Caring-Healing Inquiry for Holistic Nursing Practice: Model for Research and Evidence-Based Practice

Karen Dorn, RN, PhD, APRN-BC


Topics in Advanced Practice Nursing eJournal. 2004;4(4) 

In This Article

An Integrated Approach

Stetler and associates [6] identify the 4 bases of nursing practice as the evidence base, philosophic and conceptual base, regulatory base, and traditional base. Caring, as a central paradigm of nursing, provides a rich philosophic and conceptual base on which to build a nursing research program. Rooted in humanistic values, caring philosophy has a basic concern for human dignity, recognizing the unique worth of each person.[7] Florence Nightingale is considered by some to be the first caring theorist in nursing.[7,8] Her action-oriented approach to caring is evident in modern nursing and, according to Watson,[9] may not yet be fully realized.

Many nurse theorists view caring as the essence of nursing[10] -- the central focus[11] and central value of nursing practice.[12] Conceptualizations of caring in nursing convey caring as a human trait, moral imperative, affect, interpersonal interaction, and therapeutic intervention.[13] Although diverse perspectives of caring exist, a unifying theme is that the ultimate aim of caring is to alter a patient's response: a response that may be a shift in subjective meaning or a change in physical or emotional condition. Caring theory, although an appropriate foundation for any health profession,[14,15] is uniquely central to the nursing profession.

The evidence base for nursing practice consists of research and EBP -- both essential, yet distinct processes. Research focuses on knowledge discovery, whereas EBP focuses on knowledge application.[16] Holistic practice requires consideration of multiple types of theories, including empirical, ethical, personal, and aesthetic -- each with unique modes of inquiry and corresponding evidence.[17] Caring research in nursing validates the rich philosophic and conceptual basis of caring.[1,18] Swanson[18] identifies the 5 levels (I-V) of caring research on the basis of a meta-analysis. These are (1) the human capacity for caring, (2) concerns and commitments reflecting the values that underlie nurse caring, (3) conditions that either enhance or inhibit caring, (4) caring actions and caring-based nursing interventions, and (5) caring outcomes or consequences of caring. Beginning with the first level, each subsequent level requires an assumption that the previous level exists. Thus, in order for the nurse to alter the conditions that enhance caring, it is assumed that the nurse has the capacity for caring.

Definitions of EBP in nursing reflect a commitment to value the diverse perspectives described in nursing theories (such as caring theories) and the multiple research methods derived from those theories, both qualitative and quantitative.[16,17] EBP has been broadly defined as "the conscientious, explicit and judicious use of theory-derived, research-based information in making decisions about care delivery to individuals or groups of patients and in consideration of individuals needs and preferences.[16]" Evidence, as a basis for nursing practice, may be derived from research, performance data from operations and quality improvement, consensus recommendations of experts, and affirmed experiences of nurses, such as reflections of practice and documentation of goals and outcomes.[6]

There is a need to build the existing knowledge base of caring theory, research, and EBP. Caring research is needed to increase the knowledge and understanding of the role of caring on health and healing, to empirically validate caring theories and practice models, to bench mark nursing practice, and to encourage multiple modalities of caring-healing practice.[1]


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