Jean Watson’s 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

• Watson’s 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• 1970’s: 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 profession’s unifying factor.

• Ability of nurses to sustain their caring ideal will determine nursing’s 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

ConceptsThe 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)

ConceptsCaring 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 one’s 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– Watson’s 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

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.

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 person’s choices and decisions• View the person’s health through Watson’s caring lens – “a

person’s health is a subjective experience” (Cara, 2004)

• “The nurse’s 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” (Coates, 2002)

• Studies have linked Watson’s 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)

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