Swanson's theory of caring applied to mechanical ventilation weaning in the ICU: Humanizing care

Abstract

Objective

To analyze the scientific evidence on the application of Swanson's Theory of Caring in the process of invasive mechanical ventilation weaning in Intensive Care Units (ICU), identifying nursing interventions that correspond to Swanson's five theoretical processes (knowing, being with, doing for, enabling, and maintaining belief) and assessing their implications for clinical practice.

Method

Scoping review conducted according to the methodological framework of Arksey and O’Malley (2005), enhanced by Levac et al. (2010), and the updated JBI guidance for scoping reviews (Peters et al., 2020). Reporting followed the PRISMA extension for Scoping Reviews (PRISMA-ScR). A search of scientific literature published between January 2020 and January 2026 was performed in PubMed/MEDLINE, SciELO, CUIDEN, Cochrane Library and CINAHL, complemented by backward citation tracking. Forty-five articles were included after applying rigorous selection criteria, through independent screening by two reviewers with discrepancies resolved by consensus. Data were analyzed through structured extraction and narrative synthesis, organizing interventions according to Swanson's five caring processes.

Results

The review identified multiple nursing interventions during ventilator weaning that showed conceptual correspondence with Swanson's theory. Only 8 of the 45 articles (18%) explicitly used Swanson's framework, and a single study directly linked it to ventilator weaning, identifying a significant knowledge gap. The “knowing” process includes individualized assessment using validated scales and continuous monitoring. “Being with” is manifested through therapeutic presence, effective communication, and facilitation of family contact. “Doing for” encompasses sedation titration, ventilation management, and respiratory physiotherapy techniques. “Enabling” comprises health education, use of augmentative communication systems, and support in decision-making. “Maintaining belief” is materialized through positive reinforcement, management of realistic expectations, and emotional accompaniment.

Conclusions

Swanson's Theory of Caring provides a relevant and potentially operational theoretical framework to structure and humanize nursing care during ventilator weaning in the ICU. The conceptual correspondence identified suggests that its systematic application could contribute to improving patient experience, reducing psychological complications, and optimizing weaning outcomes. Implementation gaps are evident due to the absence of prospective studies, scarcity of data to quantify the impact of relational care on the weaning process, and the absence of specific protocols that merge the NANDA-NIC-NOC taxonomy and the Swanson theoretical framework. Prospective studies applying Swanson's framework from the design phase are required to evaluate the specific impact of interventions based on this theory through controlled clinical trials.