jean watson report

Running Head: Theory of Human Caring 1

Jean Watson

_______________________

Shastine P. Tiong

Harris Cacanindin

Saint Louis University

Jean Watson

Theory of Human Caring 2

Theorist - Jean Watson was born in 1940.Grew up in the 1940s-1950s in Southern Welch,

West Virginia, US in the Appalachian mountains and is the youngest of eight children, she was

surrounded by an extended family-community environment.She attended the Lewis Gale School

of Nursing in Roanoke, Virginia from which she graduated in 1961. In the same year of 1961,

she moved to Colorado with her husband, Douglas. Then she earned her B.S. in 1964 and her

Ph.D. in Educational Psychology and Counseling in 1973 from the University of Colorado at

Boulder and achieved six (6) Honorary Doctoral Degrees. In 1966 she earned her M.S. in

Psychiatric and Mental Health Nursing in the University of Colorado at Denver.Watson has held

faculty and administrative positions (Professor) at the University in Colorado Health Sciences

Center including deanship of the School of Nursing from 1983-1990 and served as the president

of the National League for Nursing from 1995–1996. She was also a fellow of the American

Academy of Nursing. The foundation for her theory was first published in 1979 and in 1988, her

theory was published in “nursing: human science and human care”.

T h e s e v e n a s s u m p t i o n s :

1. Caring can be effectively demonstrated and practiced only interpersonally.

2. Caring consists of carative factors that result in the satisfaction of certain human needs.

3. Effective caring promotes health and individual or family growth.

4. Caring responses accept person not only as he or she is now but as what he or she may

become.

5. A caring environment is one that offers the development of potential while allowing the

person to choose the best action for himself or herself at a given point in time.

6. Caring is more “healthogenic” than is curing. The practice of caring integrates

biophysical knowledge with knowledge of human behavior to generate or promote health

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and to provide ministrations to those who are ill. A science of caring is therefore

complementary to the science of curing.

7. The practice of caring is central to nursing (Watson 1979)

The essence of Watson’stheoryisauthenticcaring for the purpose of preserving the dignity and

wholeness of humanity. Watson seesnursing’s "collective caring -healingrole and it’s mission in

society as attending to, and helping to sustain, humanity and wholeness."According to Watson,

knowledge and practice for a caring – healing discipline are primaryderivedfrom the arts and

humanities and an emerginghuman science thatacknowledgesa convergence of art and

science.Originallydefined as a human - to - humanconnectednessoccuring in a nurse – patient

encounterwherein ‘eachistouched by the human center of the other’.A recentelaboration on the

concept of a transpersonalcaringrelationshipdescribesthisrelationshipoccuringwithin a

caringconsciousness , wherein a nurse enters ‘into the life space or phenomenalfield of

anotherperson and is able to detect the otherperson’s condition of being (spirit or soul level),

feelsthis condition within self, and responds in such a waythat the personbeingcared for has a

release of feelings, thought and tension’.

Key Concept:

o Caring is a moral ideal: mind-body-soul, engagement with another

The original theory included 10 Carative Factors:

Nursing interventions related to human care originally referred to as carative factors have

now been translated into clinical caritas processes(Watson, 2006): Caritas means ‘to cherish’

The TEN CARATIVE FACTORS wereidentified by Watson as factorsthatcharacterize

the nursing-caring transaction occuringwithin a givencaring moment or occasion. Watson notes

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that the carativefactors are not intended to be a checklist but to be a philosophical and conceptual

guide to nursing.

1. The formation of a humanistic- altruistic system of values.

"Practice of loving-kindness and equanimity within context of caring consciousness”

Begins developmentally at an early age with values shared with the parents; Mediated through

one’s own life experiences, the learning one gains and exposure to the humanities; is perceived

as necessary to the nurse’s own maturation which then promotes altruistic behavior towards

others.

2. The instillation of faith-hope becomes:

“Being authentically present, and enabling and sustaining the deep belief system and

subjective life world of self and one-being-cared-for.”

Is essential to both the carative and the curative processes; When modern science has nothing

further to offer the person, the nurse can continue to use faith-hope to provide a sense of well-

being through beliefs which are meaningful to the individual.

3. Cultivation of sensitivity to one's self and to others, becomes:

"Cultivation of one's own spiritual practices and transpersonal self, going beyond ego

self"

Explores the need of the nurse to begin to feel an emotion as it presents itself; Development of

one’s own feeling is needed to interact genuinely and sensitively with others; Striving to become

sensitive, makes the nurse more authentic, which encourages self-growth and self-actualization,

in both the nurse and those with whom the nurse interacts; The nurses promote health and higher

level functioning only when they form person to person relationship.

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The first three carative factors form the “philosophical foundation” for the science of

caring. The remaining seven carative factors spring from the foundation laid by these

first three.

4. The development of a helping-trusting relationship becomes:

“Developing and sustaining a helping-trusting authentic caring relationship.”

Strongest tool is the mode of communication, which establishes rapport and caring;

Characteristics needed to in the helping-trust relationship are:Congruence, empathy and

warmth;Communication includes verbal, nonverbal and listening in a manner which connotes

empathetic understanding.

5. The promotion and acceptance of the expression of positive and negative feelings

becomes:

“Being present to, and supportive of the expression of positive and negative feelings as a

connection with deeper spirit of self and the one-being-cared-for.”

“Feelings alter thoughts and behavior, and they need to be considered and allowed for in a caring

relationship”; Awareness of the feelings helps to understand the behavior it engenders.

6. The systematic use of the scientific problem-solving method for decision making

becomes:

“Creative use of self and all ways of knowing as part of the caring process; to engage in

artistry of caring-healing practices.”

The scientific problem- solving method is the only method that allows for control and prediction,

and that permits self-correction; the science of caring should not be always neutral and objective.

7. The promotion of interpersonal teaching-learning becomes:

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“Engaging in genuine teaching-learning experience that attends to unity of being and

meaning attempting to stay within other’s frame of reference.”

The caring nurse must focus on the learning process as much as the teaching process;

Understanding the person’s perception of the situation assist the nurse to prepare a cognitive

plan.

8. The provision for a supportive, protective, and(or) corrective mental, physical,

sociocultural, and spiritual environment becomes:

“Creating healing environment at all levels (physical as well as non-physical), subtle

environment of energy and consciousness, whereby wholeness, beauty, comfort, dignity,

and peace are potentiated.”

Watson divides these into eternal and internal variables, which the nurse manipulates in order to

provide support and protection for the person’s mental and physical well-being; the external and

internal environments are interdependent; Nurse must provide comfort, privacy and safety as a

part of this carative factor.

9. Assistance with gratification of human needs, becomes:

"Assisting with basic needs, with an intentional caring consciousness, administering

‘human care essentials', which potentiate alignment of mind-body-spirit, wholeness, and

unity of being in all aspects of care“

It is based on a hierarchy of need similar to that of the Maslow’s; each need is equally important

for quality nursing care and the promotion of optimal health; all the needs deserve to be attended

to and valued.

Watson’s ordering of needs:

Lower order needs (biophysical needs)

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The need for food and fluid

The need for elimination

The need for ventilation

Lower order needs (psychophysical needs)

The need for activity-inactivity

The need for sexuality

Higher order needs (psychosocial needs)

The need for achievement

The need for affiliation

Higher order need (intrapersonal-interpersonal need)

The need for self-actualization

10. The allowance for existential-phenomenological forces becomes:

“Opening and attending to spiritual-mysterious and existential dimensions of one’s own

life-death; soul care for self and the one-being-cared-for.”

Phenomenology is a way of understanding people from the way things appear to them, from their

frame of reference; Existential psychology is the study of human existence using

phenomenological analysis; This factor helps the nurse to reconcile and mediate the incongruity

of viewing the person holistically while at the same time attending to the hierarchical ordering of

needs; Thus the nurse assists the person to find the strength or courage to confront life or death.

W a t s o n ’ s t h e o r y a n d t h e f o u r m a j o r c o n c e p t s :

1. Human being - Human being refers to “….. a valued person in and of him or herself to be

cared for, respected, nurtured, understood and assisted; in general a philosophical view of a

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person as a fully functional integrated self. He, human is viewed as greater than and different

from, the sum of his or her parts”.

Essential to human existence ‘ isthat the human has transcended nature – yetremains a

part of it. The humancan go forward, through the use of the mind, to higherlevels of

consciousness … one’s soul possesses a body thatis not confined by objective space and

time; Watson elaborated on this transcendent nature of beinghumanwhenshequoted de

Chardin in 1996:‘We are not humanbeingshaving a spiritual experience. We are spiritual

beingshaving a humanexperience.’

Of the basic premisesthat Watson identified in her caring model, five relate to person:

1. A person’smind and emotions are windows to the soul…..

2. A person’s body isconfined in time and space, but the mind and soul are not confined to

the physical universe…..

3. A nurse may have access to a person’smind, emotions and inner self

indirectlythroughanysphere - mind, body or soul – provided the physical body is not

perceived or treated as separatefrom the mind and emotions and highersense of self (soul)

…..

4. The spirit, inner self, or soul of a person exists in and for itself…..

5. People needeachother in a caring, lovingway….

2. Health - Watson adds the following three elements to WHO definition of health:

A high level of overall physical, mental and social functioning

A general adaptive-maintenance level of daily functioning

The absence of illness (or the presence of efforts that leads its absence)

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Health refers to unity and harmony within the mind, body and soul; Health is also

associated with the degree of congruence between the self as perceived and the

self as experienced; Watson noted that illness can result from a troubled inner

soul, and illness can lead to disease, but the two concepts do not fall on a

continuum and can exist apart from one another.

Illness is defined as subjective turmoil or disharmony within a person’s inner self

or soul at some level or disharmony within the spheres of the person, for example,

in the mind, body and soul, either consciously or unconsciously; Illness connotes

a felt incongruence within the person such as an incongruence between the self as

perceived and the self as experienced.

3. Environment/society - According to Watson, caring (and nursing) has existed in every

society.A caring attitude is not transmitted from generation to generation.It is transmitted by the

culture of the profession as a unique way of coping with its environment.

Watson made use of her 8th carative factor to define environment. ‘Attending to

supportive, protective and/or corrective mental, physical, societal and spiritual

environments’; In recent discussions, environment is considered in the context of a

human-environment field. This field forms an ‘unbroken wholeness and connectedness

of all (subject-object-person-environment-nature-universe-all living things)’.

4. Nursing - “Nursing is concerned with promoting health, preventing illness, caring for the

sick and restoring health”. It focuses on health promotion and treatment of disease. She believes

that holistic health care is central to the practice of caring in nursing.She defines nursing

as…..“A human science of persons and human health-illness experiences that are mediated by

professional, personal, scientific, esthetic and ethical human transactions”.

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Nursing defined as a noun consists of knowledge, thoughts, values, philosophy,

commitment and action, with some degree of passion… related to human care

transactions and intersubjective personal human contact with the lived world of the

experiencing person; Nursing defined as a verb is carried out through human care and

caring which Watson views as the moral ideal of nursing and consists of transpersonal

human-to-human attempts to protect, enhance, and preserve humanity by helping a

person find meaning in illness, suffering, pain and existence; to help another gain self-

knowledge, control and self-healing wherein a sense of inner harmony is restored

regardless of the external circumstances; As a profession, nursing ‘exists in order to

sustain caring, healing and health where, and when, they are threatened biologically,

institutionally, environmentally, or politically by local, national or global influences’.

W a t s o n ’ s t h e o r y a n d n u r s i n g p r o c e s s :

Nursing process contains the same steps as the scientific research process. They both try

to solve a problem. Both provide a framework for decision making.

1. Assessment - Involves observation, identification and review of the problem; use of

applicable knowledge in literature.Also includes conceptual knowledge for the formulation and

conceptualization of framework.Includes the formulation of hypothesis; defining variables that

will be examined in solving the problem.

2. Plan - It helps to determine how variables would be examined or measured; includes a

conceptual approach or design for problem solving. It determines what data would be collected

and how on whom.

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3. Intervention - It is the direct action and implementation of the plan.It includes the

collection of the data.

4. Evaluation - Analysis of the data as well as the examination of the effects of interventions

based on the data.Includes the interpretation of the results, the degree to which positive outcome

has occurred and whether the result can be generalized.It may also generate additional hypothesis

or may even lead to the generation of a nursing theory.

W a t s o n ’ s t h e o r y a n d t h e c h a r a c t e r i s t i c o f a t h e o r y :

1. Logical in nature.

2. Relatively simple

3. Generelizable

4. Based on phenomenological studies that generally ask questions rather than state

hypotheses.

5. Can be used to guide and improve practice.

6. Supported by the theoretical work of numerous humanists, philosophers,

developmentalists and psychologists.

Strengths/Weaknesses

Strengths: Watson’s work can be used to guide and improve practice. It can provide the nurse

with the most satisfying aspects of practice and can provide the client with holistic care.The

theory is relatively simple. Watson’s work is logical in that the carative factors are based on

broad assumptions that provide a supportive framework. The carative factors are logically

derived from the assumptions and related to the hierarchy of needs. The carative factors delineate

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nursing from medicine.This theory places client in the context of the family, the community and

the culture.It places the client as the focus of practice rather than the technology.

Weakness:Watson’s theory becomes more complex when entering the area of existential-

phenomenology, for many nurses may not have the liberal arts background to provide the proper

foundation for this area.Biophysical needs of the individual are given less important.The ten

carative factors primarily delineate the psychosocial needs of the person.Needs further research

to apply in practice.

Importance to Nursing:

This theory is important to nursing due to the central concept of caring. This theory is

grounded in the discipline of nursing and nursing science but has evolved to include a

variety of other disciplines increasing its relevance in a variety of fields

Related research:

The effectiveness of Watson's Caring Model on the quality of life and blood pressure of

patients with hypertension. J Adv Nurs. 2003 Jan; 41(2):130-9.

This study demonstrated a relationship between care given according to Watson's Caring

model and increased quality of life of the patients with hypertension. Further, in those patients

for whom the caring model was practised, there was a relationship between the Caring model and

a decrease in patient's blood pressure. The Watson Caring Model is recommended as a guide to

nursing patients with hypertension, as one means of decreasing blood pressure and increase in

quality of life.

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Analysis

It is undeniable that technology has already been part of nursing’s whole paradigm with

the evolving era of development. Watson’s suggestion of purely “caring” without giving

much attention to technological machineries cannot be solely applied but then her

statement is praiseworthy because she dealt with the importance of the nurse patient

interaction rather than a practice confined with technology. Watson stated the term “soul-

satisying” when giving out care for the clients. Her concepts guide the nurse to an ideal

quality nursing care provided for the patient. This would further increase the involvement

of both the patient and the nurse when the experience is satisfying. In providing the

enumerated clinical caritas processes, the nurse becomes an active co-participant with the

patient. Thus, quality of care offered by the nurse is enhanced.

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References:

Andrews, M., Arnerich, J. (2008). Jean Watson’s Philosophy and Science of Caring. Retrieved

from http://www.authorstream.com/Presentation/SacState217-105326-jean-watson-

andrews-arnerich-212-presentation-education-ppt-powerpoint/

Nursing Theories. (2012). Jean Watson's Philosophy of Nursing. Retrieved from

http://currentnursing.com/nursing_theory/Watson.html

St. Luke’s College Of NursingTrinity University Of Asia. (2010). The Philosophy And Science

Of Caring Jean Watson. Retrieved from http://www.slideshare.net/1NU07/jean-watson-

5372896

Theoretical Foundation of Nursing. (2011). Jean Watson Caring Science as Sacred Science.

Retrieved from http://nursingtheories.weebly.com/jean-watson.html

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