Children With a Terminal Illness: Nursing Theories

Topic: Nursing
Words: 1407 Pages: 5


In the field of nursing, it is one of the responsibilities of nurse practitioners to deliver care to individuals and their families by providing support in managing health issues. Therefore, it is particularly important to ensure evidence-based and theoretically validated delivery of care to families, the members of which are diagnosed with terminal illnesses. Given such a background, the POI for this research is as stress management of parents with hospitalized children with a terminal illness. The theoretical framework supporting this POI consists of the Theory of Caring introduced by Jean Watson and the Theory of Unitary Caring by Marlaine Smith, which inform nursing decision-making and care delivery in their complexity. The adoption of the principles of the nursing metaparadigm, the two theories, and the implications of the complexity theory allows nurses to develop a balanced strategy to support the served population. The paper claims that through the use of Jean Watsons Theory of Caring and Marlaine Smith’s Theory of Unitary Caring, nurses might facilitate their skills and strategies of providing compassionate and empathic help when promoting stress management of parents with hospitalized terminally ill children.

Nursing Metaparadigm

The nursing metaparadigm is a complete system of recurring themes and concepts that are inevitable and core for the discipline of nursing. It has been advanced by Fawcett (1984), who claimed that “the metaparadigrn of any discipline is a statement or group of statements identifying its relevant phenomena” (p. 84). In the case of nursing, the themes, phenomena, and concepts that continue being used across multiple theories of nursing comprise the four concepts of the nursing paradigm. According to Fawcett (1984), who had reviewed multiple research studies and nursing theories to detect the recurring concepts, they are person, environment, health, and nursing. These four concepts constitute the essence of nursing in general, as well as they, are applicable to any nursing issue or theory.

Moreover, the nursing metaparadigm is characterized by three recurring themes that depict the core of nursing practice’s ultimate purpose. Firstly, the metaparadigm contains “the principles and laws that govern the life-process, well-being, and optimum function of human beings, sick or well” (Fawcett, 1984, p. 85). Secondly, nursing practice is based on the identification of patterns in human behavior within the environment. Thirdly, the nursing metaparadigm is perceived as “the process by which positive changes in health status are affected” (Fawcett, 1984, p. 85). In unity, the four concepts and three themes inform balanced nursing theory and advance the development of the nursing practice toward achieving benefits for patients, families, and communities.

The nursing metaparadigm components are directly related to the POI. Indeed, the concept of a person entails the central role in nursing care in order to ensure their well-being and the well-being of their families. According to Rosenberg et al. (2019), parents of children with cancer or other terminal disease encounter significant psychological damage when handling their children’s health issues. In such a manner, taking a person with a problem at the center of nursing care allows for providing support to parents since they need it. In a similar manner, the concept of health relates to the POI because the health of parents is also impaired under the burden of continuous stress, which validates nursing care. Stress management is particularly connected with the environment since family is the environment in which a terminally ill child exists (Muscara et al., 2018). The patient will be more likely to feel better and overcome the disease with proper family support, boosted by nurses. Finally, nursing has a direct influence on the problem addressed by POI since the concept of nursing as the delivery of care predetermines the health outcomes of both parents and minor patients.

Nursing Theory

Grand Nursing Theory

The grand nursing theory that applies best to the POI is Jean Watson’s Theory of Caring. This theory is based on the assumption of the innate importance of human care for the benefits of others and their self-actualization. In particular, the “core of the theory of human caring has love as the starting point for practicing caring” (Turkel et al., 2018, p. 68). The delivery of care should be based on thoughtful reflection and contemplation within the nursing science (Watson, 1990). The conceptual framework of this theory entails ten core creative factors that predetermine the delivery of care. In particular, they include “a relational caring for self and others; transpersonal caring relationship; caring occasion/caring moment; multiple ways of knowing; reflective/meditative approach; caring is inclusive, circular, and expansive, and caring changes self, others and the culture of groups/environments” (Barker, 2019, p. 9). These factors serve as guidance for nursing care in the context outlined by the POI.

Overall, it is relevant that nurses delivering stress management care to parents with terminally ill children care for others building transpersonal relationships using multiple ways of knowing. Indeed, parents under stress demonstrate symptoms and require care, which is why nurses might detect the need for care at a caring occasion and utilize a reflective approach to help patients change their attitudes and strive for well-being (Muscara et al., 2018; Rosenberg et al., 2019). Ultimately, by caring for the environment, which is the family of an ill child, nursing practice is capable of making a change in the patient.

Middle Range Nursing Theory

The middle range theory utilized for the theoretical framework is Marlaine Smith’s Theory of Unitary Caring. Similar to Watson’s theory, this theoretical approach holds that caring is the central concept of nursing science (Smith, 2015). It is Marlaine Smith’s Theory of Unitary Caring that is based on five assumptions. Firstly, human beings are unitary with their environment; secondly, “caring is a quality of participating knowingly in human–environmental field patterning,” thirdly, caring is a whole human process based on innovative solutions (Smith, 2015, p, 497). Fourthly, caring expands consciousness and connects one to self and others; finally, caring resonates with the Universe (Smith, 2015). These five assumptions inform the theory’s core concepts, namely “manifesting intentions, appreciating pattern, attuning to dynamic flow, experiencing the Infinite, and inviting creative emergence” (Smith, 2015, p. 503). They apply to the POI by using the concept of manifesting intentions as the beliefs that a nurse should have about the ability to help parents overcome stress.

The appreciating pattern is the attitude and behavior of knowing the patients in order to improve their well-being. It is decisive for parents’ stressful experiences since it is through this step of the theory that nurses obtain knowledge about the family issues and propose support (Rosenberg et al., 2019). Moreover, attuning with the flow and experiencing the infinite implies nurses’ involvement in care as a process with necessary changes and adaptation. Finally, nurses might introduce innovative solutions based on the particularities of the parents’ experiences.

Complexity Theory

Another theory that applies to the case of stress management of parents with hospitalized children with a terminal illness is complexity science. This theory holds that nursing is a complicated system of multiple interrelated parts, which function in conjunction with one another. Nursing care delivery is a system characterized by complexity “when there is a high level of interrelatedness among many system elements, making it impossible to predict what outcomes will occur” (Gear et al., 2022, p. 1). According to Olsson et al. (2020), the complexity theory is based on the perception of a number of complex adaptive systems (CAS) that is a core concept of the theory. Within the context of the POI, a CAS is a family unit where the behavior, experiences, health, and recovery of each member are intertwined with others, affecting the overall functioning of the system. Moreover, in this CAS, the elements are interrelated because a child’s terminal disease triggers parents’ high stress level, while parents’ capability of managing stress has positive outcomes for the child’s recovery.


In summation, the delivery of care to parents experiencing a high level of stress due to the hospitalization of children with a terminal illness is essential to benefit the patients and the environment. According to the four components of the nursing metaparadigm, person, environment, health, and nursing are essential to ensure that parents effectively manage stress to support their children through the process of a disease. The theoretical framework developed on the basis of Jean Watson’s Theory of Caring, Marlaine Smith’s Theory of Unitary Caring, and complexity theory allow for comprehensive and validated delivery of care to the served population as a system functioning according to human care principles.


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