"Jean Watson's Theory of Human Caring"

Introduction of Theorist

 Margaret Jean Watson was born in South West Virginia and grew up during the 1940s
and 1950s in the small town of Welch.
 She graduated in 1961 from Lewis Gale School of Nursing in Roanoke, Virginia.
 She continued her graduation in nursing from the University of Colorado.
 She did BSc in 1964 at Boulder Campus and MSc in Psychiatry Nursing in 1966 at
the Health Science Campus.
 She completed her PhD in Educational Psychology and Counseling in 1973 at
Graduate School, Boulder Campus.
 Dr. Jean Watson was a distinguished professor of nursing and former dean of the
School of Nursing, University of Colorado from 1983–1990.
 She developed a post-baccalaureate nursing curriculum in human caring, health, and
healing, which led to career professional clinical doctoral degrees. This program was
selected as a national program and was implemented in 1990.
 She received honorary doctoral degrees from Assumption College in Worcester,
Massachusetts; The University of Akron; University of West Virginia; Gothenburg
University in Sweden; and the University of London.
 She also received the award for Distinguished Professor of Nursing at the University
of Colorado in 1992.
 In 1993, she received the National League for Nursing Martha E. Rogers Award.
 She was president of the NLN from 1995–1996.
 She is the founder of the Center of Caring in Colorado. She is also a member of the
American Academy of Nursing and has served as president of the National League of
Nursing.
 National and International Works of Watson
 Her national and international works include lectureships throughout various states.
 Her international activities include an International Kellogg Fellowship in Australia,
Fulbright Research and Lecture Award in Sweden.
 She is also involved in international projects and invited to various countries.

Publications of Watson
 In 1979: Nursing: The Philosophy of Science and Technology.
 Nursing Human Science and Human Caring – A Theory of Nursing, published in
1988.
 Most recently in 1999, she published Postmodern Nursing and Beyond.
 One of her earliest written treatises on the Caring Model was presented at an
American Nurses Association Division of Practice meeting in 1979.
 Caring Science as Sacred Science in 2005

Overview of the Theory

The Theory of Human Caring, developed by Jean Watson, highlights the importance
of caring in nursing. It focuses on healing through compassion and understanding,
rather than just treating physical illnesses. This theory emphasizes nursing’s unique
role in healthcare, prioritizing the therapeutic relationship between nurse and patient.

Watson’s definition of nursing:

Nursing is a human science of persons and human health-illness experiences that are
mediated by professional, personal, scientific, esthetic, and ethical human care
transactions.

Watson’s definition of human caring in nursing:

Human caring is an act and a science in which caring is a human-to-human process

demonstrated through therapeutic interpersonal interactions.
 WATSON’S THEORY AND THE FOUR MAJOR CONCEPTS

Health

 Watson believes in health promotion, restoration, and illness prevention.

 Health refers to unity and harmony within the mind, body, and soul.
 It is associated with the degree of congruence between self as perceived and the self
as experienced.
 Watson seeks to search for spiritual aspects of health and healing, acknowledging the
metaphysical/spiritual level, attending to nonphysical, spiritual dimensions of
existence.

Nurse

 According to Jean Watson:

 Nurse includes life experiences of her in caring for the patient.
 Nurse is to be sensitive to one's feelings, thoughts, experiences, and develop her own
and that of the patient’s potentials.
 She cultivates the higher self-consciousness.
 Nurse focuses on health promotion and treatment of disease.
 Holistic care is central to nursing practice.
 Nurse has opportunities to obtain advanced education and engage in a higher level of
analyses of problems and their concern in education and practice, allowing nurses to
combine their humanistic orientation with relevant science.
 She is responsible for another person as she separates one person from another in
being.
 She develops a helping-trust relationship with the patient.
 Environment

 Focus of care is both internal and external environment.

 Healing environment comes through the intentional use of consciousness.
 Focus is on internal and external environments such as stress, comfort, privacy, safety,
and clean aesthetic surroundings.
 Watson situates the body within the spirit and helps to potentiate the self-healing
capability.
 Positive interaction with the environment helps the caring attitude, which exists in
every 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.

Human Being

 Watson categorized the human needs in terms of biophysical needs such as food and
fluid, elimination, and psychophysical needs such as achievement and affiliation, and
interpersonal needs such as self-actualization.
 The nurse enters into and remains within the frame of reference of another person and
connects herself to inner world of meaning and spirit.
 The person is viewed as a whole and complete regardless of illness and disease.
 Major Conceptual Elements

 Carative Factors / Caritas Processes

 Transpersonal Caring Relationship
 Caring Moment / Caring Occasion
 Caring-Healing MODALITIES

Carative Factors / Caritas Processes

1. Formation of a humanistic-altruistic system of values.

2. The installation of faith-hope.
3. The cultivation of sensitivity to oneself and 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,sociocultural, and spiritual environment.
9. Assistance with the gratification of human needs.
10. The allowance for existential-phenomenological forces.

1. 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 nurses own maturation which then promotes
altruistic behavior towards others.

2. 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. 3. Cultivation of sensitivity to one’s self and to others

• Development of one’s own feeling is needed to interact genuinely and sensitivity

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.

4. 4. Establishing a helping- trust relationship

• Strongest tool is the mode of communication, which establishes rapport and caring.
• She has defined the characteristics needed to develop the helping- trust relationship.
They are congruence, empathy and warmth.
• Communication includes verbal, nonverbal and listening in a manner which express
empathy, understanding.

5. 5. The expression of feelings, both positive and negative

• According to Watson, “feelings alter thoughts and behavior, and they need to be
considered and allowed for in a caring relationship.”
• According to her such expression improves one’s level of awareness.
• Awareness of the feelings helps to understand the behavior its engenders.

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

• According to Watson, the scientific problem solving method is the only method that
allows for control and prediction, and that permits self correction.
• She also values the relative nature of nursing and supports the need to examine and
develop the other methods of knowing to provide a holistic perspective.

7. 7. Promoting 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. 8. Provision for a supportive, protective and/or corrective mental, physical, socio-
cultural and spiritual environment

• Watson divides these into external and internal variables, which the nurse
manipulates in order to provide support and protection for the persons mental and
physical well being.
• The external and internal environments are interdependent.
• Watson suggests that the nurse also must provide comfort, privacy and safety as a
part of this carative factors.

9. 9. Assistance with the gratification of human needs

• It is grounded in a hierarchy of need similar to that of the Maslow’s.

• She has created a hierarchy which she believes is relevant to the science of caring in
nursing.
Watson’s ordering of needs-

Lower order needs (biophysical needs, psychological need)-

• The need for food and fluid.
• The need for elimination.
• The need for ventilation.
• The need for sexuality.

Watson’s ordering of needs- Higher order needs (psychosocial needs).

• The need for achievement.
• The need for affiliation.
• The need for self- actualization.

10. 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 of courage to confront life or
death.
• According to her, each need is equally important for optimal health. All the needs
deserve to be attended to and valued.

TRANSPERSONAL CARING RELATIONSHIP

 • Transpersonal describes an intersubjective, human to human relationship that
encompasses two individuals, both the nurse and the patient in a given moment.
• Describes how the nurse goes beyond the objective assessment to show concern
toward the person’s subjective/deeper meaning of their healthcare situation.
• Involves mutuality between the two individuals involved

Goal of transpersonal caring relationship

 Is protects, enhances and preserve human dignity, humanity, wholeness and inner
harmony

CARING OCCASION / MOMENT

A caring occasion is the moment when the nurse and another person come together in
such a way that an occasion for human caring is created.
• Both persons come together in a human-human transaction.
• The one caring for and the one being cared for are influenced by the choices and
actions decided within the relationship
.

Caring-healing Modalities

 It includes the caring modalities:

 It is considered as a philosophical and moral/ethical foundation for professional
nursing.
 It offers a framework that embraces and intersects with art, science, humanity,
spirituality, and new dimensions of mind, body, spirit, medicine and nursing.
 It is an initiative and opportunity to interact with ideas, experiment with and grow
with philosophy, and live it and put it in one's personal/professional life.

Assumptions Related to Science of Caring in Nursing

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

2) Caring consists of caring factors that result in satisfaction of certain human

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

4) Caring response accepts person not only as he/she is now but what a person
can become. A development of potential while allowing the person to choose
the best action for himself/herself at a given time. Caring environment offers
the

5) Caring is more than curing

.
6) The practice of caring is central to nursing.

WATSON’S THEORY AND NURSING PROCESS

Watson’s points out that 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.

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.

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.
• Intervention-

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

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 ever lead to the generation of a
nursing theory.
 APPLICATIONS OF WATSON’S THEORY

Nursing Education

 A two-year curriculum of serial seminars designed to support new heirs in their

clinical, educational, and professional growth now includes a unit on self-care to
promote healing and self-growth.
 Caring modalities are used in pain management units.
 Watson’s theory is being taught in numerous baccalaureate nursing curricula,
including Bellarmine College in Worcester, Massachusetts; Indiana State University
in Terre Haute, Indiana; and Florida Atlantic University in Boca Raton, Florida.
 Watson emphasizes that both the core and trim of nursing are necessary in curricula of
nursing. The core of nursing includes those aspects of nurse-patient relationships
resulting in a therapeutic outcome. The trim of nursing includes the procedures, tasks,
and techniques used by various practice settings.
 Clock hours are designed to respond to immediate needs and to encompass a diverse
range of topics from conflict resolution, professional development, health treatment
plans, physiology of medical diagnosis, and in-service on new technologies and
pharmacological interventions.

Nursing Practice

 A holistic approach is being instituted in various institutions.

 Watson’s theory is clinically validated in various populations and settings.
 Clinical settings include critical care units, neonatal intensive care units, pediatric and
gerontological care units.
 The population includes women who have had newborns in intensive care units and
women identified as socially at risk, post-myocardial patients, oncology patients,
persons with AIDS, and the elderly.
 Nursing Research

 Watson’s caring is used in conceptual and theoretical development.

 Jean Watson hopes that nursing research will incorporate and explore esthetic,
metaphysical, empirical, and contextual methodologies.
 Abstractness of the concept of caring and the clinical reality (e.g., brief interactions
with patients afforded by outpatient or office visits) has limited the development of
the knowledge base in Watson’s caring theory.
 Research and practice must focus on both the subjective and objective patient
outcomes in determining whether caring is the essence of nursing.

STRENGTHS

• Besides assisting in providing the quality of care that client ought to receive, it also
provides the soul satisfying care for which many nurses enter the profession.
• As the science of caring ranges from the biophysical through the intrapersonal, each
nurse becomes an active co-participant in the clients struggle towards self-
actualization.
• The client is placed 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

• Given the acuity of illness that leads to hospitalization, the short length stay, such
quality of care may be deemed impossible to give in the hospital.
• While Watson acknowledge the need for biophysical basis to nursing, the area
receives little attention in her writings.
• The ten carative factors primarily delineate the psychosocial needs of the person.
• While the carative factors have a sound foundation based on other disciplines, they
need further research in nursing to demonstrate their application to practice.
Reference

1. Parker, M. E., & Smith, M. C. (2015). Nursing Theories and Nursing Practice
(4th ed.). F.A. Davis.

2. Watson, J. (2008). Nursing: The Philosophy and Science of Caring (Revised

Edition). University Press of Colorado.

3. Alligood, M. R. (2018). Nursing Theorists and Their Work (9th ed.). Elsevier.
4.
5. Tappen, R. M. (2022). Advanced Nursing Research: From Theory to Practice
(3rd ed.). Jones & Bartlett Learning.