Marlaine Smith is well-known for her middle-range theory called, Unitary Caring, which is derived from other theorists such as Rogers, Newman, and Watson (Nursology, 2021).
Marlaine Smith is well-known for her middle-range theory called, Unitary Caring, which is derived from other theorists such as Rogers, Newman, and Watson (Nursology, 2021). As many others have done, Smith focuses on caring and how it is central to nursing. Her theory is based on the question “what is the substantive domain of caring knowledge from a unitary perspective” (Smith, 2020, p. 494). She used the assumptions from the above-mentioned theorists to then form the five concepts of her theory which include manifesting intentions, appreciating pattern, attuning to dynamic flow, experiencing the infinite and inviting creative emergence (Smith, 2020).
Smith’s does not give clear-cut definitions to each of the four metaparadigms however upon review of her work one can differentiate them. Person is defined as human beings. Smith believes “human beings are pandimensional energy fields, integral and in mutual process of patterning with pandimensional environmental energy fields, who knowingly participate in the unitary patterning of their wellbeing” (Nursology, 2021). Nursing is centered around caring and “caring is a quality of consciousness and a way of participating knowingly in human-environment field patterning through which wholeness is affirmed, diversity is appreciated, emergent possibilities are potentiated and wellbecoming is nurtured” (Nursology, 2021). In this theory the nurse “becomes the healing environment” (Nursology, 2021). Health is seen as healing which is defined as a “dynamic and ongoing process of remembering wholeness or one’s unitary nature” (Smith, 2020, p. 495). Environment seems to have a less clear definition but is comprised of many concepts. The nurse can become the healing environment by way of their care and presence. The environment also takes into consideration “pandemensional awareness of coextensiveness with the universe occurring in context of human relating” (Smith, 2020, p. 496). The nurse is responsible for fostering an environment in which “pandimensional awareness of past-present-future” (Smith, 2020, p. 502) is at the forefront .
One sentiment regarding this theory that stuck out was a line from the textbook which states “it isn’t the time we have; it is what we do with that time that counts” (Smith, 2020, p.502). That is something many if not all nurses can relate to. The exemplar in the textbook shows how implementing Smith’s five core concepts can truly improve the quality of care we provide. All these concepts are important so it is hard to choose just one that can be implemented into everyday use as nurses, however “attuning to dynamic flow” is very clearly a standout. As shown in the exemplar of our textbook, attuning to dynamic flow “happens by being truly present in the moment and is a back-and-forth movement of relationship building through a vibrational sensing of where to place focus and attention” (Smith, 2020, p. 496). Had the nurse in the scenario given not used this concept, the patient would not have opened up or shared more about her personal issues, which was needed to treat her holistically.
In the emergency room setting, attuning to dynamic flow, is something we as nurses do all the time whether we realize it or not. Working in the ER setting is like trying to complete a puzzle without all the pieces. We are constantly trying to gain more information and insight to address and fix the current issue at hand. Emergency medicine also takes a lot of intuition and being able to read a patient, know when to ask questions and sometimes, when to just let a patient vent or be a silent presence. One patient example that comes to mind is a patient I had who was unfortunately raped. These situations are already extremely fragile and one wrong move by the nurse or healthcare team can cause these patients to retreat. This patient had clear physiological and psychosocial needs. I can recall watching for her cues, her mannerisms, things she said, things she did not say and attuning myself to her to provide the best care. I don’t feel I could’ve done anything better per se, however now knowing about Smith’s theory I am proud that attuning myself to my patient came naturally for me. I feel it is something I do in practice every day and a skill I will always use in my care, especially moving forward as an APRN. As stated in our text, “it is hearing the call that may be spoken or unspoken” (Smith, 2020, p. 496). I believe this is a very strong concept to carry with us as nurses and as APRNs. We must truly be present, mindful, and open to all the spoken and unspoken insights from our patients.
In conclusion, Smith’s theory is very clearly relevant to nursing today. It can easily be applied to any clinical setting. Smith also discussed “turbulence-ease” which is significant to nursing and life in general. “Turbulence and ease are natural rhythms of the life process. We experience turbulence ease throughout our lives in those chaotic periods of dramatic change, during a catastrophic event or a time of uncertainty when we may have a sense of agitation, turmoil, exuberance, or panic, until with time and help, we are able to regain a sense of ease” (Smith, 2020). I believe Smith’s theory captures the essence of life and how nursing, in particular, nurses can be a vehicle of positive change. It is clear through her five concepts that nurses can become the environment in which healing, education, change and understanding can commence.
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