Jean Watson’s responses to changing medicine “ The current dilemmas in health care are often located within a framework that emphasizes the outer forces of economics, staffing shortages, and technological - medical issues, or system/institutional needs ” (Watson, 2004b, p. 249). This disconnection between the current focus in addressing health care issues conflicts with and greatly differs from the deeply human-to-human caring relationships and human-to-human connections that give meaning and purpose to nurses, patients, and other health practitioners alike. Jean Watson has recognized that many of the practical matters of health care conflict with the need to promote the caring relationships and connections between patients and health care providers.

The Theory of Human Caring Unique Concepts of the Theory of Human Caring Transpersonal caring relationship Caring occasion/caring moment Clinical Caritas Process Kearney, 2008 The theory is divided into three main groups: the transpersonal caring relationship; the caring occasion/caring moment; and the clinical caritas process.

Transpersonal Caring Relationship “The human-to-human connectedness” “A high regard for the whole person and his or her being-in-the-world.” Kearney, 2008 The transpersonal caring relationship is an intentional relationship between the nurse and the patient as a human being to human being. By consciously viewing the patient as a whole being, instead of as an “illness”, the nurse views the patient as a whole, complete, and loving person.

Caring Occasion/Caring Moment “A caring occasion occurs whenever the nurse and another come together with their unique life histories and phenomenal fields in a human-to-human transactions…the actual caring occasion has a greater field of its own in a given moment.” Watson, 2007 Watson didn’t clearly define the criteria for the caring moment. Instead she described what it can do. Caring moment/caring occasion is a unique experience between the patient and nurse that involves mutual, transpersonal and reciprocal interactions between the nurse and patient. As a result of the caring moment, the patient and the nurse enlarge their personal life histories. The influence of the caring moment extends to generate new patterns of life and potentiates healing.

The Theory of Human Caring Originally the theory was organized by a framework of “carative factors”. However, recently this has evolved in to “clinical caritas” and “caritas processes” Watson, 2007 Previously, called Carative Factors evolved into 10 caritas processes to reflect Watson’s belief that caring is not a task but rather an ongoing and fluent process that could take place in multiple settings and in multiple ways reflecting the patient’s and the nurse’s personalities and experiences.

Evolution of the Theory of Human Caring Carative Factors Clinical Caritas Processes Formation of humanistic-altruistic system of values Instillation of faith-hope 1.) Practices of loving-kindness and equanimity within context of caring consciousness 2. ) Being authentically present and enabling and sustaining the deep belief system and subjective life world of self and one-being-cared-for In rewording the Carative factors to the Caritas she is intentionally expressing an intention to be loving instead of just caring. Equanimity means calmness and composure. Personal unresolved conflicts can affect and alter the nurse’s perception of the patient needs. The first two Carative Processes ask the nurse to move her own beliefs aside and work with the patient within his own value and belief system.

Evolution of the Theory of Human Caring Carative Factors Clinical Caritas Processes Cultivation of sensitivity to one’s self and to others Development of a helping-trusting, human caring relationship 3.) Cultivation of one’s own spiritual practices and transpersonal self, going beyond ego self 4.)Developing and sustaining a helping-trusting, authentic caring relationship Clinical Caritas 3 emphasizes that personal, spiritual and emotional positive practices, self-acceptance and self-awareness of one’s self is essential for one’s ability to connect to the patient. The commitment to the first 3 caritas is how the relationship develops.

Evolution of the Theory of Human Caring Carative Factors Clinical Caritas Processes Promotion and acceptance of the expression of positive and negative feelings Systematic use of a creative problem-solving caring-process, 5.) 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 6.)Creative use of self and all ways of knowing as part of the caring process: to engage in artistry of caring-healing practices The Caritas highlight that the caring moments influence both the nurse and the patient. The caring moments are possible only when two are authentically present and open to each other. Caritas 5 allows for the patient to rid himself of negative feelings. A non-judgmental approach to patient behavior and recognition of the underlying causes of it allows the nurse to create caring moments. Transpersonal changes and changes in the patient’s health promotion and preservation behavior are possible through and within the caring moment. Caritas 6 is the creative and individualized use of all available resources. This includes emotional, spiritual and physical resources and will stimulate recovery and healing of the patient’s body-mind-spirit complex.

Evolution of the Theory of Human Caring Carative Factors Clinical Caritas Processes 7.)Engaging in genuine teaching-learning experience that attends to unity of being and meaning attempting to stay within other’s frame of reference 8.)Creating healing environment at all levels physical as well as non-physical, subtle environment of energy and consciousness, whereby wholeness, beauty, comfort, dignity and peace are potentiated Promotion of transpersonal teaching-learning Provision for a supportive, protective, and /or corrective mental, physical, societal, and spiritual environment Another unique feature of the Caritas is that the patient is viewed as a complex, intertwined, and dynamic system of physical and metaphysical entities that will determine the frame for the patient-nurse relationship. When we say something is metaphysical we meaning it includes emotional, spiritual, mental and social aspects. Assessing and recognizing what hinders a patient’s recovery and healing will allow the nurse to collaborate with the patient to address patient specific problems or potential problems. These obstacles could be emotional or spiritual imbalances. Caritas 8 emphasizes that the nurse creates the environment. Even the words a nurse uses give off certain vibrations that can bring a patient “up” or bring them “down”. That’s why Watson’s theory put so much emphasis on the nurse’s emotional and spiritual well-being as a means to create a healing environment for the patient.

Evolution of the Theory of Human Caring Carative Factors Clinical Caritas Processes Assistance with gratification of human needs Tending to both embodied spirit and evolving spiritual emergence; allowance for existential-phenomenological-spiritual forces 9.) Assisting with basic needs, with an intentional caring consciousness, administering “human care essentials: which potentiate alignment of mind-body-spirit, wholeness, and unity of being in all aspects of care 10.) Opening and attending to spiritual-mysterious and existential dimensions of one’s own life-death: soul care for self and one-being-care-for The caritas process invite you to shift emphasis from the “nursing care” to the “humane care.” To quote Dr Watson, “Preserving human dignity and integrity through human caring is ultimately the measure by which patients evaluate their…experience” (Watson, J. 2006). Allowing assistance with basic care needs (such as toileting, feeding, repositioning, bathing) could be awkward and embarrassing for the patient. By communicating understanding and acceptance of the patient’s feelings and conveying of appreciation for the trust put in the nurse could ease a patient’s struggle and open a door for transpersonal caring moments. The final caritas means that the nurse needs to be open to nurturing, caring, love and the possibility of miracles.