Jean Watson The Philosophy and Science of Caring

1. Jean WatsonThe Philosophy and Science of Caring By Amanda Buisman and Stephanie Kimbrel

2. Background Jean Watson was born in West Virginia in 1940. She has a bachelor’s degree in nursing, a master of science degree in psychiatric-mental health nursing, and a doctorate in education psychology and counseling; all of which were obtained from the University of Colorado. Watson is the former Dean of the School of Nursing at the University of Colorado. She also founded and directed the Center for Human Caring at the Health Sciences Center in Denver. She has 6 honorary Doctoral degrees.

3. Background Watson published multiple books on her theory- Nursing: The Philosophy and Science of Caring (1979) Nursing: Human Science and Human Care: A Theory of Nursing (1996) Watson’s Theory of Transpersonal Caring (1996) The Theory of Human Caring: Retrospective and Prospective (1997) Postmodern Nursing and Beyond (1999) Jean Watson: Theory of Human Caring (2001) Caring Science as Sacred Science (2005)

4. Summary of Theory The central idea of Watson’s theory is; “Humans cannot be treated as objects, [and] that humans cannot be separated from self, other, nature, and the larger universe”(Watson, 1997, p. 50) Watson believes that while her theory encompasses the “whole” of nursing, the emphasis is on the interpersonal process between the caregiver and the care recipient.

5. Summary of Theory The Science of Human Caring focuses on the relation between use of the 10 Carative Factors and the development of a transpersonal caring relationship within the context of the caring occasion, caring moment, and caring (healing) consciousness. Watson’s theories are considered middle-range explanatory theories.

6. Summary of Theory Watson’s theory is based on a humanitarian, metaphysical, spiritual-existential, and phenomenological orientation which draws largely from Eastern philosophy. In Watson’s words, her theories are- “concerned with spirit rather than matter, flux rather then form, inner knowledge and power, rather then circumstance”(Watson, 1996, p. 219)

7. Key Theory Terms Transpersonal caring relationship- General term for the connection made between self, the universe, the spirit/soul, and the current moment in time. Involves the nurse and the life space or phenomenal field of another person. Caring moment/caring occasion- Involves an action and choice by both the nurse and the other person in which they come together within the moment and in the relationship. Each feels a connection with the other at the spirit level. It transcends space and time. Caring (Healing) Consciousness- The whole caring-healing-loving consciousness is contained within a single caring moment. Both the one caring and the one being cared for are interconnected, the caring-healing process is connected with the other human, and everything is in connection with the higher energy of the universe. The process is intersubjective with transcendent possibilities that go beyond the given caring moment.

8. Key Theory Terms Developed ten “Carative Factors” which form a framework for understanding the science of caring. • 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-trusting 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. 9-10)

9. Metaparadigm Concepts/Definitions Human Being- A valued person to be cared for, respected, nurtured, and assisted. Health- 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. Nursing- 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- 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. McEwen & Wills, 2011, p. 176

10. Metaparadigm Concepts/Definitions Transpersonal- An intersubjective human-to-human relationship on which 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 part of the life history of both. Phenomenal Field- The totality of human experience of one’s being in the world. This refers to the individual’s frame of reference that can only be known to that person. Self- The organized conceptual gestalt composed of perceptions of the characteristics of the “I” or “ME” and the perceptions of the relationship of the “I” or “ME” to others and to various aspects of life. Time- The present is more subjectively real, and the past is more objectively real. The past is prior to, or in a different mode of being than the present, but is not clearly distinguishable. Past, present, and future incidents merge and fuse. McEwen & Wills, 2011, p. 176

11. Fawcett Criteria Significance- Watson does meet the criteria for significance. Philosophical claims, metaparadigmatic origins, and conceptual orientation is all defined and explained. (Fawcett, 2005, p. 566) Antecedent Knowledge- Watson states her theory is the result of her own values and beliefs. She cites her experience in practice, education, as well as her philosophical, and intellectual background as antecedents. She also acknowledged Carl Rogers, Mumford, Peplau, Marcel, Sarte, Yalom, and Lazarus’ works as inspiration. (Fawcett, 2005, p. 560)

12. Fawcett Criteria Internal Consistency- Watson only partially meets the criteria for internal consistency. There are dual meanings in Watson’s distinctions between body, mind, and soul; subjective and objective experience; and health and illness. There are also several different views on what a human being is defined as. Semantic clarity is evident in the definitions and descriptions Watson provided. (Fawcett, 2005, p. 566-567) Parsimony- This theory does meet the criteria for parsimony. However, it is recommended by Fawcett that one must read Watson’s older work in order to fully appreciate and understand the progression of her theory. (Fawcett, 2005, p. 568)

13. Fawcett Criteria Testability- Watson only partially meets the criteria for testability of middle-range theories. While Watson cites several research/testing methodologies, none of them is directed toward measurement of the relation between the Clinical Caritas Processes and Transpersonal Caring Relationship, which is the central focus of her theory. Watson did publish a report in 2002 citing 21 instruments designed to “assess and measure caring”. Some of the listed instruments were developed by Watson herself, and many of the listed instruments lack citation of theoretical origin. Fawcett recommends that “empirical indicators must be developed to measure the complexity of the concepts of Transpersonal Caring Relationship, Caring Moment/Caring Occasion, and Caring/Healing Consciousness in the real world of nursing practice. In addition, data analysis techniques must be developed to measure the relation between the concepts of Clinical Caritas Processes and Transpersonal Caring Relationship”. (Fawcett, 2005, p. 571)

14. Fawcett Criteria Empirical Adequacy- Watson partially meets the criteria for empirical adequacy for middle-range theories. A variety of methodologies, phenomenology's and grounded theories are used. Watson also employs the Theory of Human Caring-based Descriptive-Empirical Phenomenological Research Method and the Transcendental-Poetic Expression of Phenomenology Research Method. Published reports are beginning to show evidence regarding the empirical adequacy of the Theory of Caring Science. Watson is lacking published reports showing full empirical evidence of the effects of the Clinical Caritas Processes and the outcomes of a Transpersonal Caring Relationship. (Fawcett, 2005, p. 571)

15. Fawcett Criteria Pragmatic Adequacy- Watson does meet pragmatic adequacy. She clearly defines the special education requirements for the application of her theory. She also developed a complete outline on how nurses should be educated on how to apply her theory. Several studies have applied Watson’s theory in real life situations, with positive outcomes. It may not be practical to apply this theory in all care settings however. It is legal for the practitioner to apply and implement this theory for measurement of effectiveness. (Fawcett, 2005, p. 571)

16. Drawbacks/Limitations/Criticisms Theory is very abstract and can be difficult to teach and implement. Involves a large emotional/spiritual investment on behalf of the nurse which may or may not always be possible for each individual nurse. Evidence is lacking showing any actually outcomes from the Caritas Process or from a Transpersonal Caring Relationship. No mention has been made to the possible negative effects this may have on the nurse as they must open up themselves on such a personal/spiritual level.

17. How well do you know Watson? Watson defined 10 specific concepts in relation to the science of caring.... Were they called; • Watson’s 10 Care Plans • Watson’s 10 Care Bears • Watson’s 10 Carative Factors • Watson’s 10 Carative Concepts

18. Answer The correct answer is item “C”, they are called Watson’s 10 Carative Factors.

19. How well do you know Watson? True or False; Watson’s theories draw largely from Eastern culture?

20. Answer True! Watson’s theories are largely influenced by Eastern culture and spiritual beliefs.

21. How well do you know Watson? Which of the following are key concepts in Watson’s theory? • A Transpersonal Caring Relationship • An Actual Caring Moment/Occasion • Caring/Healing Consciousness • All of the above

22. Answer The correct answer is “D”, or all of the above listed concepts.

23. References Fawcett, J. (2005). Chapter 16 Watson's Theory of Human Caring. In Contemporary Nursing Knowledge Analysis and Evaluation of Nursing Models and Theories (2nd ed., pp. 553-583). Philadelphia: F.A. Davis Company. Watson, J. (2005). Caring Science as Sacred Science. Philadelphia: F.A. Davis Company. McEwen, M., & Wills, E. (2011). Chapter 8 Grand Nursing Theories Based on Interactive Process. In Theoretical Basis for Nursing (3rd ed., pp. 174-179). Philadelphia: Lippincott Williams & Wilkins.