JEAN WATSON’S THEORY OF HUMAN CARING

Dr. Jean Watson is a nurse theorist who developed “Philosphy and Theory of Transpersonal Caring” or “Caring Science” and founder of Watson Caring Science Institute.

Jean Watson (June 10, 1940 – present) is an American nurse theorist and nursing professor who is well known for her “Philosophy and Theory of Transpersonal Caring.” She has also written numerous texts, including Nursing: The Philosophy and Science of Caring. Watson’s study on caring has been integrated into education and patient care to various nursing schools and healthcare facilities all over the world.

Nowadays, a lot of people choose nursing as a profession. There are many reasons to consider in becoming a professional nurse, but compassion is often a trait required of nurses. This is for the reason that taking care of the patients’ needs is its primary purpose. Jean Watson’s “Philosophy and Theory of Transpersonal Caring” mainly concerns on how nurses care for their patients, and how that caring progresses into better plans to promote health and wellness, prevent illness and restore health.

In today’s world, nursing seems to be responding to the various demands of the machinery with less consideration of the needs of the person attached to the machine. In Watson’s view, the disease might be cured, but illness would remain because, without caring, health is not attained. Caring is the essence of nursing and connotes responsiveness between the nurse and the person; the nurse co-participates with the person. Watson contends that caring can assist the person to gain control, become knowledgeable, and promote health changes

What is Watson’s Theory of Transpersonal Caring?

According to Watson’s theory, “Nursing is concerned with promoting health, preventing illness, caring for the sick, and restoring health.” It focuses on health promotion, as well as the treatment of diseases. According to Watson, caring is central to nursing practice, and promotes health better than a simple medical cure.

The nursing model also states that caring can be demonstrated and practiced by nurses. Caring for patients promotes growth; a caring environment accepts a person as he or she is, and looks to what he or she may become.

THE SEVEN ASSUMPTIONS

1. Caring can be effectively demonstrated and practiced only interpersonally.

2. Caring consists of carative factors that result in the satisfaction of certain human needs.

3. Effective caring promotes health and individual or family growth.

4. Caring responses accept person not only as he or she is now but as what he or she may become.

5. 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.

6. Caring is more “ healthogenic” than is curing. A science of caring is complementary to the science of curing.

7. The practice of caring is central to nursing.

THE TEN PRIMARY CARATIVE FACTORS

1. The formation of a humanistic- altruistic system of values.

2. The installation of faith-hope.

3. The cultivation of sensitivity to one’s self and to others.

4. The development of a helping-trust relationship

5. The promotion and acceptance of the expression of positive and negative feelings.

6. The systematic use of the scientific problem-solving method for decision making

7. The promotion of interpersonal teaching-learning.

8. The provision for a supportive, protective and /or corrective mental, physical, socio-cultural and spiritual environment.

9. Assistance with the gratification of human needs.

10.The allowance for existential-phenomenological forces.

The first three carative factors form the “philosophical foundation” for the science of caring. The remaining seven carative factors spring from the foundation laid by these first three.

1. THE FORMATION OF A HUMANISTIC- ALTRUISTIC SYSTEM OF VALUES

• Begins developmentally at an early age with values shared with the parents.
• Mediated through ones own life experiences, the learning one gains and exposure to the humanities.
• Is perceived as necessary to the nurse’s own maturation which then promotes altruistic behavior towards others.

2. FAITH-HOPE

• Is essential to both the carative and the curative processes.
• When modern science has nothing further to offer the person, the nurse can continue to use faith-hope to provide a sense of well-being through beliefs which are meaningful to the individual.

3. CULTIVATION OF SENSITIVITY TO ONE’S SELF AND TO OTHERS

• Explores the need of the nurse to begin to feel an emotion as it presents itself.
• Development of one’s own feeling is needed to interact genuinely and sensitively with others.
• Striving to become sensitive, makes the nurse more authentic, which encourages self-growth and self-actualization, in both the nurse and those with whom the nurse interacts.
• The nurses promote health and higher level functioning only when they form person to person relationship.

4. ESTABLISHING A HELPING-TRUST RELATIONSHIP

• Strongest tool is the mode of communication, which establishes rapport and caring.
• Characteristics needed to in the helping-trust relationship are:
• Congruence
• Empathy
• Warmth

• Communication includes verbal, nonverbal and listening in a manner which connotes empathetic understanding.

5. THE EXPRESSION OF FEELINGS, BOTH POSITIVE AND NEGATIVE

• “Feelings alter thoughts and behavior, and they need to be considered and allowed for in a caring relationship”.
• Awareness of the feelings helps to understand the behavior it engenders.

6. THE SYSTEMATIC USE OF THE SCIENTIFIC PROBLEM-SOLVING METHOD FOR DECISION MAKING

• The scientific problem- solving method is the only method that allows for control and prediction, and that permits self-correction.
• The science of caring should not be always neutral and objective.

7.  PROMOTION OF INTERPERSONAL TEACHING-LEARNING

• The caring nurse must focus on the learning process as much as the teaching process.
• Understanding the person’s perception of the situation assist the nurse to prepare a cognitive plan.

8. PROVISION FOR A SUPPORTIVE, PROTECTIVE AND /OR CORRECTIVE MENTAL, PHYSICAL, SOCIO-CULTURAL AND SPIRITUAL ENVIRONMENT

• Watson divides these into eternal and internal variables, which the nurse manipulates in order to provide support and protection for the person’s mental and physical well-being.
• The external and internal environments are interdependent.
• Nurse must provide comfort, privacy and safety as a part of this carative factor.

9. ASSISTANCE WITH THE GRATIFICATION OF HUMAN NEEDS

• It is based on a hierarchy of need similar to that of the Maslow’s.
• Each need is equally important for quality nursing care and the promotion of optimal health.
• All the needs deserve to be attended to and valued.

WATSON’S ORDERING 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

10.  ALLOWANCE FOR EXISTENTIAL-PHENOMENOLOGICAL FORCES

• Phenomenology is a way of understanding people from the way things appear to them, from their frame of reference.
• Existential psychology is the study of human existence using phenomenological analysis.
• This factor helps the nurse to reconcile and mediate the incongruity of viewing the person holistically while at the same time attending to the hierarchical ordering of needs.
• Thus the nurse assists the person to find the strength or courage to confront life or death.

WATSON’S THEORY AND THE FOUR MAJOR CONCEPTS

1.     HUMAN BEING

• Human being refers to “….. a valued person in and of him or herself to be cared for, respected, nurtured, understood and assisted; in general a philosophical view of a person as a fully functional integrated self. He, human is viewed as greater than and different from, the sum of his or her parts”.

2.     HEALTH

• Watson adds the following three elements to WHO definition of health:
• A high level of overall physical, mental and social functioning
• A general adaptive-maintenance level of daily functioning
• The absence of illness (or the presence of efforts that leads its absence)

3.      ENVIRONMENT/SOCIETY

• 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.

4.      NURSING

• Nursing is concerned with promoting health, preventing illness, caring for the sick and restoring health”.

• It focuses on health promotion and treatment of disease. She believes that holistic health care is central to the practice of caring in nursing.
• She defines nursing as…..
  “a human science of persons and human health-illness experiences that are mediated by professional, personal, scientific, esthetic and ethical human transactions”. 

WATSON’S THEORY AND NURSING PROCESS

• Nursing process contains the same steps as the scientific research process. They both try to solve a problem. Both provide a framework for decision making.

1.      ASSESSMENT

• Involves observation, identification and review of the problem; use of applicable knowledge in literature.
• Also includes conceptual knowledge for the formulation and conceptualization of framework.
• Includes the formulation of hypothesis; defining variables that will be examined in solving the problem.

2.      PLAN

• It helps to determine how variables would be examined or measured; includes a conceptual approach or design for problem solving. It determines what data would be collected and how on whom.

3.      INTERVENTION

• It is the direct action and implementation of the plan.
• It includes the collection of the data.

4.      EVALUATION

• Analysis of the data as well as the examination of the effects of interventions based on the data.
• Includes the interpretation of the results, the degree to which positive outcome has occurred and whether the result can be generalized.
• It may also generate additional hypothesis or may even lead to the generation of a nursing theory.

WATSON’S THEORY AND THE CHARACTERISTIC OF A THEORY

1. Logical in nature.

2. Relatively simple

3. Generelizable

4. Based on phenomenological studies that generally ask questions rather than state hypotheses.

5. Can be used to guide and improve practice.

6. Supported by the theoretical work of numerous humanists, philosophers, developmentalists and psychologists.

Carative Factors and Caritas Processes

Carative Factors	Caritas Process
1. “The formation of a humanistic-altruistic system of values”	“Practice of loving-kindness and equanimity within the context of caring consciousness”
2. “The instillation of faith-hope”	“Being authentically present and enabling and sustaining the deep belief system and subjective life-world of self and one being cared for”
3. “The cultivation of sensitivity to one’s self and to others”	“Cultivation of one’s own spiritual practices and transpersonal self going beyond the ego self”
4. “Development of a helping-trust relationship” became “development of a helping-trusting, human caring relation” (in 2004 Watson website)	“Developing and sustaining a helping trusting authentic caring relationship”
5. “The promotion and acceptance of the expression of positive and negative feelings”	“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”
6. “The systematic use of the scientific problem solving method for decision making” became “systematic use of a creative problem solving caring process” (in 2004 Watson website)	“Creative use of self and all ways of knowing as part of the caring process; to engage in the artistry of caring-healing practices”
7. “The promotion of transpersonal teaching-learning”	“Engaging in genuine teaching-learning experience that attends to unity of being and meaning, attempting to stay within others’ frame of reference”
8. “The provision of supportive, protective, and (or) corrective mental, physical, societal, and spiritual environment”	“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)”
9. “The assistance with gratification of human needs”	“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. “The allowance for existential-phenomenological forces” became “allowance for existential-phenomenological spiritual forces” (in 2004 Watson website)	“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”

STRENGTHS

• This theory places client in the context of the family, the community and the culture.
• It places the client as the focus of practice rather than the technology.

LIMITATIONS

• Biophysical needs of the individual are given less important.
• The ten caratiive factors primarily delineate the psychosocial needs of the person.
• Needs further research to apply in practice.