1. “…In trying to measure caring, one is drawn into a process of reducing a complex subjective, intersubjective, relational, often private, and invisible human phenomenon to a level of objectivity that…trivialize, and dilutes its authenticity and deeper meaning”.
Watson, 2009
“…In trying to measure caring, one is drawn into a process of reducing a complex subjective, intersubjective, relational, often private, and invisible human phenomenon to a level of objectivity that…trivialize, and dilutes its authenticity and deeper meaning.” Because of the abstract framework of the Watson Theory it is difficult to conduct studies about caring. She believes the reason for it is a gap between the essence of the nursing and the methods used for the studies (Alligwood, 2006, P.101). Watson’s proposal to look at the patient as a spirit-mind-body entity requires development of specialized assessment tools to evaluate patient experience and outcomes.

2. Current Difficulties
“ ..The abstractness of the concept and the clinical reality in some situations…has limited the development of a knowledge base in Watson’s caring theory…”
Alligood, 2006, p.102
How do you measure love, compassion, faith and caring? Watson’s theory stepped out of the measurable outcomes of the cc’s, pounds and degrees. It tapped into a sacred part of what defines us as human and tries to encompass a variety of human subjective expressions of health and wellbeing

3. Caring Assessment Tools
1.CARE-Q 2.CARE/SAT 3.CBI 4.PCB 5.Care Efficacy Scale 6.Caring Factor Survey
In response to the difficulty of measuring caring the Caring Assessment Report Evaluation was developed. Referred to as CARE-Q it was the first quantitative caring assessment tool for nursing. Based on the CARE-Q, Watson developed the Care Satisfaction Questionnaire or CARE/SAT to assess overall patient satisfaction with nurse caring behavior.
The third generation tool that evolved from the first 2 that measures the patient’s perception of nurse caring is the Caring Behavior Inventory (CBI).
The Professional Caring Behaviors (PCB)is another tool that measures caring as perceived by the patient. Some of the criteria are use of touch; individualized care, listening, interest, explaining, use of time, voice, presence, facial expression, level of concern, family involvement, spirituality, managing the environment and technical proficiency.
The Care Efficacy Scale assesses the nurse’s individual confidence in her ability to establish caring relationships and deliver care based on it.
The Caring Factor Survey is the newest tool for measuring professional caring practices, nurse retention and patient outcomes. It was created by group of authors including Jean Watson.

4. Caring Relationship General feeling of wellbeing
Psycho-social development
Development of support system
Development of appropriate coping mechanisms
Self-expression
Promotes:
The Watson theory promotes a human caring relationship between the nurse and the patient. Presence of an authentic caring relationship promotes general wellbeing. It is an essential part for promoting psychological development and development of social skills for patients of all age groups. It allows for the building of a strong support system and ongoing reciprocal communication between health care providers, family and patient. It helps the patient and his caregiver to develop appropriate coping mechanisms to reduce burn out and stress. Caring relationships promote self-expression for both the patient and the nurse (Clarke, 2003).

5. Limitations of Watson's Theory
Watson’s theory is difficult to understand. Some knowledge of the eastern religions and their terminology, and philosophy of human personality are necessary in order to fully understand her theory . It is very complex and abstract.

6. “… the congruence between… the values and major concepts and beliefs in the model and the given nurse, group, system, organization, curriculum, population needs, clinical administrative setting, or other entity that is considering interacting with the caring model to transform and/or improve practice.”
Watson, 1996
In this statement Watson identifies that all aspects of the care and care delivery must be accounted for in the model. She infers that if they are not in harmony then it won’t work.

7. The spiritual aspects are difficult for some to relate to.
It is difficult for those that are steeped in reality to understand and apply her theory. Watson's theory is a philosophical grand theory ... one that provides a philosophical framework for practice. It's not intended to provide much in the way of specific treatments. That makes it difficult sometimes to apply to practice. Some feel it is “new agey.”

8. Some situations in the clinical setting do not lend themselves to practicing her theory.
The acute care setting is a noisy busy place that has interruptions as the norm. If a patient is crashing how does one take the time, energy and effort it takes to “be in the moment” with the patient? This theory does not give concrete practice guidelines.

9. Is it feasible to “let go” of your concerns and thoughts about other clients while being with this particular one?
Overload
Critical labs
phones
Call bells
Should we turn off our phones and beepers? Should we tell our co-workers and physicians they are going to have to wait until we are done? Would your other patients understand that you are not “thinking” about them ? Aren't interruptions and prioritizing part of the setting whether it is acute care, an office or even long term care?

10. “I consider my work more of a philosophical, ethical, intellectual blueprint for nursing’s evolving disciplinary/professional matrix rather than a specific theory per se”
Watson, 1996
Based on the multiple revisions she has made since introducing her theory, it makes it difficult to utilize her theory within a consistent framework. If she doesn’t consider her theory a “theory” how can we take it seriously?