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Jean Watson Dr. Jean Watson, PhD, RN, AHN- BC, FAAN Watson Caring Science Institute Distinguished Professor of Nursing University of Colorado, Denver Caring Science and Human Caring Theory Presented by Emily Becker, Laura Dryjanski, and Kristen Neigebauer
“I emphasize that it is possible to read, study, learn about, even teach and research the caring theory; however, to truly "get it," one has to personally experience it; thus the model is both an invitation and an opportunity to interact with the ideas, experiment with and grow within the philosophy, and living it out in one’s personal/professional life.” -Jean Watson www.watsoncaringscience.org
A Brief Background • The Theory of Human Caring was developed between 1975 and 1979, first published in 1979 • According to Watson, “It was my initial attempt to bring meaning and focus to nursing as an emerging discipline and distinct health profession […]” (Parker, 2001) • “[…] I tried to make explicit that nursing’s values, knowledge, and practices of human caring were geared toward subjective inner healing processes and the life world of the experiencing person, requiring unique caring-healing arts and a framework called “carative factors” which complemented conventional medicine but stood in stark contrast to “curative factors” (Parker, 2001)
The Basics • The philosophy of caring and science examines the relatedness of everything, including: • Human Science • Human Caring Processes • Experiences • Phenomena • Watson’s Caring Science and Human Caring Theory blends the sciences and humanities • Watson likes to cite Eastern Philosophy and the foundations of Buddhism • Focus on holism
A Three Part Foundation According to Watson (2001), there are three main conceptual elements comprising her theory: 2. The development & utilization of the transpersonal caring relationship
Carative Factors • Goal was to guide the “core” of nursing • In contrast to medicine’s “curative factors” • Interdependent • Used to “honor the human dimensions of nursing’s work and the inner life world and subjective experiences of the people we serve” (Watson,2007) • First three factors are the philosophical foundation for the science of caring • The final seven build upon these • Transitioned to the “caritas processes”, expanding on the original factors
“It is when we include caring and love in our work and our life that we discover and affirm that nursing, like teaching, is more than just a job; it is also a life-giving and life-receiving career for a lifetime of growth and learning” (Parker, 2001). -Jean Watson
Original 10 Carative Factors • Formation of a humanistic-altruistic system of values • Instillation of faith-hope • Cultivation of sensitivity to one’s self and to others • Development of a helping-trusting, human caring relationship • Promotion and acceptance of the expression of positive and negative feelings (Watson, 1985)
Original 10 Carative Factors Continued • Systematic use of a creative problem-solving caring process • Promotion of transpersonal teaching-learning • Provision for a supportive, protective, and/or corrective mental, physical, societal, and spiritual environment • Assistance with gratification of human needs • Allowance for existential-phenomenological-spiritual forces (Watson, 1985)
10 Caritas Processes • Practice of loving kindness and equanimity within the context of caring consciousness • Being authentically present, and enabling and sustaining the deep belief system and subjective life world of self and one-being-cared-for • Cultivation of one’s own spiritual practices and transpersonal self, going beyond ego self, opening to others with sensitivity and compassion (Parker, 2001)
10 Caritas Processes Continued • Developing and sustaining a helping-trusting, authentic caring relationship • Being present to, and supportive of, the expression of positive and negative feelings as a connection with deeper spirit of self and the one-being-cared-for • Creative use of self and all ways of knowing as part of the caring process; to engage in artistry of caring-healing practices (Parker, 2001)
10 Caritas Processes Continued • Engaging in genuine teaching-learning experience that attends to unity of being and meaning, attempting to stay within other’s frames of reference • Creating healing environment at all levels • Assisting with basic needs, with an intentional caring consciousness, administering ‘human care essentials’, which potentiate alignment of mindybodyspirit, wholeness, and unity of being in all aspects of care, tending to both embodied spirit and evolving spiritual emergence (Parker, 2001)
10 Caritas Processes Continued • Opening and attending to spiritual-mysterious, and existential dimensions of one’s own life-death; soul care for self and the one-being-cared-for (Parker, 2001)
The Person • A complex, holistic being; an evolving soul • People have value, meaning • Not an object, and cannot be separated from self, other, nature, or the larger universe • Impacted and influence by the surrounding environment • A human being has complex needs including physical, psychological, psychosocial • A person is to be cared for, nurtured, and both valued and respected
The Person Continued • Comprise of three ‘spheres of being’: mind, body, and spirit • “[…] a valued person in and of him or herself is to be cared for, respected, nurtured, understood, and assisted; in general a philosophical view of a person as a fully functional integrated self. He, human is viewed as greater than and different from the sum of his or her parts” (Watson, 1985) • “The core of human caring theory is about human caring relationships and the deeply human experiences of life itself, not just health-illness phenomena, as traditionally defined within medicine” (Fawcett, 2002).
The Environment • Driven by Curative Factors/ Caritas Process 8 and 9 • Should be conducive to holistic healing • Designed to be comfortable, not the typical hospital environment • An open system containing both internal (mental, spiritual, and cultural) and external (physical, environmental, and safety) variables that we as caregivers can manipulate • Can serve to expand the person’s “awareness and consciousness”, to promote mind-body-spirit healing, wholeness, and well-being (Watson, 1999) • Is comprised of“[…] noise, privacy, light, access to nature, color, space and smells that can have an impact on the caring-healing process” (Watson, 1999)
Environment Continued • “The person is split apart and the soul is replaced with narcissism of self or denied all together. The human soul is further destroyed with a depersonalized, manmade environment, advanced technology, and robot treatment for cure, delivered by strangers in a strange environment” (Watson, 1988) • The typically employed medical model reduces humans to body systems, individual cells or atoms, in order to treat and cure • Calls for a balance between the high tech environments of the typical hospital setting with a high touch environment • To “[…] transform the environment into one in which healing can occur” (Ryan, 2005)
Health • Holistic- “When the human being is considered from a holistic perspective, health implies harmony and balance among the various dimensions of human experience- physical, emotional, mental, spiritual, and so on” (Parker, 2001) • Defined as a high level of overall physical, mental, spiritual, and social well-being and functioning • Can be defined as the absence of illness, but health can be obtained even when physical wholeness cannot be obtained • Adaptive-maintenance in daily functions, harmony
Nursing • Driven by most Curative Factors/ Caritas Process • “This caring science seeks to honor the depth, humility, connection, compassion, responsibility, and concern for human welfare and optimal human development/evolution” (Watson, 2008) • Watson defines as “A human science of persons and human health-illness experiences that are mediated by professional, personal, scientific, esthetic, and ethical human transactions” (Watson, 1985) • “[…] being present, attentive, conscious, and intentional as the nurse works with another person” (Fawcett, 2002) • “Nurses and practitioners who are literate with caring relationships are capable of having loving, caring, kind, and sensitively meaningful, personal connections with an increasingly enlightened public: a public seeking wholeness and spiritual connections for their wellbeing, not just sterile, depersonalized medical technological interventions, void of human-to-human caring relationships” (Watson, 2009) • Comprised of loving kindness, caring, compassion, gentleness, calmness, wholeness/healing • Occurs during the caring event
Nursing Continued • Starts with an authentic presence • Connection with another person • A spiritual practice, a calling • Both a science and an art • Acknowledges science, art, intuitive, cultural, and spiritual knowledge • Like Carper, also acknowledges and places high value on aesthetic, ethical, and personal ways of knowing • Caring is just as valuable and essential to our patients as curing • Nursing is complimentary to curing • You can have caring without curing, but you cannot have true curing without caring
Nursing Continued • Caring affects self and others • Bidirectional relationship, we also benefit, learn • The transpersonal care/transpersonal relationship is central to Watson’s theory and what she calls of nurses • A true presence • Moving toward a unitary-transformative perspective from a more general, multiple paradigm view
Nursing Continued • Nursing’s tasks according to Watson • “Healing our relationship with self and other/s, and our place in the wider universe; • Finding meaning in our own life and health-illness concerns, as we re-awaken to our profound compassionate, caring and healing service in the world; • Understanding and transforming our own and other’s suffering; • Deepening our understanding and acceptance of impermanence, the expanding-contracting of all life cycles (birthing-dying/the dark and light), including preparing for our own death” (Watson, 2002) • Waton’s definition of caring is often incongruent with current hospital systems and policy
The Transpersonal Caring Relationship • Occurs during the ‘caring event’, central to Watson’s view of nursing • Calls the nurse to go beyond the objective, physical assessment with concern for the person’s deeper, subjective well-being • The nurse “[…] seeks to connect with and embrace the spirit or soul of the other, through the process of caring and healing and being in authentic relation, in the moment” (Parker, 2001) • Goal is to protect, enhance, and preserve the person’s dignity, humanity, wholeness, inner harmony, and overall well-being • Can be nurtured by movements, gestures, facial and bodily expressions, the sharing of information, touch, sound, etc.
The Caring Event • “Two persons (nurse and other) together with their unique life histories and phenomenal field in human care transaction comprise an event” (Watson, 1985) • “An event, such as an actual occasion of human care, is a focal point in space and time from which experience and perception are taking place, but the actual occasion of caring has a field of its own that is greater than the occasion itself” (Watson 1985) • Implementation of nursing actions • Every encounter has the opportunity to be a caring occasion
Implications for Nursing Practice • Need for an extensive understanding and appreciation of the caritas process • Very complex, can be difficult to understand • No defined parameters • Reality: • Nurses generally like her theory, emphasis on care and compassion • Values aspects of nursing central to why nurses become nurses and not doctors • How realistic is the implementation of this theory in current practice with constrains such as • “Working conditions that inhabit caring are lack of accountability for nurses, poor staffing, unreasonable workloads, and poor patient care” (Quinn et al 2003)
Implications for Nursing Practice Continued • Person: • Our healthcare system acknowledges that humans are holistic beings, but often treats them more as objects • Environment: • Sterile, non-home-like, not conducive to healing
Implications for Nursing Practice Continued • Health: • Generally accepted as overall physical, emotional, psychosocial, psychological, etc. • Implementing practices to better achieve this • Ex: Child Life, complimentary medicine, music therapy • Still falling short, placed on back burner, first to be forgotten • Nursing: • Congruent with how most nurses feel about nursing care • Grounded in the discipline of nursing and nursing science • Incongruent with current institution standards, policy, and how nursing is actually implemented
Assumptions (Philosophical) • “Care and love are the most universal, the most tremendous, and the most mysterious of cosmic forces: they comprise the primal and universal psychic energy.” (Watson, 1985, pg 32) • Needs of care and love are often overlooked; although we know people who need to be loved and cared for we often do not act this way toward each other (Watson, 1985, pg 32) • “If our humanness is to survive, we need to become more caring and loving to nourish our humanity and evolve as a civilization and live together” (Watson, 1985, pg 32) • “As a beginning we have to impose our own will to care and love upon our own behavior and not on others. We have to treat ourself with gentleness and dignity before we can respect and care for others with gentleness and dignity.” (Watson, 1985, pg 33)
Assumptions continued (Philosophical) • “Caring is the essence of nursing and the most central and unifying focus for nursing practice.” (Watson, 1985, pg 33) • “Nursing’s social, moral, and scientific contributions to human-kind and society lie in its commitment to human care ideals in theory, practice and research.”(Watson, 1985, pg 33)
Assumptions continued (Philosophical and Scientific) • “Since nursing is a caring profession, its ability to sustain its caring ideal and ideology in practice will affect the human development of civilization and determine nursing’s contribution to society.” (Watson, 1985, pg 33) • “Preservation and advancement of human care as both an epistemic and clinical endeavor is a significant issue for nursing today and in the future.” (Watson, 1985, pg 33) • Nursing and society are in a critical situation; human care role threatened by increased medical technology, bureaucratic-managerial institutional constraints in a nuclear age society & proliferation of curing/radical treatment cure techniques often without regard to costs (Watson, 1985, pg 33)
Assumptionscontinued (Scientific) • “Human care, at the individual and group level, has received less and less emphasis in the health care delivery system.” (Watson, 1985, pg 33) • “Nursing has always held a human-care and caring stance in regard to people with health-illness concerns.” (Watson, 1985, pg 33) • Human care is effectively demonstrated and practiced only interpersonally (Watson, 1985, pg 33) • “Intersubjective human process keeps alive a common sense of humanity; teaches us how to be human by identifying ourselves with others whereby the humanity of one is reflected in the other” (Watson, 1985, pg 33)
Theory Structure • Patient as an Agent of Change • Agent of change “viewed as the individual patient, but the nurse can be a coparticipant in change through the human care process” (Watson 1985, pg 74) • “The agent of change is not the physician, nurse, medication, treatment, or technology per se, but the persona, internal mental-spiritual mechanisms of the person who allows the self to be healed through various internal or external means, or without external agents, but through an intersubjective interdependent process…” (Watson 1985, pg 74)
“In a transpersonal caring relationship, a spiritual union occurs between two persons, where both are capable of transcending self, time, space, and the life history of each other. In other words, the nurse enters into the experience (phenomenal field) of another and the other person enters into the nurse’s experience. This shared experience creates its own phenomenal field and becomes part of a larger, deeper, complex pattern of life.” -Jean Watson (Watson, 1985, p. 66-67)
Theory Structure Intervention Modes Watson refers to these as “caring processes” or carative factors 10 Carative Factors The formation of a humanistic-altruistic system of values The instillation of faith-hope The cultivation of sensitivity to one’s self and to others The development of a helping-trust relationship The promotion and acceptance of the expression of positive and negative feelings The systematic use of the scientific problem-solving method for decision making The promotion of interpersonal teaching-learning The provision for a supportive, protective, and (or) corrective mental, physical, sociocultural, and spiritual environment Assistance with the gratification of human needs The allowance for existential-phenomenological forces (Watson, 1985, p. 74)
Interview with Jean Watson 0:11 What motivated you to introduce 0:13 a humanistic perspective into your theory? 0:42 Why do you think that 0:43 psychology is important in nursing? 1:03 Do you think that showing empathy 1:06 to patients is positive? 1:39 Is it possible to apply your theory 1:41 in hospitals? 2:23 What advice would you give our classmates and ourselves, 2:27 first year students, 2:28 in order for us to become good nurses? http://www.youtube.com/watch?v=xbDJwmCJhIU another interview link: http://www.youtube.com/watch?v=qX1fxKfZifo
Discussion of scientific, philosophic and praxiologic (how to) knowledge necessary to practice nursing according to Jean Watson’s Theory of Caring
Discuss Kinds of scientific knowledge needed to practice nursing like Watson Intended • The nurse makes a purposeful conscious change to increase interaction with patients • Caring-healing interactions • Want to inspire patients to heal physically, emotionally, and spiritually
Address patient concerns • Assess patient’s subjective and objective concerns and incorporate those into the plan of care • Through the nurse’s caring, will encourage patients to understand their feelings
An Example: Pain • Is a subjective experience • Has objective symptoms • Increased heart rate • Diaphoretic • Nausea • Knowledge that some nursing actions can help reduce pain symptoms and are also considered caring actions that can be incorporated into the caring theory • Diming the lights • Aromatherapy • Calming music • Speaking in quite tones
Discuss the kinds of philosophical knowledge needed to practice nursing like Watson Intended • The concept of transpersonal caring is an important component of Watson’s theory • Being spiritual • Being present to self • The presence of self then opens the door to opportunity for spiritual connection
