JEAN WATSON’S THEORY OF HUMAN CARING
A caring environment is one that offers the development of potential while
DESCRIPTION
According to Watson’s theory, “Nursing is concerned with promoting health, preventing
illness, caring for the sick, and restoring health.” It focuses on health promotion, as
well as the treatment of diseases. According to Watson, caring is central to nursing
practice, and promotes health better than a simple medical cure.
The nursing model also states that caring can be demonstrated and practiced by nurses.
Caring for patients promotes growth; a caring environment accepts a person as he or
she is, and looks to what he or she may become.
ASSUMPTIONS
1. Caring can be effectively demonstrated and practiced only interpersonally.
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.
4. Caring responses accept the patient as he or she is now, as well as what he or
she may become.
5.
allowing the patient to choose the best action for him or herself at a given
point in time.
6. A science of caring is complementary to the science of curing.
7. The practice of caring is central to nursing.
MAJOR CONCEPTS
The Philosophy and Science of Caring has four major concepts: human being, health,
environment or society, and nursing.
Society
Society provides the values that determine how one should behave and what goals one
should strive toward. Watson states:
“Caring (and nursing) has existed in every society. Every society has had some people
who have cared for others. A caring attitude is not transmitted from generation to
generation by genes. It is transmitted by the culture of the profession as a unique way
of coping with its environment.”
Human being
Human being is a valued person to be cared for, respected, nurtured, understood, and
assisted; in general a philosophical view of a person as a fully functional integrated
self. Human is viewed as greater than and different from the sum of his or her parts.
Health
Health is the 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. It is defined as a high level of overall physical, mental, and social
functioning; a general adaptive-maintenance level of daily functioning; and the absence
of illness, or the presence of efforts leading to the absence of illness.
Nursing
Nursing is 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
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
Watson devised 10 caring needs specific carative factors critical to the caring human
experience that need to be addressed by nurses with their patients when in a caring
role. As carative factors evolved within an expanding perspective, and as her ideas and
values evolved, Watson offered a translation of the original carative factors into clinical
caritas processes that suggested open ways in which they could be considered.
The first three carative factors are the “philosophical foundation” for the science of
caring, while the remaining seven derive from that foundation. The ten primary carative
factors with their corresponding translation into clinical caritas processes are listed in
the table below.

The transpersonal concept is an intersubjective human-to-human relationship in which Carative Factors and Caritas Processes
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 Carative Factors Caritas Process
part of the life story of both.
“Practice of loving-kindness and
SUBCONCEPTS 1. “The formation of a humanistic-
equanimity within the context of caring
altruistic system of values”
Phenomenal field consciousness”

The totality of human experience of one’s being in the world. This refers to the “Being authentically present and enabling
individual’s frame of reference that can only be known to that person. and sustaining the deep belief system and
2. “The instillation of faith-hope”
subjective life-world of self and one being
Self cared for”
The organized conceptual gestalt composed of perceptions of the characteristics of the
“Cultivation of one’s own spiritual
“I” or “ME” and the perceptions of the relationship of the “I” and “ME” to others and to 3. “The cultivation of sensitivity to
practices and transpersonal self going
various aspects of life. one’s self and to others”
beyond the ego self”
Time
4. “Development of a helping-trust
The present is more subjectively real and the past is more objectively real. The past is relationship” became “development of “Developing and sustaining a helping
prior to, or in a different mode of being than the present, but it is not clearly a helping-trusting, human caring trusting authentic caring relationship”
distinguishable. Past, present, and future incidents merge and fuse. relation” (in 2004 Watson website)
10 CARATIVE FACTORS
 “Being present to, and supportive of, the phenomenological spiritual forces” (in and the one-being-cared for”
5. “The promotion and acceptance of
expression of positive and negative 2004 Watson website)
the expression of positive and negative
feelings as a connection with deeper spirit
feelings”
and self and the one-being-cared for”
WATSON’S HIERARCHY OF NEEDS
6. “The systematic use of the scientific
“Creative use of self and all ways of
problem solving method for decision Within assisting with the gratification of human needs, Watson’s hierarchy of needs
knowing as part of the caring process; to
making” became “systematic use of a begins with lower-order biophysical needs or survival needs, the lower-order
engage in the artistry of caring-healing
creative problem solving caring psychophysical needs or functional needs, the higher order psychosocial needs or
practices”
process” (in 2004 Watson website) integrative needs, and finally the higher order intrapersonal-interpersonal need or
growth-seeking need.Watson’s Hierarchy of Needs
“Engaging in genuine teaching-learning
7. “The promotion of transpersonal experience that attends to unity of being Lower Order Biophysical Needs or Survival Needs
teaching-learning” and meaning, attempting to stay within
Watson’s hierarchy of needs begins with lower-order biophysical needs or survival
others’ frame of reference”
needs. These include the need for food and fluid, elimination, and ventilation.
“Creating healing environment at all Lower Order Psychophysical Needs or Functional Needs
8. “The provision of supportive, levels (physical as well as nonphysical,
protective, and (or) corrective mental, subtle environment of energy and Next in line are the lower-order psychophysical needs or functional needs.
physical, societal, and spiritual consciousness, whereby wholeness, These include the need for activity, inactivity, and sexuality.
environment” beauty, comfort, dignity, and peace are
Higher Order Psychosocial Needs or Integrative Needs
potentiated)”
The higher order psychosocial needs or integrative needs include the need for
“Assisting with basic needs, with an achievement, and affiliation.
intentional caring consciousness,
9. “The assistance with gratification of administering ‘human care essentials,’ Higher Order Intrapersonal-Interpersonal Need or Growth-seeking Need
human needs” which potentiate alignment of mind body
The higher order intrapersonal-interpersonal need or growth-seeking need is the need
spirit, wholeness, and unity of being in all
for self-actualization.
aspects of care”
WATSON’S THEORY AND THE NURSING PROCESS
10. “The allowance for existential- “Opening and attending to spiritual-
phenomenological forces” became mysterious and existential dimensions of The nursing process in Watson’s theory includes the same steps as the scientific
“allowance for existential- one’s own life-death; soul care for self research process: assessment, plan, intervention, and evaluation. The assessment
includes observation, identification, and review of the problem, as well as the
formation of a hypothesis. Creating a care plan helps the nurse determine how
variables would be examined or measured, and what data would be collected.
Intervention is the implementation of the care plan and data collection. Finally, the
evaluation analyzes the data, interprets the results, and may lead to an additional
hypothesis.
STRENGTHS
Although some consider Watson’s theory complex, many find it easy to understand. The
model can be used to guide and improve practice as it can equip healthcare providers
with the most satisfying aspects of practice and can provide the client with holistic care.
Watson considered using nontechnical, sophisticated, fluid, and evolutionary language
to artfully describe her concepts, such as caring-love, carative factors, and cartas.
Paradoxically, abstract and simple concepts such as caring-love are difficult to practice,
yet practicing and experiencing these concepts leads to greater understanding.
Also, the theory is logical in that the carative factors are based on broad assumptions
that provide a supportive framework. The carative factors are logically derived from
the assumptions and related to the hierarchy of needs.
Watson’s theory is best understood as a moral and philosophical basis for nursing. The
scope of the framework encompasses broad aspects of health-illness phenomena. In
addition, the theory addresses aspects of health promotion, preventing illness and
experiencing peaceful death, thereby increasing its generality. The carative factors
provide guidelines for nurse-patient interactions, an important aspect of patient care.
WEAKNESS
The theory does not furnish explicit direction about what to do to achieve authentic
caring-healing relationships. Nurses who want concrete guidelines may not feel secure
when trying to use this theory alone. Some have suggested that it takes too much time
to incorporate the caritas into practice, and some note that Watson’s personal growth
emphasis is a quality “that while appealing to some may not appeal to others.”
CONCLUSION
Watson began developing her theory while she was assistant dean of the
undergraduate program at the University of Colorado, and it evolved into planning and
implementation of its nursing PhD program.
The Philosophy and Science of Caring addresses how nurses express care to their
patients. Caring is central to nursing practice, and promotes health better than a simple
medical cure. Watson believes that a holistic approach to health care is central to the
practice of caring in nursing.
This led to the formulation of the 10 carative factors: (1) forming humanistic-altruistic
value systems, (2) instilling faith-hope, (3) cultivating a sensitivity to self and others, (4)
developing a helping-trust relationship, (5) promoting an expression of feelings, (6)
using problem-solving for decision-making, (7) promoting teaching-learning, (8)
promoting a supportive environment, (9) assisting with gratification of human needs,
and (10) allowing for existential-phenomenological forces. The first three factors form
the “philosophical foundation” for the science of caring, and the remaining seven come
from that foundation.
Describing her theory as descriptive, Watson acknowledges the evolving nature of the
theory and welcomes input from others. Although the theory does not lend itself easily
to research conducted through traditional scientific methods, recent qualitative nursing
approaches are appropriate.
Watson’s theory continues to provide a useful and important metaphysical orientation
for the delivery of nursing care. Watson’s theoretical concepts, such as use of self,
patient-identified needs, the caring process, and the spiritual sense of being human,
may help nurses and their patients to find meaning and harmony during a period of
increasing complexity. Watson’s rich and varied knowledge of philosophy, the arts, the
human sciences, and traditional science and traditions, joined with her prolific ability to
communicate, has enabled professionals in many disciplines to share and recognize her
work.