Caring and the Professional Practice of Nursing

by Teresa Vance, RN
Caring and nursing have always been thought of synonymously. Most individuals choose nursing as a profession because of their desire to care for other individuals. Caring as a central concept has led to the development of several caring theories. Two well known theories were developed in the 1970s, Leiningers Theory of cultural care and Jean Watsons Theory of human caring (McCance, McKenna, Boore 1999). Jean Watson defines caring as a science. She states; Caring is a science that encompasses a humanitarian, human science orientation, human caring processes, phenomena, and experiences. Caring science includes arts and humanities as well as science. A caring science perspective is grounded in a relational ontology of being-in-relation, and a world view of unity and connectedness of all. Transpersonal Caring acknowledges unity of life and connections that move in concentric circles of caring-from individual, to others, to community, to world, to Planet Earth, to the universe. Caring science investigations embrace inquiry that are reflective, subjective and interpretative as well as objectiveempirical; Caring science inquiry includes ontological, philosophical, ethical, historical inquiry and studies. In addition, caring science includes multiple epistemological approaches to inquiry including clinical and empirical, but is open to moving into new areas of inquiry that explore other ways of knowing, for example, aesthetic, poetic, narrative, personal, intuitive, kinesthetic, evolving consciousness, intentionality, metaphysical-spiritual, as well as moral-ethical knowing. Caring science is an evolving new field that is grounded in the discipline of nursing and evolving nursing science, but more recently includes other fields and disciplines in the Academy, for example, Women/Feminist studies, Education, Ecology, Peace Studies, Philosophy/Ethics, Arts and Humanities, Mindbodyspirit Medicine. As such, caring science is rapidly becoming an Interdisciplinary Transdisciplinary field of study. It has relevance to all the health, education human service fields and professions (Watson 2003). Caring behaviors are defined as; Behaviors evidenced by nurses in caring for patients. The top ten caring behaviors, derived from nursing literature are; attentive listening, comforting, honesty, patience, responsibility, providing information so the patient can make an informed decision, touch, sensitivity, respect, calling the patient by name (Tabers 1993). Some Caring behaviors are evident in other professions. Law enforcement is noted for their honesty and respect. Psychologists are comforting and require attentive listening skills to help their patients. Teachers must possess patience, attentive listening, sensitivity, and great responsibility to mold our children into productive adults. The lists of professions are endless. Madeleine Leininger subscribed to the central tenet that care is the essence of nursing and the central, dominant, and unifying focus of nursing (Leininger 1991). Watson describes nursing as a human science, with the major focus being the process of human care for individuals, families, and groups. Her theory is based on a form of humanism and has its origins in metaphysics (philosophy of being and knowing) (McCance, Mckenna, Boore 1999). The goal of nursing with Watsons theory is centered around helping the patient gain a higher degree of harmony within the mind, body, and soul. It is achieved through caring transactions. Watsons ten carative factors, referred to as interventions of the theory, are presented in table one. (McCance, McKenna, Boore 1999). It also involves the transpersonal caring relationship. Transpersonal caring is demonstrated in an event or actual caring occasion. Transpersonal conveys a concern for the inner life. The patient is viewed as whole and complete, regardless of illness or disease (Watson 2003). The transpersonal nurse seeks to connect with, embrace the spirit or soul of the patient, through the processes of caring and healing (Watson 2003).

Caring and the Professional Practice of Nursing -Part 2

by Teresa Vance, RN
Caring in the nursing profession takes place every time a nurse-to-patient contact is made. The nurse enters the world of the patient in order to come to know the patient as a caring person, and that it is from this epistemology that the caring of nursing unfolds (Schoenhofer 2002). That caring makes a difference to the patients sense of well being. Caring may occur without curing but curing cannot occur without caring (Watson 2003). It is with that belief that nurses care for patients in the hope that we contribute to the cure or wellbeing of that patient. Hope and commitment are ingredients of caring. Hope is described as more than mere wishful thinking, but as an awareness of the moment alive with possibilities (Schoenhofer 2002). Hope may be the only crutch a patient has to keep their optimism. Nurses care enough to honor that hope and support the patient. We view that patient as whole and complete. The second carative factor of Jean Watsons ten carative factors is faith-hope (see table one). Hope is guided by our commitment as nurses to our patients. It is also clouded with preconceived beliefs and morals that we are reared with. I am a field nurse in a for-profit hospice organization. Caring is a central concept to the delivery of hospice care. The patients we encounter are in a variety of settings, such as, own home, nursing home, retirement center, family home, or a friends home. They are often frightened with the knowledge of their imminent death and in unfamiliar surroundings. They rely on the nurse and the delivery of care to help them feel physically better. As a hospice nurse we also view the patient as a spiritual being. That means reaching out to the patient and forming a deeper connection to the spiritual self. It means becoming one. The one caring and the one being cared for are interconnected (Watson 1997). Its experiencing human connection at a deeper level than a physical interaction (Watson 2003) The nurse must have an inner peace with her own mortality. The nurse must be comfortable with death and dying and possess a deep understanding and acceptance of all life cycles and be prepared for their own death (Watson 2002). Caring is directed to a pain free death with dignity and a belief of a spiritual transformation or journey after death. Caring centers on the person, preserving dignity and humanity. It is a commitment to alleviate anothers vulnerabilities by providing attention and concern for each human life (Watson 2002). Hospice is holistic focused caring. Our goal is to offer the dying patient the opportunity to die in the comfort of their own home surrounded by those who care. The dying patient in the nursing home is offered the opportunity to die with a caring nurse holding their hand. Often the nursing home patient has no family or living relatives that can share in the dying experience. The hospice nurse will be the one to care for the dying patient and ease his journey. This relates to the carative factor number eight of Jean Watsons ten carative factors, it states; supportive, protective, and/or corrective mental, physical, societal and spiritual environment, and that is what we hope to achieve with the dying patient (see table one). Hospice also cares for the family. Caring approaches to nursing affect the nurse and the family being cared for. This can be very challenging with dysfunctional families. Our focus is always centered on the patient while dealing with the family. We must be guided by caring, compassion, tenderness, gentleness, loving kindness, and equanimity for self and others. Caring in hospice goes beyond the actual death. Bereavement contact is done on a routine basis for a year after the death. Nurses often attend services for the deceased to say goodbye and receive closure with that patient and family.

Caring and the Professional Practice of Nursing -Part 3

by Teresa Vance, RN
Ive related most of my understanding of the caring model to hospice care because that is my area of expertise. However, the caring models are used in a variety of settings, such as, major hospitals, organizations, feminists groups, and major universities. A model of caring includes a call for both art and science. It offers a framework that embraces and intersects with art, science, humanities, spirituality, and new dimensions of mindbodyspirit medicine (Watson 2003). Caring can save the life of a patient, offer a death with dignity, and convey trust and commitment to patients, families, and staff. Nursing is a caring profession that is honored as the spiritual, spirit-filled practice that it is. I believe it is a calling for a special spiritual person who cares about the spirituality of others. Little girls care for their dolls; boys care for their trucks; parents care for their children; sons and daughters care for elderly parents; and nurses care for the sick. The humanistic nature of nursing is reflected in the caring model. Caring is the central concept in the discipline of nursing. I would not want to imagine nursing without the concept of caring. Would you? ____________________________ Table 1 Watsons 10 Carative Factors (McCance, McKenna, and Boore 1999) 1. Humanistic-altruistic system of values 2. Faith-hope 3. Sensitivity to self and others 4. Helping-trusting, human care relationship 5. Expressing positive and negative feelings 6. Creative problem-solving caring process 7. Transpersonal teaching-learning 8. Supportive, protective, and/or corrective mental, physical, societal and spiritual environment 9. Human needs assistance 10. Existential-phenomenological-spiritual forces

Introduction to Nursing Theories

This page was last updated on February 21, 2011

INTRODUCTION

Each discipline has a unique focus for knowledge development that directs its inquiry and distinguishes it from other fields of study.(Smith & Liehr, 2008).

Nursing knowledge is the inclusive total of the philosophies, theories, research, and practice wisdom of the discipline.As a professional discipline this knowledge is important for guiding practice.(Smith & Liehr, 2008).

Theory-guided, evidence-based practice is the hallmark of any professional discipline. Nursing is a professional discipline (Donaldson & Crowley, 1978). Nursing theory is the term given to the body of knowledge that is used to support nursing practice Almost 90% of all Nursing theories are generated in the last 20 years. Nursing models are conceptual models, constructed of theories and concepts

METAPARADIGMS IN NURSING 1. Person

Recipient of care, including physical, spiritual, psychological, and sociocultural components. Individual, family, or community

2. Environment

All internal and external conditions, circumstances, and influences affecting the person

3. Health

Degree of wellness or illness experienced by the person

4. Nursing

Actions, characteristics and attributes of person giving care

COMPONENTS OF A THEORY

A theory is a group of related concepts that propose action that guide practice. A nursing theory is a set of concepts, definitions, relationships, and assumptions or propositions derived from nursing models or from other disciplines and project a purposive, systematic view of phenomena by designing specific inter-relationships among concepts for the purposes of describing, explaining, predicting, and /or prescribing.. Based on the knowledge structure levels the theoretical works in nursing can be studied under the following headings:

Metaparadigm (Person, Environment, Health & Nursing) (Most abstract) Nursing philosophies. Conceptual models and Grand theories. Nursing theories and Middle range theories (Least abstract)

DEFINITIONS

Definitions

Theory

o
Concept

a set of related statements that describes or explains phenomena in a systematic way

o o

a mental idea of a phenomenon Concepts are the building blocksthe primary elements

of a theory.

Construct-

o o

a phenomena that cannot be observed and must be inferred Constructs are concepts developed or adopted for use in a particular theory. The key concepts of a given theory are its constructs.

Proposition

o o o

a statement of relationship between concepts

Conceptual modelmade up of concepts and propositions They epresent ways of thinking about a problem or ways of representing how complex things work the way that they do.

o o

Different Frameworks will emphasize different variables and outcomes and their interrelatedness.( Bordage, 2009) Models may draw on a number of theories to help understand a particular problem in a certain setting or context. They are not always as specified as theory.

Variables

Variables are the operational forms of constructs. They define the way a construct is to be measured in a specific situation.

Match variables to constructs when identifying what needs to be assessed during evaluation of a theory-driven program.

NURSING PHILOSOPHIES Theory Florence Nightingales Legacy of caring Key emphasis Focuses on nursing and the patient environment relationship. Helping process meets needs through the art of individualizing care. Nurses should identify patients need-for help by:

Ernestine Wiedenbach: The helping art of clinical nursing

Observation Understanding client behaviour Identifying cause of discomfort Determining if clients can resolve problems or have a need for help

Virginia Hendersons Definition of Nursing

Patients require help towards achieving independence. Derived a definition of nursing Identified 14 basic human needs on which nursing care is based. Patients problems determine nursing care

Faye G.Abedellahs Typology of twenty one Nursing problems Lydia E. Hall :Care, Cure, Core model Jean Watsons Philosophy and Science of caring

Nursing care is person directed towards self love. Caring is moral ideal: mind -body soul engagement with one and other.

Caring is a universal, social phenomenon that is only effective when practiced interpersonally considering humanistic aspects and caring. Patricia Benners Primacy of Caring is central to the essence of nursing. It caring sets up what matters, enabling connection and concern. It creates possibility for mutual helpfulness. Caring creates - possibilities of coping possibilities for connecting with and concern for others, possibilities for giving and receiving help Described systematically five stages of skill acquisition in nursing practice novice, advanced beginner, competent, proficient and expert. CONCEPTUAL MODELS AND GRAND THEORIES Dorothea E. Orems Self Selfcare maintains wholeness. care deficit theory in nursing Three Theories: Theory of Self-Care Theory of Self-Care Deficit

Theory of Nursing Systems Wholly compensatory (doing for the patient) Partly compensatory (helping the patient do for himself or herself) Supportive- educative (Helping patient to learn self care and emphasizing on the importance of nurses role Holism is maintained by conserving integrity Proposed that the nurses use the principles of conservation of:

Myra Estrin Levines: The conservation model

Client Energy Personal integrity Structural integrity Social integrity A conceptual model with three nursing theories Conservation Redundancy Therapeutic intention

Martha E.Rogers: Science Person environment are energy fields that of unitary human beings evolve negentropically Martha proposed that nursing was a basic scientific discipline Nursing is using knowledge for human betterment. The unique focus of nursing is on the unitary or irreducible human being and the environment (both are energy fields) rather than health and illness Individuals maintain stability and balance through adjustments and adaptation to the forces that impinges them. Individual as a behavioural system is composed of seven subsystems. Attachment, or the affiliative subsystems is the corner stone of social organisations. Behavioural system also includes the subsystems of dependency, achievement, aggressive, ingestive-eliminative and sexual. Disturbances in these causes nursing problems.

Dorothy E.Johnsons Behavioural system model

Sister Callista: Roys Adaptation model

Stimuli disrupt an adaptive system The individual is a biopsychosocial adaptive system within an environment. The individual and the environment provide three classes of stimuli-the focal, residual and contextual. Through two adaptive mechanisms, regulator and cognator, an individual demonstrates adaptive responses or ineffective responses requiring nursing interventions Reconstitution is a status of adaptation to stressors A conceptual model with two theories Optimal patient stability and prevention as intervention Neumans model includes intrapersonal, interpersonal and extrapersonal stressors. Nursing is concerned with the whole person. Nursing actions (Primary, Secondary, and Tertiary levels of prevention) focuses on the variables affecting the clients response to stressors. Transactions provide a frame of reference toward goal setting. A conceptual model of nursing from which theory of goal attainment is derived. From her major concepts (interaction, perception, communication, transaction, role, stress, growth and development) derived goal attainment theory. Perceptions, Judgments and actions of the patient and the nurse lead to reaction, interaction, and transaction (Process of nursing). Individuality in living. A conceptual model of nursing from which theory of goal attainment is derived. Living is an amalgam of activities of living (ALs). Most individuals experience significant life events which can affect ALs causing actual and potential problems. This affects dependence independence continuum which is bi-directional. Nursing helps to maintain the individuality of person by preventing potential problems, solving actual problems and helping to cope.

Betty Neumans : Health care systems model

Imogene Kings Goal attainment theory

Nancy Roper, WW.Logan and A.J.Tierney A model for nursing based on a model of living

Hildegard E. Peplau: Psychodynamic Nursing Theory

Interpersonal process is maturing force for personality. Stressed the importance of nurses ability to understand own behaviour to help others identify perceived difficulties.

The four phases of nurse-patient relationships are: 1. Orientation 2. Identification 3. Exploitations 4. Resolution

The six nursing roles are:

1. Stranger 2. Resource person 3. Teacher 4. Leader 5. Surrogate 6. Counselor

Ida Jean Orlandos Nursing Interpersonal process alleviates distress. Process Theory Nurses must stay connected to patients and assure that patients get what they need, focused on patients verbal and non verbal expressions of need and nurses reactions to patients behaviour to alleviate distress. Elements of nursing situation: 1. Patient 2. Nurse reactions 3. Nursing actions Therapeutic human relationships. Nursing is accomplished through human to human relationships that began with: The original encounter and then progressed through stages of Emerging identities Developing feelings of empathy and sympathy, until the nurse and patient attained rapport in the final stage. Kathryn E. Barnards Parent Growth and development of children and Child Interaction Model motherinfant relationships Individual characteristics of each member influence the parentinfant system and adaptive behaviour modifies those characteristics to meet the needs of the system.

Joyce Travelbees Human To Human Relationship Model

Ramona T.Mercers :Maternal Role Attainment

Parenting and maternal role attainment in diverse populations

A complex theory to explain the factors impacting the development of maternal role over time. Katharine Kolcabas Theory Comfort is desirable holistic outcome of care. of comfort Health care needs are needs for comfort, arising from stressful health care situations that cannot be met by recipients traditional support system. These needs include physical, psycho spiritual, social and environmental needs. Comfort measures include those nursing interventions designed to address the specific comfort needs. Caring is universal and varies transculturally. Major concepts include care, caring, culture, cultural values and cultural variations Caring serves to ameliorate or improve human conditions and life base. Care is the essence and the dominant, distinctive and unifying feature of nursing Rosemarie Rizzo Parses Indivisible beings and environment co-create :Theory of human becoming health. A theory of nursing derived from Rogers conceptual model. Clients are open, mutual and in constant interaction with environment. The nurse assists the client in interaction with the environment and co creating health Nola J.Penders :The Health Promoting optimum health supersedes disease promotion; model prevention. Identifies cognitive, perceptual factors in clients which are modified by demographical and biological characteristics, interpersonal influences, situational and behavioural factors that help predict in health promoting behaviour

Madeleine Leiningers Transcultural nursing, culture-care theory

CONCLUSION The conceptual and theoretical nursing models help to provide knowledge to improve practice, guide research and curriculum and identify the goals of nursing practice. The state of art and science of nursing theory is one of continuing growth. Using the internet the nurses of the world can share ideas and knowledge, carrying on the work begun by nursing theorists and continue the growth and development of new nursing knowledge. It is important the nursing knowledge is learnt, used, and applied in the theory based practice for the profession and the continued development of nursing and academic discipline

Jean Watson's Philosophy of Nursing

This page was last updated on July 27, 2011

Introduction

Theorist was born in West Virginia, US Educated: BSN, University of Colorado, 1964, MS, University of Colorado, 1966, PhD, University of Colorado, 1973 Distinguished Professor of Nursing and endowed Chair in Caring Science at the University of Colorado Health Sciences Center. Fellow of the American Academy of Nursing. Previously, Dean of Nursing at the University Health Sciences Center and President of the National League for Nursing Undergraduate and graduate degrees in nursing and psychiatric-mental health nursing and PhD in educational psychology and counseling. She has six (6) Honorary Doctoral Degrees.

Her research has been in the area of human caring and loss. In 1988, her theory was published in nursing: human science and human care.

The seven assumptions

Caring can be effectively demonstrated and practiced only interpersonally. Caring consists of carative factors that result in the satisfaction of certain human needs. Effective caring promotes health and individual or family growth. Caring responses accept person not only as he or she is now but as what he or she may become. 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.

Caring is more healthogenic than is curing. A science of caring is complementary to the science of curing. The practice of caring is central to nursing.

The ten primary carative factors 1. 2. 3. The formation of a humanistic- altruistic system of values. The installation of faith-hope. The cultivation of sensitivity to ones self and to others.

4. 5.

The development of a helping-trust relationship The promotion and acceptance of the expression of positive and negative feelings.

6.

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

7. 8.

The promotion of interpersonal teaching-learning. The provision for a supportive, protective and /or corrective mental, physical, socio-cultural and spiritual environment.

9.

Assistance with the gratification of human needs.

10. The allowance for existential-phenomenological forces.

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

Begins developmentally at an early age with values shared with the parents. Mediated through ones own life experiences, the learning one gains and exposure to the humanities. Is perceived as necessary to the nurses own maturation which then promotes altruistic behavior towards others.

2. Faith-hope

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 ones self and to others

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

4. Establishing a helping-trust relationship

Strongest tool is the mode of communication, which establishes rapport and caring. Characteristics needed to in the helping-trust relationship are:

o o o

Congruence Empathy Warmth

Communication includes verbal, nonverbal and listening in a manner which connotes empathetic understanding.

5. The expression of feelings, both positive and negative

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

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. Promotion of interpersonal teaching-learning

The caring nurse must focus on the learning process as much as the teaching process. Understanding the persons perception of the situation assist the nurse to prepare a cognitive plan.

8. Provision for a supportive, protective and /or corrective mental, physical, sociocultural and spiritual environment

Watson divides these into eternal and internal variables, which the nurse manipulates in order to provide support and protection for the persons 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 the gratification of human needs

It is based on a hierarchy of need similar to that of the Maslows.

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.

Watsons ordering of needs

Lower order needs (biophysical needs)

o o o o o o o o o

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. Allowance for existential-phenomenological forces

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.

Watsons theory and the four major concepts 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 person as a fully functional integrated self. He, human is viewed as greater than and different from, the sum of his or her parts.

2.

Health

Watson adds the following three elements to WHO definition of health:

A high level of overall physical, mental and social functioning

o o

A general adaptive-maintenance level of daily functioning The absence of illness (or the presence of efforts that leads its absence)

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.

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.

Watsons theory and nursing process

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.

3.

Intervention

4.

It is the direct action and implementation of the plan. It includes the collection of the data.

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.

Watsons work and the characteristic of a theory 1. The basic assumptions for the science of caring in nursing and the ten carative factors that form the structure for that concept is unique in Watsons theory. 2. Watsons work is logical in that the factors are based on broad assumptions which provide a supportive framework. 3. The theory is relatively simple as it does not use theories from other disciplines that are familiar to nursing. The theory is simple relatively but the fact that it de-emphasizes the pathophysiological for the psychosocial diminishes its ability to be generalizable. 4. Watsons theory is based on phenomenological studies that generally ask questions rather than state hypotheses. 5. 6. Watsons work can be used to guide and improve practice. Watsons work is supported by the theoretical work of numerous humanists, philosophers, developmentalists and psychologists.

Strengths

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.

Limitations

While Watson acknowledges the need for biophysical base to nursing, this area receives little attention in her writings. The ten caratiive factors primarily delineate the psychosocial needs of the

person.

While the carative factors have a sound foundation based on other disciplines, they need further research in nursing to demonstrate their application to practice.

Research related to Watsons theory 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.

Martin, L. S. (1991). Using Watsons theory to explore the dimensions of adult polycystic kidney disease . ANNA Journal, 18, 403-406 . Mullaney, J. A. B. (2000). The lived experience of using Watsons actual caring occasions to treat depressed women . Journal of Holistic Nursing, 18(2), 129-142 Martin, L. S. (1991). Using Watsons theory to explore the dimensions of adult polycystic kidney disease . ANNA Journal, 18, 403-406

Conclusion

Watson provides many useful concepts for the practice of nursing. She ties together many theories commonly used in nursing education. The detailed descriptions of the carative factors can give guidance to those who wish to employ them in practice or research.

Watson describe Human being should be valued should be nurture and respected. Health likewise in WHO. Absence of disease, should be complete as a whole healthy. Environment is the ability to cope up to a new environment. Nursing she believes that a holistic is central to effective care. Promoting and obtaining health is the main focused.