Jean Watson’s Nursing Theory of Human Caring Presented by Emelie Elliott, Julie Hammatt, and Andrea Walsh NURS 6600: Theoretical Foundations for Nursing Practice Idaho State University October 27, 2013

Background Born June 10, 1940 in a small town in the Appalachian Mountains of West Virginia World renowned for her Philosophy and Science of Caring Distinguished Professor of Nursing, and former Dean of Nursing, at University of Colorado, Boulder Founder of Center for Human Caring in Colorado Founder and Director of the Watson Caring Science Institute Received many awards and honors, including Fetzer Institute Norman Cousins Award, and International Kellogg Fellowship in Australia October, 2013- Awarded Lifetime Leadership Award from American Academy of Nursing. Devoted mother and grandmother Link to Jean Watson’s CV http://watsoncaringscience.org/files/CVs/CV2013-14JeanWatsonupdatednov12013.pdf

Educational Background 1961- Nursing Diploma from Lewis Gale School of Nursing, Roanoke, VA 1964- BS in Nursing from University of Colorado (CU), Boulder 1966- MS in Psychiatric and Mental Health Nursing from CU, Boulder 1973- PhD in Educational Psychology & Counseling from CU, Boulder Currently has 10 Honorary Doctoral Degrees 7 international Honorary Doctorates

Development of Theory of Caring While writing a baccalaureate textbook, Watson developed the basic caring nursing process. She published Nursing: The Philosophy and Science of Caring in 1979. Revised in 2008. (Fawcett & DeSanto-Madeya, 2013) This initial publication established the carative factors in nursing, and were renamed in 2001 to Clinical Caritas Process (Wagner, 2010) Another hallmark in Watson’s exploration and development of the science and art of caring is her book, Postmodern Nursing and Beyond (1999). Watson feels that her work is continually open for refinement, “until this moment in history” (Watson, 1996, p. 141). Theory of Caring focuses on the interpersonal and transpersonal relationship between nurse and other (self, patient, family, society, universe) “Human caring is the moral ideal of nursing” (Fawcett & DeSanto-Madeya, 2013)

Major Influences on Watson’s Work Loss of vision and loss of left eye in 1997 “I lost my eye, literally, metaphorically and symbolically – losing my eye/(ego)/ I…I had to learn to be still, to surrender to all, to let go, to learn to receive, to be open to unknown mystery and miracles – it was the mystic and metaphysical/spiritual practices and inner experiences that carried me through” (Watson, 2013). Loss of her husband in 1998 Losses in her life brought her to the realization of the supreme power of love, and to her own philosophical writings.

Setting and Client Client- caregiver and care recipient Relational theory- between caregiver and care recipient, nurse and other, self and universe. Involves the development of the transpersonal caring relationship (Fawcett & DeSanto-Madeya, 2013) Setting- caring moment/caring occasion Involves any setting or time of coming together to share meaningful, intentional human experiences (Fawcett & DeSanto-Madeya, 2013)

Philosophical Underpinning Philosophy pulled from humanitarian, metaphysical, spiritual-existential, and phenomenologic orientations Nursing process examined through looking at the soul and transcendence Ideas and ideals were created through reflective thinking The philosophical claims form the values, the assumptions, and the statements of her theory Reflective Thinking about Nursing Theory

Assumptions of the Science of Caring Caring can only be effectively demonstrated and practiced interpersonally Caring consists of carative factors that result in the satisfaction of certain human needs Effective caring promotes health and individual or family growth Caring responses accept a person not only as he or she is now but as what he or she may become A caring environment offers the development of potential while allowing the person to choose the best action for himself or herself at a given time Caring is more “healthogenic” than is curing. It integrates biophysical knowledge with knowledge of human behavior to generate or promote health and to provide ministrations to those who are ill. A science of caring is complementary to the science of curing. The practice of caring is central to nursing (Watson, 1979, pp. 8-9)

Values About Human Care and Human Caring Nonpaternalistic values are related to human autonomy and freedom of choice (Watson, 1985, pp. 34, 73) Caring is acknowledged as the highest form of commitment to self, to other, to society, to environment, and even to the universe (Watson, 1996, p. 146) If human caring-healing is not sustained as part of our collective values, knowledge, practices, and global mission, the survival of humankind is threatened (Watson, 1996, p. 147)

Assumptions Related to Human Care and Human Caring Care and love are the most universal, most tremendous, and most mysterious cosmic forces (Watson, 1996, p. 149) Caring is based on an ontology and ethic of relationship and connectedness (Watson, 1999, p. 102) Caring can be most effectively demonstrated and practiced interpersonally and transpersonally (Watson, 1999, p. 102) Caring is the essence of nursing and the most central and unifying focus for nursing practice (Watson, 1996, p. 150) Nursing’s social, moral, and scientific contribution to humankind lie in its commitment to a human caring-healing ethic (Watson, 1996, p. 151) Transpersonal caring becomes transformative, liberating us to live and practice love and caring in our ordinary lives in nonordinary ways (Watson, 2003, p.79)

Concepts and Propositions Transpersonal Caring Relationship – relationship involving a high regard for the whole person and his or being in the world (Watson, 1996, p. 151) > Self – transpersonal-mind-body-spirit oneness > Phenomenal Field – person’s subjective reality that determines perceptions and responses in given situations > Intersubjectivity – the person of the nurse affects and is affected by the person of the other (Fawcett, 2013, p. 406) Caring Moment/Caring Occasion – an action and a choice by nurse and other person deciding how to be in the moment (Fawcett, 2013, p. 407) Caring (Healing) Consciousness – exists through and transcends time and space and can be dominant over physical dimensions (Fawcett, 2013, p. 407) Carative Factors and Clinical Caritas Processes

Transpersonal Moment “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, pp. 66-67)

10 Carative Factors Formation of a Humanistic-Altruistic System of Values Instillation of Faith-Hope Cultivation of Sensitivity to Self and to Others Development of a Helping-Trust Relationship Promotion and Acceptance of the Expression of Positive and Negative Feelings Systematic Use of the Scientific Problem-Solving Method for Decision Making Promotion of Interpersonal Teaching-Learning Provision for Supportive, Protective, and Corrective Mental, Physical, Sociocultural and Spiritual Environment Assistance with Gratification of Human Needs Allowance for Existential Phenomenological Forces

Clinical 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 the ego self 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 and 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 the artistry of caring-healing practices

Caritas Processes Continued Engaging in genuine teaching-learning experience that attends to unity of being and meaning attempting to stay within other’s frame of reference Creating healing environment at all levels (physical as well as nonphysical, subtle environment of energy and consciousness, whereby wholeness, beauty, comfort, dignity and peace are potentiated) Assisting with basic needs, with an intentional caring consciousness, administering ‘human care essentials’, which potentiate alignment of mindbodyspirit, wholeness, and unity of being in all aspects of care 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 (Tomey & Alligood, 2006, p. 104) Caritas is from the Greek vocabulary meaning to cherish

Foundation of Human Caring Theory THE CARING OCCASION OR CARING EVENT DEVELOPMENT & UTILIZATION OF THE TRANSPERSONAL RELATIONSHIP CARATIVE FACTORS/CARITAS PROCESSES

Theory of Human Caring: Then and Now Originally developed and published in 1979, refined, changed, and updated over the years. Early concepts of “Carative Factors” evolved to “Clinical Caritas Processes” (Fawcett & DeSanto-Madeya, 2013). More recent writings include interpretations of Carative Factors into Clinical Caritas Processes. Example: “Formation of humanistic-altruistic system of values, becomes: ‘Practice of loving-kindness and equanimity within context of caring consciousness’,” (Watson, n.d., p. 4).

Then and Now Continued Later writings of theory included terms “mind-body-spirit” and “mind-body-spirit unity of being” to reduce inconsistencies in earlier publications regarding the holistic human being (Fawcett & DeSanto-Madeya, 2013). More recent writings clarify and expand on concepts of Transpersonal Caring Relationship and associated assumptions, Caring Moment/Caring Occasion, and Caring (healing) Consciouness (Watson, n.d.). Watson continuously expands and further develops on Clinical Caritas Processes.

Watson’s Theory Applied

Theory Applied The task-oriented nurse, though competent and skilled, did not nurture emotional and spiritual elements of the human being. Patient fears/concerns were disregarded. Touch, taking the time to sit with a patient, and actively listening better encompassed caring between the patient and the nurse. Caring opens doors for interpersonal relationships, healing, well-being, and improved health outcomes. True nursing incorporates the preservation and emphasis of humanity and dignity. Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around. ~ Leo Buscaglia

Just For Fun http://www.youtube.com/watch?v=Fr9TFbE_13o

Theory and Nursing Practice Caring is the underlying foundation and essence of nursing. According to Watson, caring is especially important when curing has failed (Fawcett & Desanto-Madeya, 2013). Nursing practice must be holistic, ethical, compassionate, and open to new thoughts or change. Theory of Human Caring components implemented in every-day practice: engaging patients and families, protecting the person and human dignity, actively listening, being present, supporting, developing and maintaining trust, providing healing environments, teaching and learning from patients, providing basic human needs, reflecting on self, and acknowledging own feelings and past experiences. Modalities of Transpersonal Caring-Healing promote comfort and healing and may include: music, white noise, calming sounds, art, aromatherapy, specific foods (i.e. patient diet and preferences), acupressure, breathing exercises, deep massage, therapeutic touch, therapeutic massage, and bathing (Fawcett & Desanto-Madeya, 2013). At any moment or opportunity for nursing, there is an opportunity for caring.

Conclusion Jean Watson’s life work of the philosophy and science of nursing is applied to practice worldwide. Watson’s Theory of Human Caring emphasizes dignity and the person as a whole, not an object or diagnosis. “Caring is the essence of nursing and the most central and unifying focus for nursing practice,” (Fawcett & Desanto-Madeay, 2013, p. 404).