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1. Middle Range vs. Grand Theories

2. The Concept of Caring in Nursing

Caring Theories Examples

• Jean Watson – Theory of Human Caring

• Kristen Swanson – Theory of Caring

• Madeleine Leininger – Cultural Care Theory

• Boykin & Schoenhofer – Nursing as Caring

• Sister M. Simone Roach – 5 Cs of Caring

Definition of Caring

• Central to nursing

• Helps the nurse:

• Know the person

• Explore problems

• Discover solutions

• Involves:

• Ethics

• Respect for personhood

• Advocacy

• A relationship-based approach

Nurse Behaviors Perceived as Caring (Hynnekleiv et al., 2024)

• Honesty, competence, clear expectations

• Accessibility, keeping families informed

• Relieving suffering, supporting independence

• Teaching family how to provide comfort

Barriers to Caring

• Task-oriented care

• Technology dominance

• Staffing and skill mix issues

• Lack of time

• Leadership limitations

The Art of Nursing: Caring Behaviors

• Wisdom, insight, compassion

• Hope, connectedness, humor

• Presence, empowerment

• Spiritual comfort and adaptation

3. Middle Range Theory of Comfort (Kolcaba, 1994)

Purpose

• Address comfort needs in nursing practice and research

• Enhances patient well-being and satisfaction

Four Contexts of Comfort

1. Physical – Body symptoms and sensations

2. Psychospiritual – Self-esteem, meaning, spirituality

3. Environmental – External surroundings, ambiance

4. Sociocultural – Relationships and cultural norms

Three Forms of Comfort

1. Relief – Needs are met

2. Ease – Calm, contentment

3. Transcendence – Rising above problems

Examples of Comfort Strategies

• Pain relief, emotional safety

• Supportive environments

• Promoting resilience

• Enhancing hope and spirituality

Outcomes of Comfort-Focused Care

• Higher function

• Quicker discharge

• Fewer readmissions

• Better patient satisfaction

• Financial benefits to the institution

4. Middle Range Theory of Chronic Sorrow (Eakes, Burke, Hainsworth, 1998)

Definition

• Chronic sorrow is the recurring grief experienced from ongoing loss

• A response to the disparity between current reality and what was hoped for

Four Defining Characteristics

1. No predictable end

2. Cyclic or recurrent

3. Triggered by internal or external events

4. Progressive – Can intensify over time

Types of Loss

• Single Loss Event: Sudden life-altering events

• Ongoing Loss Events: Chronic conditions, ongoing caregiving

Coping Strategies for Chronic Sorrow

• Encourage personal activities

• Offer respite to caregivers

• Provide information and support

• Take a “one-day-at-a-time” approach

• Facilitate peer and professional conversations

• Support use of personal/spiritual beliefs

Application to Nursing Practice

• Be sensitive to trigger events that may arise during care

•Understand how theory (e.g., comfort, chronic sorrow) can guide interventions and build relationships with patients and families