Jean Watsons Theory of Caring

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Jean Watsons Theory of Caring
Alyson Conway, Sally Erickson, Patty Lynch,
Kimberly Myers Sarah Palmer
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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)

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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.

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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

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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

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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

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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)

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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

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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.

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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

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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

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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)

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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)

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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)

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Propositions - Diagram
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World View - Diagram
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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

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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

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Application Level

• 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.

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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

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Application Testability

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

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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