1. Introduction

Nursing theorists such as Nightingale and Swanson espouse the value of “commitment” as a core behavior of nursing, especially when providing direct personal care. Nightingale did describe the phenomena of being called to nursing that needs a commitment to nursing work. Her example of nursing practice in the Crimea provides evidence of caring behaviors with commitment. These include her commitment to attending persons regardless of time, a critical situation like the dying process, and offering therapeutic support during surgical procedures, etc. (Pfettscher, 2014; Alligood, 2017, p. 66). Swanson (1991); Alligood (2017) also emphasized that “caring is a nurturing way of relating to a valued other toward whom one feels a personal sense of commitment and responsibility (p. 162).”

However, in the American Nurses Association Code of Ethics, it does not give a precise definition of the concept commitment, but it mentioned that a nurse sustains a caring and compassionate relationship with a commitment to fair treatment of others and conflict resolution. Concerning this, with unresolved conflict, the nurse keeps to the commitment that the wishes of the person remain superior. And the primary commitment of the nurse is to the person, whether the person is defined as an individual, group, or community (Epstein and Turner, 2015). Further, the professional commitment of nurses enhances person’s safety (Al-Hamdan, Dalky, Al-Ramadneh, 2017). On the other hand, the College of Nurses of Ontario (2009) mentioned that regulated health professionals like nurses must maintain their commitment, which means keeping the pledge, observing honesty and performing the obligations towards persons, the nursing profession, themselves, colleagues, other healthcare professionals and quality practice settings.

Furthermore, according to Girard, Linton & Besner (2005), a commitment to the professional nursing practice means compassion, caring and strong ethical values; continuous development of self and others; being accountable and responsible for prudent practice; showing a spirit of collaboration and flexibility. On the other hand, West, Armit, Loewenthal, Eckert, West, and Lee (2015) described commitment in the context of an organization as seen by assuming responsibility and making it a personal priority to contribute in the success of the organization as a whole, rather than as individual success.

With the preceding statements, the quality of health care services rendered to person relies on the essential quality of nurses. Similarly, in the practice of the nursing profession, it should have possessed the required attributes to fulfill the meaning of the discipline. Furthermore, fulfillment of the nursing profession would mean a commitment that will offer a complete and selfless provision of nursing care and a commitment to professional advancement that will enrich the profession.

Philosophical Underpinnings

The foundational support of the Selfless Caring of Theory Commitment emanated from the various ideologies of some nursing theorist and philosophers. One of those is the philosophy of existentialism which describes by the 19th Century philosopher Kierkegaard that it is a philosophy that emphasizes individual existence, freedom, and choice through which self and the meaning of life found. But, Gabriel Marcel, however, an existentialist philosopher whose concept seems particularly relevant to nursing “believes in an open being in which man can, and must, participate. Consequently, according to him, man’s dauntless choices will result in personal growth, fuller human stature, and greater participation in being. Hence, in existentialism, commitment is a willingness to live fully one’s own life, to make that life meaningful through acceptance of, rather than detachment from, all that it may hold of both joy and sorrow (Sister Madeleine Clemence, 1966, p. 502-503).” With these themes, I believed that it gives a real significance to what the nurse does. “If the nurse is truly committed, they will be part of everything that nursing brings to themselves – its challenges, its frustrations, its future. They will care about nursing, and it will be part of their lives, whether a bedside nurse, educator or administrator. And; in so committing themselves, the nurse will enrich the profession, persons, and self (Sister Madeleine Clemence, 1966, p. 500).”

Hence, as a post-modernist I believed that nursing is not just a job, it’s a calling, and it is not just a profession, but it requires dedication/commitment. Even Florence Nightingale described that the phenomenon of being called to nursing requires a commitment to nursing work. I do believe it that to realize the meaning of nursing is to be committed to performing the nursing work despite the norm of difficulties in doing it. Thus, the essential equipment of a nurse to succeed in the profession is their commitment as a core of nursing action critical to meeting the healthcare needs of the person as a human being and in upholding its best interest. While, Swanson (1991) as cited in Wojnar (2014); Alligood (2017) supports the theory that caring is a nurturing way of relating to a valued other toward whom one feels a personal sense of commitment and responsibility (p. 688), and one of its domains refers to individuals’ concerns and commitments that lead to caring actions (p. 691).” Also, Roach (2002) as cited in Purnell (2014) accentuates that commitment is one of her “6 C’s (Care, Compassion, Competence, Communication, Courage, and Commitment)” that contribute to the language of caring (p. 360). Also, the theory is believed to have underpinned by the humanistic concept of Carl Rogers (1957) that have contributed to the nursing practice the understanding that each person is a unique individual. Thus, holistic approach to nursing care emerged in the nursing practice. A committed nurse observes that a person as a one-time human being with unique health needs requires a person-focused approach or individualized provision of selfless nursing care.

On the other hand, this theory is also based on the interpretive point of view that it is interacting and outcome-based. I believed that this theory revolves around the relationships nurses form with persons. A selfless caring inspired by commitment facilitates a helping and healing relationships with persons. It encourages a helping process through engaging person and significant others in the plan of care to promote healing-promoting behavior and attain positive health outcomes. Thus, the theory is also evolving in an outcome where it delineated a committed nurse as the changing force, who enables persons to adapt to or cope with ill health. It influences persons towards promoting an attitude that modifies poor health actions and helps them recuperate leading to positive health outcomes. Furthermore, as a post-modernist, it is also viewed that enriching the profession and self is not just because of our intellectual and personal capacities to accomplish it, but it is also because of our commitment to the nursing profession despite the given challenges and frustrations.

Hence, it is in these philosophical perspectives that I believed that a meaningful practice of the caring profession requires the spirit of commitment. And this commitment sets out actions towards achieving positive health outcomes among person, and a work that resonates to maintain and improve the core values, dignity and integrity of the profession despite the everyday adversities, respectively.

2. Description of the Theory

The quality of health care services rendered to the person whether individual, family, group or community depends on the integral character of nurse professionals. In the practice of the profession, its meaning is realized with adherence to the required attributes of the said discipline. Furthermore, fulfillment of the nursing profession is about commitment in the provision of selfless nursing and a commitment to enhancing the profession.

Committed nurses are emotionally bound to provide safe, efficient, ethical and selfless care; without regard to person’s socio-politico-cultural association. Because of their commitment, nurses are acting in the best interest of persons according to persons’ wishes and the standards of practice. Committed nurses are not capable of neglecting a person, like those living in the remote places that have no convenient access to healthcare services; without complaint of the distance and fatigue in reaching persons in the far-flung areas thus committed nurse are selflessly delivering the health services. Similarly, committed nurses are seen to provide care services without regard to time; they are willing to extend duty hours to render the complete care services. Furthermore, sleepless duties, making available for services even during special holidays or after a disaster, and shouted at by people who are upset, irritable or in pain. Despite these, a committed nurse will still put on the white uniform and unceasingly continue to care and will use every experience to make him/her a better nurse for the benefit of a person and the profession.

In addition, committed nurse is able to promote person-centered care which means: treating each as an individual person, protect a person’s dignity, respect one’s rights and preferences, empower person to make informed decisions about their care, provide holistically or individualize care; and develop a therapeutic relationship between the care provider and care recipient which is built on mutual trust and understanding. Also, commitment to care involves meeting the physical, developmental, and emotional care needs of the persons. Thus, committed nurse value and encouraged the involvement of families in the care of their loved ones, with respect to families’ right to privacy and cultural beliefs. Likewise, as committed to advocate for the person, the nurse espouse competent, ethical and professional practice by any member of the healthcare team and help sustain a collaborative working environment for all.

Similarly, committed nurses have a personal and professional pledge to the nursing profession. Being a member of the profession brings with it the respect and trust of the public. They uphold and display not only professional but also a personal commitment to the standards of the profession. Nurses conduct themselves in a manner that resonates well on the profession, and participates in and promote the growth of the discipline. Thus, nurses commit to welcome lifelong learning and the need for continuing professional development to expanding the knowledge and skills in the profession so to better serve the person.

As committed members of a self-regulating profession, nurses also help regulate nursing to protect the public’s right to quality nursing services and promote a safe environment. To ensure that a person has equal access to competent healthcare professionals that provides efficient, effective and quality health services across health settings without regard to their socio-politico-cultural association. Committed nurses participate in the dynamic progression of self-regulation where each nurse has to adhere to the professional duties and responsibilities, making them accountable for their action. Moreover, with its commitment to serving the entire population, nurses are also part of the country’s legislative body that promulgates health policies to address the current health issues and needs of the society. They participated in the creation of the nursing law and other health-related policies to ensure that the practice of the profession is committed to rendering and upholding the best nursing care to the person in a manner that is ethical, professional and personal.

In summary, Figure 1 shows the transcendence of selfless willingness to help that result in a broader sense of extending hands to others. It presents the two critical concepts in the context of commitment which includes commitment to a person and a commitment to the profession. In the former, it results to a selfless involvement in the provision of optimal care without regard to persons’ characteristics (dynamic status of wellness and socio-politico-cultural association) and environment (situation, time and place). Also, it values and encourages participation of person’s family in the provision of care.

Figure 1. The Transcendence of Willingness to Help

The next concept of The Selfless Caring of theory Commitment also influenced the practice of the profession despite the norm of challenges, like the promotion of teamwork among health care providers and safe working environment, embraces lifelong learning and continuing professional education to deliver high-quality nursing care, and promotes collaboration and coordination of person’s care with other healthcare professionals to provide continuity of care. But most importantly, these two concepts in the context of commitment go hand-in-hand to realize the hallmark of nursing.

Assumptions of the theory

This theory was based on the following assumptions:

1. Commitment is an emotional and intellectual state of being bound to some course of profession and action.

2. Commitment is personal in nature.

3. Commitment is necessary in the nursing practice.

Key Concepts

The Selfless Caring of theory Commitment is composed of key concepts and is hereby operationally defined:

• Commitment is defined as a promise to keep, a sense of dedication that transcends all other considerations, an unswerving allegiance to a given point of view. In existentialism, commitment means even more: a willingness to live fully one's own life, to make that life meaningful through acceptance of, rather than detachment from, all that it may hold of both joy and sorrow (Sister Madeleine Clemence, 1966).

• Selfless is defined as having or showing great concern for other people and little or no concern for yourself (Merriam-Webster’s Online Dictionary, 2018).

• Caring is a content specific interpersonal process which is characterized by the professional knowledge, skills, personal maturity, and interpersonal sensitivity of nurses, which result in the protection, emotional support, and the meeting of bio-psycho-social needs of patients (Drahošová and Jarošová, 2016).

• Willingness is defined as being ready to do something without being persuaded (Merriam-Webster’s Online Dictionary, 2018).

• Involve is defined as to cause (someone) to be included in some activity, situation, etc. (Merriam-Webster’s Online Dictionary, 2018).

• Acceptance is defined as an agreement with or belief in an idea or explanation (The Online Oxford Dictionary of English, 2018).

Propositions

These mentioned concepts are the heart and spirit of this theory, and their relationship between and among one another are explained in the following propositions:

1. If personal willingness to help others selflessly and unconditionally is present, commitment will occur.

2. If nurses are committed to the nursing profession, they embrace lifelong learning and continuing professional development to promoting knowledge and skills in the nursing practice.

3. If nurses are committed to the profession, they uphold the rights and integrity of the profession from any abuse and discrimination.

4. If nurses are committed to the profession, they participate in the promulgation of policies or laws to enrich the welfare of the nurses in the practice of the profession.

5. If a nurse is committed to the person, they perform the ethical/professional duties and responsibilities to uphold person’s best interests and meet quality nursing care.

6. If a nurse is committed, they will accept the professional obligations along with their work and, sometimes, the heartbreaks they may experience.

7. If a nurse is committed, they will involve themselves in the care of a person as a human being and not as an object.

8. Commitment to the profession and commitment to the person is intertwined; therefore, commitment to one will affect commitment to the other.

Meta-paradigm

The Selfless Caring of Theory Commitment views the 4 nursing meta-paradigms in such manner:

Person is a patient, whether an individual, a family, a group or a community without regard to its socio-politico-cultural association is the recipient of nursing care for committed nurses. Is considered as sick or well that necessitates an equal and selfless provision of nursing care to aid in its recovery and maintenance/improvement of homeostasis respectively.

Health refers to a person’s dynamic status of wellness; if the person is sick, committed nurse promotes its recovery. On the other hand, if the person is well, the committed nurse helps maintain its balance.

Environment refers to a setting of a person whether near or difficult to reach is accessed by committed nurses to provide nursing care and deliver health services and resources. Additionally, it also a working area for health professionals that is influenced by committed nurses to promote participation and coordination among health care providers for a safer delivery of quality health care services to a person.

Nursing refers to activities directed toward helping or caring a person selflessly and regardless of socio-politico-cultural association and the constraints in care delivery. Is driven by a state of being bound emotionally and intellectually to some course of a profession, like in nursing where caring is willingly provided to a person without condition at any given situation, time and place.

3. Application to Nursing Practice

It is possible that, for some nurses, doing nursing is maybe merely performing the nursing task in more complex healthcare settings, but the action just the same. Acquire the necessary skills to operate a new technology to render its purpose to the patient. Administer medications that observe the proper ways of doing it. Or, a nurse may say the appropriate words and performs the right gestures as indicated. To the degree that they are skillful, the technique attains its purpose, and the person benefited from it. But this nurse only lends, instead that gives of, themselves to the person. The nurse remains distant and detached from the person. It is in these circumstances that the Selfless Caring Theory of Commitment will remind nurses about the true essence of being involved with the profession and the person. The theory will emphasize that commitment in nursing is not about focusing on a nursing task, but it is more of focusing and involving self in the alleviation of person’s suffering.

On the other hand, some nurses in the world of practicing the profession are facing various challenges. Nurses are frustrated by low salary but overworked, and fed up with demanding work schedule. Or, they feel pressured to adopt new techniques, methods, and procedures in nursing care. For some nurses they found difficulty carrying out nursing actions because of lack of resources, or a demand for additional knowledge and skills because of the dynamics of the health conditions of patients. These are a few difficulties that sometimes they rich the point of thinking to give up the profession because of burnout, frustrations, disappointments, and fatigue. However, the theory will renew the nurses’ mindset about commitment to nursing. The pledge to the nursing profession is not just doing the nursing work; it needs commitment. In the broadest sense, a committed nurse accepts the professional obligations along with their work and sometimes, the adversities which they may experience.

4. Testing the Theory

The theory is relevant because it helps us to decide what we know and what we need to know (Parsons, 1949). Nursing theory aims to describe, predict and explain the phenomenon of nursing (Chinn and Jacobs, 1978). However, the foremost exponent of nursing – caring – with a core element of commitment cannot be measured; it is vital to have the theory to analyze and explain what nurses do in the context of commitment. With this, I suggest that an interpretative phenomenology can be conducted to understand better and explain the context of selfless caring of committed nurses. It is best because the different subjective reality of committed nurses concerning selfless caring can be viewed and taken with the ontological and epistemological positions of interpretivism, respectively. Further, according to Creswell (2009, p. 8) as cited in Scotland (2012) that interpretative methodology is directed at understanding phenomena from an individual’s perspective, investigating interaction among individuals as well as the historical and cultural contexts which people inhabit. In this case, to yield the insights and understandings of committed caring behavior and to explain the actions from the nurses’ perspective, open-ended interviews, focus groups, open-ended questionnaires, and open observations can be done by the researcher. However, I also suggest that the perspective of the persons about the selfless caring of committed nurses must also be taken. And, the ontological and epistemological undertakings are likewise guided by the core concepts of the theory.

5. Conclusions

Indeed, commitment is considered an essential element in all aspects of practicing nursing as a profession. And most importantly it can be served as one of the core values in the provision of care to persons. Furthermore, the value of commitment is seen to improve also the practice of the profession. It is assumed that the more we are committed to the profession of caring the more that we engaged ourselves to continuous enhancement of learning in the field. At this end, selfless caring is rooted from our personal involvement to the profession that transcends to our willingness to help person and the profession regardless of what, who, when and where they are, and whatever challenges we encountered in providing and improving nursing we are still holding our stance because of it, respectively. In short, involving self in the process of alleviating one’s suffering despite the constraints, and engaging self as a team player in winning the challenges of the profession is what the Selfless Caring of Theory Commitment is all about.

ACKNOWLEDGEMENTS

My sincere gratitude goes to Dr. Annabelle R. Borromeo for guiding me in this scholarly work. Because of her being a selfless mentor I was able to learn to develop my capacity in writing a scientific paper. Also, she inspired me to be firm in the midst of challenges and developed my mettle to succeed in every undertaking. With this, I thank you, Madam! I also acknowledge the emotional support and understanding given to me by my lovely wife Stephanie, and to my wonderful kids Marguerette and Stephen, you are all my inspiration.

To God be the Glory!