espoused by nurses around the world. While there was a surge of caring theories in the 1970s and 1980s, a recent search revealed that Watson's theory is the most referenced caring theory in literature, and it is the theory researched most extensively in this book. It is the conclusion of the editors and authors of this book and all of its chapters that the observable presence of caring behaviors is an important predictor of a satisfying and safe healthcare experience—both for patients and for providers in all roles and disciplines. All studies in this book took place in institutions pursuing implementation of caring behaviors using frameworks of care that espoused the importance of caring for both self and others. While outcomes indicate dramatic improvement due to the contributions of Nightingale and McGaw, such outcomes proving that caring for self and others improves patient health and nurse satisfaction are newer and fewer. This book contains research that goes a long way to solidify the paradigm “caring contributes to healing” as an evidence‐based reality.
It is the intent of the many authors of this book to find the best theory or combination of theories to demonstrate not only that caring contributes to healing, but that the frameworks of care, through which caring behaviors are supported within systems of care, have inestimable value. We are at the point in this work where Benjamin Franklin was, just prior to his discovery of electricity. Prior to his famous encounter with the lightning bolt, there were several other theorists working on understanding electricity (Kuhn, 1962). It was not until Franklin considered the similarities of all the theories, and conducted a fascinating experiment with liquid electricity in a jar called a Layden jar, that Franklin's work resulted in what we now know as electricity as well as a profession for electricians to practice (Kuhn, 1962). Will one or more of the case studies in this book be the lightning bolt that shifts healthcare into a more complete and irrevocable understanding that caring contributes to healing?
Will one or more of the case studies in this book be the lightning bolt that shifts healthcare into a more complete and irrevocable understanding that caring contributes to healing?
Theory
Nursing works closely with medicine and other healthcare professions, but nurses are unique in that they are with the patient 24 hours a day and have the most consistent contact with the patient during care. This requires nurses to work within the systems of the organization and thus it is important to not only study nursing's many theories of caring, but how that caring is enabled or hindered by the social and technical aspects of the work environment.
Caring Theory
There are several theories of caring proposed in the profession of nursing, all asserting that caring is an important part of the healing process in care delivery. The most commonly cited theories are Watson's Theory of Human Caring (1979, 1985) and her more contemporary Theory of Transpersonal Caring (2008a). Several theorists have amended Watson's theory by adding concepts or combining it with other theories, including Duffy's Quality Caring Nursing Model (Edmundson, 2012), and Caroline Coates' theory (1997) which combines Watson's Theory of Transpersonal Caring with Bandura's concept of self‐efficacy. Swanson's Theory of Caring Behaviors was derived from research Swanson conducted in obstetrics, which took into consideration the care experiences of both mothers and fathers (1999). The theories of both Watson and Swanson have been applied extensively in the studies reviewed in this book.
Sociotechnical Systems Theory
When studying the experience of the work of nurses, or any employee who works directly with patients, it is important to consider the ease or difficulty of operations for enacting care. The study of operations includes theories to help guide the development of research, methods to measure success, and interpretation and application of findings to achieve operational improvements. Sociotechnical systems (STS) theory proposes that both social and technical aspects of operations contribute to the experience of work (Trist & Bamforth, 1951; Trist & Emory, 2005). It has been established that while good equipment and resources are essential to carry out the technical aspects of the work, relationships contribute at least as much as the technical aspects of work to a productive and enjoyable work experience (Trist & Bamforth, 1951; Trist & Emory, 2005).
Misaligned, stressed, or missing relationships can impede productivity just as surely as poor equipment or resources can, which is consistent with concepts of pause and flow proposed in constructal theory (Bejan, 2019; Bejan & Zane, 2012). Bejan and Zane (2012) quote Michelangelo as saying, “Design is the root of all sciences” (p. 827). This ancient principle applies to the science of care delivery, both in how care is delivered by teams and how it is supported within systems. Constructal theory provides a theoretical framework with which to study the design of care, including the flow of work that results in enjoyment and productivity.
Frameworks of Care
It is important to distinguish a theory of caring from a framework of care. Typically a framework of care is based on one or more caring theories. What makes a framework different is that it includes a methodology for the theory to take hold in all of the structures, processes, policies, and people in an organization. A framework of care is designed to see to it that a theory of care, with its concomitant behaviors, becomes pervasive throughout a system. As mentioned, the two frameworks discussed in this book are Relationship‐Based Care (RBC) and the Caring Behaviors Assurance System (CBAS).
Relationship‐Based Care (RBC) is a framework of care with eight dimensions:
1 Patient and Family (in the center of everything)
2 Healing Cultures
3 Leadership
4 Teamwork
5 Interprofessional Practice
6 Care Delivery
7 System Design
8 Evidence
Like many frameworks of care, RBC engages staff councils in embedding its principles into the structures, processes, policies, and people in the organization. Most of the case studies in this book were carried out in organizations that practice RBC. Operationalization of the RBC model uses the powerful formula for change outlined in the book I2E2: Leading Lasting Change (Felgen, 2007) as it is key to a successful transformation. Appendix B offers a description of the I2E2 formula.
Another framework of care, which is reviewed at length in the international section of this book, is the Caring Behaviors Assurance System (CBAS). CBAS has six dimensions, which are based on the “7 Cs” derived from a 2010 paper published by the Scottish government, called The Healthcare Quality Strategy for NHSScotland [sic]. You will see that two of the 7 Cs are combined in the first dimension:
1 Care and Compassion
2 Communication
3 Collaboration
4 Clean Environment
5 Continuity of Care
6 Clinical Excellence
The chief difference between RBC and CBAS is that the CBAS framework seeks cultural change entirely through the implementation of behavioral changes for staff members. It is a framework, rather than a theory, because, like RBC, it engages staff members in embedding these behavioral changes in the structures, processes, policies, and people in the organization.
Unlike RBC, CBAS
