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Concept of nurturing in nursing theory practice gap


Caring begins from childhood and grows with us till we become a grown-up, this is a behavior that may be felt, trained and utilized, if the person has objective to perceive it. For instance the child discovers it from his mother in the manner she talks, touch and deal with. Alternatively caring is recognized as an important tendencies and a key aspect to advertise patient's health insurance and accelerating the healing process.

Caring in the medical profession happens whenever a nurse have connection with a patient with trust and dedication as quite parts. Matching to Watson's theory the purpose of nursing is supporting a patient to attain harmony within your brain, body, and soul.

As contrast we can't expect everybody to care for us. We are able to ask ourselves what's the relation between learning how to care and attention and practicing it. In fact it's a turmoil between theoretical concept of caring and vocational practice of it.

In the following essay I will explore the key facts about nurturing.

Definition of caring

Caring is a difficult subject to establish as it is the feeling which show matter, empathy in gratifying the physical, psychological, spiritual, cultural, interpersonal and emotional needs. This is achieved by being compassionate, caring, kind, warm, very sensitive, sympathetic, reactive, and considerate to others.

We have a number of different theories of caring, Leininger (1991) who considered nurturing is a global wide phenomenon originates from the ethnicities and affects the individual response. Predicated on the needs of an individual, she also stated "care and attention as the essence of nursing and the central, dominant, and unifying focus of nursing". Others believe that" caring is an art as well as a science that accept a humanitarian, knowledge established, process and experience with treatments for mind, body and soul, commitment to patients and families, defined by beliefs and morals. No matter diseases or diseases patients are having, they must be seen as a complete and complete transpersonal Caring allows unity of life and hook up to move caring from one individual to another" (Watson, 2003).

Bearing in mind the Nursing theories integrates the caring concept in medical practice and considered the nurse as the key key point in the complete process. Which means "Nursing has distinctive views of folks and strong commitments to compassionate and educated care of persons through medical" (Parker, 2001).

Side by area the patient attention, not treat, should be tackled in a alternative framework and not in particularistic method. The care should grant the use of the medical process (to assess, plan, put into practice and evaluate patient attention), clinical, ethical and working experience followed by data based practice to increase patient's results.

The Medical caring theory is based on practical, educational and research aspects and the "nurses reflective-critical practice models" are increasingly sticking with caring ethic and ethos (Watson, 2008).

Relevance of the caring

In 1987 the World Health Organization improved the quality of healthcare by publishing aims that help gain health and promote it, Hood (2010). Florence Nightingale is considered as the first person involved in improving the quality of care, similarly the quality of care defined" as a concept that reaches its most important when applied to the individual consumer of healthcare" (Campbell, 2000). Appendix (1)

Watson (2007) outlined steps used to attain the Individuals caring theory as the following: First merging the worthiness, practice and values with self and more, then placing faith and desire to honor others, accompanied by improving the assisting - trusting - caring marriage and promoting, developing and acknowledging positive and pessimistic thoughts to hear other folks. Problem-solving methods should be used in decision making, besides focusing on teaching and learning individual requirements to create a host that respects individuals dignity, helps physical, mental and religious requirements, and lastly offers the opportunity for miracles to happen.

Nevertheless "Between 2002 and 2026, the amount of older people who'll require care will probably surge by 50 %, and costs per brain will also grow, unless the federal government increases its contribution, the excess costs will show up on attention users" (Royal collage of Nurses, 2008).

It seems that caring can be threatened by an monetary wedge between doctors and patients that will weaken and finally destroy the dedication for caring and ultimately the fantastic calling. Health care providers should not be too fascinated and preoccupied by modern research and technology and then neglect caring for the human person who gets the disease.

Lots of corporations started to focus on better look after everyone in a hospital, care home and at home (The Care Quality Payment, 2010).

Palliative Look after terminally sick and tired people is an excellent example; that presents the importance of nurturing in nursing. Healthcare providers handles the problem in a all natural method, by offering the dying patient the dignity and the support, but also to his family, friends and caregivers in both internal, mental and spiritually aspects, that assist them to handle the journey.

However the Palliative treatment is also thought as "a remedy that focuses on reducing pain and hurting by giving treatment for comfort of symptoms along with comfort and support for patients of all ages Additionally it is. to obtain apprehension for every single human life, having internal peacefulness with own mortality and know and allow all cycles of life (Watson 2002).

Palliative care uses a team approach which involves the dealing with doctor, the family, other healthcare professionals and interpersonal services" (Journal of the American Medical Connection, 2006) and assist the individual and his family to make informed decision for the desire treatment.

High quality palliative health care can differentiate between a comfortable existence and the one which involves much enduring. Besides, it aim to relieve the anguish, improve quality of life for folks facing serious and complicated illness, treating the pain and other distressing symptoms, provides mental and spiritual good care and a support system to help the individual live as positively as is possible and try to sustain and rehabilitate the individual's family and enable them to cope with the issues of grief and bereavement.

Caring is an important tendencies, that disciplining a nurse's function and show them commitment to earn the individual and his family's trust. Because of this it promotes the healing process, prevents further condition and will save lives. In addition, it offers him value and a fatality in dignity along with allowing the patient and the nurse to choose the suitable action to a certain degree.

Care -Q instrument is a widely used examination tool to measure the level of good care provided. The "Care -Q device" consists of 50 action items purchased in six subscales of nurturing: accessible; explains and facilitates; comforts; anticipates; trusting romantic relationship; monitors and comes after through. This tool is utilized to research the qualitative and quantitative approach to the caring principle (Cutcliffe, 2005).

Other matters to focus on are the level of patient satisfaction by also calculating the connection or relationship between your care service provider and the individual, not only in terms of social treatment, but also in the potency of communication, comprehensiveness and continuity of care and attention.

Defining the Theory Practice gap

After looking in literature I realize the idea practice space is a global wide problem and every nation tries to solve it by creating different measures. Nevertheless the theory practice space dilemma rose up predicated on the hypothesis of making use of the medical theory into the direct practice. The idea practice gap can be because of the presence of shortage in integration of theory into medical practice which impacts the patient satisfaction. "The individual satisfaction can be used as an important indicator of quality of attention and often included in planning and evaluation of medical" (Zavare, 2010).

"The theory practice difference occurs between the knowledge and practical application that make a difference professional competence and donate to difficulties in progressing from scholar to a novice professional" (Michau et al, 2009).

Both Maben (2006) and Vedam (2007) experienced the differences between

The ideal practice prices in theory and the actual daily practice. Thus "The values and values are indicated in the philosophies of medical that are essential underpinnings of theoretical innovations in the self-discipline" (Parker, 2001).

Consequently the presence of theory practice distance affects "the Patient's satisfaction and was reported as the main predictor of the overall satisfaction in clinic care and this is a very important goal to think about health organization care " (Mrayyan, 2006).

Although knowledge is electric power, the learner nurses discovers the rationalized health care based on ideas, however the controversy starts after they starts working in the clinical areas, facing the real situation and facts. As a result it might be beneficial to them if the content examined correlates with the clinical practice, to reduce the theory practice gap. They have to utilize their specialized medical experience, modifies the idea, making use of and facilitating it in the individual healing process. As compare the students should identify the proper facts of performing the theory and make an effort to justify the practice.

Relevance of the idea gap practice

All the nursing professionals and theorists adding their work in narrowing the idea practice space by inspiring a fresh attractive theory model derived from professional medical experience to influences the continuing future of medical practice. This explains the importance to customize the individual care in line with the patient's needs. Which means clinical nurse isn't only a practitioner, but a researcher and theorist who responds to patients needs by reflecting their past experience in their action of caring.

Julia Unwin "many older people and jobs feel unsupported by something that too often seems to be working against them, alternatively than giving them essential support at the same time of the life when they are at their most prone. " (Joseph Rowntree Foundation, 2010).

World wide facts:

United status of America

The Institute of Remedies (2001) provided their health care as an art they clean and redesign the whole health system and close the health care difference by prepared a new health system for the 21st Hundred years by the committee on the quality of health care in the us and released in March 2001.

Saudi Arabia

A research conducted and showed a distance in nursing performance and highlighted the result of nationwide culture behaviour between Saudi nurses. The finding shows the "nurse's attitudes towards their careers; and commitment with their employing organizations have been compelling to researchers because of the impact of their behavior at work and on quality of patient care"(Al-Ahmadi, 2008).

United Kingdom

Alexis et al (2006) conducted a study that reported different experience of UK nurses working abroad and the difference they are facing in applying the procedures while looking after patient, inaddition to the unequal opportunities for training and the chance for growing their skill.


In Bahrain we've an enormous theory practice space, unfortunately this simple truth is not backed up by a study; it's only based on individual scientific practice. For instance most students experiencing shortage in hospital materials and supplies, like gloves. They were taught to make use of gloves while doing a procedure and also to make use of it once only, but because of the shortage of gloves in a healthcare facility, the nurses were suggested to use them more often than once. This creates a theory practice discord and only assertiveness of the students will solve the trouble.

Both Cutcliffe (2005) and Wilson (2008) listed some factors that hinder the nursing practice from being achieved and provide the theory practice difference, for example poor knowledge and skill provide likelihood of making errors. As well as the lack of social communication between your nurses and patients, this causes attitudes reactions. Irrelevant patient nurse ratio and limited time to finish assigned jobs, along with peer pressure on each other hand, can either encourage or discourage their excitement.

To succeed in nurturing, communication to an individual or family should be comforting and create trust which is often a powerful restorative tool that provides consolation and a feeling of wellbeing. In nursing caring needs effective communication that validates the individual as well as the nurse as human being.

Chiang (2008) focused on organizational factors like downsizing or minimizing the employee statistics and discrimination between home and overseas employees in the facilities. Distinguishing between maintaining the standard of quality good care in the hospital and bridging the idea practice gap depends upon reporting and looking into those factors to be able to solve it.

Although the Ministry of Health in the Kingdom of Bahrain create a good strategy (2002) by offering an "open communication way, staff empowerment in debate making, provide rewards and appropriate training " to achieve the dedication and best staff performance, this strategy is merely considered on paper as it's not completely applied by clinics in the Kingdom of Bahrain.


Caring is a patterns which ranges from straightforwardness to intricacy in understanding, and perceiving it. On the other hand it is the way to provide safe support and productive care to all or any. For example the North american Nurses Association mentioned that the development between "healthcare and managed attention has significantly modified practice adjustments and has brought broadened practice opportunities".

Others like Florence Nightingale International Foundation visualize the importance of the treatment behavior by making a good Caring Symbol which illustrated four elements jointly such as a flame, hand, heart and soul and world. The flame symbolizes the light of nursing knowledge and caring. In addition, it reflects back again to the light Florence Nightingale taken while looking after the wounded during the Crimean Conflict. The hand illustrates nurses calling help and comfort others. The white heart and soul characterizes the data and mankind that infuse the work and nature of nursing, and finally the globe form illustrates the universality of the Foundation and the planet where each nurse provides attention. Appendix

Nevertheless the Florence Nightingale International Foundation given scholarships and fellowships to allow nurses to undertake projects in several areas including advocacy, command, new types of patient care and new assignments for nurses.

On the other hand merging nursing theories with practice will be on the top of the list as "The community will require a fundamental, sweeping redesign of the entire health system" to match the action needed (Institute of Medicine, 2009).

Pryjmachunk (1996) and Fealy (1997) cited in Cronin (2004) arranged that research, ideas and practice are interdependent of each other. Growing the medical practice and providing the best quality of attention, nurses should apply the nursing process so that a nurse may use her discretion in working with a patient's situation instead of applying the nursing theory as it is. Appendix (3)

Skills maximizes by theory, guide and impact practice which should be applied artfully and medically.


Having the concept of improve the medical practice and decrease the theory practice space I listed some advice as the next: First nurses must have access to kept up to date information, learning resources, and continuous educational opportunities. Second option of job-related materials and equipment needed to improve and help in better patient good care. Third medical Group should encourage the professional staff to conduct researches to point the factors affecting the theory-practice gap. Fourth apply the related theory target in to practice. Fifth the nurses should build in do it yourself interest to adjust to medical center environment change. 6th emphasis to be on personnel representation, revise and signify mal practice and observation and analysis of patient treatment. Seventh keep a set of multiple tasks to be completed. Eighth report all care activities to reduce mistakes. Ninth find a simple measure to keep a good nurse patient communication skill to market the patient healing process. Tenth use the appreciating or incentive rewards to encourage the personnel adherence to clinic policies.

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