Jean Watson's Theory of Caring Ashley Bridges Nicole Chambers Jennifer Hanson Chelsea Melrose

Introduction “Caring is the essence of nursing.” - Jean Watson Jean Watson is a psychiatric and mental health nurse, whose innovative views on nursing helped shape her nursing theory of caring. The following presentation will outline the origins and philosophy behind her theory, as well as present the four global concepts and how she incorporates each into her theory. Last, a case study will presented for student evaluation of understanding of Watson's theory.

Origins and Philosophies Jean Watson specialized in psychiatric-mental health nursing which allowed her to recognize the needs of both the caregiver and the patient. Watson's work is recognized as a "Human Science" for this reason. Recognized human caring as the basis of nursing practice and placed a large emphasis on how the nurse and patient interact together to promote healing. She equated health with harmony, resulting from the unity of the body, mind and soul. Believed that nursing is based on human values and interest in the welfare of others therefore placing a large emphasis on the caregiver recognizing his/her own values as a nurse. Believed that nursing is concerned with health promotion, health restoration and illness prevention therefore placing a large emphasis on the development of a trusting patient-nurse relationship and providing a caring environment.

Historical Background Jean Watson developed her Theory of Human Caring between 1975 and 1979 while she taught at the University of Colorado o Theory evolved as she worked on a curriculum for a bachelor's of science in nursing program Was originally based on her beliefs about nursing and was augmented by her doctoral studies in psychology Watson's goal in developing her theory was to bring meaning to nursing as a unique and distinct health profession with its own values and knowledge base Wanted to bridge the gap between the caring and focus on health of nursing and the focus on diagnosis and illness of medicine (Fawcett, 2002) o Beliefs centered on the carative factors of nursing, which stood apart from the curative factors of medicine o Original theory proposed ten carative factors of nursing Wanted a body of work that was applicable to every area of nursing across time (Watson, n.d.)

Philosophic Values About Nursing Watson's fundamental belief about nursing is that it is a human science (McCance, McKenna, & Boore, 1999) Believes that the primary goal of nursing is to help individuals achieve harmony of mind, body, and soul through caring transactions o Core of nursing is based on the essence of caring Goal of nursing is to guide the individual to find meaning in sickness and pain, which will improve human nature Nursing, as part of the transpersonal caring relationship, involves being present, showing kindness, developing trust, listening to the expression of feelings, and assisting in the meeting of basic needs (Watson, n.d.)

Knowledge Development Believes that one has to experience the caring theory before one can learn about and research it, and ultimately, add to it Because the theory can be experienced, it provides the opportunity to grow the theory and practice its fundamentals in personal and professional life Use of the theory is ever-changing Believes what is meant by nursing discipline needs to be rethought so that nursing can continue to mature as a distinct profession (Fawcett, 2002) o Nursing has generally borrowed knowledge from other disciplines, especially medicine o Once nursing knowledge can guide its own practices, then other disciplines can draw from nursing knowledge Feels that caring should remain at the center of knowledge development and that all healthcare disciplines will have to incorporate a caring model into their practices to meet the public's expectations (Watson, n.d.)

Influences on Nursing Philosophy The transpersonal caring relationship was the major influence on Watson's nursing philosophy o Transpersonal caring relationship is defined by a spiritual connection that allows for the possibility of healing o Transpersonal caring requires being involved in the moment, being authentic, providing a caring environment, and making a spiritual connection Believed that caring in nursing has been present in every society and could be transmitted through the nursing profession (Fawcett, 2002) Belief in holistic care was critical in the development of her caring philosophy

Global Concepts According to Watson's Theory of Caring Person, Environment, Health and Nursing

Global Concepts: Person One of the only theories involving the caregiver and the patient. Encourages the nurse and patient to develop a trusting relationship Requires nurse to be conscious of own morals and values Encourages going beyond ones "ego" to reach a spiritual connection in promoting the patients comfort and healing. The goal is to promote, protect, enhance, and preserve the patients dignity, humanity, wholeness and inner harmony. The art of caring provides compassion and eases patients and families suffering. An individual who receives care, is respected, appreciated, cultivated and assisted with care while being viewed as an individual. Watson's Carative Factors related to this concept: The formation of humanistic- altruistic system of values The cultivation of sensitivity to one's self and others The development of a helping- trust relationship

Global Concepts: Environment Environment should support caring accepts an individual as they are or who they may become. A caring attitude is attained by one ’ s culture to cope with its environment. Watson's Carative Factors related to this concept: o The provision for a supportive, protective, and/or corrective mental, physical, sociocultural, and spiritual environment

Global Concepts: Health Applying caring values in our practice is essential to our own health, as healthcare providers. Encourages a teaching- learning environment that supports and promotes health. The spiritual strength of the patient is recognized and encouraged for its contribution to the health of the individual. Holistic approach to promote health and prevent illness Maintaining functions of daily living. Watson's Carative Factors related to this concept: o The systematic use of the scientific problem-solving method for decision making o The promotion of interpersonal teaching- learning o Assistance with the gratification of human needs

Global Concepts: Nursing Encourages nurses to practice the "art of caring" and provide compassion to ease patient and families suffering. Promotes healing and dignity but it can also expand to help nurses reach their own self-actualization. Believes that holistic health is central to the practice of caring in nursing. Encourages nurses to be their genuine selves with their patients, which allows for development of a trusting relationship between the nurse and patient. Nursing is the science of humans with experiences of health promotion and illness preventions Nursing provides care for patients and facilitates health in a professional, ethical and personal interaction. Watson's Carative Factors related to this concept: o The promotion and acceptance of the expression of positive and negative feelings o The cultivation of sensitivity to one's self and others o The development of a helping- trust relationships o The instilation of faith and hope o The allowence for existential phenomenological forces

Evaluation of Watson's theory Watson's background in mental health nursing helped her recognize the needs of both the caregiver and the patient, which directly influenced her views on nursing and development of her theory. Theory was started while Watson was working towards a BSN, and evolved while in her doctorate program. Theory originally began as Watson's definition of nursing. Theory is unique to nursing, however, Watson established the carative factors in hopes that her theory could be applied to all areas of nursing.

Theory of Human Caring: Where, When and How? Can be applied to all areas of nursing, including both ambulatory and acute care A guide to articulate what nursing is and does, beyond task orientation A guide for all nursing roles and specialities Framework that helps build awarenss of how our values guide moment to moment practice Theory of Human Caring can be applied to interdisciplinary relationships within healthcare, as well as with nurse colleagues. Two main elements of the theory are human caring and being sensitive to others, which can be applied to all interpersonal relationships (within family units, work, etc)

Case Study Mrs. Doubtfire is a 43 year old female who is admitted to your oncology unit to receive chemotherapy and radiation for stage 2 breast cancer. She has been told that in order to adequately treat her cancer she must undergo a double mastectomy. As a mother of three teenage daughters, she voices concern to you that she will no longer feel feminine after already losing her hair and potentially both of her breasts. Using Jean Watson's theory of caring, answer the following questions related to Mrs. Doubtfire's situation.

1. Using Watson's caring philosophy, what would your nursing care interventions be? a. Convince Mrs. Doubtfire to have her breasts removed so that she will not die and leave her daughters behind. b. Tell her that her daughters will still see her as a woman. c. Sit down with the patient and allow her to express her positive and negative feelings about having the bilateral mastectomy. d. Tell her that you will give her time to rethink her decision and go see your next patient.

2. Inspired by Watson's theory, what question would help Mrs. Doubtfire share her feelings? a."Tell me about your spiritual and cultural beliefs regarding feminity." b. Don't ask questions, let her sleep and go review her chart. c. Don't ask questions, put in a social work consult and have them come talk with her. d. "Do you feel that having this surgery will effect having a relationship with your daughters?"

3. Identify the clinical carative factors that you could apply to the situation with Mrs. Doubtfire. Choose all that apply. a. Assistance with the gratification of human needs. b. The development of a helping-trust relationship. c. Work in such a way that there is a sense of accomplishment. d. Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities. e. The promotion and acceptance of the expression of positive and negative feelings.

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