Jean Watson’s Theory of Caring

“A theory, as a general term, is a notion or an idea that explains experience, interprets observation, describes relationships, and projects outcomes (Parker & Smith, 2010). When applied to nursing, theories help us “understand and create meaning from our experience, organize and articulate our knowing, and ask questions leading to new insights (Parker & Smith, 2010). Since Florence Nightingale’s “Notes on Nursing” in 1859, theorists have continued to study, research and expand nursing theories. This paper will discuss the importance of nursing theory and Jean Watson’s well known Theory of Human Caring. Examples of the application of Watson’s theory will also be discussed. Nursing Theory

The development of nursing theories has defined nursing practice. Prior to nursing theories, nursing was “largely subsumed under medicine” (McEwen & Wills, 2014). Nurses mostly followed physician orders and completed tasks. According to McEwen and Wills (2014), the “use of theory offers structure and organization to nursing knowledge and provides a systematic means of collecting data to describe, explain, and predict nursing practice.” Nursing theories provide guidance and define standards for nursing practice. Nursing theories have also led to the development of patient classification systems, quality assurance programs, and clinical information systems (McEwen & Wills, 2014). There are four levels of nursing theories. The most abstract are metatheories.

These are theories about theory (McEwen & Wills, 2014). Grand theories are abstract and broad. They often incorporate the ideas of many other theories (McEwen & Wills, 2014). Middle range theories are more specific and have fewer concepts. The development and use of middle range theories has grown significantly over the last two decades (McEwen & Wills, 2014). Practice theories are more explicit and guild nursing practice in specific situations. These theories are research based and prescriptive. Jean Watson’s Theory of Human Caring

Jean Watson’s Theory of Human Caring was chosen for this assignment because of its common application in the workplace, including my own. As one of the most recently developed grand theories, Watson’s theory is used in a variety of diverse settings and has been part of many research projects and articles. Watson believes that nurses make social, moral, and scientific contributions to civilization and that their caring ideal can influence human development (McEwen & Wills, 2014). Watson’s theory includes a “’deep respect for the wonders and mysteries of life’ and recognition that spiritual and ethical dimensions are major elements of the human caring process” (McEwen & Wills, 2014). This theory consists of ten carative factors, six assumptions, and eight major concepts. Watson’s ten carative factors, according to McEwen and Wills (2014) include:

1. Humanistic-altruistic system of values
2. Faith-hope
3. Sensitivity to self and others
4. Developing helping- trusting, caring relationship
5. Expressing positive and negative feelings and emotions
6. Creative, individualized, problem-solving caring process
7. Transpersonal teaching-leaning
8. Supportive, protective, and/or corrective, mental, physical, societal, and spiritual environment
9. Human needs assistance
10. Existential-phenomenologic and spiritual forces

Six assumptions were derived from Watson’s theory. They include an ontologic assumption of oneness, wholeness, unity, relatedness, and connectedness; an epistemologic assumption that there are multiple ways of knowing; diversity of knowing assumes all, and various forms of evidence can be included; a caring science model makes these diverse perspectives explicitly and directly; moral-metaphysical integration with science evokes spirit; a caring science emergence, founded on new assumptions, makes explicit an expanding unitary, energetic worldview with a relational human caring ethic and ontology as its starting point (McEwen & Wills, 2014).

Watson’s theory defines three of the four metaparadigm concepts, including human being, health, and nursing, and several other concepts that are vital to understanding the Theory of Caring. Watson’s definitions (as sited by McEwen & Wills, 2014) are provided below. Human being: A valued person to be cared for, respected, nurtured, understood, and assisted. Health: Unity and harmony within the mind, body, and soul; health is associated with the degree of congruence between the self as perceived and the self as experienced. Nursing: A human science of persons and human health–illness experiences that are mediated by professional, personal, scientific, esthetic, and ethical human care transactions. Actual caring occasion: Involves actions and choices by the nurse and the individual.

The moment of coming together in a caring occasion presents the two persons with the opportunity to decide how to be in the relationship—what to do with the moment. Transpersonal: An intersubjective human-to-human relationship in which the nurse affects and is affected by the person of the other. Both are fully present in the moment and feel a union with the other; they share a phenomenal field that becomes part of the life history of both. Phenomenal field: The totality of human experience of one’s being in the world. This refers to the individual’s frame of reference that can only be known to that person. Self: The organized conceptual gestalt composed of perceptions of the characteristics of the “I” or “ME” and the perceptions of the relationship of the “I” or “ME” to others and to various aspects of life. Time: The present is more subjectively real and the past is more objectively real. Past, present, and future incidents merge and fuse.

Over time, Watson has refined the relationships of the theory to more closely relate to her current understanding of human caring and spirituality. The following are some of these relationships (McEwen & Wills, 2014). A transpersonal caring relationship connotes a spirit-to-spirit unitary connection between the practitioner and the patient within a caring moment. The practitioner’s authentic intentionality and consciousness of caring has a higher frequency of energy than noncaring consciousness, providing greater access to one’s inner healer. Transpersonal caring is communicated via the practitioner’s energetic patterns of consciousness, intentionality, and authentic presence in a caring relationship. Caring-healing modalities are often noninvasive, nonintrusive, natural-human, energetic environmental field modalities. Transpersonal caring promotes self-knowledge, self-control, and self-healing patterns and possibilities. Advanced transpersonal caring modalities encompass ethical and relational caring, along with energetic consciousness modalities that honor wholeness, healing, comfort, balance, harmony, and well-being. Application of Watson’s Theory of Caring

Watson’s Theory of Caring is used by nurses in many disciplines, including leadership, education, and direct patient care. Below are two examples of the use of the theory in nursing education.  The Butterfly Effect of Caring (Gustin & Wagner, 2012) was a study aimed at exploring participants’ understanding of self-compassion as a foundation to compassionate care. During this study, participants studied and experienced Watson’s 10 Caritas Processess through a variety of experiential and reflective exercises (Gustin & Wagner, 2012). Participants noticed during the study that compassion for self and others could be taught and learned and new understandings of the meaning of compassionate care giving (Gustin & Wagner, 2012).

Recordings and notes from these sessions were analyzed and interpreted using Watson’s Theory of Caring as the theoretical framework. Findings showed that development of compassion diminishes caregiver fears. Therefore, it would be beneficial to support students’ development of a compassionate self prior to teaching compassionate care of others (Gustin & Wagner, 2012). The results of this study were used in the development of a teaching-learning model that develops students’ ability to be compassionate towards themselves and toward others while learning caring theory (Gustin & Wagner, 2012).

In Teaching Theoretically Based Interventions: Use of Life Review, Hermanns, Mastel-Smith, Lilly, Deardorff, and Price (2009) study the effects of a life review assignment of nursing students. The life review assignment is based on Eriksons’ developmental theory and requires the student to implement several factors of Watson’s caring theory (Hermanns et al., 2009). The purpose of the life review assignment is for students to utilize the carative features of Watson’s theory and to understand the life review process. It also allows the older person to reflect on their life and share their experiences (Hermanns et al., 2009). Students selected an older person, 65 years or older, and asked them specific questions that summarized their life experience.

The students then reflected on their experience and analyzed the information as it relates to Erikson’s theory of development (Hermanns et al., 2009). The students’ reflections brought feelings of anguish and inspiration, as well as cultural awareness. The assignment required students to apply the concepts of Watson’s theory. Students were able to “experience being in the moment and being in relation to individual through listening with authentic presence” (Hermanns et al., 2009). Through review of the students’ responses, the faculty realized the benefit of life review. This theory based intervention supports the concept of caring through human connections (Hermanns et al., 2009). Conclusion

The use of nursing theory has long been used to define nursing practice and provide guidance. Jean Watson’s Theory of Caring focuses on human interaction as the basis for nursing care, research, and education (McEwen & Wills, 2014). Watson’s carative factors serve as a guide to the “core of nursing,” guiding therapeutic healing processes and relationships (Parker & Smith, 2010). Research of Watson’s Theory of Caring has shown that compassion for self and others can be taught and learned, human connections promote caring and compassion, and that the development of compassion diminishes caregiver fears.

Reference

Gustin, L. W. & Wagner, L. (2012). The butterfly effect of caring – clinical nursing teachers’
understanding of self-compassion as a source to compassionate care. Scandinavian
Journal of Caring Sciences 27, 175-183.
Hermanns, M., Mastel-Smith, B., Lilly, M. L., Deardorff, K., & Price, C. (2009). Teaching
theoretically based interventions: Use of life review. International Journal
of Human
Caring 13(4), 44-49.
McEwen, M., & Wills, E. (2014). Theoretical basis for nursing (4th ed.). Philadelphia, PA:
Lippincott, Williams & Wilkins.
Parker, M. E., & Smith, M. C. (2010). Nursing theories and nursing practice (3rd ed.).
Philadelphia, PA: F. A. Davis Company.