Kristen Swanson's theory of care: literature review

Beristain-García, Isabel; Álvarez-Aguirre, Alicia; Huerta-Baltazar, Mayra Itzel; Casique-Casique, Leticia; Beristain-García, Isabel; Álvarez-Aguirre, Alicia; Huerta-Baltazar, Mayra Itzel; Casique-Casique, Leticia

doi:10.36789/revsanus.vi1.212

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Sanus

versão On-line ISSN 2448-6094

Sanus vol.7 Sonora Jan./Dez. 2022 Epub 08-Abr-2022

https://doi.org/10.36789/revsanus.vi1.212

Review

Kristen Swanson's theory of care: literature review

Isabel Beristain-García¹^*
http://orcid.org/0000-0001-9112-9421

Alicia Álvarez-Aguirre²
http://orcid.org/0000-0001-5538-7634

Mayra Itzel Huerta-Baltazar³
http://orcid.org/0000-0003-0908-424X

Leticia Casique-Casique⁴, Profesora Investigadora
http://orcid.org/0000-0002-0532-4819

^¹Estudiante de Doctorado en Ciencias de Enfermería. División de Ciencias de la Salud e Ingenierías. Universidad de Guanajuato. Campus Celaya Salvatierra. Guanajuato, México.

^²Profesora del Departamento de Enfermería Clínica. Universidad de Guanajuato. División de Ciencias de la Salud e Ingenierías. Campus Celaya Salvatierra. Guanajuato, México.

^³Profesora Investigadora. Universidad Michoacana de San Nicolás de Hidalgo. Facultad de Enfermería. Michoacán, México.

^⁴Profesora Investigadora. Universidad de Guanajuato. División de Ciencias de la Salud e Ingenierías, Campus Celaya Salvatierra. Departamento de Enfermería y Obstetricia. Guanajuato, México.

Abstract

Introduction

The nursing discipline has sought over the years to base the interventions of its work by applying theories specific to the discipline, such as the theory of care, which provides the guideline to transfer it to the areas of action.

Objective

To analyze the scientific evidence available on the application of Kristen Swanson's theory of care in nursing practice.

Methodology

Review of the literature on the theory of care, Cooper's methodology was used, different databases were consulted: IMBIOMED, CUIDEN, ScienceDirect, Fundación Index, MEDLINE, ciberINDEX, SciELO, Redalyc, among others. The descriptors used were: nursing, nursing care, nursing theory, in Spanish, English and Portuguese language between the years 2015 and 2019, all types of literature were included, obtaining a sample of 42 articles and dissertations.

Results

Most of the documents analyzed do not fully capture the basic processes of care proposed by Swanson. The theory has proven to be useful in the area of care, development of intervention programs with neonates, post-operative heart children patients, breastfeeding, puerperium care and modification of attitudes towards organ donation.

Conclusion

Theory is considered essential for integral assessment, adopting its foundations and concepts is of great utility, since it favors the generation of a first learning space, it is useful to provide accompaniment to the patient and his family, and to offer them strategies for improvement. More intervention, qualitative and teaching research is required.

Key words: Nursing; Nursing theory; Nursing care (DeCS)

Resumen

Introducción

La disciplina de enfermería ha buscado a lo largo de los años fundamentar las intervenciones de su quehacer aplicando teorías propias de la disciplina, como la teoría de los cuidados, la cual proporciona la pauta trasladarla a las áreas de acción.

Objetivo

Analizar la evidencia científica disponible sobre la aplicación de la teoría de los cuidados de Kristen Swanson en el quehacer de enfermería.

Metodología

Revisión de la literatura que aborda la teoría de los cuidados, se utilizó la metodología de Cooper, se consultaron diferentes bases de datos: IMBIOMED, CUIDEN, ScienceDirect, Fundación Index, MEDLINE, ciberINDEX, SciELO, Redalyc, entre otras. Los descriptores empleados fueron: enfermería, atención de enfermería, teoría de enfermería, en idioma español, inglés y portugués entre los años 2015 y 2019, se incluyó todo tipo de literatura, obteniendo una muestra de 42 artículos y disertaciones.

Resultados

La mayoría de los documentos analizados no plasman por completo los procesos básicos de cuidado que plantea Swanson. La teoría ha demostrado ser útil en el área asistencial, elaboración de programas de intervención con neonatos, pacientes pos-operados de cardiopediatría, lactancia materna, cuidados en el puerperio y modificación de la actitud hacia la donación de órganos.

Conclusión

La teoría se considera esencial para la valoración integral, adoptar sus fundamentos y conceptos es de gran utilidad, ya que favorece la generación de un primer espacio de aprendizaje, resulta útil para brindar un acompañamiento al paciente y su familia, y ofrecerles estrategias de mejora. Se requiere realizar más investigaciones de intervención, cualitativas y de docencia.

Palabras clave: Enfermería; atención de enfermería; Teoría de enfermería (DeCS)

Abstrato

Introdução

A disciplina de enfermagem tem procurado ao longo dos anos basear as intervenções de seu trabalho aplicando teorias específicas à disciplina, como a teoria do cuidado, que fornece a diretriz para transferi-la para as áreas de ação.

Objetivo

Analisar as evidências científicas disponíveis sobre a aplicação da teoria de Kristen Swanson sobre o cuidado na prática da enfermagem.

Metodologia

Revisão da literatura sobre a teoria dos cuidados, foi utilizada a metodologia de Cooper, foram consultadas diferentes bases de dados: IMBIOMED, CUIDEN, ScienceDirect, Fundación Index, MEDLINE, ciberINDEX, SciELO, Redalyc, entre outros. Os descritores utilizados foram: enfermagem, cuidados de enfermagem, teoria da enfermagem, em espanhol, inglês e português entre os anos de 2015 e 2019, todos os tipos de literatura foram incluídos, obtendo-se uma amostra de 42 artigos e dissertações.

Resultados

A maioria dos documentos analisados não capta completamente os processos básicos de cuidados propostos pela Swanson. A teoria provou ser útil na área de cuidados, desenvolvimento de programas de intervenção com recém-nascidos, pacientes cardiopediátricos pós-operatórios, amamentação, cuidados com o puerpério e modificação de atitudes em relação à doação de órgãos.

Conclusão

A teoria é considerada essencial para a avaliação integral, a adoção de seus fundamentos e conceitos é de grande utilidade, pois favorece a geração de um primeiro espaço de aprendizado, é útil para proporcionar acompanhamento ao paciente e sua família, e oferecer-lhes estratégias de melhoria. É necessária mais intervenção, pesquisa qualitativa e pedagógica.

Palavras-chave: Enfermagem; Cuidados de enfermagem; Teoria de enfermagem (DeCS)

Introduction

The nursing discipline has been evolving from Florence Nightingale to the present time, and in this search for identity in the fifties of the twentieth century, nursing began the separation of medical knowledge with the discipline's own knowledge; this beginning led to the need to develop nursing theories ¹, there is general and nursing literature that provides different concepts of theory ²; the word "theory" comes from the Greek theoreo which means "to look", "to observe" ³.

Theories allow the generation of knowledge, and in this way advance in the conformation of a body of disciplinary knowledge, they have allowed nursing to improve its professional and disciplinary capacity, through knowledge and methods applied systematically for greater probability of success ⁴. The theories are intended to describe, explain, predict and control or prescribe the phenomenon ⁵.

Theory is the second theoretical entity, in abstraction level, according to Fawcett ⁶, and it is usually confused with conceptual model, because both terms are used indiscriminately as if they meant the same thing; when referring to a theory it is usually named as model, however; the conceptual model is descriptive and if you want to do research with it, it must be fragmented in logical parts and its concepts must be operative; although many theorists do not make any difference between both ³. Theories are differentiated into grand theories, theories and mid-range theories. The theory of greater amplitude is the grand theory, the one of smaller amplitude the micro-theory, and it is located within the concept of mid-range theory according to the Spanish term MRT. MRTs deal with specific nursing phenomena, arise from and reflect both practice and clinical processes ⁷.

Kristen Swanson in 1991, proposed the "Theory of Care (TC)" ¹ considered MRT or middle level; it is worth mentioning that the theory was empirically derived from a phenomenological research. Swanson's theory is useful when applying the 5 basic processes of care proposed by the theorist ⁸; a) Knowing: the important thing is to know people with respect, understanding their lives without prejudice, valuing each activity that leads to the appropriation of knowledge. b) To be with: it starts with the identification of the person as unique and individual, accompanying and stimulating the expression of emotions and perceptions about the moment being lived. c) To do for: to be emotionally present with the other and to do for the other what we would do for ourselves. For this, a process of education, accompaniment and help-seeking is initiated, according to the individual needs identified. d) Maintaining beliefs: through interaction, beliefs, experiences, skills, abilities and knowledge that are important for people and that can be rediscovered, oriented or placed, are discovered to ensure appropriate care practices at this stage of life. e) Enabling: people are educated about specific recommendations according to the identified need; also included in the care are other professionals who accompanied with their discipline.

The TC is clear, simple and can be generalized to any nurse-person relationship, in any clinical context ¹; it provides the guideline for nursing to transfer it to the areas of action where it is performed; nursing at the care level (clinical or home), administrative, teaching and research ⁹. In order to provide humanized care, nursing professionals are required to have experience, ability, skill and capacity in the integral and holistic knowledge of the person in the area of their performance; thus, TC is a useful tool since it has been proven in research, training and clinical practice; its usefulness has been demonstrated in research, education and clinical practice ¹; but is it really so? For this reason, the objective of analyzing the evidence available in the scientific literature on the application of Kristen Swanson's TC in the four areas of nursing work arises, by means of Cooper's methodology ¹⁰.

Methodology

A literature review was conducted on scientific publications that addressed the TC; considering the seven steps of Cooper: ¹⁰ 1) Formulation of the problem, in this case the question was what has been the application of the TC in the areas of administration, teaching, care and research in nursing; 2) Search of the literature, in the conducive proceeded to investigate in different databases: Pubmed, IMBIOMED, EBSCO, Elsevier, CUIDEN, ScienceDirect, Hemeroteca Cantárida, Fundación Index, Biblioteca Virtual en salud, MEDLINE; ciberINDEX, SciELO, Redalyc, these databases were considered for their quality: between 2015 and 2019; using the descriptors DeCS in Spanish: enfermería, atención de enfermería, atención de enfermería, teoría de enfermería, in English (nursing, nursing care, nursingtheory), and Portuguese (enfermagem, cuidado de enfermagem, teoría de enfermagem); the AND Boolean operator was used. Quantitative, qualitative articles, clinical trials, reviews, meta-analyses or case series, which used Kristen Swanson's theory, as well as undergraduate and graduate dissertations were included; the only criterion for excluding articles was that they were published before 2015.

3) Collecting information on the studies for the proposed purpose, for which general aspects such as title, year of publication, authors and summary were obtained; subsequently, the complete text was read to find biases or duplicity. 4) Evaluation of the quality of the studies, consequently, a critical reading was made identifying the TC and that it complied with the sections of introduction, summary, methodology used, results, conclusions, suggestions or recommendations and bibliography. 5) Analysis and interpretation of the results of the studies, in such a way that we proceeded to read each of the articles identifying: author, year, country, instrument used, sample, age of the participants, research design and in which area of nursing the theory was focused 6) Interpretation of the evidence, in which methodological aspects of the studies were analyzed in depth: variables, conceptual definitions, type of study (empirical or theoretical), type of methodology (quantitative, qualitative or mixed) and design (descriptive, correlational, case-control, etc.); objective, hypothesis or purpose of the study (empirical or theoretical). ); objective, hypothesis or purpose of the study, study population, selection of participants (random or by convenience), measurement instruments used (reliable and valid), procedures, limitations during the procedures, congruence between the statistics and the objectives or hypotheses proposed. 7) Presentation of results, 62 articles were identified in the databases consulted, 20 articles were excluded because they were outside the range of the years covered, the total number of articles included was 42 for the final report (Figure 1).

Figure 1 Literature review

Results

Regarding the general characteristics of the articles, 14.2% corresponded to qualitative research of original articles with a phenomenological approach ¹¹, one without specifying the method used ¹², grounded theory ¹³, reflective ¹⁴, life history ¹⁵ and hermeneutic ¹⁶, 71.4% were dissertations, 11.9% were quantitative research and 2.3% were systematic reviews. The main characteristics are shown in Table 1 based on the Cochrane handbook ¹⁷.

Table 1 Characteristics of the dissertations analyzed, n=30.

Authors/Academic degree	Year, country	Methods and objective	Participants	Primary Results
Aquino AY, et al.24 Bachelor's Degree	2018, Peru	Quantitative, quasi-experimental design with pre- and post-test with control group. Apply TC to modify the attitude towards organ donation in fifth year middle school students of I. E. Manuel Benito Linares Arenas, Arequipa, 2017.	Control group=16 students Experimental group=15 students.	The attitude towards organ donation in the students of the control group in the pre- and post-test did not present a significant statistical difference. The attitude towards organ donation of the experimental group in the pre- and post-test showed a significant statistical difference.
Mogollon AL, et al. 25 Bachelor's Degree	2019, Peru	Qualitative with case study methodological approach. Analyze and understand the perception of nursing care in hospitalized patients in the surgery service: according to the TC, Chiclayo-2019.	12 hospitalized patients from the surgery service, aged 18 to 60 years, with a hospital stay of 3 days. .	Contrasts when faced with the patient's call; differences in nursing practice: communication and medication administration, generating alternatives for better patient care.
Romero AR, et al. 26 Bachelor's Degree	2019 Peru	Descriptive, correlational, cross-sectional. To establish the relationship between the level of knowledge and practices on breastfeeding and the nutritional status of infants under six months of age at the Centro de Salud de Liberación Social.	92 infants and their mothers. .	55.4% of mothers had a high level of knowledge and 44.6% had a medium level of knowledge.
Ding CS, et al.27 Bachelor's Degree	2018 country missing	Qualitative, exploratory, descriptive. To describe the feeding practices of caregivers of children under 5 years of age in the community.	Caregivers with children under 5 years of age. .	There were three categories: 1 access to food, 2 lack of knowledge of the population and 3 cultural context.
Bajaña AZ, et al. 28 Bachelor's Degree	2018, Ecuador	Qualitative interpretative socio-critical study. To propose nursing interventions in the safety of the neonate in mixed accommodation at the Pablo Arturo Suarez Hospital.	9 caregivers, of which 5 were mothers and 4 were community mothers.	The safety of the neonate in the overall housing is affected due to extrinsic factors such as the lack of quality assistance, evidenced by the deficit of human talent and the inadequate infrastructure of the service, exposing the neonate to risks of asphyxia, falls, infection, and the risk of jaundice.
Chinguel YK, et al.29 Bachelor's Degree	2018, Peru	Quasi-experimental. To determine the effectiveness of home nursing care with a family approach in patient adherence to treatment for arterial hypertension at the Dr. Enrique Martin Altuna Zapallal maternal and child health center. Cuasi experimental.	80 participants.	At the beginning of the study showed a low level of therapeutic adherence in the intervention group with 62.5% and the control group with 55%, 3 months after the application of home care the intervention group presented a high adherence with 52.5% and in the control group there were no significant changes.
Fray PE, et al.30 Bachelor's Degree	2018 Ecuador	Bibliographic review. To systematize nursing actions in the care of culturally appropriate childbirth according to the criteria of the different authors.	35 documents.	35 authors who describe nursing actions in relation to 10 specific cultural characteristics during cultural childbirth.
Quiñonez FJ, et al.31 Bachelor's Degree	2018 Ecuador	Quantitative-qualitative, cross-sectional descriptive. To evaluate the knowledge and practices of maternal and child care for children from 0 to 3 years of age in the 24 de mayo neighborhood of Esmeraldas canton.	30 mothers or caregivers in charge of children.	93% of mothers know at what age to give or introduce food to their children, while 7% preferred to wait until their children are at an age when they can adequately digest food.
Palomino SM, et al.32 Bachelor's Degree	2018, Peru	Quantitative study, cross-sectional descriptive non-experimental design. Knowing the factors associated with their abandonment is essential to identify the vulnerable groups that require nursing intervention.	55 mothers with children under 6 months of age.	There is an association of the abandonment of exclusive breastfeeding with the demographic factors and their indicators mother's age (0.042), father's age (0.000), father's level of education (0.008) and mother's employment status (0. 030); the social factor and family support with its indicator child under 6 months with colic or gas receives aniseed water (0.040); the physical factor with its indicator illness that prevents breastfeeding (0.000) and the hospital routine factor and professional support with the indicator time separated from the child after delivery (0.004).
Abanto SL, et al.33 Bachelor's Degree	2017, Peru	Quantitative, descriptive, cross-sectional study. Objective: To determine the level of knowledge that mothers have about home care of preterm newborns.	93 mothers of preterm newborns attended at the Lambayeque Regional Hospital from January to October 2016.	In the safety and protection dimension, 75.3% of the mothers have an average level of knowledge. In the comfort dimension, 71.0% have an average level of knowledge. In the food dimension, 60.2% of mothers have an average level of knowledge. In the emotional bonding dimension, 60.2% of the mothers have an average level of knowledge. It is therefore concluded that 65.6% of the mothers have a medium level of knowledge and 12.9% have a
				low level of knowledge. The highest percentage of the mothers evaluated reported medium knowledge of home care of the preterm newborn.
Colorado LD, et al.34 Bachelor's Degree	2017, Colombia	Qualitative study, non-experimental, cross-sectional design. To characterize the conceptions of "humanization", "humanized health care" and "citizen training" in students and professors of the Nursing program of the Catholic University of Manizales. .	178 students and 14 professors of the nursing program.	After the observed analysis, they show a prevalence in the category of Humanization, followed by Citizen Formation and finally the category of Humanized Health Care, with the category of Others emerging in some responses.
Niño CL, et al. 35 Bachelor's Degree	2017, Peru	Relational, observational, cross-sectional and prospective study. To determine the relationship between knowledge and practices on newborn care in adolescent mothers attending the Pillcomarca-Huánuco Health Center, 2016.	50 adolescent mothers. .	60% of adolescent mothers had good knowledge and 40% had poor knowledge about newborn care; regarding practices, 64% had adequate practices and 36% had inadequate practices; knowledge was significantly related to newborn care practices. 60
Pérez BR, et al. 36 Bachelor's Degree	2016, Peru	Simple descriptive study. To determine the performance of primiparous mothers aged 18 to 25 years in newborn care in the neonatology service of the Hermilio Valdizán Medrano Regional Hospital of Huánuco in 2016.	75 primiparous mothers aged 18 to 25 years. .	The 65.3% of primiparous mothers had a good level of performance in newborn care, being statistically significant (p = 0.0008).
Ayalas RE, et al. 37 Bachelor's Degree	2015, country missing	Quantitative, descriptive, cross-sectional comparative study. To compare the care provided by nurses in the surgical service of the Victor Lazarte Hospital with the care provided by nurses of the	98 adults	There was no significant difference in the compassionate healer subscale, only in the competent healer subscale.
Mamani PJ.38 Bachelor's Degree	2015, Peru	Belen Hospital of Trujillo in postatectomized adults. Quantitative, descriptive, comparative, cross-sectional study. To analyze the knowledge and attitudes of mothers and fathers about breastfeeding in the Hospital Hipólito Unanue de Tacna 2015.	Mothers and fathers of newborns discharged from the neonatology service and in mixed accommodation. .	56.8% of fathers have a high level of knowledge about breastfeeding and 65.1% of mothers. The level of knowledge in the dimension of definition and characteristics of breastfeeding in mothers and fathers is medium (59.2% and 58.6%).
Mansillas RR, et al. 39 Major	2019, Peru	Quasi-experimental study. To measure the needs of the patient's relative in the ICU, apply care sessions according to Kristen Swanson's model and analyze the level of satisfaction achieved.	30 relatives	60% and 73.3% of relatives in the control and experimental groups entered the program unsure of achieving satisfaction of their needs. .
Marín PG, et al. 40 Major	2018, Colombia country missing	Logical model. To design an educational tool for parents on basic newborn nursing care.	Logical model matrix.	A booklet was obtained and a socialization proposal was developed for the nurses of the unit and for the parents in order to socialize, unify concepts and knowledge and implement the booklet as an educational tool in the educational moment provided by the nurse.
Guzmán OY, et al.41 Major	2018, Peru	Quantitative, quasi-experimental study. To determine the effectiveness of the educational intervention on the primary caregiver's knowledge of post-operative patient care in the cardiopediatrics hospitalization service at the Instituto Nacional de Salud del Niño San Borja from October - November 2018.	58 primary caregivers of pediatric patients.
Ponte VK, et al.42 Major	2017, Peru	Quantitative, descriptive, cross-sectional study. To determine the effects of Shantala massage on the level of pain in infants (chlidren) under two years of age subjected to mechanical ventilation.	30 infants.	The nurses working in rotating shifts will apply the adapted Shantala massage guide with content validity to infants under invasive mechanical ventilation in PSV and CPAP mode, relieving pain, favoring their neurological development and promoting this nursing activity as an innovative and humanized care,
Hooker ZL, et al. 43 Major	2018, Colombia country missing	Logical model. Objective tree: To ensure good breastfeeding of the newborn when the mother is not in the hospital.	Bibliographic review.	Through a bibliographic review and the guidance of a group of experts, a guide for the handling and conservation of breast milk was developed.
Reategui AJ, et al. 40 Major	2018, Peru	Quantitative, non-experimental study. To determine the association between the quality of nursing care and the hospital stay of premature neonates in the neonatal ICU of the Regional Hospital of Loreto.	15 nurses working in the neonatal ICU.	Protocol, no results.
Flores HG, et al. 45 Major	2017, Colombia country missing	Logical model matrix. Unify the "kangaroo mother care" intervention for the care of premature and/or low weight infants hospitalized in a fourth level institution.	30 nurses from the neonatal ICU of the Children Heart Foundation.	An educational strategy (flip chart) was designed for nurses to unify kangaroo care in order to educate parents of premature or low birth weight infants.
Vargas BD, et al. 46 Major	2016, Colombia	Literature review. To elaborate a humanized interactive care guide for the taking of arterial gases applying CT for undergraduate and graduate students of the nursing faculty of the Universidad Nacional de Colombia, generating an educational tool of clinical simulation that allows offering the patient a safe and humanized procedure. .		During the entire process of searching and selecting the available literature, no evidence was found on the application of TC for arterial gas sampling that would lead the learning process and the procedure to humanized care.
Arellano MA, et al. 47 Major	2016, Colombia	Descriptive study. To establish an improvement plan to intervene the "explains and facilitates" and "anticipates" dimensions of the "CARE Q" instrument through activities that encourage nursing staff to improve the quality of care and establish effective communication with the parents of neonates hospitalized in the neonatal special care area of the Bolivarian University Clinic, during the period between February - May 2016. .	Parents (mother and/or father) of the neonate hospitalized in the special care service, with more than 48 hours in the service and those who were discharged or transferred to another service.	The "explains and facilitates" dimension of the "CARE Q" instrument had a satisfactory result of 90%, which exceeded 73.6%. The "anticipates" dimension yielded a result of 96.6%, which exceeded 71.9%.
Reyes OA, et al. 48 Major	2016, Colombia	Logical model methodology. To design, implement and evaluate an educational strategy that favors nursing care to parents with children in a situation of imminent death in the pediatric ICU of the Hospital Universitario de Santander.	Parents with children in imminent death situation	By providing adequate support to the parents of children in a situation of imminent death, negative feelings are reduced, favoring tranquility and an environment of greater warmth during these difficult moments.
Aguirre SE, et al. 49 Magister	2018, Peru	Quantitative study, applied, explanatory, experimental-preexperimental type of study. To determine the effectiveness of the program: preparation of mothers to improve the care of the premature newborn at home, neonatology service Hospital Loayza, Lima 2015.	30 mothers of preterm newborns, between October to November 2015.	When comparing the experimental group in the two conditions (before and after the application of the program), highly significant differences (p < 0.000) were observed. The negative ranges indicate that 100% of the mothers improved the care of the preterm newborn.
Espinoza CM, et al. 50 Magister	2018, Peru	Pre-experimental study. To determine the effectiveness of the "Kangaroo Mom" Program on knowledge, practices and satisfaction with neonatal care, in mothers of a private clinic in Lima, 2018.	10 mothers served from December 2017 through March 2018.	The level of knowledge, practices and satisfaction of mothers enrolled in the kangaroo mother program had an effectiveness of 100%.
Humán HD, et al. 51 Magister	2017, Peru	Quasi-experimental study pre and post-test design. To evaluate CT-based nursing care in improving the acceptance of breastfeeding practice of primigravid mothers at the Augusto Hernández Mendoza hospital - EsSalud. Ica 2016.	30 primigravid mothers hospitalized in the maternity and mixed housing area.	63.3% of mothers presented a regular level of knowledge of breastfeeding. In the first checklist on the acceptance of the practice of breastfeeding among primigravida mothers, there was 80% acceptance, while in the second checklist there was 70% acceptance.
Diaz OM.52 Magister	2016, Peru	Qualitative, descriptive, non-experimental and correlational. To determine the relationship between caregiving skills and the burden of the informal primary family caregiver (IPFC) of patients with chronic disease belonging to the "Companion Family" program of the Hospital Nivel II Vitarte - EsSalud, 2015.	All relative who are caregivers of the adult patients over 60 years of age, treated in the Hospitalization service who suffer from a chronic disease and who are registered in the accompanying family program during the months of July to October 2015. .	There is no relationship between caregiving skill and caregiver strain p=0.099).
Rojas EB, et al. 53 PhD	2017, México	Mixed study, hermeneutic method. Objective: To describe nursing care and interventions focused on the health needs of older adults attending a day care center in Toluca in order to design a model of nursing care and interventions based on TC.	177 women aged 65 to 84 years from the day home.	The importance of the study lies in obtaining a validated instrument for the assessment of the healthy elderly, as well as the proposal of a model of care based on TC.

Source: Own development

Regarding the basic processes of TC care, it has been shown that it supports the modification of the attitude towards organ donation, since when applying a post-test it presented a significant statistical difference and its intervention was elaborated with each of the basic processes ²⁴. Also, a model of care has been proposed under the theoretical approach of TC for the healthy older adult through a validated instrument for the older adult based on TC⁵³. In 38.0% of the total research, the development of TC is not visualized in the results and conclusions in spite of being the theoretical support; other research mentions TC in the theoretical or conceptual framework and in the rest of the work it is not mentioned again. The basic processes are placed in the tree of problems and objectives; however, when referring to the intervention, they are not visualized ⁴⁸.

Regarding the contribution in the clinical area, a care scale was developed to identify the care provided by nurses ³⁷, "the interactive care guide for arterial blood gases based on TC" was elaborated, stating that it is an easily accessible and innovative tool that will allow students to strengthen their knowledge and focus on patient care ⁴⁶; The TC allows the nursing professional to adopt model behaviors for mothers since, through the five basic processes of care, behaviors are progressively modified ³⁸; the instrument designed to measure the impact of miscarriage has been developed ¹²^,¹⁹^,¹⁸.

In the teaching area, the application of the theory allowed the elaboration of a "Management guide for the extraction and conservation of breast milk" ⁴³. When interventions were carried out using the basic processes in their entirety, needs were identified at the physical, family and social levels, which would be affecting gestational development ⁵⁵; the guarantee of care was significantly improved by applying the TC ³⁹, and the acceptance of breastfeeding practice by primigravid mothers was improved ⁵¹.

In the community setting, it is suggested to include home care applying TC by the nursing professional, so that patients do not abandon their treatment²⁹; It was observed that TC "is closely related to the care provided by nursing in terms of education and practice, in its clinical and collective context, it approaches the individual and his/her family in a holistic manner" ⁴⁰; incorporating TC in research, combining teaching and hospital practice, to detect deficiencies in the nursing care received by hospitalized patients in the different hospitalization services and to improve it²⁵ ; TC is suitable for supporting people who are experiencing the loss of a child¹⁵. At the community level, TC for older women is based on: dialogue, hope, movement and health orientation centered on the exercise of autonomy ⁵³.

Discussion

Based on the analysis of the available evidence of the scientific literature on the application of Kristen Swanson's TC in the areas of nursing work, it has been possible to demonstrate its great usefulness and applicability to support and provide holistic care. In the care area, some authors demonstrated satisfactory results applying the TC ⁴⁷, in maternal practice and infant care, the TC contributed to the strengthening of the theoretical and philosophical foundations supporting nursing care¹⁴.

In teaching, it is important to incorporate TC in nursing programs to strengthen the curriculum ³⁴. In the area of administration, some authors have included the theory in their problems, however, they have not mentioned it again in their interventions⁴⁸; In intervention research where knowledge was evaluated to later reinforce it, TC was very helpful, its application leads to a reflection on knowledge and attitudes about breastfeeding ³⁸, the ideal is to apply the complete TC, it should permeate from the beginning and throughout it, until reaching the proposal, that is, with its five basic processes; knowledge, being with, doing for, enabling and maintaining beliefs³⁹, this allows reflection on the care provided by nursing. There is also evidence of the effectiveness of home care in adherence to treatment in hypertensive patients²⁹.

The TC originated from phenomenology, therefore, it helps to understand from the meanings that people attribute to the processes they live, thus allowing to successfully carry out the proposed interventions, which is why it is important to conduct qualitative research as some authors did ³⁴^,⁵³. Likewise, it was identified that there was a change in the attitude towards organ donation in students ²⁴. Regardless of the nurse's experience at that moment, care is provided with the same quality and kindness.

Conclusions

This research allowed synthesizing and analyzing the available scientific literature, in English and Spanish, regarding the application of TC in the four areas of nursing practice; the evidence presented may be useful for researchers and nursing personnel interested in implementing a theory of the nursing discipline in their interventions, regardless of the area of performance.

Nursing professionals should strive to bring nursing theories into practice to strengthen the discipline; and to Kristen Swanson's own mid-range theory; theory-based practice feeds back and helps to understand experiences and phenomena in different areas when providing care, theory put into practice generates empirical knowledge of the discipline, provides knowledge and grounds the care provided to individuals.

The findings in this literature review contribute to enriching the body of nursing knowledge because it is intimately related to nursing care by providing care to individuals, families, and the community in a holistic manner.

The TC is considered essential for the comprehensive assessment at the time of providing care, adopting the foundations and concepts of the theory are very useful when providing warm and humanized accompaniment to people, for this reason it is relevant to use it since it favors the generation of a first learning space, it is useful to have an accompaniment with the patient and his family, and to offer them improvement strategies from the TC. In addition, it is important to carry out more intervention research and to evaluate these interventions; educating and evaluating what has been learned by the population generates responses specific to a group that can be generalized; teaching needs to work more in this area and include the theory in study curricula.

Conflicts of interest

The authors state there is no conflict of interest.

Funding

There was no funding.

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Received: June 03, 2020; Accepted: December 14, 2021

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