References

Birch S, Dorosz EJ. Getting involved: a practical approach to deployment as a nurse or health care professional volunteer. In: Goodhue CJ, Blake N (eds). Cham, Switzerland: Springer;

Fee E, Garofalo ME. Florence nightingale and the Crimean war. Am J Public Health. 2010; 100:(9)1591-1591 https://doi.org/10.2105/AJPH.2009.188607

Guérin C, Albert RK, Beitler J Prone position in ARDS patients: why, when, how and for whom. Intensive Care Med. 2020; 46:(12)2385-2396 https://doi.org/10.1007/s00134-020-06306-w

Johnson DE. Development of theory: a requisite for nursing as a primary health profession. Nurs Res.. 1974; 23:(5)372-377

Kahana E, Bhatta T, Lovegreen LD, Kahana B, Midlarsky E. Altruism, helping, and volunteering: pathways to well-being in late life. J Aging Health. 2013; 25:(1)159-187 https://doi.org/10.1177/0898264312469665

McCrae N. Whither Nursing Models? The value of nursing theory in the context of evidence-based practice and multidisciplinary health care. J Adv Nurs. 2012; 68:(1)222-229 https://doi.org/10.1111/j.1365-2648.2011.05821.x

Nolte AGW, Downing C, Temane A, Hastings-Tolsma M. Compassion fatigue in nurses: a metasynthesis. J Clin Nurs. 2017; 26:(23-24)4364-4378 https://doi.org/10.1111/jocn.13766

Roy C. Key issues in nursing theory: Developments, challenges, and future directions. Nurs Res.. 2018; 67:(2)81-92 https://doi.org/10.1097/NNR.0000000000000266

Swanson KM. Empirical development of a middle range theory of caring. Nurs Res.. 1991; 40:(3)161-165 https://doi.org/10.1097/00006199-199105000-00008

Thoits PA, Hewitt LN. Volunteer work and well-being. J Health Soc Behav.. 2001; 42:(2)115-131 https://doi.org/10.2307/3090173

Wanzer M, Booth-Butterfield M, Booth-Butterfield S. ‘If we didn't use humor, we'd cry’: humorous coping communication in health care settings. J Health Commun.. 2005; 10:(2)105-125 https://doi.org/10.1080/10810730590915092

Watson J. Watson's theory of human caring and subjective living experiences: carative factors/caritas processes as a disciplinary guide to the professional nursing practice. Texto e Contexto Enfermagem. 2007; 16:(1)129-135 https://doi.org/10.1590/S0104-07072007000100016

Yeung JWK, Zhang Z, Kim TY. Volunteering and health benefits in general adults: cumulative effects and forms. BMC Public Health. 2018; 18:(1) https://doi.org/10.1186/s12889-017-4561-8

Going above and beyond: using nursing theories to explore volunteerism during the COVID-19 pandemic

25 November 2021
6 min read
Volume 30 · Issue 21

Abstract

Historically, nurses have volunteered to serve in wars and natural catastrophes. However, instead of a distant disaster, many nurses in the UK volunteered, working above and beyond, to assist their colleagues, local communities and health systems in the NHS during the peaks of the COVID-19 pandemic. Although the motivations and benefits to the community or self of volunteerism have been discussed in the literature, there is a paucity of literature and theoretical understanding from the field of nursing. Using a reflective and personal account of volunteering, this article aims to provide a better understanding of the concept of volunteerism in nursing. By exploring associated nursing theories from Jean Watson and Kristen Swanson, this article aims to illuminate and expand the knowledge base about nursing volunteerism. These nursing theories can frame the act of volunteerism and nursing and illustrate the interrelations of nursing theory and the practice of nursing volunteerism.

Volunteerism is an accepted characteristic in nursing, dating back to Florence Nightingale in the Crimean war. Nurses have also volunteered to help in natural disasters. Hundreds of nurses travelled to Haiti following the earthquake in 2010 and to Sierra Leone during the Ebola outbreak in 2014 (Fee and Garofalo, 2010; Birch and Dorosz, 2020). Nurse volunteers have the unique opportunity to practise their science and art and learn about the world from another point of view, arguably making them better nurses (Thoits and Hewitt, 2001). Nurses have volunteered in established organisations such as the Red Cross or community-based projects.

The aim of this article is to examine two nursing theories to identify, connect and place the phenomenon of volunteerism within nursing. The author's own experiences of volunteering during the COVID-19 pandemic will be used to frame these theories.

The term volunteering is based on the Latin voluntarius, which means ‘of one's free will’ (www.vocabulary.com). Additionally, the definition of volunteerism has been linked strongly to altruism (Kahana et al, 2013). Nurses will easily identify with this concept of caring for others and having the desire to increase the wellbeing of those they serve. However, not every act of volunteering is altruistic and not every altruistic act is volunteering, but the connection between the two concepts, in this context, is linked (Kahana et al, 2013). Additionally, three characteristics surrounding volunteering are offered. Firstly, volunteering can be viewed as unpaid work or service, in which the volunteer offers a skill or expertise required, such as the nurse in a vaccination centre. Secondly, volunteering can be simply offering a service or spending spare time in a meaningful way, as seen with those who assist in the video calls with isolated patients and families. Lastly, nurses volunteering in food banks are using this as a vehicle to address or bring about social change personal to the individual. These activities can be organised and formal or alternatively, more individualistic or informal. ‘Forced’ volunteerism, such as community service, corporate social responsibility or university credit is acknowledged, but not included in this article.

As described in the first definition, as an intensive care unit (ICU) nurse the author was able to offer her skills and knowledge through additional shifts during the COVID-19 pandemic. Her colleagues volunteered to work in vaccination centres, in video-call liaison, foodbanks and contact tracing. These acts of volunteerism will be explored and framed within nursing theories.

Nursing theories

The legitimacy of any profession is built on its ability to generate and apply theory (Johnson, 1974). Theories are mental patterns or constructs created to help understand and find meaning from experience, organise and articulate knowledge, and ask questions, leading to new insights (Roy, 2018). In general, nursing theory describes and explains the phenomena of interest to nursing in a systematic way to provide understanding for use in nursing practice and research. However, historically, this has been problematic, with nurses not recognising or valuing the unique contribution and body of knowledge they bring, or perceiving that theories have no place by the bedside or everyday nursing (McCrae, 2012). In revisiting existing nursing theories, there is the possibility of enhancing the practice and development of the profession as it responds to the challenges of a continually evolving clinical environment—in this case, the phenomenon of nursing volunteerism.

During the pandemic, the author volunteered in an ICU at a London hospital. To understand her role as a volunteer and nurse, the author undertook an exploration of nursing theories related to volunteering and here presents a personal account.

Understanding the author's experience of volunteerism through nursing theories

On reflection, my awareness of the desperate situation many nurses faced motivated me to assist my colleagues. Using my own experience, I identified that caring and altruism were motivational and key in the decision-making process. Encountering both Watson's and Swanson's discussion that caring is grounded on a set of universal humanistic, altruistic values appealed to me. Watson's (2007) theory gave me an insight as to the ‘why’, while Swanson (1991) illustrated the ‘how’.

Watson's (2007) theory included kindness, empathy, concern, and love for self and others in these values, pertinent to volunteerism and easily identified by nurses. Watson (2007) states that these altruistic values arise from commitments to and satisfaction from ‘receiving through giving’. Personally, I felt great gratification in being able to assist my colleagues and, although tired, left each day exhilarated. Additionally, I identified with Watson's view that caring for others promotes self-actualisation on both a personal and professional level and is a mutually beneficial experience. This also echoes Yeung et al's (2018) work, which found that volunteers experience physical and mental health benefits.

Swanson's (1991) theory of caring provided me with a meaningful structure within which to care for those with whom I volunteered. Swanson's (1991) five caring behaviours of knowing, being with, doing for, enabling, and maintaining belief can serve as the road map when volunteering in the nursing context. Each component will be explored related to my experiences.

Swanson (1991: 163) described knowing as ‘striving to understand an event as it has meaning in the life of the other’. As a volunteer in an unfamiliar unit, I felt it important to know my colleagues and to hear their stories so I could support them effectively. I listened as they recounted their experiences in the first wave of the pandemic and their sense of inadequacy and fear for themselves and families. Moreover ‘being with’ encompasses being emotionally present; I wanted to understand what the nurses, patients and families had been going through so I could better meet their needs. The nurses were emotionally drained from the strain of working during the first and second wave of the pandemic. I was able to support them by being with them. They had given so much to those who they were caring for that it left them depleted (Nolte et al, 2017).

Swanson (1991: 164) characterised ‘doing for’ as ‘comforting, anticipating and being protective of other's needs’. Although I was volunteering as a nurse in an ICU, my goal was to offer support to my colleagues, through small protective acts such as making tea, enabling a bathroom break or ensuring someone got lunch. I was constantly humbled by the ‘thank yous’ as none of these measures went unnoticed. However, I became aware of the emotional toll their experiences had on my colleagues and recognised compassion fatigue (Nolte et al, 2017).

Swanson's (1991: 164) fourth caring behaviour, ‘enabling’, with the purpose of ‘facilitating the other's capacity to grow’ encompassed my ability to teach and support those nurses who were unfamiliar with working in an ICU. With my ICU experience and years of service, I felt able to assist those who had been seconded from other wards. For those nurses unaccustomed to the monitors and pumps, or overwhelmed by the critical nature of the patients, I felt able to encourage and give confidence, allowing them time to ask questions and helping them feel capable. I witnessed such caring acts among the permanent ICU staff, who, despite being responsible for four patients with two support nurses, were committed to teach, give feedback and thoroughly explain the process and rationale of proning a patient, for example (Guérin et al 2020). Those seconded felt more relaxed, able to perform and feel a valued member of the team.

Lastly, Swanson (1991: 163) defined the fifth caring behaviour as ‘maintaining belief’ or ‘maintaining a hope-filled attitude and going the distance’. I was able to maintain optimism and faith in the abilities of the team I had joined. I believed everyone was delivering the best care they could under extraordinary circumstances, and we would all go the distance together. I made a purposeful effort in volunteering to model an appropriate level of optimism and positive attitude. I felt this could help those who were feeling overwhelmed and burdened by the loss felt by so many. As discussed by Wanzer et al (2005), humour was used by many as a stress-relieving strategy. I sought out ways to bring humour to the workplace, seeing and feeling the benefits of the sound of laughter. The nurses celebrated the accomplishments of their patients and colleagues. I intentionally circulated these accomplishments and good news to lift spirits and give hope. As the effects of the successful vaccine programme impacted admissions and there was news of a ‘road map’ out of the pandemic, nurses felt more positive, feeling the end was in sight.

Conclusion

As a nurse volunteer the author reviewed the work of two nursing theorists Watson (2007) and Swanson (1991) who offered a framework to explain volunteering in the nursing context. Watson (2007) believed that human care and caring is the moral ideal of nursing. Furthermore, the transpersonal caring relationship through connection was played out in the author's volunteer experience. This personal account illustrated the transformative experience of volunteering described by Watson (2007). Swanson's (1991) theory of caring provides an ideal framework within which to understand the caring and meaningful relationships the author formed with the permanent ICU staff. The author used Swanson's (1991) five caring processes to support her colleagues during the devastating second wave of the pandemic. The strategies discussed in this article serve as an exemplar for nurses to cultivate caring and supportive relationships with other nurses as they serve as volunteers. However, such strategies can also be used to the benefit of many other nursing settings.

KEY POINTS

  • Nurses have a history of volunteering to care for those wounded in wars and to assist in natural disasters
  • Nursing volunteerism is another dimension of nursing
  • The COVID-19 pandemic led to nurses volunteering to work with COVID-19 patients, to administer vaccines and provide virtual support to patients
  • The author has reflected on her time volunteering in an intensive care unit, using the nursing theories of Watson and Swanson
  • The author has discussed the benefits of volunteering and of applying its caring, supportive approach to other situations and aspects of nursing

CPD reflective questions

  • Consider how volunteering is articulated in the nursing Code
  • How does volunteering impact you as a working nurse?
  • How do you cultivate a supportive and caring culture in your working environment?