Jean Watsons Theory of Caring

Alyson Conway, Sally Erickson, Patty Lynch, Kimberly Myers & Sarah Palmer

Current Works
Nursing: The Philosophy and Science of Caring (1979,1985) Nursing: Human Science and Human Caring (1985,1988, 1999) Postmodern Nursing and Beyond (1999) Assessing and Measuring Caring in Nursing and Health Sciences (2002)

Theory in Our Words

Caring:
Is the essence of nursing Compliments curative medicine Gives nursing unique standing Relationship occurs when the nurse and patient come together
Transpersonal moment Results in transcendence, harmony & healing.

Phenomenon of Concern
Watsons Theory attempts to:
Define nursing as a distinct health profession Make explicit nursing's values, knowledge & practices
Inner healing process Experiencing the person

Three major elements of the theory:

Carative factors Transpersonal caring relationship Caring occasion/caring moment

Context & Significant Events

Education: Undergraduate & Graduate Degrees in Nursing & psych-mental health nursing
PhD in Educational psych & counseling

Extensive travels to Asia & Australia Years in private practice Nursing - Carl Rogers, Nightingale & Leininger Psychology - Maslow, Giorgi, Johnson & Koch 1970s: Feminism Quantum Physics Wisdom tradition Eastern Philosophy New Age, Metaphysics

Theory Development
With 1979 publication of first book, developed ideas & created 10 Carative factors Developed theory 1979-1985 1985 publication of actual theory, further developed nursing curriculum Inductive: Set out to prove theory through research Deductive:
Writing of original theory based on experience

Assumptions: Implicit
Humans cannot be treated as objects Humans cannot be separated from self, other, nature, or the larger universe There is a sacredness of life and all living things
(Marriner-Tomey, et al 2006)

Assumptions: Explicit
Care and Love:
Comprise primal and universal energy Often overlooked, but humanness requires both to survive

Our sense of humanity requires that the practice of human care be an interpersonal endeavor Nursing has always held a human-care stance in health-illness concerns Nurses must treat themselves with gentleness and dignity before they are capable of providing the same to others

Assumptions: Explicit contd.

Care is the essence of nursing, and serves as the professions unifying factor. Ability of nurses to sustain their caring ideal will determine nursings contribution to society, practice and research. Health care delivery system has placed less emphasis on human care, threatening the caring ideology in practice. Care environment offers development of potential, while enabling person to make choices for health. Theory recognition that the science of caring is complementary to the science of curing.

Assumptions: World View

Holistic view of patient and the nurse Human science orientation to nursing
of unity and connectedness of All

Transpersonal view: acknowledges unity of life

Concentric circles of caring
Individuals, others, community, state, nation, universe

Metaparadigm
Person Humans have needs that are valued, respected, supported & cared for Environment Should be conducive to holistic healing Health Holistic approach to health is necessary to function as a whole being Nursing Nurse-patient relationship is foundational to nursing

Concepts
The Carative Factors Originally created 1979 as framework for providing a format and focus for nursing phenomena Still current terminology for "core" of nursing, but term "factor" is too stagnant Trim of nursing (time, setting, procedure) is outside the core potentiates therapeutic healing processes and relationships Evolved concept today is "clinical caritas" and "caritas processes" Explicit nursing values, knowledge, and practices of human caring geared toward subjective inner healing process unique to caring as healing arts (Watson, 2007)

Concepts
Transpersonal Caring Relationship Foundation of the work Shows concern for inner life world of another fully embodied person Goes beyond ego self, reaching to the deeper connections to spirit & broader universe Nurse uses caring consciousness to preserve & honor embodied spirit & heal as experience, perception, and intentional connection take place Be an authentic being, in the moment (Watson, 2007)

Concepts
Caring Occasion - Caring Moment Occurs when nurse & another come together with unique life histories & phenomenal fields in a human-to-human transaction Transcendent: experience & perception take place = greater field potentiated Involves action & choice by both participants Becomes part of life history of each person as well as stamp on history of time Consistency: Watson uses terms interchangably
(Watson, 2007)

Propositions - Diagram

World View - Diagram

Application: Clarity
Lack of Definition Concept of intersubjective ideal Concept of Transcendence Conflicts Care Theory vs. concepts of ones wholeness, their intention and freewill, and the nature of reality Use of Language Care moment/caring transaction/caring occasion Terms used interchangeably Concept of soul Watsons language inaccessible to many nurses

Application: Congruence
Theory is internally congruent up to the outcomes aspect of theory
Terms are not clearly defined
achieving outcomes is difficult

Each nursing encounter does not offer an opportunity for transcendence

 Predictive - Weak Positive changes are potential occurrences, which cannot be predicted with certainty. Watson acknowledges that different expressions of caring in different situations may result in unpredictable outcomes. Explanatory, Descriptive Strong Explains importance of care to nursing profession and patient outcomes Explains complementary relationship between care and cure Explains inter-relationship of care and transpersonal moment, leading to transcendence, harmony, and healing outcomes.

Application: Level

Use: Application to Nursing Practice

Application of clinical caritas to care situations Recognition of caring moment Take time to be present in the moment Respect persons choices and decisions View the persons health through Watsons caring lens a persons health is a subjective experience (Cara, 2004) The nurses moral commitment, intentionality, and personal use of the clinical caritas protects, enhances and potentiates human dignity, wholeness, and healing: this encourages the patient to create (or really, co-create) a meaning of a disease and treatment.
The Art of Caring as a Philosophical Model for Nurse Practitioner Praxis, retrieved from http://www.medscape.com/viewarticle/496372_2

Application: Testability
Difficult to assess caring due to it being a dynamic process Studies have linked Watsons carative factors to improved health outcomes
(Coates, 2002) 1999; Eric et al., 2003)

(Nyman & Lutzen,

Does not control for other factors that could improve health outcomes Watson not sole variable

Multiple scales for measuring caring, not all theoretically based

Healthcare Environment Caring Factor Survey (Handout)

Application: Future
Is this a theory for the future?
The theory is one for the present and the future Huge non-profit, University of Colorado Center for Caring, integrated into curricula and organizations Thousands of followers, speaks globally Hundreds of research articles and studies undertaken Examples of Practice theory that have been developed based on Theory of Caring
Perinatal loss Hospice Geriatrics