Jean Watson's Metaparadigm
Introduction
Jean Watson’s revolutionary process of patient care was introduced in the 1970s and her theory remains relevant to modern-day nursing practice. JeanWatson’s theory of human caring has three elements which are the Carative Factors, the Transpersonal Caring Moment and Caring Moment/Caring Occasion. It is a theoretical conception that incorporates holistic care by acknowledging the philosophical and spiritual aspects of nursing (Wadsworth, 2012). This paper will provide an overview and a reflection on Jean Watson’s nursing metapardigm and on the caritas processes. A case study will also be introduced in this paper and a plan of care will be incorporated.
Personal Beliefs and Values
Concept …show more content…
in Metaparadigm of Nursing
Your definition
Person
A person being a human individual and a subjective component receiver of the offered care. A person being a receiver of care, including physical, spiritual, and psychological.
Health
There needs to be equilibrium between the physical, mental and spiritual of an individual. Not to only be free of illness but to be healthy emotionally and spiritually. Health not only pertains to disease but emotionally well being.
Environment
The environment involves the surroundings of an individual including living and non living things. Whatever or where ever you live is your environment.
Nursing Nursing is caring of all ages, families, communities, the sick or the healthy in all settings. To promote health and prevent illness. To care for the sick. Nursing is not only scientific but an art.
Jean Watson’s Metaparadigm of Nursing
Concept in Metaparadigm of Nursing
Jean Watson’s Definition
Person
According to Walker (1996) Jean Watson refers to the person as a being of human existence. A combination of mind, body and spirit. A person’s experiences and thoughts considered as a whole. A person being a combination of mind, body and spirit. A nurse cannot consider a patient’s body alone but will inquire about the patients mind and spirit as well. Nurses should not only collect data on body vital signs but also listen to the patient, to find out more about personality, culture, memories, beliefs, religion, or fears. An example is while collecting data, to not only consider the body alone but also ask questions regarding the mind and spirit. Questions such as, “Tell me about yourself” or “Tell me about your cultural or spiritual beliefs”.
Health
A union of harmony and balance contained by the mind, body and soul (Walker, 1996). An example is to observe and inquire how a patient perceives their condition.
Environment
Environment not only includes the exterior factors but also the individuals’ subjective philosophy, values or perceptions (Walker, 1996). An example is, not to consider a patient without their perspective of environment. This may include family, culture or community. During data collection always inquire about family, friends or resources. To understand how a patient relates to their environment.
Nursing
A person experienced with human health or illness.
Intervenes and commits to professional, personal and ethical caring interactions. Nursing is both a science and an art. (Walker, 1996). An example is for a nurse to be aware and engaged in care in order to bond and create a relationship with the patient.
Two similarities from the nursing metaparadigm that are related is person and nursing. With person both metaparadigms define the person as a combination of body, mind and spirit. To consider the patient as a complete entity, the patient is more than just body. It is important to consider the patients spirit and mind. As to nursing, both metaparadigms define nursing as not only being a science but an art. Also, nursing will care for the ill and promote health.
According to Walker (1996) the unity of mind, body, and spirit are subjective by the person. Both the nurse and patient are each individual selves with unique exceptional personal individualized meanings. A person does not only pertain to the body that is visual and can easily represent an individual. One does not always notice or distinguish the mind or spirit to be part of a person, in whom it is what, makes up the person to be …show more content…
complete.
The connectedness of all existence is everyone involved, especially referring to environment. Does not only refer to the patient but environment connects all those involved a reality of existence, such as the patient’s ethics, values and perceptions. Includes factors such as family, friends, community or beliefs.
Jean Watson’s Metaparadigm Related to Case Study
Concept in Metaparadigm of Nursing
Application of Watson’s metaparadigm of nursing to the case study
Person
The person being Mrs Alvarez, not only referring to her body but including her mind and spirit. The nurse should not only collect vital sign data but get to know Mrs Alvarez as a whole person. Get to know Mrs Alvarez’s beliefs, memories or fears.
Health
Mrs Alvarez not only needs care for her stoma but she needs care emotionally. She has withdrawn as she keeps her eyes closed and remains in the dark. Mrs Alvarez cries from emotional pain and feels no one understands what she is going through.
Environment
It is important to make Mrs Alvarez’s room a soothing, healing place. To also respect and view of the environment from Mrs Alvarez’s view point. If she prefers to stay in the dark to respect her choice.
Nursing
There are standardized ways of caring for patients and there are guidelines for certain diagnosis or treatment approach. Nursing involves more than knowing the science it involves the art of caring. Which involves exploring and discovering other ways to care that build on the unique aspects of the patient. Mrs. Alvarez will need resourceful or artistic approaches to healing due to her being withdrawn and sad.
Jean Watson’s Clinical Caritas
Clinical Caritas
Caritas Processes
The formation of a humanistic-altruistic system of values.
According to Jean Watson (2007) caring is generally based on one’s unselfish principles that arise from the satisfaction of giving. Selfless acts and judgment provide the foundation of caring and encourages the concept of professional ethical care. One must implement the notion of caring to experience the kindness within one self (Sitzman, 2007).
The instillation of faith and hope. A nurse should respect a patient’s beliefs and encourage their philosophies. To respect a patient’s valued way of life is important because it will influence the effectiveness of health promotion and preserve well being. Regardless of modern medicine nursing interventions, the nurse should value the patient’s belief system (Watson, 2007).
The cultivation of sensitivity to one’s self and to others. For one to be aware of another person’s feelings, an individual must experience and express feelings themselves through life experiences. Nurses that distinguish and use their compassion, understanding and sympathy promote self growth which in return will encourage the same growth in others (Watson, 2007).
The development of a trusting
relationship. To build and nourish caring relationships (Sitzman, 2007). According to Watson (2007) a helpful considerate relationship occurs when a nurse experiences another patient’s view and the patient reciprocating the nurse’s experience. If this bond happens there will be concern to maintain and respect human dignity.
The promotion and acceptance of the expression of positive and negative feelings. A deeper more sincere and genuine level of a caring relationship with the patient can be achieved if the nurse engages in focusing and listening to the patient. To support the expression of feelings. If the nurse listens it may be the utmost therapeutic act to be offered. According to Sitzman (2007) a nurse should be supportive of positive and negative feelings arising in self and others with the understanding that these opinions signify completeness.
The systematic use of the scientific problem-solving method for decision making. Nursing consists of using a problem solving method to support decision making. A resourceful approach acknowledges that a nurse will use all ways of knowing in clinical practise. A nurse should not only utilize scientific knowledge and technology but to also apply resourceful creative thoughts (Watson, 2007).
The promotion of interpersonal teaching-learning. A nurse can learn by other ways besides just receiving information and data. To engage in teaching-learning experiences that occurs from an accepting thoughtful bond with the patient (Watson, 2007).
Provision of a supportive, protective and/or corrective mental, social and spiritual environment.
A nurse not only should create and sustain a healing environment at the physical level but should also consider self as part of the environment. A nurse should consider how his or her caring affects the environment (Watson, 2007).
Assistance with the gratification of human needs. A nurse not only provides care by physically touching a patient`s body but also touches the spirit. All needs must be recognized by the nurse both physical and spiritual to establish caring and healing (Watson, 2007). According to Sitzman (2007) one must attend spiritual development of both self and other. To administer human care essentials within body, mind and soul.
The allowance for existential-phenomenological forces. Not everything can be explained scientifically, which allows an individual to experience spiritual meanings of the unknown. Cultural beliefs or myths should be respected to encourage and support healing. Spiritual care for self and the individual being cared for as well. (Watson, 2007). According to Sitzman (2007) one should be open to religious inexplicable dimensions of being, pertaining to self and others.
Two Clinical Caritas
Clinical Caritas
Application of each Clinical Carita to the case study
1. Provision of a supportive, protective and/or corrective mental, social and spiritual environment
To provide an environment of acceptance, to allow a trusting therapeutic relationship to develop by conveying an attitude of caring. To arrange Mrs Alvarez’s environment so that she can feel at ease. Allow Mrs Alvarez to describe herself, share her feelings or thoughts, regardless if it positive or negative to evaluate how Mrs Alvarez views herself or others. To respect Mrs Alvarez`s privacy and respect the way she feels in order to build trust. Observing Mrs Alvarez’s emotional changes and to evaluate her level of knowledge and anxiety related to her surgery. Not only to provide Mrs Alvarez with an environment that promotes healing such as therapeutic touch or relaxation music but for the nurse to be conscious of self as being there in existence. To be aware of one`s tone of voice, how one touches the patient, and to show sympathy by just simply listening. To encourage Mrs Alvarez to express her problem, to assess if she can adapt to the environment post surgery. To assess Mrs Alvarez`s sexual needs, if she has a husband to understand the state of situation. Also to visit Mrs. Alvarez frequently and acknowledge she is someone valuable and meaningful. This will provide opportunities to listen to Mrs Alvarez`s concerns or questions. Most of all to work with Mrs Alvarez`s self concept without moral judgement regarding her efforts or progress.
2. Assistance with the gratification of human needs
To not only provide care of Mrs Alvarez’s physical needs but her spiritual needs as well. To provide care of Mrs Alvarez’s stoma and to especially care for her spiritual needs as she is not dealing well with the situation. She keeps her eyes closed, stays in the dark with the window drapes closed and cries from emotional pain. Mrs Alvarez’s spiritual needs should be cared for to allow healing. All her needs must be recognized. To help Mrs Alvarez identify her feelings before they can be dealt with successfully.
Three Interrelationships in the Data
First interrelationship in the data is, Mrs Alvarez having increasing epigastric pain and increasing intake of TUMS. Second interrelationship is, Mrs Alvarez waking up from surgery and she has a double loop stoma. Third data interrelationship is, Mrs Alvarez admitted to hospital related to severe wave like abdominal pain.
Three Data Gaps
There are three data gaps from the case study. First data gap, there is no information of family dynamics. No information regarding if Mrs Alvarez has any family, if she is married, or if she has any children. Second data gap, there is no previous medical history. Data from the case study does not mention if Mrs Alvarez is taking any medication or if she has medical comorbidities. Third data gap, there is no information regarding Mrs Alvarez job occupation.
Implication to Health
One implication to health is that Mrs Alvarez possibly may become socially withdrawal.
Nursing Diagnosis
Disturbed body image related to altered body structure as manifested by a double loop stoma as evidenced by crying, keeping window drapes closed, eyes closed and stating, “I have pain that you would not understand...I will never get rid of this pain” and “get out, I don’t need people reassuring me, when no one understands me”.
Nursing Goal
In four days the patient will demonstrate the beginning of improved acceptance of body image as evidenced by ability to look at, touch, talk about, and care for stoma.
Nursing Interventions
To provide an environment of acceptance. Establishing a bond with Mrs Alvarez is essential to a therapeutic relationship. Recognizing her struggles and feelings is best brought about in an environment of kindness and trust.
Provide opportunities for Mrs Alvarez to glance at stoma, and use the moment to indicate positive signs of healing, normal appearance. To mention that it will take time to adjust but emotionally and physically.
Maintain an encouraging approach during care activities. Do not take angry expressions of Mrs Alvarez personally.
Encourage verbalization of feelings, perceptions, and fears. To encourage open ended nonthreatening discussions can smooth the progress of the recognition of causative and contributing factors.
Encourage Mrs Alvarez to identify her own strengths and abilities. Assist Mrs Alvarez to develop suitable strategies for coping based on her individual strengths and previous experiences.
Evaluation of Plan of Care
Mrs Alvarez should demonstrate coping as evidenced by demonstrating the ability to identify effective and ineffective coping patterns. She should recognize and talk about her negative or positive feelings regarding her stoma. Effectiveness can also be measured by Mrs Alvarez reporting a decrease in negative feelings and verbalize a sense of control. Finally, Mrs Alvarez will demonstrate proper care of stoma.
Conclusion
Jean Watson’s theory of caring is helpful and beneficial to the field of nursing. Not only through patient care but to also utilize positive relationships. It is a practical theory because it consists of comprehensible directives on how to incorporate caring science into nursing practice.
References
Sitzman, K. (2007). Teaching-learning professional caring based on Jean Watson 's
Theory of Human Caring. International Journal For Human Caring, 11(4), 8-16. Wadsworth, A. M. (2012). Student Paper. International Journal for Human Caring. 16(1). 64-67.
Walker, C. (1996). Coalescing the theories of two nurse visionaries: Parse and Watson. Journal Of Advanced Nursing, 24(5), 988-996.
Watson, J. (2007). Watson’s theory of human caring and subjective living experiences: Carative factors/Caritas Processes as a disciplinary guide to the professional nursing practice. Texto Contexto Enfern. 16(1), 129-35.
Jean Watson’s revolutionary process of patient care was introduced in the 1970s and her theory remains relevant to modern-day nursing practice. JeanWatson’s theory of human caring has three elements which are the Carative Factors, the Transpersonal Caring Moment and Caring Moment/Caring Occasion. It is a theoretical conception that incorporates holistic care by acknowledging the philosophical and spiritual aspects of nursing (Wadsworth, 2012). This paper will provide an overview and a reflection on Jean Watson’s nursing metapardigm and on the caritas processes. A case study will also be introduced in this paper and a plan of care will be incorporated.
Personal Beliefs and Values
Concept …show more content…
in Metaparadigm of Nursing
Your definition
Person
A person being a human individual and a subjective component receiver of the offered care. A person being a receiver of care, including physical, spiritual, and psychological.
Health
There needs to be equilibrium between the physical, mental and spiritual of an individual. Not to only be free of illness but to be healthy emotionally and spiritually. Health not only pertains to disease but emotionally well being.
Environment
The environment involves the surroundings of an individual including living and non living things. Whatever or where ever you live is your environment.
Nursing Nursing is caring of all ages, families, communities, the sick or the healthy in all settings. To promote health and prevent illness. To care for the sick. Nursing is not only scientific but an art.
Jean Watson’s Metaparadigm of Nursing
Concept in Metaparadigm of Nursing
Jean Watson’s Definition
Person
According to Walker (1996) Jean Watson refers to the person as a being of human existence. A combination of mind, body and spirit. A person’s experiences and thoughts considered as a whole. A person being a combination of mind, body and spirit. A nurse cannot consider a patient’s body alone but will inquire about the patients mind and spirit as well. Nurses should not only collect data on body vital signs but also listen to the patient, to find out more about personality, culture, memories, beliefs, religion, or fears. An example is while collecting data, to not only consider the body alone but also ask questions regarding the mind and spirit. Questions such as, “Tell me about yourself” or “Tell me about your cultural or spiritual beliefs”.
Health
A union of harmony and balance contained by the mind, body and soul (Walker, 1996). An example is to observe and inquire how a patient perceives their condition.
Environment
Environment not only includes the exterior factors but also the individuals’ subjective philosophy, values or perceptions (Walker, 1996). An example is, not to consider a patient without their perspective of environment. This may include family, culture or community. During data collection always inquire about family, friends or resources. To understand how a patient relates to their environment.
Nursing
A person experienced with human health or illness.
Intervenes and commits to professional, personal and ethical caring interactions. Nursing is both a science and an art. (Walker, 1996). An example is for a nurse to be aware and engaged in care in order to bond and create a relationship with the patient.
Two similarities from the nursing metaparadigm that are related is person and nursing. With person both metaparadigms define the person as a combination of body, mind and spirit. To consider the patient as a complete entity, the patient is more than just body. It is important to consider the patients spirit and mind. As to nursing, both metaparadigms define nursing as not only being a science but an art. Also, nursing will care for the ill and promote health.
According to Walker (1996) the unity of mind, body, and spirit are subjective by the person. Both the nurse and patient are each individual selves with unique exceptional personal individualized meanings. A person does not only pertain to the body that is visual and can easily represent an individual. One does not always notice or distinguish the mind or spirit to be part of a person, in whom it is what, makes up the person to be …show more content…
complete.
The connectedness of all existence is everyone involved, especially referring to environment. Does not only refer to the patient but environment connects all those involved a reality of existence, such as the patient’s ethics, values and perceptions. Includes factors such as family, friends, community or beliefs.
Jean Watson’s Metaparadigm Related to Case Study
Concept in Metaparadigm of Nursing
Application of Watson’s metaparadigm of nursing to the case study
Person
The person being Mrs Alvarez, not only referring to her body but including her mind and spirit. The nurse should not only collect vital sign data but get to know Mrs Alvarez as a whole person. Get to know Mrs Alvarez’s beliefs, memories or fears.
Health
Mrs Alvarez not only needs care for her stoma but she needs care emotionally. She has withdrawn as she keeps her eyes closed and remains in the dark. Mrs Alvarez cries from emotional pain and feels no one understands what she is going through.
Environment
It is important to make Mrs Alvarez’s room a soothing, healing place. To also respect and view of the environment from Mrs Alvarez’s view point. If she prefers to stay in the dark to respect her choice.
Nursing
There are standardized ways of caring for patients and there are guidelines for certain diagnosis or treatment approach. Nursing involves more than knowing the science it involves the art of caring. Which involves exploring and discovering other ways to care that build on the unique aspects of the patient. Mrs. Alvarez will need resourceful or artistic approaches to healing due to her being withdrawn and sad.
Jean Watson’s Clinical Caritas
Clinical Caritas
Caritas Processes
The formation of a humanistic-altruistic system of values.
According to Jean Watson (2007) caring is generally based on one’s unselfish principles that arise from the satisfaction of giving. Selfless acts and judgment provide the foundation of caring and encourages the concept of professional ethical care. One must implement the notion of caring to experience the kindness within one self (Sitzman, 2007).
The instillation of faith and hope. A nurse should respect a patient’s beliefs and encourage their philosophies. To respect a patient’s valued way of life is important because it will influence the effectiveness of health promotion and preserve well being. Regardless of modern medicine nursing interventions, the nurse should value the patient’s belief system (Watson, 2007).
The cultivation of sensitivity to one’s self and to others. For one to be aware of another person’s feelings, an individual must experience and express feelings themselves through life experiences. Nurses that distinguish and use their compassion, understanding and sympathy promote self growth which in return will encourage the same growth in others (Watson, 2007).
The development of a trusting
relationship. To build and nourish caring relationships (Sitzman, 2007). According to Watson (2007) a helpful considerate relationship occurs when a nurse experiences another patient’s view and the patient reciprocating the nurse’s experience. If this bond happens there will be concern to maintain and respect human dignity.
The promotion and acceptance of the expression of positive and negative feelings. A deeper more sincere and genuine level of a caring relationship with the patient can be achieved if the nurse engages in focusing and listening to the patient. To support the expression of feelings. If the nurse listens it may be the utmost therapeutic act to be offered. According to Sitzman (2007) a nurse should be supportive of positive and negative feelings arising in self and others with the understanding that these opinions signify completeness.
The systematic use of the scientific problem-solving method for decision making. Nursing consists of using a problem solving method to support decision making. A resourceful approach acknowledges that a nurse will use all ways of knowing in clinical practise. A nurse should not only utilize scientific knowledge and technology but to also apply resourceful creative thoughts (Watson, 2007).
The promotion of interpersonal teaching-learning. A nurse can learn by other ways besides just receiving information and data. To engage in teaching-learning experiences that occurs from an accepting thoughtful bond with the patient (Watson, 2007).
Provision of a supportive, protective and/or corrective mental, social and spiritual environment.
A nurse not only should create and sustain a healing environment at the physical level but should also consider self as part of the environment. A nurse should consider how his or her caring affects the environment (Watson, 2007).
Assistance with the gratification of human needs. A nurse not only provides care by physically touching a patient`s body but also touches the spirit. All needs must be recognized by the nurse both physical and spiritual to establish caring and healing (Watson, 2007). According to Sitzman (2007) one must attend spiritual development of both self and other. To administer human care essentials within body, mind and soul.
The allowance for existential-phenomenological forces. Not everything can be explained scientifically, which allows an individual to experience spiritual meanings of the unknown. Cultural beliefs or myths should be respected to encourage and support healing. Spiritual care for self and the individual being cared for as well. (Watson, 2007). According to Sitzman (2007) one should be open to religious inexplicable dimensions of being, pertaining to self and others.
Two Clinical Caritas
Clinical Caritas
Application of each Clinical Carita to the case study
1. Provision of a supportive, protective and/or corrective mental, social and spiritual environment
To provide an environment of acceptance, to allow a trusting therapeutic relationship to develop by conveying an attitude of caring. To arrange Mrs Alvarez’s environment so that she can feel at ease. Allow Mrs Alvarez to describe herself, share her feelings or thoughts, regardless if it positive or negative to evaluate how Mrs Alvarez views herself or others. To respect Mrs Alvarez`s privacy and respect the way she feels in order to build trust. Observing Mrs Alvarez’s emotional changes and to evaluate her level of knowledge and anxiety related to her surgery. Not only to provide Mrs Alvarez with an environment that promotes healing such as therapeutic touch or relaxation music but for the nurse to be conscious of self as being there in existence. To be aware of one`s tone of voice, how one touches the patient, and to show sympathy by just simply listening. To encourage Mrs Alvarez to express her problem, to assess if she can adapt to the environment post surgery. To assess Mrs Alvarez`s sexual needs, if she has a husband to understand the state of situation. Also to visit Mrs. Alvarez frequently and acknowledge she is someone valuable and meaningful. This will provide opportunities to listen to Mrs Alvarez`s concerns or questions. Most of all to work with Mrs Alvarez`s self concept without moral judgement regarding her efforts or progress.
2. Assistance with the gratification of human needs
To not only provide care of Mrs Alvarez’s physical needs but her spiritual needs as well. To provide care of Mrs Alvarez’s stoma and to especially care for her spiritual needs as she is not dealing well with the situation. She keeps her eyes closed, stays in the dark with the window drapes closed and cries from emotional pain. Mrs Alvarez’s spiritual needs should be cared for to allow healing. All her needs must be recognized. To help Mrs Alvarez identify her feelings before they can be dealt with successfully.
Three Interrelationships in the Data
First interrelationship in the data is, Mrs Alvarez having increasing epigastric pain and increasing intake of TUMS. Second interrelationship is, Mrs Alvarez waking up from surgery and she has a double loop stoma. Third data interrelationship is, Mrs Alvarez admitted to hospital related to severe wave like abdominal pain.
Three Data Gaps
There are three data gaps from the case study. First data gap, there is no information of family dynamics. No information regarding if Mrs Alvarez has any family, if she is married, or if she has any children. Second data gap, there is no previous medical history. Data from the case study does not mention if Mrs Alvarez is taking any medication or if she has medical comorbidities. Third data gap, there is no information regarding Mrs Alvarez job occupation.
Implication to Health
One implication to health is that Mrs Alvarez possibly may become socially withdrawal.
Nursing Diagnosis
Disturbed body image related to altered body structure as manifested by a double loop stoma as evidenced by crying, keeping window drapes closed, eyes closed and stating, “I have pain that you would not understand...I will never get rid of this pain” and “get out, I don’t need people reassuring me, when no one understands me”.
Nursing Goal
In four days the patient will demonstrate the beginning of improved acceptance of body image as evidenced by ability to look at, touch, talk about, and care for stoma.
Nursing Interventions
To provide an environment of acceptance. Establishing a bond with Mrs Alvarez is essential to a therapeutic relationship. Recognizing her struggles and feelings is best brought about in an environment of kindness and trust.
Provide opportunities for Mrs Alvarez to glance at stoma, and use the moment to indicate positive signs of healing, normal appearance. To mention that it will take time to adjust but emotionally and physically.
Maintain an encouraging approach during care activities. Do not take angry expressions of Mrs Alvarez personally.
Encourage verbalization of feelings, perceptions, and fears. To encourage open ended nonthreatening discussions can smooth the progress of the recognition of causative and contributing factors.
Encourage Mrs Alvarez to identify her own strengths and abilities. Assist Mrs Alvarez to develop suitable strategies for coping based on her individual strengths and previous experiences.
Evaluation of Plan of Care
Mrs Alvarez should demonstrate coping as evidenced by demonstrating the ability to identify effective and ineffective coping patterns. She should recognize and talk about her negative or positive feelings regarding her stoma. Effectiveness can also be measured by Mrs Alvarez reporting a decrease in negative feelings and verbalize a sense of control. Finally, Mrs Alvarez will demonstrate proper care of stoma.
Conclusion
Jean Watson’s theory of caring is helpful and beneficial to the field of nursing. Not only through patient care but to also utilize positive relationships. It is a practical theory because it consists of comprehensible directives on how to incorporate caring science into nursing practice.
References
Sitzman, K. (2007). Teaching-learning professional caring based on Jean Watson 's
Theory of Human Caring. International Journal For Human Caring, 11(4), 8-16. Wadsworth, A. M. (2012). Student Paper. International Journal for Human Caring. 16(1). 64-67.
Walker, C. (1996). Coalescing the theories of two nurse visionaries: Parse and Watson. Journal Of Advanced Nursing, 24(5), 988-996.
Watson, J. (2007). Watson’s theory of human caring and subjective living experiences: Carative factors/Caritas Processes as a disciplinary guide to the professional nursing practice. Texto Contexto Enfern. 16(1), 129-35.