Nursing Theorists: Watson & Newman Lindsay Parker Kimberly Wright Marissa Zingaro Sacred Heart University

Abstract Looking at two well known nursing theorists: Jean Watson and Margaret Newman Examining their theories and concepts Analyzing each theorist’s model of care Applying each theorist’s model in current practice

Nursing: The Philosophy and Science of Caring Jean Watson Nursing: The Philosophy and Science of Caring

Background Was born in West Virginia Attended Lewis Gale School of Nursing in Roanoke, VA Received her BSN in 1964, MS in 1966, and PhD in 1973 all from the University of Colorado. Her master’s degree is in psychiatric-mental health nursing. Her doctorate is in educational psychology and counseling (McEwen and Wills, 2011, p. 174) Jean Watson has a passion for mental health nursing, thus she earned her phd in educational psychology and counseling. This definitely impacted her theory development.

Background She is the former Dean of the School of Nursing at the University of Colorado. Distinguished Professor of Nursing and Chair in Caring Science at the University of Colorado Health Sciences Center (founder). Fellow of the American Academy of Nursing. “Her theory is one of the newest of nursing’s grand theories, having only been completely codified in 1979, revised in 1985, and broadened and advanced more recently” (McEwen and Wills, 2011, p. 174) Watson’s theory work includes a number of titles. In 1979 she published, Nursing: The Philosophy and Theory of Human Care in Nursing. She revised that work in 1985 and wrote Nursing: Human Science and Human Care. Her two most recent theory publications include: Watson’s Philosophy and Theory of Human Caring in Nursing (1989) and Human Science and Human Care (1999). Watson founded the Watson Caring Science Institute in 2007 (See reference list for website).

Theory Description “Watson called her earlier work a descriptive theory of caring and stated that it was the only theory of nursing to incorporate the spiritual dimension of nursing at the time it was first conceptualized” (McEwen and Wills, 2011, p. 174). “The value system that permeates Watson’s (1988, 2008) theory of human caring includes a “deep respect for the wonders and mysteries of life” (1988, p.34) and recognition that spiritual and ethical dimensions are major elements of the human care process” (McEwen and Wills, 2011 p. 175). “Caring science encompasses a humanitarian, human science orientation to human caring processes, phenomena and experiences. Caring science includes arts and humanities as well as science” (Watson Caring Science Institute, 2007).. “Watson’s concepts came from nursing: Nightingale and Rogers, Psychologists: Giorgi, Johnson, and Koch, and philosophy” (McEwen and Wills, 2011, p. 175). “The model has been implemented at the University of Colorado in education and clinical practice. Also, Georgia Southern University taught undergraduate and nurse practitioner courses from the human caring philosophy” (McEwen and Wills, 2011, p. 177). Watson’s theory is a grand interactive theory. Her theory is broad in scope and incorporates concepts from other disciplines. She was influenced greatly by nursing theorists, Nightingale and Roger. In addition, she favored psychologists, Giorgi, Johnson, and Koch.

Meta-paradigmal Concepts 1. Human being- A valued person to be cared for, respected, nurtured, understood, and assisted. 2. 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. 3. Nursing- A human science of persons and human health—illness experiences that are mediated by professional, personal, scientific, esthetic, and ethical human care transactions. (McEwen and Wills, 2011, p. 176, Table 8-8) 4. Environment- “According to Watson, caring (and nursing) has existed in every society. A caring attitude is not transmitted from generation to generation. It is transmitted by the culture of the profession as a unique way of coping with its environment” (Nursing Theories, 2012) Watson definitely valued several meta-paradigmal concepts in her research and theory development. She believed humans were to be cared for, respected, and nurtured. Her definition of health included harmony with the mind, body and soul. Caring for an individual holistically is vital to their health. Furthermore, Watson believes that caring is developed through culture and is a way to cope with the environment.

Other Concepts 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 and Wills, 2011, p. 176). Transpersonal- “An intersubjective human-to-human relationship in 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” (McEwen and Wills, 2011p. 176). 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” (McEwen and Wills, 2011, p. 176). 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” (McEwen and Wills, 2011, p. 176). 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 it is not clearly distinguishable. Past, present, and future incidents merge and fuse” (McEwen and Wills, 2011, p.176). Watson other concepts play into the relationships that come from the caring science. The actual caring occasion and transpersonal both refer to the caring moment between the nurse and the individual. Through this moment both parties have a phenomenal field, which is a human experience of being that becomes part of their life.

The seven major assumptions Caring can be effectively demonstrated and practiced only interpersonally. Caring consists of curative factors that result in the satisfaction of certain human needs. Effective caring promotes health and individual or family growth. Caring responses accept person not only as he or she is now but as what he or she may become. A caring environment is one that offers the development of potential while allowing the person to choose the best action for himself or herself at a given point in time. Caring is more “ healthogenic” than is curing. A science of caring is complementary to the science of curing. The practice of caring is central to nursing. (Nursing Theories, 2012) Watson’s seven major assumptions involve caring. She believes caring goes beyond the person and into the environment. She determined that a caring environment allows a person to choose the best action for himself at any given time. In addition, she calls caring “healthogenic” which means the science of caring complements the science of curing. Taking care of all aspects of the person is vital.

Ten Caritas Processes Embrace altruistic values and practice loving kindness with self and others. Instill faith and hope and honor others. Be sensitive to self and others by nurturing individual beliefs and practices. Develop helping – trusting- caring relationships. Promote and accept positive and negative feelings as you authentically listen to another’s story. Use creative scientific problem-solving methods for caring decision making. Share teaching and learning that addresses the individual needs and comprehension styles. Create a healing environment for the physical and spiritual self which respects human dignity. Assist with basic physical, emotional, and spiritual human needs. Open to mystery and allow miracles to enter. (Watson Caring Science Institute, 2007) These are the ten caring processes that Watson uses in her theory. The refer to the way the caring nurse should interact with her client. Watson’s 9th principle is similar to Maslow’s hierarchy of needs. Lower order needs (biophysical needs) The need for food and fluid The need for elimination The need for ventilation Lower order needs (psychophysical needs) The need for activity-inactivity The need for sexuality Higher order needs (psychosocial needs) The need for achievement The need for affiliation Higher order need (intrapersonal-interpersonal need) The need for self-actualization (Nursing Theories, 2012)

Theory Analysis A logical theory that examines caring, spirituality and human and energy fields (McEwen & Wills, 2011, p.176). The theory contains many characteristics of a human interaction model (McEwen and Wills, 2011, p. 174). Incorporates principles from the unitary process theories (McEwen and Wills, 2011, p. 174).

Relationships of the Theory “A transpersonal caring field resides within a unitary field of consciousness and energy that transcends time, space, and physicality” (McEwen & Wills, 2011, p. 176) “The practitioner’s authentic intentionality and consciousness of caring has a higher frequency of energy than a noncaring consciousness (McEwen and Wills, 2011, p. 177) “Caring-healing modalities are often noninvasive, nonintrusive, natural-human, energetic environmental field modalities” (McEwen and Wills, 2011, p.177) Jean Watson found transpersonal caring “promotes self-knowledge, self-control, and self-healing patterns and possibilities” (McEwen and Wills, 2011, p. 177). This is utilized in many aspects of nursing and has a substantial impact on different areas of care.

A Useful Theory Can be applied to a variety of settings Examples: A researcher used the model in caring for morbidly obese individuals Individuals who have HIV, Wounded warriors, Older Adults (McEwen & Wills, 2011, p.177) Because this theory is used often, the University of Colorado and Georgia Southern University implemented this model in nursing (McEwen and Wills, 2011, p.177). It is used in their plan of study in addition to the care they provide.

Testability Allows quantitative and qualitative research methods (McEwen & Wills, 2011, p. 177) Science of caring is researched by numerous nurses in recent years (McEwen and Wills, 2011, p.177) Researchers have tested the theory to explore “hope, spiritual well-being, and quality of life in hospitalized patients” (McEwen and Wills, 2011, p.177)

Theory Evaluation “…nursing is the art and science of human care; nurses engage in transpersonal caring transactions to assist person to achieve mind-body-soul harmony” (DeNisco & Barker, 2013, p. 368). Faith is an integral part of the healing process Working in a faith based healthcare facility allows the nurse to make a deeper connection with patients Using Jean Watson’s philosophy of nursing helps the nurse to present a well rounded scope of caring to the patient. She not only addresses the physical ailments, she focuses on the patient’s spiritual health as well. She believed caring and curing work hand in hand. Her transpersonal approach had an effect on the nurse as well as the patient.

Theory Evaluation (cont.) Nursing “focuses on health promotion and treatment of disease” (Nursing Theories, 2012). As a masters-prepared nurse, one can use Watson’s theory to educate others in the healthcare field. “When (nursing) students perceive the climate of nursing education as caring, they learn a professional way of being” (Wade & Kasper, 2006, p.162). One of Watson’s areas of focus was education. As mentioned earlier, several universities have implemented Watson’s model of caring in their advanced nursing practice curriculum. Watson’s theory also has been used by nursing instructors in relation to their students as evidenced by a study from Wade and Kasper (2006).

Advanced Practice Application “Caring experiences may lead to enhanced clinical judgment, increased skills and knowledge, mobilization of caring abilities, enhanced empathy, and a love of nursing” (Wade & Kasper, 2006, p. 163). Using Watson’s model of caring can shape the future of nursing by increasing the capacity of caring in nursing students. Having a connection with one’s patients can help to keep the nurse from becoming hardened and unsympathetic toward the patients.

References DeNisco, S., & Barker, A. (2013). Advanced Practice Nursing: Evolving Roles for the Transformation of the Profession (2nd ed.). Burlington, MA: Jones & Bartlett Learning. Hayes, M. & Jones, D. (2007). Health as Expanding Consciousness: Pattern Recognition and Incarcerated Mothers, a Transforming Experience. Journal of Forensic Nursing, 3(2), p.61-66. McEwen, M., & Wills, E. M. (2011). Theoretical Basis for Nursing (3rd ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. Nursing Theories, (2012). Retrieved from http://currentnursing.com/nursing_theory/Watson.html

References (cont.) Nursing Theories, (2012). Retrieved from http://currentnursing.com/nursing_theory/Newman_He alth_As_Expanding_Consciousness.html Pilkington, F., (2007), Envisioning Nursing in 2050 Through the Eyes of Nurse Theorists: Katie Eriksson and Margaret Newman. Nursing Science Quarterly, 20 (3), p. 200. doi: 10.1177/0894318407303099. Predeger, E., & Mumma, C., (2004). Connectedness in Chronic Illness: Women’s Journeys. International Journal for Human Caring, 8(1), p. 13-19.

References (cont.) Wade , G. & Kasper, N. (2006). Nursing Students’ Perceptions of Instructor Caring: An Instrument Based on Watson’s Theory of Transpersonal Caring. Journal of Nursing Education, 45(5), 162-168. Watson Caring Science Institute. (2007). Caring Science. Retrieved from http://watsoncaringscience.org/about- us/caring-science-definitions-processes-theory/# Weingourt, R., (1998). Using Margaret A. Newman's Theory of Health with Elderly Nursing Home Residents. Perspectives in Psychiatric Care,34(3), p. 25-30.