Jean Watson began her theory of human caring in 1979 and over the years, she has been revising her theory to provide more specific explanations of her concepts and philosophy. The core of her theory remains, that human caring is based on values such as kindness, concern, and love of self and others.(Falk Rafael, 2000). This paper exhibits human caring as it relates to the patient -nurse interaction in a caring moment. Caring moments are relational, reciprocal and the patient is the focus of the nurse’s thoughts and actions.
A caring moment can be described as an interaction between a patient and nurse, when respect, honesty and a genuine act of kindness is shared without conditions and is given freely. According to (Lachman, 2012), “caring is a feeling and exhibiting concern and empathy for others; showing or having compassion.” As this definitions illustrates, caring is a feeling that also requires an action. The nurse is committed to becoming involved in the needs of the patient. Simply expressed the caring moment is the space and time where a patient and nurse come together in a manner for caring to occur.
Watson’s theory considers that human caring and relationship centered care is the foundation for healing practices; upholds the unity of whole human being while creating a healing environment. Successful patient outcomes are affected by the quality of life, inner healing experiences, subjective meaning, and caring practices. Human-to-human caring is the moral foundation and the core of the nurse’s role and responsibilities. (Watson, 2006). Jean Watson has written and published several books on her theory of human caring. “The theoretical concepts were derived and emerged from, my personal/professional experiences; they were clinically inducted, empirically grounded and combined with my philosophical, intellectual, and experiential background.” (Watson, 2006). Watson’s theory describes three major conceptual elements; the ten carative factors, the caring moment and the transpersonal relationship that encompass the philosophy and theory of human caring.
First, Watson describes ten carative factors as a framework for providing a format and focus for the nursing phenomena. The carative factors are still the current terminology for the core of nursing. Evolving from the original carative factors are the clinical caritas and caritas processes that presents a more fluid and contemporary ideology.(Watson,). Second, is the concept of caring moments. According to (Falk Rafael, 2000), “caring moments stresses the importance of the lived experience not only of the client, but also of the nurse. Both come together in a caring moment that becomes part of the life history of each person.” Third, is the transpersonal caring relationship. This theory acknowledges the unique dimensions of mind-body-spirit without compromising the wholeness of the person.(Falk Rafael, 2000). The nurse makes an intentional connection with the patient based on a conscious and moral commitment .
A caring moment occurs at any time and is often unpredictable. It is a natural progression of trust and respect between a patient and nurse. The conversation occurred at the time of a long, laborious dressing change. This patient was battling breast cancer that had invaded her entire chest, underneath her left breast to her mid back. The patient spoke of her depression and how the uncaring treatment and ridicule by the other staff nurses made her feel even worse. She described her living situation as indigent, surviving on food stamps, caring for her grandchildren and there was no extra money to go to a doctor. Listening closely, holding back the tears and encouraging the patient to talk was foremost. This is a caring moment as evidenced by the early findings of Watson’s caring categories from data that revealed the following processes: Treating the individual as a person, concern and empathy, personalized characteristics of the nurse, communication process, and extra effort. (Watson, 2012). This interaction concluded with a moment of self- reflection and introspection.
A newer, deeper level of patient –nurse interaction was experienced as the nurse becomes as vulnerable as the patient. An interaction of intimate caring; when emotions are freely expressed, and a spiritual connection is felt without fear of being ridiculed or judged. The patient and nurse may or may not perceive the same interaction in the same way. At the time of the caring moment, many emotions surfaced. Tears and a long embrace express gratitude and thankfulness. The nurse reciprocated this action and the patient expressed interest in further nurse –patient interactions. The caring moment was fondly remembered in future conversations. In a hospital setting it is difficult to shield the patient from emotional ridicule and provide emotional security. The conversation focused on the poor nursing care received from other nurses, and how this treatment emotionally drained the patient.
This nursing care can be described as biostatic, where the patient experiences the nurse as cold and as a nuisance. (Watson, 2012). Allowing appropriate time to vent negative emotions is healthy but too much time is detrimental. Guiding the conversation away from long periods of negative emotional conversation would have been beneficial for the patient. Also, more time redirecting the conversation back to the patient and what she could do to participate in her care to promote health, would have a good solution to the negativity of the conversation. The nursing metaparadigm is comprised of four concepts that are central to the discipline of nursing. These concepts are described as the person who is receiving the nursing care, the environment in which the person exists, the health of the person derived from a continuum, recorded at the time of the interaction and the nurse’s actions. These concepts can be illustrated using the caring moment. First, the person is the central focus of informed caring.
The patient sees her self as unworthy of respect and dignity related to the decisions she made regarding her medical care. The patient has the right to make choices for herself even though she is taking a risk and may face consequences. Second, the environment in which the patient lives is an inner city, and indigent, poor neighborhood that does not offer emotional, psychological or financial support. The patient’s life revolved around her grandchildren whom she was raising. Considering her living conditions, she was thankful she could provide food and shelter for her family. The third concept is health, and according to the (University of Arkansas for Medical Sciences, 2013), “Health, as perceived by the person, is the integration of physical, emotional, intellectual, social, cultural, and spiritual well- being that enables the performance deemed necessary and desirable to maintain existence in the environment.” The patient forfeited her own healthcare needs, ignoring her physical and emotional well being for the sake of her family.
By choice, she devalued her needs and hoped in time the cancer would disappear. At the time of the caring moment, the patient’s cancer had advanced and her mortality was imminent. Fourth, nursing actions are carried out to provide support that will allow the patient to die with dignity. Four of Watson’s carative factors are revealed in the caring moment. The four carative factors chosen to best describe the caring moment are: the cultivation of sensitivity to one’s self and to others, the promotion and acceptance of the expression of positive and negative feelings, the provision for a supportive, protective, and (or) corrective mental, physical, socio-cultural, and spiritual environment, and the assistance with the gratification of basic human needs while preserving human dignity and wholeness. (Watson, 2006). First, the cultivation of sensitivity to one’s self and to others. Nurses who are sensitive to others feelings are willing to learn about another’s view or opinion. As the patient is describing her living environment, she was ashamed of her socio-economic status.
Remaining open minded and asking questions that promoted an interest in learning about her family and living situation was pivotal to the caring moment. The patient believed she would be judged and would receive unjust treatment, because she was not educated and lived in poverty. Secondly, the promotion and acceptance of the expression of positive and negative feelings is orchestrated by further discussing the patient’s cancer and how it affected her inner feelings. By listening to another person’s story, it may be the greatest healing act we can offer. (Watson, 2006). The patient expressed feelings of true and genuine caring when the nurse quietly listened to her life story. The third concept is the for a supportive, protective, and (or) corrective mental, physical, socio-cultural, and spiritual environment. Nurses have a great deal of control in the hospital environment. A task of changing her dressing needed to be completed, and some planning went into the timing of the dressing change. This timing was crucial, in order to have the patient participate in her care.
The patient always needed to systematically arrange her room before the dressing change could begin. It had to occur when the patient was awake, pain free and mentally prepared for the task. The Fourth concept is the assistance with the gratification of basic human needs while preserving human dignity and wholeness. Providing care to assist in meeting the patient needs is primary. Helping the patient change her dressing allowed the ability to touch her in a physical sense, but to the patient it is more than a touch. Physically touching the open wounds which the cancer invaded gave the patient a sense that the nurse was unafraid, despite the grotesque appearance.
A self-actualized nurse will agree with Watson’s statement, “as such it is a privilege and great gift to society to take care of others when in need of care.” (Watson, 2006). In conclusion, Jean Watson’s theory of human caring is exhibited through patient –nurse interactions that can be described as a caring moment. These interactions provide a framework for learning about one’s self, perceptions of the interaction from the patient and the nurse. The nursing metaparadigm and four carative factors were discussed in relation to the caring moment. As stated by (Watson, 2006), “The moral ideals and caring factors and processes proposed foster the evolution and deepening of humankind and serve to sustain humanity.”
Falk Rafael, A R. (2000). Watson’s philosophy, science, and theory of human caring as a conceptual framework for guiding community health nursing practice. Advances in Nursing Science, 23(2), 34-49. This article describes current nursing theories in relation to community health nursing and that the theories are primarily developed for individuals, making them inadequate for community nursing. Watson’s theory of human caring is recognized as a nursing framework that is line with community health nursing. Jean Watson’s identifies her theory of caring and concepts are developed to provide a guide for community nursing.
Lachman, V. (2012). Applying the ethics of care to your nursing practice. Ethics, Law and Policy, 21(2), 112-114. This article discussed the theory of care ethics as it applies to nursing a clinical practice. The definition of caring was outlined using Watson’s theory of human caring. Three versions of the theory of care ethics were explained according to S.D. Edwards. The author’s, C. Gilligan, J. Tronto, C. Gastmans and M. Little each described theory contribution to the theory of caring ethics. Tronto’s four phases of caring and four element of care are illustrated in a case study. Noting that Watson and Tronto have very similar theories of caring.
University Of Arkansas For Medical Sciences. (2013, January). College of nursing: Philosophy. Retrieved November 15, 2014, from http://nursing.uams.edu/about/philosophy/ This article is written to introduce the University of Arkansas philosophy of advancement of nursing through teaching, research and service. The curriculum is based on the metaparadigm of nursing; person, nursing, health and environment. An outline and brief description of the baccalaureate, master’s, and doctoral study as
it relates to education, theoretical foundation and standards. Watson, J. (, November). The theory of human caring. Retrieved November 15, 2014, from http://http://watsoncaringscience.org/images/features/library/THEORY%20OF%20HUMAN%20CARING_Website.pdf This article, written by Jean Watson, describes her background history and emerging perspectives of her theory of human caring. In great detail, she outlines her major conceptual elements and dynamic aspects of her theory. The original ten carative factors are noted and then, she describes how they evolved into the clinical caritas and caritas processes. From this, Watson considers her work more of a philosopher than a specific theory. The transpersonal caring relationship and the caring moment are foundations of her work. Watson’s original caring model has evolved into a philosophical and moral foundation for nursing. Watson, J. (2006). Watson’s theory of human caring and subjective living experiences: Carative factors/caritas process as a disciplinary guide to the professional nursing practice. Danish Clinical Nursing Journal, 20(3), . This article was written by Jean Watson as an introduction and outline of her theory of human caring. It introduces and briefly describes three books she has written. The main focus of this article is the detailed description of Watson’s development of the ten carative factors and the caritas processes.
Watson, J. (2006). Caring theory as an ethical guide to administrative and clinical practices. Jona’s Healthcare Law, Ethics, and Regulation, 8(3), . In this article Jean Watson describes the relationship between caring and economics, and caring and administration. These entities are in conflict because the human value of caring is removed as an ethic and moral foundation for nursing practice. The dominant institution such as a hospitals, use economics, technology, science and administrative theory, to describe values and thus, pushing caring aside as a value. Jean Watson’s theory of caring and emerging models of caring is a framework for ethics in caring. The nurse administrator and the bedside nurse’s responsibilities are outlined in theory-guided models. Watson, J. (2012). Human caring science (2 ed.). Sudbury, MA: Jones & Bartlett Learning. This chapter discusses the values underlying human caring science as it relates to nursing. The differences between caring and non -caring is discussed according to research findings. Watson describes eleven assumptions related to human