The Concept of Caring in Nursing with different Ontological Traditions

This article discusses the concept of caring in nursing and its evolution over time. It explores the different ontological traditions of caring, including human science, complexity theory, and critical theory. The article also identifies ethical issues related to nursing care and the controversies and intersections that occur when comparing the concept of caring in nursing across ontological traditions.

Concept of caring in nursing 1
The Concept of Caring in Nursing with different Ontological Traditions.
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Concept of caring in nursing 2
Caring is the fundamental concept of nursing that differentiates it from other health care
professions and provides a framework to guide the nursing practice (Cook & Peden, 2017).
According to Calong & Soriano (2018), many nursing theorists identified that caring is the
fundamental principle in nursing practice applied to achieve and maintain the well-being of
patients. One of the first theorist, Leininger, stated that caring is the principle, dominant and
unifying focus of nursing (Cook & Peden, 2017). The concept of care is an integral component
of holistic nursing practice. It integrated with knowledge, skills, and competence to provide safe
quality care (Como, 2007). According to Leyson, caring is the interaction between the nurse and
the patient with the goal of preserving life (Calong & Soriano, 2018). Just as the role of the nurse
has changed over the years, the concept of caring has also similarly evolved over time and has
also influenced nursing practices, education, and research (Calong & Soriano, 2018).
Nurses have a wide range of roles from educators, to researchers, to policymakers, in
order to satisfy the complex needs of healthcare consumers (Davidson, Rushton, Kurtz, Wise,
Jackson, Beaman, & Broome, 2018). This article elaborates the concept of caring in nursing by
using different ontological lenses such as Human science, Complexity, and Critical theory,
besides identifying ethical issues related to nursing care. This article also describes controversies
and intersections that occur when comparing the concept of caring in nursing across ontological
traditions.
The concept of caring with different ontological traditions.
Caring as a human science.
The concept of caring in nursing as a human science emphasizes on life and health as
human experiences (McIntyre & McDonald, 2013). This concept suggests that patients are

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subjects with the ability to take charge of their own lives, rather than as mere objects (Pilkington,
2005). Nurses provide care to vulnerable individuals with ailments such as illness, mental or
social problems. According to my clinical practice, patients with dementia are unique human
beings who can feel and respond to any stimuli, that possess a unique history, values, beliefs, and
experiences (Bell & Troxel, 2013). The human science hypothesis enables medical caretakers to
think about the patient's life direction and encounters, including the moral and individual setting
(Federal, Porto, & Grande, 2018). Hence, this theory allows patients with dementia to require the
same level of holistic care as other patients, regardless of their current competencies.
According to human science ontological tradition states that human beings are unitary
wholes in continuous interrelationship with their dynamics, historical, and cultural world
(Mitchell & Cody, 1992). Watson suggested the need for cultivation of intentionality and caring
consciousness to be mindful about what is most important for patients to provide the best
possible care (Pilkington, 2005). Patients with dementia have the right to live in a safe and
stimulating environment where they can experience meaningful engagement (Bell & Troxel,
2013). The caring theory suggested by Watson narrows down to the application critical reasoning
to center around the humanistic components of patient consideration in the distinctive settings to
accomplish ideal results (Federal et al., 2018).
The complexity theory.
The complexity theory of nursing is a way to understand the communities and the
healthcare organization where patient care remains the central focus of a complex health care
system (Mitchell, Jonas-Simpson & Cross, 2013). Nursing happens within complex intersections
where human relationships, social determinants, global forces, and personal realities mingle and

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influence health (Mcsherry & Douglas, 2011). It offers an appropriate perspective to understand
the unpredictable nature of a complex health system and multiple determinants that influence
organizational culture for the health care of a patient (Thompson, Fazio, Kustra, Patrick &
Stanley, 2016). The complexity theory is nonlinear dynamics that offers a perspective to
studying complex systems in a manner to understand how minor changes have an impact on the
overall health outcome (Thompson et al., 2016). Inter-professional collaboration is the best
strategy to achieve desired health outcomes effectively by monitoring health status, coordinating
care, and developing an evidence-based care plan in the complex health system (Martin,
Ummenhofer, Manser, & Spirig, 2010).
Complexity theory provides a better framework for understanding the impact of the
different factors influencing health while maintaining the distinctiveness of each nursing
interaction (Walsh, 2000). Nowadays, clinical care is becoming more complex and multi-
disciplinary cooperation is crucial to facilitate a well-coordinated health care provision
framework to deliver safe quality care; where one patient needs more than one professional to be
satisfied (Martin, Ummenhofer, Manser, & Spirig, 2010). Inter-professional collaboration is
achieved by bringing skills and knowledge of all health professionals in one platform and
working together as a team to deliver better care to maximize health benefits (Engel & Prentice,
2013). Collaborative practice is an ethical responsibility of nurses to maximize health benefits of
the patient by recognizing and respecting the knowledge, skills, and perspectives of the
specialties (Ewashen, McInnis-Perry & Murphy, 2013).
The ontology of critical theory

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The ontology of critical theory is derived from the Marxist philosophy. It focusses on
the idea understanding human activities and how the influences are felt by the large social
structures (Mosqueda-Diaz, Vilchez-Barboza, Valenzuela-Suazo, & Sanhueza-Alvarado, 2014).
Human beings are a product of their environment, history, society, and culture. Experiences are
viewed as a major contributor of their perspective of the world (Gathercoal, Gathercoal,
Seegobin, & Hadley, 2017). Watson’s human care theory assists nurses to consider patient’s life
experiences, and also develop skills for holistic assessments to understand the historical bio-
psycho-social context and cultural context of the patient (Federal et al., 2018). When nurses
understand the health of a society is shaped by the social, political, and economic influences, and
they are more likely to acknowledge social action as a part of nursing care to reduce social
inequities and take actions on behalf of their patients (Butterfield, 1990). According to Watson
caring theory that humans cannot be separated from the social environment because it is
centrality focus on therapeutic healing processes and relationships and it affects both the one
who is caring and the one who is being cared for (Pilkington, 2005).
According to the critical theory nurses should offer culturally acceptable care, identify
social disparities, and implement creative strategies to find a practical solution to modify
differences and provide quality care (Mosqueda-Diaz, Vilchez-Barboza, Valenzuela-Suazo, &
Sanhueza- Alvarado, 2014). The caring concept in nursing is socially constructed, thus the value
of nursing care may be different depending on the basis of attitudes and contexts (Dick, Patrician
& Loan, 2017). Nursing care takes place in a many different individuals, societal cultures and
practice environments (Davidson, Rushton, Kurtz, Wise, Jackson, Beaman, & Broome, 2018).
Nursing care is critical in different healthcare settings because nurses proudly focus on to
provide holistic care and contribute to the positive health outcomes of their patients in tangible

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and intangible ways (Dick, Patrician, & Loan, 2017). Critical theory helps to examine the
interaction between power and the social structures that produce the societal inequalities
(Mosqueda-Diaz et al., 2014). Nursing care focusses on the protecting and promoting of health,
prevention of illness, alleviation of suffering, and advocacy in the care of individuals, families,
and communities (Davidson et al., 2018). Nurses need to understand the complex social, cultural,
environmental, political and economic forces have a more profound influence on health
behaviors to promote health in individuals and groups (Butterfield, 1990).
Ethical issues related to nursing care
Nurses practice in assorted settings where different extents of training, social insurance
directions, and approaches, impact moral basic leadership to give the most ideal consideration.
Despite the setting, nurses must hold fast to an arrangement of expert and philosophical qualities
that are reflected in their codes of morals (Rooddehghan, Yekta, and Nasrabadi, 2018). A portion
of the normal moral issues emerges in expert nursing practice while giving consideration to
accomplish wellbeing objectives are the regard for the self-governance of patients, helpfulness,
equity, and non-perniciousness (Vryonides, Papastavrou, Charalambous, Andreou, and
Merkouris, 2015).
complexity ontology theory underscored that people are living in complex versatile
frameworks where intelligent process, non-straight change, organized associations, and changes
persistently developing to deliver new substances and new potential outcomes (Mitchell, Jonas-
Simpson and Cross, 2013). Comprehensive nursing care considers the experience of the patient
and makes a social insurance condition concentrated on patient wellbeing, nature of
consideration, and enhanced soundness of the populace through interdisciplinary cooperation

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(Dick et al., 2017). Inter-professional care is fundamental to give the most ideal consideration as
indicated by their claim, yet now and then it is the most conspicuous hindrance to accomplish
ideal wellbeing results. Multidisciplinary team member comes with different viewpoints
according to their unique knowledge and skills which may evoke a disagreement within the inter-
professional team and can cause moral distress for the nurse (Engel & Prentice, 2013).
Sometimes circumstance raises serious issues about the viability of true collaboration in health
care. Lack of collaboration and communication between healthcare professionals have a negative
impact on patient health outcomes and the delivery of safe quality care (Martin, Ummenhofer,
Manser, & Spirig, 2010). A lack of communication or intervention during some situations raises
ethical issues for nurses (HL Preshaw, Brazil, McLaughlin, & Frolic, 2016). The most significant
barrier is resulting mainly from a lack of proper articulation, awareness, and recognition of the
role of the other professionals (Supper, Catala, Lustman, Chemla, Bourgueli, & Letrilliart, 2015).
Critical social theory helps nurses to expose social inequities that prohibit people
from reaching their full potential and limited the choices truly available for them (Butterfield,
1990). Nursing care focus beyond scientific knowledge to gain a better understanding of lived
experiences of patients, systems, and communities that are affected by social determinants of
health (Davidson et al., 2018). Nursing care aims at preserving and promoting the dignity of
individuals and ensuring the provision of fundamental rights to achieve social justice, foster the
economic and social development of the community (Wood, 2011). Salmon supports that
principles of western medicine focus the health and illness of the individual while obscuring the
exploration of their social, economic conditions (Butterfield, 1990). Critical theory supports the
identification of social disparities and the promotion of quality care to improve health outcomes
for society (Mosqueda-Diaz et al., 2014). It is tough for nurses to distribute recourses equitably

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according to organizational policies due to a lack of resources when patients health get
compromised (HL Preshaw, Brazil, McLaughlin, & Frolic, 2016). Nursing care includes
advocacy on behalf of patients when the wellbeing of patients is threatened (Butterfield, 1990).
Human science theory focuses on the importance of the nurse-client relationship by
exploring the life experience of the client in connection with the universe (Mitchell & Cody,
1992). This crucial time spent with the patient can help to identify their unique experience and
health goals. Patients always perceive compassion as closely linked to the broader concept of
conveying care within the nursing practice. Compassion requires time and commitment by
practitioners in order to build an honest relationship (Bramley & Matiti, 2104). Nurses proudly
provide holistic care to contribute to the best health outcomes of patients. However, at times
nurses experience ethical dilemma when trying to balance highly acute patient needs with limited
resources, and the physical demands of nursing overload (Duffy, 2009). Inadequate staffing and
unrealistic workloads place an unnecessary burden on nursing staff members, reduce the quality
of care that nurses can provide, lead to fatigue and unachievable expectations, and result in
uncompleted tasks (Garrett, 2008). Evidence suggests that inadequate nursing staffing level can
be a danger to patients since burnt-out nurses are less likely able to provide holistic and
compassionate care (Scott et al., 2014).
Controversies and intersections between different ontological traditions
Nursing care includes patient-centered care planning, critical thinking, advocacy, and
care coordination within complex health systems to achieve the best health outcomes. All
different philosophical, ontological traditions are interconnected and make a significant
contribution to gain proper knowledge to provide safe quality care according to a specific

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situation. All different ontological traditions are based on self-reflection of life experiences and
how external factors such as societal, historical, ideological, cultural influence the health
outcomes of an individual (McIntyre & McDonald, 2013). Nursing care is fundamental to
achieve high-quality healthcare by addressing the social determinants of health and enabling
people to make choices regarding health promotion, and illness prevention (Mcsherry &
Douglas, 2011). Some of the controversies related to the different ontological traditions are
more complex and inconsistent for application in clinical practice. In modern society, evidence-
based research is focused on treating illness and achieving the best health outcomes. Therefore,
nursing care emphases solely on the biomedical and clinical aspects of healthcare delivery in
hospitals because complex realities are too big to address (Mcsherry & Douglas, 2011).
Best Ontological tradition
Nurses continuously provide care to different patients on a daily basis and
continuously fulfill patient’s needs and expectations (Calong & Soriano, 2018). It is clear that
one particular ontological tradition can not offer a complete view of nursing care. Nurses need to
critically evaluate and incorporate different ontological traditions to determine the most effective
and appropriate nursing action to provide the best possible care. The Complexity theory is the
best ontological tradition that emphasizes to understand the complex health system and elements
existing within the nursing system interact with one another to produce specific behavior, in
relation to the safe quality nursing care (Chandler, Rycroft-Malone, Hawkes & Noyes, 2016).
Nowadays, health care is becoming more complex and specialized necessitating different
healthcare professionals to work together as a team to coordinate patient's care to reduces the
number of medical errors and increases patient safety (Manser, 2009). Watson’s theory argues
that the application of critical thinking is focused on the humanistic dimensions of patient care in

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the different contexts to provide the optimal level of care (Federal, Porto, & Grande, 2018).
Nurses have a central role to support the family participation and collaboration in care to
positively enhance the quality of patient care (Mackie, Marshall & Mitchell, 2018). In
conclusion, nursing practice is a blend of all different ontological traditions to provide the best
possible care to ultimately achieve the well-being of the patient.