Jean Watson: Caring Science As Sacred Science

Jean Watson: Caring Science as Sacred Science

Biography
• Born in West Virginia in the 1940’s
• Graduated from the Lewis Gale School of Nursing in Roanoke, Virginia in 1961
• BS degree University of Colorado at Boulder in 1964
• MS degree in psychiatric and mental health nursing in 1966
• Ph.D. in educational psychology and counselling in 1973
• Distinguished Professor of Nursing and holds an endowed Chair in Caring Science at the University of Colorado Health Sciences Center
• Founder of the original Center for Human Caring in Colorado
• Fellow of the American Academy of Nursing
• Served as Dean of Nursing at the University Health Sciences Center
• Past President of the National League for Nursing
• Six Honorary Doctoral Degrees
• Created the Watson Caring Science Institute

Jean Watson’s theory evolved from Watson’s personal beliefs, values, and assumptions about caring of human life, health, and healing; together with her extensive background in philosophy and psychology. Watson also noted that she drew her theory from nursing writers, including Nightingale (healing environment concept)—that an individual’s environment affects their healing—, Henderson, Leininger, Gadow, Peplau, and Rogers. In her more recent work, Watson refers to that of others such as Maslow, Heidegger, Erickson, Selye, Lazarus, Whitehead, de Chardin, and Satre. In addition, she acknowledges philosophical and intellectual guidance from feminist theory, quantum physics, wisdom traditions, and perennial philosophy.

Originally, the theory began as philosophy and was never meant to be a testable theory. Jean Watson’s goal was to move nursing from the belief that the human body is a machine to the belief that the “interdependent and non-discrete nature of a world and the spiritual nature of humans is of paramount importance”.

It is difficult to categorize Watson’s theory in to a single model because it contains aspects of both the Human Interaction Model and the Unitary Process Model. However, it follows closest with the former model because it stresses the importance of human interactions. The Human Interaction Model is based on believing that humans are holistic beings that interact within the situation they find themselves and that there is constant interaction between human and environment. In addition, her theory encompasses some of the Unitary Process Model which describes the human as an energy field and explaining health and illness as manifestations of the human pattern.

Metaparadigm concepts:
• Human being o A valued person in and of him to be cared for, respected, nurtured, understood and assisted
• Health o Unity and harmony of mind, body, and soul o High-level of overall physical, mental, and social function o A general adaptive-maintenance level of daily function o Absence of illness
• Nursing o Collective caring-healing role o Concerned with promoting health, preventing illness, caring for the sick and restoring health o Mission in society: attending and helping to sustain humanity and wholeness
• Environment o Was not defined but devised ten caring needs specific carative factors that needs to be addressed by the nurses with their clients when in a caring role
• Phenomenal field o Totality of human experience o Person’s reference of human experience consisting of feelings, bodily sensations, thoughts, spiritual beliefs, goals, expectations, environmental considerations, and meaning of one’s perceptions—all of which are based upon one’s past life history, one’s present moment, and one’s imagined future.

Jean Watson’s theory is based on seven main assumptions which are the foundation for the theory of caring. These assumptions are:
1. Caring can be effectively demonstrated and practiced only interpersonally
 There must be personal contact for caring to occur
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
 Caring can directly contribute to the overall welfare of the patient and the patient’s family
4.
Caring responses accept person not only as he or she is now but as what he or she may become
 The potential of a person is as important as the person in their current state of being
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
 People feel more cared for when they are empowered to make their own choices about health care
6. Caring is more “healthogenic” than is curing. A science of caring is complementary to the science of curing
 Caring and curing needs to coexist for the individual to achieve their maximum health potential
7. The practice of caring is central to nursing
 Caring is at the center of nursing practice
 Nurses must engage in caring in order to be effective at improving the health and wellness of their patients

Human Caring Theory
• Completely codified in 1979, revised in 1985 and broadened more recently
• Newest of nursing’s grand theories
• Only theory that incorporates spiritual dimension of nursing at the time it was
conceptualized
• Focused on the human component of caring and the moment-to-moment encounters between the one who is caring and the one who is being cared for, esp the caring activities performed by nurses as they interact with others
• Focused on preserving the dignity and wholeness of humanity
• Caring is central to nursing practice
• Caring promotes health better than a simple medical cure
• Believes that holistic approach to health care is central to the practice of caring in nursing

Major elements/components of Watson’s Theory
• 10 Carative Factors  Clinical Caritas Processes o Used the term “carative” instead of “curative” to distinguish nursing and medicine whereas, curative factors aim at curing the patient’s disease, carative factors aim at the caring process that helps the person attain or maintain health or die a peaceful death o Used to deliver quality nursing care o Basis of the caring science theory o First three factors forms the philosophical foundation for the science of caring while the remaining seven are from the foundation laid by the first three 1. The formation of a humanistic-altruistic system of values
 Altruistic - selfless or unselfish
 Humanistic and altruistic are learned early age in life that is influenced by the parents
 Also learned through one’s own life experiences
 Necessary to the nurse’s own maturation which then promotes altruistic behaviour towards others
Clinical caritas: practice of loving kindness and equanimity within context of caring consciousness

2. The instillation of faith-hope
 Essential to both carative and curative processes
 Facilitates the promotion of holistic nursing care and positive health within the patient.
• When modern science has nothing further to offer the person, the nurse can continue to use faith and hope to provide a sense of well-being through beliefs which are meaningful to the individual
Clinical caritas: being authentically present, and enabling and sustaining the deep belief system and subjective life world of self and the one-being-cared-for

3. The cultivation of sensitivity to one’s self and to others
 Development or acknowledgement of one’s own sensitivity and feeling is needed to interact genuinely and sensitively with others
 Forms a person-to-person relationship that promotes health and higher level functioning for the patient
Clinical caritas: cultivation of one’s own spiritual practices and transpersonal self, going beyond ego self (opening to others with sensitivity and compassion)

4. The development of a helping-trust relationship
 Strongest tool – communication  establishes rapport and caring
 Communication = verbal, non-verbal, listening which implies empathetic understanding
 Characteristics needed: congruence, empathy, warmth
 Congruence – involves being real, honest, genuine, authentic
 Empathy – the ability to experience and understand the other person’s perceptions and feelings and to communicate those understandings
 Non-possessive warmth – demonstrated by a moderate speaking volume, a relaxed, open posture, and facial expressions that are congruent with other communications.
Clinical caritas: developing and sustaining a helping-trusting, authentic caring relationship

5. The promotion and acceptance of the expression of positive and negative feelings
 A risk-taking experience for both nurse and patient.
 Nurse must be prepared for either positive or negative feelings shared
 Awareness of the feelings helps understand the behaviour it causes
Clinical caritas: 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

6. The systematic use of the scientific problem-solving method for decision making
 By using the nursing process, it allows for control and prediction, and that permits self-correction
Clinical caritas: creative use of self and all ways of knowing as part of the caring process; to engage in artistry or caring-healing practices

7.
The promotion of interpersonal teaching-learning
 Separates caring from curing. This factor is more on nurses caring for the patient
 Understand the patient’s perception of the situation to prepare a cognitive plan
 Allows the patient to be informed and shifts the responsibility for wellness and health to the patient
 Enables the patient to provide self-care, determine personal needs, and provide opportunities for their personal growth
Clinical caritas: engaging in genuine teaching-learning experience that attends to unity of being and meaning, attempting to stay within others’ frames of reference

8. The provision for a supportive, protective and/or corrective mental, physical, socio-cultural and spiritual environment
 Divided into external and internal variables, which the nurse manipulates in order to provide support and protection for the patient’s mental and physical well-being
 External variables – includes comfort, privacy, safety, and clean, aesthetic surroundings
 Internal variables – includes mental and spiritual well-being and socio-cultural beliefs of the individual
Clinical caritas: 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.

9. Assistance with the gratification of human needs
 Based on hierarchy of needs similar to Maslow’s
 All the needs deserves to be attended to and valued
 Patients must satisfy the lower order needs before attempting to attain higher order needs

Watson’s ordering of needs:
 Lower order needs (biophysical needs) o Food and fluid o Elimination o Ventilation
 Lower order needs (psychophysical needs) o Activity-inactivity o Sexuality
 Higher order needs (psychosocial needs) o Achievement o Affiliation
 Higher order needs (intrapersonal-interpersonal need) o Self-actualization
Clinical caritas: assisting with basic needs, with an intentional caring consciousness, administering “human care essentials,” which potentiate alignment of mindbodyspirit, wholeness and unity of being in all aspects or care; tending to both the embodied spirit and evolving spiritual emergence

10. The allowance for existential-phenomenological forces
 Existential psychology is the study of human existence using phenomenological analysis
 Phenomenology is a way of understanding people from the way things appear to them from their frame of reference
 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
 The nurse assists the person to find the strength or courage to confront life or death
Clinical caritas: 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

• Transpersonal Caring Relationship o Characterizes a special kind of human care relationship that depends on:
 The nurse’s moral commitment in protecting and enhancing human dignity as well as the deeper self
 The nurse’s caring consciousness communicated to preserve and honor the embodied spirit, therefore, not reducing the person to the moral status of an object
 The nurse’s caring consciousness and connection having the potential to heal since experience, perception, and intentional connection are taking place o Strong and unique relationship between nurse and patient o Nurse enters “into the life space or phenomenal field of another person and is able to detect the other person’s condition of being (spirit or soul), feels this condition within self, and response in such a way that the person being cared for has a release of feelings, thought, and tension” o Knowledge and sensitivity is necessary that can be gained through work with other cultures, study of the humanities, and exploration of one’s own values, beliefs, and relationship with self o Goal: protecting, enhancing, and preserving the person’s dignity, humanity, wholeness, and inner harmony

• Caring Occasion/Caring Movement o Moment when the nurse and another person’s phenomenal fields come together in such a way that an occasion for human caring is created o These moments transforms both the one cared for and the one caring through the choices and actions decided o The caring occasion becomes a transpersonal when it allows for the presence of the spirit of both. o Watson believes that both are linked together wherein, through nurse’s attitude and competence the client’s world can become larger/smaller, rich/dull, brighter/drab, threatening/secure.

All these three components define her original concept of transpersonal caring which was defined as a human-to-human connectedness occurring in a nurse-patient encounter wherein each is touched by the human center of the other.

Strengths
• Can be applied in a variety of patients and situations (health care setting) to guide and improve practice
• Also places the patient in the context of the family, community, and culture
• Patient is the focus rather than technology o Use of technology only for enhancement of healthcare practices and not as sole guiding factor in healthcare o Provides not only standard quality care but also soul satisfying care
• Allows the nurse to be flexible in their practice o Transpersonal caring theory focuses on the individual and not the disease o Allows to utilizes different interaction methods with different individuals o Allows to adjust the approach and style of care based on the needs of each individual as separate entities and apart from their disease

References:
Conceptual Models and Theories of Nursing Venes D; Taber’s Cyclopedic Medical Dictionary, 21st ed, F.A. Davis Company, 2010. CINAHL AN: t0hAPP20

Kuuriku, A. (2010). Distinguished Professor of Nursing Dr. Jean Watson. Nursing Essays

Berman, A., Snyder S.J., Kozier, B., Erb, G. (2008) Fundamentals of Nursing concepts, process, and practice, 8th ed. Upper Saddle River, New Jersey. Pearson Education, Inc.

Wills, E. A. and McEwan M. (2007). Theoretical Basis for Nursing 2nd ed. Lippincott Williams & Wilkins

Tomey, A. M. And Alligood, M. R. (2006). Nursing Theorists and Their Work 6th ed. St. Louis, Missouri. Mosby Elsevier

Watson. J. (1988) Nursing. Human Science and Human Care: A Theory of Nursing. New York. National League for Nursing Press

Cara, C. (2003) A Pragmatic View of Jean Watson’s Caring Theory. International Journal for Human Caring

Biography of Jean Watson. Nursing Theories, 2013. Available from http://nursingtheories.info/biography-of-jean-watson

Jean Watson’s Philosophy of Nursing. Nursing Theories. A companion to nursing theories and models, 2012. Available from http://currentnursing.com/nursing_theory/Watson.html

Jean Watson – Nursing Theorist. Nursing Theory, 2011. Available from http://nursing-theory.org/nursing-theorists/ Jean-Watson.php