org/10.1016/j.hrtlng.2015.12.007   

Swanson-Kauffman, K. M. (1988).  Empirical development and refinement of a model of caring. Communicating Nursing Research, 21, 80.

Swanson, K. M. (1990). Providing care in the NICU: Sometimes an act of love. Advances in Nursing Science, 13(1), 60-73. Relf, M. V., Holt, L., Kirton, C., Overstreet, K., Ramos, S. R., Swanson, B., & Webel, A. (2021). Race as a research variable: Should it be retained or discarded? The Journal of the Association of Nurses in AIDS Care: JANAC, 32(5), 531–533. https://doi.org/10.1097/JNC.0000000000000293

Swanson, K. M. (1990). Providing care in the NICU: sometimes an act of love: Sometimes an act of love. ANS. Advances in Nursing Science, 13(1), 60–73. https://doi.org/10.1097/00012272-199009000-00008

Swanson, K. M. (1991). Empirical development of a middle range theory of caring.  Nursing Research, 40(3), 161-166. 

Swanson, K. M. (1993).  Nursing as informed caring for the well-being of others. Image: The Journal of Nursing Scholarship, 25(4), 352-357.

Swanson, K. M. (1999). Effects of caring, measurement, and time on miscarriage impact and women’s well-being in the first year subsequent to loss, Nursing Research, 48(6), 288-298. 

Swanson, K. M. (1999). What is known about caring in nursing: A literary meta-analysis.  In A.S. Hinshaw, J. Shaver, and S. Feetham (Eds). Handbook of Clinical Nursing Research (pp. 31-60).   Thousand Oaks: Sage Publications.https//doi.org/10.4135/9781412991452.n3 

NOTE: Published again (2012) In M. C. Smith, M. C. Turkel, Z.R. Wolf (Eds) Caring in Nursing Classics: An Essential Resource  doi: 10.1891/9780826171122.0004

Swanson K. M., Chen H. T., Graham J. C., Wojnar D. M., & Petras A. (2009). Resolution of depression and grief during the first year after miscarriage: A randomized controlled clinical trial of couples-focused interventions. J Women’s Health and Gender-based Medicine, 18(8), 1245-1257. http://www.liebertonline.com/doi/abs/10.1089/jwh.2008.1202. 

Swanson, K. M. (2019).  Kristen Swanson’s Theory of Caring.  In M. C. Smith (Ed.) Nursing theories and nursing practice, (5th ed., pp. 503-508). Philadelphia: F. A. Davis Co.

About Kristen M. Swanson

Kristen M. Swanson PhD, RN, FAAN is Dean and Professor, Seattle University College of Nursing. Former positions include 25 years at the University of Washington in Seattle where she began as a postdoctoral fellow and concluded Kristen M. Swanson PhD, RN, FAAN is Dean and Professor, Seattle University College of Nursing. Former positions include 25 years at the University of Washington in Seattle where she began as a postdoctoral fellow and concluded her tenure as the University of Washington Medical Center Distinguished Professor in Nursing Leadership and Chair of the Department of Family and Child Nursing. For five years, she served as Dean and Alumni Distinguished Professor at the University of North Carolina at Chapel Hill. Dr. Swanson received her BSN from the University of Rhode Island, MSN from the University of Pennsylvania, PhD from the University of Colorado (Chair, Dr. Jean Watson) and completed an individually awarded postdoctoral fellowship at the University of Washington (Mentor, Dr. Kathryn Barnard). She empirically developed the Swanson Caring Theory (a mid-range theory) through phenomenological studies in three perinatal contexts. Through two NIH, NINR funded randomized controlled trials, she tested the effectiveness of caring-based interventions in supporting couples healing after miscarriage. The Swanson Caring Theory is used internationally as a framework for research, practice, and teaching. Dr. Swanson was a former Robert Wood Johnson Executive Nurse Fellow, is a member of the American Academy of Nursing, is an at-large member of the American Association of Colleges of Nursing, and serves as Board Chair of the Swedish Health System in Seattle, Washington. She is most proud of her two adult sons, their wives, and her precious granddaughter.