Jean Watson

Nursing is Caring
Bonter, Belinda Hernandez, Rosa Karasiewicz, Andrea Mygrants, Andrea

What Was Her Theory All About?

Watsons work (1979, 1988, 1999) addressed the philosophical question of the nature of nursing as viewed as human-to-human relationship. She focused on the relationship of the nurse and the patient, drawing on philosophical sources for a new approach that
emphasized how the nurse and patient change together through transpersonal caring.
(Chitty & Black, 2011, p. 309)

Development of Her Model

Human Caring Theory was developed between 1975-1979, while she was teaching at the University of Colorado It stemmed from three places: Her own nursing views, doctoral studies in educational-clinical, and social psychology Watson states, It was my initial attempt to bring meaning and focus to nursing as an emerging discipline and distinct health profession with its own unique values, knowledge and practices, with its own ethic and mission to society. Watson also said, My involvement with an integrated academic nursing curriculum and efforts to find common meaning and order to nursing that transcended settings, populations, specialty, subspecialty areas, and so forth.

Assumptions and Point of View

I tried to make explicit nursing's values, knowledge, and practices of human caring that are geared toward subjective inner healing processes and the life world of the experiencing person, requiring unique caringhealing arts and a framework called "carative factors."

Her 10 carative factors are meant to work side by side with conventional medicines curative factors

The Core of Watsons Theory

The nurse acts to rid the patient of disharmony, making way for spiritual healing throughout his/her universe
Watson believes the nurse genuinely connects, interpersonally, with the patients spirit by way of his/her body language, words, intuition, thought process, and feelings

This interpersonal relationship can be observed by way of any intentional caring-healing modality

The Caring Moment

The caring moment is the point where the nurse and the patient can connect as human beings The moment happens when the nurse and patient wish it to If it is transpersonal, it occurs at the spiritual level and goes beyond time and space The caring moment allows the healing process to reach beyond medical means

NURSING

ENVIRONMENT

HEALTH

PERSON

PERSON

Watson makes it clear that humans cannot be treated as objects and humans cannot be separated from self, other, nature, and the larger universe
(Tomey & Alligood, 2006, p.100)

Human Care Process according to Watson:

1. A persons mind and emotions are windows to the soul 2. A persons body is confined in time and space, but the mind and soul are not confined to the physical universe 3. A nurse may have access to a persons mind, emotions, and inner self indirectly through any sphere -mind, body or soul- provided the physical body is not perceived or treated as separate from the mind and emotions and higher sense of self (soul) 4. The spirit, inner self, or soul (geist) of a person exists in and for itself 5. People need each other in a caring, loving way

6. To find solutions, it is necessary to find meanings

7. The totality of experience at any given moment constitutes a phenomenal field

Environment: Watson described internal and external environments that affect the patient:
Internal environment

include the mental and spiritual well-being and sociocultural beliefs of an individual
(Tomey & Alligood, 2006, p.96)

External environment

include comfort, privacy, safety, and clean aesthetic surroundings

(Tomey & Alligood, 2006, p.96)

Health
Watson refers to health as unity and harmony within the mind, body, and soul associated with the degree of congruence between the self as perceived and the self as experienced (Tomey &
Alligood, 2006, p. 99)

Illness or disease

was equated with lack of harmony within the mind, body, and soul experienced in internal or external environments (Chitty
& Black, 2011, p.309)

Nursing According to Watson:

nursing is concerned with health promotion, restoration, and illness prevention caring is a nursing term representing the factors nurses use to deliver health care to patients (Tomey
& Alligood, 2006, p. 99)

(Tomey & Alligood, 2006, p. 99)

Watson proposed nursing be concerned with spiritual

matters and the inner knowledge of nurse and patient as they participate together in the transpersonal caring process (Chitty & Black, 2011, p. 309)

Watsons 10 Carative Factors:

1. Formation of a humanistic-altruistic system of values
6. Systematic use of the scientific problem-solving method for decision making 7. Promotion of interpersonal teachinglearning 8. Provision for a supportive, protective, and/or corrective mental, physical, sociocultural, and spiritual environment 9. Assistance with the gratification of human needs 10. Allowance for existentialphenomenological forces

2. Instillation of faithhope
3. Cultivation of sensitivity to ones self and others 4. Development of a helping-trust relationship 5. Promotion and acceptance of the expression of positive and negative feelings

 The goal of Watsons metaparadigm is accomplished by teaching patients personal changes to promote health, providing situational support, teaching problem-solving methods, and recognizing coping skills and adaption to loss
(Tomey & Alligood, 2006, p.97)

Interpretation and Inference

The theory and philosophy given by Jean Watson gives the nursing profession a means of improving their practice through emphasis on human contact, caring, and connecting with patients in a deeper personal manner. Jean Watson also calls for the recognition, empowerment, and growth of spirituality for both nurses and patients.

Interpretation and Inference

While Watson does not dismiss the importance of clinical skills, she does believe that they should not be made the basis of practice. Watson believes that caring, and a holistic view of the patient as a human being first and foremost should be the basis for nursing practice.

Interpretation and Inference

Possible strengths of this theory:

Encourages nurses to be more sensitive to the human needs of patients Focuses on health promotion and teaching which is more central to nursing, rather than focusing on curing diseases which is the medical model. Watsons language in her writings concentrate on nurses improving themselves as people to become better able at leading patients in personal growth. This benefits both nurses and patients at the same time.

Interpretation and Inference

Possible limitations of the theory:
The theory has a heavy focus on using spirituality which may be uncomfortable and/or unfamiliar for some nurses and patients. The theory addresses psychosocial needs very well, but does not give any information on how to incorporate physical needs and necessary procedures. The fast paced delivery of todays healthcare makes it more difficult to build the interpersonal relationships that are necessary to carry out this theory.

Implications and Consequences

The implications of this theory:

Higher quality patient interactions Personal growth of nurses Furthering the goal of nursing as a holistic and human condition centered practice Increases research about how caring affects patient outcomes Promotes awareness about a connection between the physical body and the mental and/or spiritual aspects of humans. This can have both positive and negative effects on health and well being.

Implications and Consequences

Consequences of this theory:
Caring theory moves the nurse away from focusing on biological science and responses and toward focusing on human emotional needs and responses. Caring theory would require more training of nurses in how to establish open authentic relationships with patients. This openness to strangers may be difficult for some nurses. Caring theory may lead to a decrease in nurse productivity, as it is more time intensive.

Evaluation of the nursing model

Clarification of origins:
The model came about in 1975-1979 while Jean Watson was a nursing instructor at the University of Colorado. While Watson brought about this theory to define and move the direction of nursing, she believes it is applicable to other health and human service professions. Watson states, caring science is rapidly becoming an Interdisciplinary or Transdisciplinary field of study. It has relevance to all the health, education, and human service fields and professions. (Watson, 2008) In Jean Watsons curriculum vitae, it is found that her earliest jobs were as a psychiatric nurse, and then a counselor. This focus on mental health may have influenced her to focus on how the mind-body connection relates to overall health.

Content
Jean Watsons model clearly describe the four global concepts

Her model can be used in any hospital setting were nursing time is abundant as this theory requires for nurses and patients to experience transpersonal growth during the caring process

Have Other Theories Been Generated From This Model? Are the Concepts Abstract or Concrete?
There have been a number of people who have used Watsons theory to validate their nursing practice. There are published entries in multiple nursing journals, ANNA and Journal of Holistic Nursing, stating how Jean Watsons carative factors have improved the health of their patients. Her concepts are more abstract than concrete. The focus is on how nurses can focus on the person rather than the disease at hand. The theory is centered on the psych/social aspect, and not so much biophysical.

Where Can Her Theory Be Used?

Jean Watsons theory can be used in any situation that directly involves patient contact. This would be any setting in which the nurse has direct involvement with the patient and patient outcome. According to nursing-theory.org her theory is one that can be applied to a variety of situations and patients. The field of nursing is so broad and there are so many different facets of nursing, this theory would apply to most of them. I do not see this theory working at an insurance company or informatics.

 Jean Watson continues to offer her basic theory courses at the University of Colorado School of Nursing were she holds the prestige title of Distinguished Professor of Nursing Her publications reflect the evolution of her theory of caring and three of her major works include:
Nursing: The Philosophy and Science of Caring (1979)
Nursing: Human Science and Human Care- A theory of Nursing (1985) Postmodern Nursing and Beyond (1999)

Jean Watson is founder and creator of the non-profit organization Watson Caring Science Institute. For more information on Watsons latest work please visit:
http://www.watsoncaringscience.org/#

Showing of the Carative Factors: A Case Study

Lets Meet Nancy

Nancy is a 64 year old female who resides in a long term care facility. Nancy has been living there for about 3 years. She is limited to extensive assist with all of her activities of daily living. She has dx of OCD, Bipolar, Schizophrenia, OA, and early stage dementia. She at times refuses her medications even after education on what they are for and refuses care. When Nancy wheels herself down for meals the staff stop in the hallway to say hello and asks how she is doing. Nancy often replies, horrible, I just feel horrible. Most staff just let her keep going. One staff member in particular, the nurse, is concerned with the way Nancy has been acting recently. The nurse walked to the CENA documentation book and found that Nancy has been having an increase in hallucinations and that have documented her making threats to herself.

When Nancy returns from lunch the nurse, and staff member who kept the comments fresh in her mind, sat down with Nancy in her room. The nurse held Nancys hand and asked why Nancy was feeling so horrible. Nancy was able to open up and the nurse was assessing for Nancys ability to cope with her feelings. Nancy states that she notices after she refuses her medications that she feel worse as the day goes on, but is too afraid to ask for them at a later time. As a nurse how would you handle this situation? After your conversation with Nancy she is much happier with her life and her negative comments decrease. The nurse did ask Nancy what makes her think about the comments of hurting herself. Nancy states that she feels that staff do not like her and what is the point of living if this is true. Nancy also informs the nurse that she only thinks this way when she does not receive her medications.

Questions
1. By actively listening how did the nurse use Carative Factor number 8?
2. Which Carative Factor is the development of a helping-trust relationship? 3. Give two examples of how the nurse showed Nancy that she was concerned for her? 4. How would you handle Nancy stating to you that she notices after she refuses her medications that she feel worse as the day goes on, but is too afraid to ask for them at a later time?

Chitty, K. K., & Black, B. P. (2011). Professional nursing: Concepts and challenges (6th ed.) Maryland Heights, MO: Saunders Jean Watson(2011)Nursing-Theory.org/nursing-theorists/Jean-Watson.php Jean Watson's Philosophy of Nursing. Nursing Theories. N.p., 26 Jan. 2012. Web. 9 Oct. 2012. http://currentnursing.com/nursing_theory/Watson.html Tomey, A. M., & Alligood, M. R. (2006). Nursing theorists and their work (6th ed.). St. Louise, MO: Mosby Elsevier Wade, G., & Kasper, N. (2006) Nursing students perceptions of instructor caring: An instrument based on Watsons theory of transpersonal caring. Journal of Nursing Education, 45(5), 162-168. Retrieved October 12, 2012, from CINHL database. Watson Caring Science Institute. (2007). Caring Science Ten Caritas Processes. Retrieved from http://www.watsoncaringscience.org/index.cfm/category/80/theory.cfm

Reference

References
Watson, J. (2012). Caring: About Dr. Jean Watson. Retrieved from http://www.ucdenver.edu/academics/colleges/nursing/caring /Pages/DrJeanWatson.aspx Watson, J., & Foster, R. (2003). The attending nurse caring model: Integrating theory, evidence and advanced caringhealing therapeutics for transforming professional practice. Journal of Clinical Nursing, 12, 360-365.