Caring as a Generative Principle: Reconfiguring the Metaparadigm and Operative Mechanisms in Nursing Theory

AIM(S): To develop a comparative meta-theory of nine caring theories by explicating their assumptions, operative mechanisms and consequences for nursing. DESIGN: Qualitative meta-theoretical document analysis. METHODS: Canonical texts were analysed using an intra-source strategy. Paginated statements were extracted and coded across assumptions, metaparadigm anchors (person, health, environment, nursing and care) and mechanisms linking caring intention to clinical action. Synthesis produced a typology and meta-theoretical propositions. RESULTS: Caring functioned as a generative principle that reorganised person, health, environment and nursing and care into distinct practice architectures. Six mechanism-based subfamilies were identified: transpersonal caritas; phenomenological and embodied clinical wisdom; ethical and relational caring; cultural and contextual caring; systemic and organisational caring; and operationalisable caring. Ten propositions linked assumptions to mechanisms and expected effects. CONCLUSION: The caring school is best understood as an ordered set of non-equivalent caring mechanisms rather than a single doctrine, supporting translation to practice design, education and congruent evaluation. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Mechanism-based comparison can reduce conceptual ambiguity and improve alignment between caring interventions and intended outcomes. IMPACT: This study addresses the under-specification of how caring theories work. It provides a comparative typology and propositions that make mechanisms explicit, informing nursing education, theory development and caring-based practice in diverse settings. REPORTING METHOD: No EQUATOR reporting checklist is available for meta-theoretical discursive analyses; the manuscript follows Journal of Advanced Nursing guidance for discursive papers. PATIENT OR PUBLIC CONTRIBUTION: This study did not include patient or public involvement in its design, conduct, or reporting.