Review Article

総 説

Examining Caring Theories in Nursing from Non-nursing Viewpoints
Rieko Matsuoka
National College of Nursing, Japan ; 1-2-1 Umezono, Kiyose-shi, Tokyo, 〒 204-8575, Japanmatsuokar＠adm.ncn.ac.jp【Abstract】 Caring is regarded as a fundamental concept to humans and in nursing, as Heidegger (1975) posits caring as an essential part in being a,human. Accordingly, caring is a universal phenomenon that influences humans way of living in relation to one another. This review article examines
main caring theories in nursing, and compares them in terms of the meaning, the constructs of care, and the way in which caring is applied in nursing,from non-nursing perspectives with some attention towards communication, based on the belief that caring, which is relational and interactive, shouldarise in the relationship and/or communication between the nurse and patient. Furthermore, the supposition that caring should be the central part ofnursing will be discussed.

【Keywords】 care ケア，caring ケアリング，caring theory ケア理論，phenomenology 現象学，carative factors ケアの要因

In this review article, main caring theories in nursing are
Introduction

examined and compared, in terms of the meaning, the constructs
of care/caring, and the way in which caring is applied in nursing.

Caring, which is regarded as a fundamental concept to humans
based on the fact that humans are social beings, meaning that we

Furthermore, the supposition that caring should be the central partof nursing (e.g., Watson, 2005) will be discussed.

humans are related to one another in our lives, is posited as an
essential part in being a human by Heidegger (1975).

Definitions of Care / Caring

Accordingly, caring is a universal phenomenon that influences,
humans way of living in relation to one another, and has been

In our social lives, care has been one of the most frequently

studied and theorized by nursing researchers (e.g., Watson, 1985,

used words in verbal exchange, as its attribute of involving the2005; Leininger, 1988, Benner & Wrubel, 1989, Roach, 1992).

other individual. According to Bevis (1988), the word care, as

Watson (2005), for instance, argues that caring should be awell as cure, is derived from the word cura, which has the dual

framework for research in nursing, while Leininger (1988)

meaning of anxious exertion, and carefulness and devotedness;believes that caring has been the central part in nursing. By thethese meanings influence the modern English use of these words.

same token, Benner and Wrubel (1989) take the position of

May (1969) defines caring as a feeling denoting a relationshipviewing caring as primacy and as a concept central to their theoryof nursing practice. On the other hand, Sumner (2006) in herof dedication, taking the ultimate terms, to suffer for, the other .
,Bevis (1988) further elaborates May s definition, stating thatconcept analysis of caring claims that caring in nursing remains an

caring demands that feelings be converted into behaviors and thatunresolved topic, and that existing theories have limitations.
The author of this review paper, with expertise not in nursing

the behaviors and feelings be accompanied by thought,
constructively and positively, and in taking account of Heidegger s

but in communication, has been interested in caring theories inview (1975) seeing it as equivalent to the will or the motivating

nursing partly because caring, which is relational and interactive,

force of life.

should arise in the relationship and/or communication between theLeininger (1988), whilst acknowledging that care and caring

nurse and patient. In fact, Sumner (2006) believes that caring inhave multiple conceptualizations and characterization, defines

nursing is communication action as an ideal.

care/caring as a generic sense of assistive, supportive, or－ 43 －J Nurs Studies N C N J Vol.6 No.1 2007

facilitative acts toward or for another individual or group with

Philosophical perspectives about care/caring
Parse (1988) suggests that in order to understand caring from aevident or anticipated need to improve the condition.
Mayeroff (1971) speaks about caring as the antithesis of,simply using the other person to satisfy one s needs; it is not as an

human science perspective, it is important to explore the six basic

isolated feeling or a momentary relationship, but a process oftenets of it as an emerging theory about man, living, and health.
,
The first tenet is living unity referring to man s wholeness, which

helping another grow and actualize oneself through mutual trustmeans that man and environment create patterns of expression

and through a deepening and qualitative transformation of thewith each other, and through the patterns man is recognized. The

relationship.

second one is negentropy, the concept of negative entropy, which

Watson (1985, 2005) defines caring as a science and herrefers to the growth as multidimensional and moving toward

operational definition of caring science has been described as anincreasingly complex and heterogeneous dimensions. The third

evolving philosophical ethical-epistemic field of study that is

tenet is freedom in situation; Man chooses the place of existence

grounded in the discipline of nursing and informed by related

from contextual nature based on multidimensional experiences.

fields (Watson, 2005, p.63). Her philosophical metaphysical and

The fourth one is intersubjectivity i.e., an encounter between two

empirical findings are as follows;

human subjects. The fifth tenet is coexistence, meaning thata) Caring is a way of manifesting intentions,humanness is confirmed only in relation with other human beings.

b) Caring is the way of appreciating patterns,

The last one is co-constitution, i.e., making up relationships inc) Caring is a way of experiencing the infinite, andwhich each individual chooses a way of being.
Leininger (1988) posits that a worldview approach is essentiald) Caring is a way of inviting creative emergence.
Benner and Wrubel (1989) suggests that caring is a word forto conceptualize paradigms, theories, and models related tobeing connected and having things work and a term for a wide

holistic caring. Kuhn (1970) has discussed the role andrange of involvements, such as from romantic love to parental

importance of paradigms in the evolution of the body oflove.

knowledge of a discipline, arguing the belief that knowledge andRoach (1992), on the other hand, has tried to define

caringscientific fields have developed through steady increments offrom the theological point of view, related to love, putting anknowledge. He emphasizes the importance in relational ontology

emphasis on involvement in the other individual.

of being in relations and the worldview of unity andA brief look at the literature for locating the definition has
revealed the complexity and vastness of meanings in care/caring.

connectedness, which should support diverse paradigms aboutcaring, rather than epistemology.

However, the inevitable attribute in care/caring, can be found in

Heidegger (1975) used the term Dasein to designate the being

the interactiveness or involvement with other individual(s); in

to whose being an understanding of beings belongs (p. 312),

other words, care/caring cannot be realized without the otherexistence. Though some researchers (e.g., Roach, 1992) havethough in German the word Dasein means simply existence ,,as in man s everyday existence (Drefus, 1987, p. 263). From a

included love in the notion of care , the subtle difference

phenomenological viewpoint, the relationship of the person to thebetween care/caring and love must be noted, that is, care seems

world, which has a fundamentally different meaning from ourto be generated at the higher level in the emotional and cognitive

common understanding of world, constructs our existence. World,

structure than love (c.f., Erikson, 1968).

according to Heidegger (1975), is a priori, given in our cultural

This brief review of definitions from some literature has

and linguistic practices and in our history. The world isrevealed the multiplicity within the notion of care/caring. Prior toconstitutive in the self and shaped by it in a process that is not theviewing caring theories, phenomenology needs to be consideredcausal interaction of self and world as objects, but rather the non-given that phenomenology offers a rich methodology to thereflective taking up of the meanings, linguistic skills, culturalscience of caring and that the existential-phenomenologicalpractices, and family traditions by which we become persons

factors acknowledge the personal, subjective experience of the(Leonard, 2001). Heidegger (1975) argues that one can arrive at

person as Watson (1985, 1988, 1999) asserts. Therefore, thethe view of the self only by passing over the world. Human

following philosophical considerations will help to excavate andexistence is involved in the working-out of the possibilities thatclarify the underlying meanings of care/caring, and theexist for us by virtue of our being thrown into a particular cultural,significance of care/caring in nursing, with communication being

historical, and familial world (Leonard, 2001).
As Bevis (1988) explicates, Heidegger regards

accordingly highlighted at the same time.

in German) as

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care(Sorgethe source of the will . For him, the will is thedriving force of life, and care is its source. Heidegger (1975),
cared for in today s world devaluing and demeaning human life,

thinks care to be the basic phenomenon of human existence

which may lead human race to being belittled. The last one is toincluding the sense of selfhood. In other words, by not caring we

explore and define care per se because the nursing profession

lose our selfhood, our being, our will. In not caring our being

since Nightingale has not systematically studied caring.

disintegrates. Heidegger (1975) believes that consciencemanifests itself as care.

On the other hand, Watson (1988), who believes that humanlife is a gift to be cherished - process of wonder, awe, and mystery,
Boykin, et al. (2005), following Heidegger s philosophy, state(p.17) , holds the view that the humans are valued to be caredthat the underlying structure of the nursing philosophical system isfor, respected, nurtured, understood and assisted, as a fully

created by the belief that all persons are caring by virtue of theirfunctional integrated self based on the philosophical belief that thehumanness, that to be human is to be caring. It is posited that all

humans are greater than and different from the sum of their parts,

nursing takes place in nursing situations − shared, lived experiences

instead of reducing the human to body systems.

in which the caring between nurse and nursed (patient) enhances

Vance (2003) mentions that caring and nursing have been

personhood; therefore, all nursing exists in the special relation ofthought of synonymously, and many individuals choose nursing as

caring between them. The nurse enters intentionally into the world

their profession because of their desire to care for otherof the other (patient) in order to come to know the other (patient)

individuals (cf. Roach, 1992); caring has been a central concept

as person (Boykin, et al., 2005).

in nursing for many researchers.

According to Watson (2002, 2005), a caring science
perspective exists in a relational ontology of being, and a

Caring theories in nursing

worldview of unity and connectedness of all. Furthermore, she

Several caring theories in nursing, which have been establishedadded that caring science investigations are reflective, subjective

based on the beliefs that caring is a seminal part in nursing, follow,

and interpretative, including multiple epistemological approaches.

as indicated in Table 1.

Watson states that the inner and infinite nature of the reality ofMayeroff (1971) observed that caring is more than merely

belonging and being is allowed for in caring science.
,
Following Heidegger s (1975) attitudes towards care/caring,interest, finding that essence of caring is a deep regard for anothermost researchers dealing with caring theories seem to adopt

regarded care/caring as a process that offers both carers and caredphenomenological perspectives in viewing the notion of care/

opportunities for personal growth. His caring process consists ofcaring given that human existence itself come into existencea) getting knowledge, b) alternating rhythms, c) being patient, d)through caring for the other. Accordingly, the elements featuring

being honest, e) trust, f) humility, g) hope, and h) courage.

and that caring is a crucial and vital component in nursing. He

phenomenology such as intersubjectivity and/or connectedness,

Leininger (1988) suggested that searching for the essence,

being relational, and/or relative, and being interpretative and,reflective, in contrast with Cartesian s philosophy which allows

nature, expression, and function of caring and its relationship tofor dichotomy, have been observed deep inside of each of theadmitting that caring should be the central, critical, and unifying

following theories of care/caring.

domain and focus for nursing care knowledge. She holds that

nursing care remains a major area of investigation, thoughcaring is the dominant intellectual, theoretical, heuristic, andCaring Theories

central practice in nursing, and no other profession has paid suchattention to caring behaviors, caring processes, and caring

Rationale

relationships. To endorse this claim, Leininger developed a,
Leininger s (1988) rationale for studying caring in nursingclassificationof

ethnocaring

constructs

based

on

her

research consists of the following four reasons. First, caring is theethnosceintific research (Ray, 1988), as an evidence of her belief

necessary ingredient for helping other people under the threat ofthat caring behaviors should appropriate the ethno-cultural

illnesses or diseases in a humanistic and scientific manner.

context.
Watson (2005) gave a credit to the theoretical and empirical

Leininger (1988) believes that humanistic caring is essential in
helping people in the middle of stressful, most adverse andwork of Swanson (1991, 1999), as an important contribution tochanging environments. Her second reason is to clarify the roles

caring science knowledge and understanding. Swanson (1991)

of caregivers and care recipients in various contexts as caring has

holds that caring is a nurturing way of relating to a valued otherinterdependent relationships between people. Her third reason is

toward whom one feels a personal sense of commitment andto preserve and maintain the human attribute of caring and being

responsibility, with caring aspects of a) knowing, b) being with,－ 45 －J Nurs Studies N C N J Vol.6 No.1 2007

Table 1 Overview of Caring Theories
Researcher

Meaning of Caring

Constructs of Caring

Mayeoff

Deep regard for another.

a) Getting knowledge,b) Alternating rhythms,

The clue to understandourselves; To find ourc) Being patient,d) Being honest,

stable place in the world.

e) Trust,f) Humility,

Application to Nursing
A crucial and vital
component in nursing.

Significance of Caring in
Nursing
A process that offers bothcarers and cared opportunities for personal growth.

g) Hope, andh) Courage.
Leininger

The essence, nature,

A classification of ethnocaring

The dominant intellectual,

expression, function;needs investigation.

constructs from her ethnoscein- theoretical, heuristic, andtific research.
central practice in nursing.
*Nursing has the mostThe essence and a central,
critical, and unifying
domain and focus fornursing care knowledge.

direct and immediate
relationship with caring.
SwansonNurturing way of relatinga) Knowing,

Can produceemotional-

Central to understanding

to a valued other.

b) Being with,c) Doing for,spiritual well-being,physical enhance healing,

the way caring is related toissues of concern andd) Enabling, ande) Maintaining belief.

trust relationship.

significance.

Benner andPerson, events, projects,

Lived experience of the illness,

Phenomenology based onPrimacy in nursing.

Wrubeland things matter topeople; a wide range ofpresencing, and the delicate useof humor as a means of relating.

abundant empirical dataon real-world experience

The power of caring.

involvement.

and experimentstherefore,
it describes, interprets, andNursing education needs

Specific and relational,
interpersonal interaction.

explains actual expert
nursing-context based andreform that will enable
nurses to critiquegrounded in nursing
practice.

organizational life based
upon expert caring
practice.

Roach

Fundamental phenomenonof constructing the humanCompassion, competence,
confidence, conscience, andUnique and attributive indescribing nursing though

Essence and core innursing.

existence;commitment.

other professions may
implicate it.

A word with multiplesocial usages; witha) Formation of a umanisticaltruistic system of values,

The core and basic
foundation for nursing

symbolic and functional
meanings.

b) Faith-hope,c) Sensitivity of self and others,

Intrinsic to the actual
nursing process.
,As the nurse s moral
commitment to others andd) Creation of a helping-trust
human care relationship,

involves transpersonalcaring relationship.

specialized language are
the trim]

Integration of inner selfand harmony with theother.
Watsone) Expressing positive andnegative feelings,f) Using carative problemsolving in the caring process,g) Transpersonal teachinglearning,

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practice.
[skills, techniques,Researcher

Meaning of Caring

WatsonConstructs of Caring

Significance of Caring in
Nursing

Application to Nursingh) Promotion of support,
protective, and/or corrective
mental, physical, societal, andspiritual environment,i) Assistance with thegratification of human needs,andj) Existential-phenomenologicalspiritual forces.

c) doing for, d) enabling, and e) maintaining belief. In her 1999a) formation of a humanistic-altruistic system of values,

study of Meta-analysis from 130 empirical studies, Swansonb) faith-hope,found that consequences of caring included emotional-spiritualc) sensitivity of self and others,

well-being, physically enhanced healing, trust relationship,d) creation of a helping-trust human care relationship,emotional spiritual sense of accomplishment, preserved integrity,e) expressing positive and negative feelings,

whilstf) using carative problem-solving in the caring process,consequencesof

non-caring

included humiliation,

frightened feelings, despair, helplessness, alienation, vulnerability,g) transpersonal teaching-learning,

lingering bad memories, decreased healing (Watson, 2005).

h) promotion of support, protective, and/or corrective mental,

Benner and Wrubel (1989), who highlight stress coping as anphysical, societal, and spiritual environment,

embodied nursing context, also developed a caring theory with ani) assistance with the gratification of human needs, andexplicit phenomenological stance from Heidegger and Merleau-j) existential-phenomenological-spiritual forces.

Ponty, endorsed by abundant empirical data (Benner, 1984).

The first three factors interact to establish a philosophical

Therefore, their theory is grounded on real-world experiences andexperiments from their own data; consequently, it describes,

foundation for the science of caring (Watson, 1985). Humanistic,
values and an altruistic approach to life bring meaning to one s life

interprets, and explains actual expert nursing, using specified

through relationships with other people as Adler (1927) believed

paradigms such as the lived experience of the illness (Benner &that everyone tends to develop social interest as the individual

Wrubel, 1989). As the title of their book Primacy of caring

outgrows egoism and strives for superiority over self.

indicates, care/caring is regarded as primacy in nursing.

formation of a humanistic-altruistic value system is considered the

The

Roach (1992) reviews various caring theories and presents her

first and most basic factor for the science of caring (Watson,

theory from both philosophical and theological points of view;

1985, 1988, 1999), and enhances the other factors. The formation

conceptualizing the notion of caring with five categories −of a humanistic-altruistic value system and the third factor of

ontological,

anthropological,

instillation of faith-hope complement each other (Watson, 1985,

ontic, epistemological, and,pedagogical. She proposes fives C s − compassion, competence,

1988, 1999). The individual needs to recognize and have feelings

confidence, conscience, and commitment − as attributes that care/in order to develop sensitivity to self and to others, which, in turn,caring may connote (Roach, 1992). She specifies that care/caring

provides one with a foundation for empathy with others (Watson,should be attributive in nursing and be placed as an essence and1985).

core in nursing.
,
Watson s caring theory (1985, 1988, 1999), which is regarded

Watson (1985) suggests that development of a helping-trust

as the most comprehensive (e.g., Roach, 1992; Ryan, 2005), isrelationship (the 4th factor) depends on the first three factors as,
they may determine the quality of one s relationship. The otherbased on the belief that human caring can be effectively

characteristics affecting the development of human relationships

demonstrated

orprovided by Watson (1985) are; a) congruence, b) empathy, andintersubjectively. Her theory is organized by the following tenc) non-possessive warmth. Watson (1985, 1988) also states thatcarative factors which combine science and humanities to form acommunication needs to be considered within the context ofstructure for studying the caring process (Watson, 1985, 1988,

developing

2002, 2005).

consisting of all the cognitive, affective, and behavioral responses

andpracticed

onlyinterpersonally－ 47 －

ahelping-trust

relationship.

Communication

J Nurs Studies N C N J Vol.6 No.1 2007

has three basic types of communication: 1) the somatic level, 2)

to-day nursing care. Watson (1985, 1988) discusses those

the action level, and 3) the language level consisting of denotative

functions as the eighth factor: promotion of a supportive,

communication, the explicit meanings of words, and connotative

protective, and (or) corrective mental, physical, societal, andcommunication, the implicit meaning, associated ideas, feelings,

spiritual environment, some of which are external, whilst others

symbolic responses, and latent content of words. The three basic

are internal to a person.

messages/requests of the other person are a) action, b)

Assistance with the gratification of human needs involves a

information, and c) understanding. A fourth is the inappropriate

great deal of information and subparts, though conceptually

message/request, in which Gazda, et al. (1975) identified fiveit is only one broad carative factor (Watson, 1985). A

categories, 1) rumor, 2) gossip, 3) chronic or inordinate griping,

psychophysiological view is also consistent with contemporary4) inappropriate dependency, and 5) inappropriate activities, suchstudies of the effect of stress on the body. The dynamic, symbolic

as illegal, unethical, safety-risk, and seductive activities.

meanings and concerns of human needs are easily understood

As Watson (1985) points out, the fifth factor of promotion andfrom an interactional perspective. Based on the different humanacceptance of the expression of positive and negative feelings isneeds, Watson (1985, 1988) categorizes lower order and higher

an inherent part of the development of a helping-trust relationship.
,
Emotions, rather than cognition, play a central role in people sorder needs. The lower order needs are 1) the biophysical food

behavior as indicated by Izard (1977) who maintains thatneed. Although they are lower order biophysical needs, they are

emotions constitute the primary motivational system of humandeveloped from a holistic, more psychological perspective

beings. Though both cognition (thoughts) and affect (feelings),
operate in an interpersonal situation, one s feelings and the non-relevant to health care. Human activity and sexuality needs arerational emotional aspect of an event should be focused on in

psychophysical rather than biophysical. The lower ordercaring behaviors, as Watson (1985) states, because feelings alterbiophysical needs are more fundamental for survival. The lower

thoughts and behavior, and they need to be considered andorder psychophysical needs suggest not only simple survival butallowed for in a caring relationship. Feelings are thought to havealso satisfaction and quality of living brought about by thea powerful effect on behavior and thoughts; for instance, a,person s thoughts and behavior may be guided by certain

gratification of those needs. The higher order needs are designatedemotions not entirely within his or her awareness or realm ofaffiliation need, and 3) the need for self-actualization. Practice ofand fluid need, 2) the elimination need, and 3) the ventilation

also classified as lower order needs, but they are labeled

as psychosocial. They include 1) the achievement need, 2) therecognition. Therefore, Watson (1985, 1988, 1999) argues thatthe factor of assistance with the gratification of human needs,

the expression of positive and negative feelings in self and others

combined with the other factors, helps gratify higher order needs

should be promoted and accepted in the science of caring.

and provide the essence of what nursing ultimately seeks for

Rosenberg (1960) examined the precise relation between theaffective and cognitive components, finding a consistency

quality health care. Assistance with the gratification of human,needs is important to nursing s role of helping persons in theirbetween the affective and cognitive components of an attitude,

growth and development. Even though it may sound all

and that certain feelings can change the associated cognition. The

encompassing, the major function of the practice of caring istheories and findings have supported the factor of acceptance anddependent on the success or failure of helping them in their efforts

promotion of the expression of positive and negative feelings in

to gratify their human needs (Watson, 1985, 2005). In the

caring.

development and practice of assistance with the gratification of

Watson (1985) argues that the use of the scientific problem-

human needs, a useful approach is to view the needs as belonging

solving method (the sixth factor) allows the nurse to draw on

to and affecting individuals, not as isolated concerns. Keeping incommon principles.

mind the holistic-dynamic framework for viewing human needs,

Interpersonal/transpersonal teaching-learning is the seventh

the factor of assistance with the gratification of human needs leads

factor that involves processes engaged in by both the nurse and theto a more complete development of each human need, which arepatient. Watson (1985) explicates that it includes the issues ofall equally important for quality nursing care and the promotion of

imparting information as well as consideration of the nature of

optimal health (Watson, 1985).

learning and what interpersonal/transpersonal processes facilitate
Discussion

learning.
As Watson (1985) points out, a number of variables, which,
affect a person s life and wellbeing, should be considered in day-

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It is apparent that there is an excessive asymmetry among thetheories in the previous section; namely, much more space is,nursing from Heidegger s phenomenological positioning of care;devoted to a single theory by Watson. This imbalance was caused,by the belief that Watson s theory may be the representative of

however, a nursing profession devoid of nursing skills, forcaring theories, because her theory appears in many articles as thefor appropriate nursing should be labeled as inevitable part ormost comprehensive and influential one (e.g., Sumner, 2006;

prerequisite in nursing profession for sure. It may be absurd to

Roach, 1992). Watson has also continued publishing articles anddichotomize nursing by care/caring and skills, since care/caring

books on caring, and owns a homepage with abundant information

should coexist with skills or vice verse, because they interact with

(Resurrection Health Care, 2006). Her theory is, indeed,each other. In fact, Watson (1988) seems to include skills in thethoroughly organized as well as elaborative and interdisciplinary.
,
However, Watson s theory appears to have limitations as Sumnername of satisfying the needs of patients. Therefore, the practical(2006) claims. First, it seems like a guideline, possibly caused bynursing practice. On the other hand, Benner (1984) and Benner

the limited amount of empirical data, which may contrast with,
Benner and Wrubel s (1989) theory. Second, the way in which

and Wrubel (1989) provide abundant examples indicating how

Watson seems to theorize care/caring is a pragmatic manner, evenpossibility, from the non-nursing eye, is highly skilled nursing

though she declares that she takes a stance of phenomenologicalwithout care/caring. One colleague, who is a nursing researcher

approach.

with nursing experience, pointed out that care/caring enables

instance, would not function. A certain amount of skills requiredcompetence such as skills should occupy the important part incare/caring enhances the quality of nursing. A dangerous,
On the other hand, Benner and Wrubel s theory is abundantnursing practice more efficiently, giving the simple example ofwith empirical data, with a finer phenomenological approach. For

giving a glass of water to a patient. She explained that eveninstance, the process that the expert nurse succeeded indifficult patients, who would trouble a nurse otherwise, will be

communicating with the patient explicates how care/caring was

satisfied with a glass of water when the nurse gives it to them withestablished using real-world interactions between the nurse andan appropriate amount of care, which eventually saves lots ofpatient, using a narrative account. However, it may lack in an,
organized system, which Watson has succeeded in. Leininger stime. As caring researchers reviewed in this article (e.g.,theory seems to include ample data, with anthropologicalbe positioned in a central part of nursing.

Leininger, 1988) have posited, care/caring seems to be entitled toperspectives, based on the belief that considering varied cultures
should occupy the vital position in caring. In her concept analysis,
of caring, Sumner (2006) designates Leininger s theory as a,leading theory in caring. Swanson s theory, which Watson praises,
is based on the empirical data using the approach of mata-Concluding Remarks
In this review paper, main caring theories, with some emphasis,
on Watson s comprehensive theory, have been reviewed. In an

analysis, proposing five caring aspects, in the similar manner that,
Watson has used. Mayeroff s aspects of viewing care/caring as a

actual nursing setting, however, it has not fully elaborated in what

process seems to be beneficial in an actual nursing setting.
,
Roach s theory, which has been introduced only briefly, uses

Kleiman (2005) discusses humanism evolved within the context

multiple perspectives, orchestrating various theories from multiple

her lived experiences. A structure of humanism in nursing isdisciplines, related to caring. Her in-depth theory may well bearticulated from these concepts and their interrelationships. In theutilized in the real world of nursing.
As mentioned above, each caring theory projects varieddifferent context, Ryan (2005) explores the possible applications,in clinical setting of Watson s nursing theory. For the future study,

meanings, different constructs in care/caring; however, all of them

the way in which caring theories have been applied in actual

seem to agree that the notion of care/caring should be the essential,
and core part of nursing, with Heidegger s phenomenologicalnursing settings and pedagogical implications from non-nursing

way caring theories should be applied. As one of the examples,of an anamnestic voyage into the past consciousness of a nurse inperspectives should be explored.

approach, whilst the seemingly more immediately requiredcondition in nursing practice, such as skills, techniques, and■ References

special language are qualified as the trim, as Leininger (1988)
posits (see Table 1). The question may be which, care/caring orpractical competency such as skills, should be seen as an essenceor core and be regarded as more important in nursing. From a
non-nursing point of view, care/caring should be a central part in－ 49 －

Adler, A. (1927, 1998). Understanding human nature. Oxford:
On world publications.
Allport, G. W. (1961, 1963). Pattern and growth in personality.
New York: Holt, Rinehart, and Winston.
Benner, P. (1984). From novice to expert: Excellence andJ Nurs Studies N C N J Vol.6 No.1 2007

power in clinical nursing practice. Menlo Park, California:

nursing. In M. M. Leininger (Ed.), Caring (pp. 25-36).

Addison-Wesley.

Detroit: Wayne State University Press.

Benner, P. & Wrubel, J. (1989). The primacy of caring: Stress

Resurrection Health Care. (2006). Mission and core values.

and coping in health and illness. Menlo Park, California:

Retrieved October 23, 2006, from http://www/reshealth.org/

Addison-Wesley.

aboutus/mission/

Bevis, E. O. (1988). Caring: A life force. In M. M. Leininger(Ed.), Caring (pp. 49-59). Detroit: Wayne State

Roach, S. (1992). The human act of caring. Ottawa: Canadian
Hospital Association Press.
Rogers, C. R. (1957). The necessary and sufficient conditions

University Press.
Boykin, A., Bulfin, S., Schoenhofer, S., & Baldwin, J. (2005).
Living caring in practice. International Journal of Humanof therapeutic personality changes. Journal of Consulting
Psychology, 21, 95.
Rogers, C. R. (1967). Person to person: The problem of being

Caring, 9 (5), 15-19
Boyle, J. S. (1988). An application of the structural-functional

human. California: Real People Press.

method to the phenomenon of caring. In M. M. Leininger

Rosenberg, M. (Eds.) (1960). Attitude organization and(Ed.), Caring (pp. 37-47). Detroit: Wayne Statechange. New Haven: Yale University press. pp. 15-65.
,
Ryan, L. A. (2005). The Journey to integrate Watson s caring

University Press.
Drefus, H. L. (1987). Husserl, Heidegger and modern existentialism. In B. Magee (Ed.), The great philosophers:
Introduction to Western philosophy (pp. 254-277).

theory with clinical practice. International Journal for
Human Caring, 9(1), 26-30.
Secord, P. F., & Backman, C. W. (1964). Social psychology.
New York: McGraw-Hill.

London: BBC Books.
Erikson, E. (1968). Identity: Youth and crisis. New York:

Smith, M. (1999). Caring and the science of unitary humanbeings. Advances in Nursing Science, 21(4), 14-28.

Norton and Company.
Gazda, G., Walters, R. P., & Childers, W. C. (1975). Human

Sumner, J. (2006). Concept analysis: The moral concept ofrelations development: A manual for health sciences.

caring in nursing as communicative action. Internation

Boston: Allyn & Bacon.

Journal for Human Caring, 10(1), 8-16.

Heidegger, M. (1975). The basic problems of phenomenology.

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

Bloomington: Indiana University Press.

Swanson, K. (1999). What is known about caring in nursing

Izard, C. E. (1977). Human emotions. New York: Plenum.
Kleiman, S. (2005). Discourse on humanism in nursing.

research: A literary meta-analysis. In S. A. Hinshaw, S.

International Journal for Human Caring, 9(1), 9-13.

Feetham, & J. Shaver (Eds.), Handbook of clinicalKuhn, T. S. (1970). The structure of scientific revolution.

nursing research (pp. 31-60). Thousand Oaks, CA: Sage.
Vance, T. (2003). Caring and the professional practice ofChicago: University of Chicago Press.
Leininger, M. M. (1988). The phenomenon of caring:
Importance,

researchquestion

andtheoreticalconsideration. In M. M. Leininger (Ed.), Caring (pp. 315). Detroit: Wayne State University Press.

nal/caring.htm
Watson, J. (1985). Nursing: The philosophy and science of
caring. Boulder, CO: Colorado Associated University

Leonard, V. W. (2001). A Heideggerian phenomenologicalperspective on the concept of person. In P. Benner (Ed.),(pp.43-63).

nursing. RN Journal, from http://www.rnjournal.com/jour-

Press.
Watson, J. (1988). Nursing: Human science and human care. A

Honolulu:

theory of nursing. New York: National League for

May, R. (1969). Love and will. New York: Dell Publishing Co.

Watson, J. (1999). Postmodern nursing and beyond.

Interpretive

phenomenology,
University of Hawai i Press.

Nursing.
Edinburgh: Churchill Livingstone.

Inc.
Mayeroff, M. (1971). On caring. New York: Harper & Row

way

Publishers.
Parse, R. R. (1988). Caring from a human science perspective.
In M. M. Leininger (Ed.), Caring (pp. 37-47). Detroit:
Ray, M. A. (1988). A philosophical analysis of caring within

第6巻

towardtransformative

leadership.

Nursing

Administration Quarterly, 25(1), 1-6.
Watson, J. (2002). Assessing and measuring caring in nursing
and health science. New York: Springer.

Wayne State University Press.

国立看護大学校研究紀要

Watson, J. (2000). Leading via caring-healing: The fourfold

第1号

2007 年－ 50 －

Watson, J. (2002). Metaphysics of virtual caring communities.

International Journal of Human Caring, 6(1), 41-45.

from http://ww2uchsc.edu/edu/son/caring/Watson, J. (2005). Caring science as sacred science.
Philadelphia, PA: FA Davis.

Watson, J. & Smith, M. (2002). Caring science and the scienceof unitary human beings: A trans-theoretical discourse for

Watson, J. (2006). Jean Watson and the theory of humancaring. Theory overview. Retrieved on August 24, 2006,

nursing knowledge development. Journal of Advanced
Nursing, 37(5), 452-461.

看護におけるケア理論の一考察

松岡里枝子
国立看護大学校；〒 204-8575 東京都清瀬市梅園 1-2-1【要旨】 ケアリングとは，ハイデッガーが人間であることの本質であると唱えているように，人間にとって，そして看護にとって基本的概念であるといえる。したがって，ケアリングは，人間がお互いにかかわりながら生活を営む際，影響を与える普遍的な現象であるといえる。本論文では，ケアの意味やケアを構成している要因やケアが看護においていかに用いられているかについて，
お互いのかかわり合いや相互作用であるケアが看護師と患者の関係やコミュニケーションから生じるものであるという観点に基づ
き，看護の背景をもたない者の見解から，主要なケア理論を検証し比較する。さらに，ケアが看護の中心となるという想定が妥当であるか否かについて考察する。

－ 51 －J Nurs Studies N C N J Vol.6 No.1 2007