Five Nursing Theories

Environmental theory
Self-care deficit theory
Theory of human caring
Cultural Care Theory
Transcultural Theory

Environmental theory:
Florence Nightingale, the creator of contemporary nursing, developed the environmental
theory. The theory emphasizes the significance of encouraging patient surroundings for
getting healed, eradicating illnesses and achieving health objectives. It lists five
environmental variables that are key to an individual's well-being. The five variables include
clean air, sunlight, bedside customs, food safety and pure water. This theory’s key concept
describe how nurses can change patients' environments to aid their recovery progress.

Self-care deficit theory:

Dorothea Orem developed the Self-Care Deficit Nursing Theory over the course of her
career from the early 1950s to 2001. Under this understanding of nursing, patients want to
care for themselves but need assistance sometimes.

In the Theory of Self-Care Deficit, nurses can help patients by empowering them to do as
much as they can independently. According to Orem’s self-care model, as the patient
improves, the nurse encourages the transition for the patient to do even more by
themselves.

Theory of human caring:

Jean Watson is a nursing professor who contributed to developing nursing theories. Her
theory focuses on how nurses can promote health and ward off illnesses by implementing
treatment strategies. Additionally, it stresses how different each patient is, allowing nurses to
customize treatment for a particular patient's improvement. The theory's main concept is that
inclusive environments and individualized care can contribute to a patient's development.

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 Theory of interpersonal relations:
Hildegard E. Palau’s Theory of Interpersonal relations suggests that good nursing is built
upon an interactive connection to the patient, and that nurses must be specially educated to
recognize and respond to individual needs in order to administer more therapeutic care.

Transcultural Theory:
Madeleine Lininger was a known educator, author, theorist and researcher. She introduced
the transcultural theory, focusing on the significance of nurses appreciating the many cultural
backgrounds of their patients. This ensures that the care patients receive is consistent with
their personal and cultural values. The transcultural nursing philosophy helps nurses give
their patients individualized care by learning about their beliefs.

1. Select one of nursing Theories Out of Five Theories Found in The Field of
nursing……

Theory of human caring:

Jean Watson is a nursing professor who contributed to developing nursing theories. Her
theory focuses on how nurses can promote health and ward off illnesses by implementing
treatment strategies. Additionally, it stresses how different each patient is, allowing nurses to
customize treatment for a particular patient's improvement. The theory's main concept is that
inclusive environments and individualized care can contribute to a patient's development.

Watson’s Theory of Human Caring:

Nursing theory provides a systematic way of looking at professional practice, describes what
nursing is, guides what nurses do, and helps generate knowledge to direct the future of
nursing. In 2007 the registered nurses at Kaweah Health selected Dr. Jean Watson’s Theory
of Human Caring as the foundation for our professional nursing practice environment.

“Caring begins with being present, open to compassion, mercy, gentleness, loving kindness,
and equanimity toward and with self before one can offer compassionate care to others”
(Watson, 2008, p. xviii).

The following Caritas Processes are the guiding framework of this theory:

 Practicing loving-kindness toward self and others

 Being authentically present
 Cultivating one’s own spiritual practices; deepening self-awareness
 Developing and sustaining a helping-trusting, authentic caring relationship
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 Being supportive of the expression of positive and negative feelings
 Creative use of self and all ways of knowing as part of the caring process
 Engaging in genuine teaching-learning experiences within context of caring relationship –
attend to whole person
 Creating healing environment at all levels
 Reverentially and respectfully assisting with basic needs
 Attending to spiritual, mysterious, unknown dimensions of life-death-suffering;“allowing for
a miracle”

*Caritas comes from the Greek word meaning “to cherish, to appreciate, to give special
attention, if not loving, attention to.” (Watson as cited in Parker, 2001, p. 345).

Watson, J. (2008). Nursing: The philosophy and science of caring (Rev. ed.). Boulder, CO:
University Press of Colorado.

2. Directly Observe a case on the field or collect data through literature review……

Abstract:
Caring for people with schizophrenia is accompanied by challenges that impact caregiver
health. We conducted this study to explore the effect of a Caring Science-Based health
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promotion program on the sense of coherence and well-being among caregivers of persons
with schizophrenia.

Methods:

This randomized clinical trial with the Solomon four-group design was conducted on 72
caregivers randomly allocated into two intervention and two control groups. A health
promotion program based on Watson’s theory was performed individually through five face-
to-face sessions and a four-week follow-up. Settings were the psychiatric centers of the three
educational, specialty, and subspecialty Ibn-e-Sina, Moharary, and Hafez hospitals affiliated
with Shiraz University of Medical Sciences (SUMS), south of Iran. The data were collected
using a demographic information form, the Sense of Coherence Scale, and the Caregiver
Well-Being Scale. One-way ANOVA, chi-square, Kruskal–Wallis, and independent t-test
were used to determine the homogeneity at baseline. In the post-test, multiple between-
groups and pairwise comparisons were assessed by One-way ANOVA and Tukey’s post-
hoc. Within-group comparisons were evaluated using paired t-tests. All tests were two-tailed,
and the statistical level was considered 0.05.

Jean Watson, a distinguished nursing theorist, introduced the Theory of Human Caring,
emphasizing the significance of interpersonal relationships, empathy, and compassion in
nursing practice. This theory, developed in the 1970s and revised over the years, has become
a cornerstone in nursing education and practice. Let's delve into the core principles and
concepts of Watson's theory.

Understanding Human Caring:

At the heart of Watson's theory is the notion that caring is central to nursing and
encompasses a deep respect for human dignity, integrity, and wholeness. Unlike the
traditional medical model that often focuses solely on curing illness, Watson emphasizes the
importance of caring-healing processes that nurture the mind, body, and spirit.

The Ten Caritas Processes:

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Central to Watson's theory are the Ten Caritas Processes, which serve as guiding principles
for fostering authentic caring relationships between nurses and patients. These processes
include practices such as cultivating a loving presence, being authentically present, and
honoring the patient's feelings and experiences.

Transpersonal Caring Relationship:

Watson introduces the concept of a transpersonal caring relationship, which transcends the
conventional nurse-patient dynamic. In this relationship, both the nurse and the patient are
deeply interconnected, fostering mutual growth, healing, and transcendence.

Application in Nursing Practice:

The Theory of Human Caring provides a framework for nurses to deliver holistic, patient-
centered care. By integrating principles of compassion, empathy, and mindfulness into their
practice, nurses can enhance the overall well-being of their patients and promote healing on
multiple levels.

Criticisms and Future Directions:

While Watson's theory has gained widespread recognition and application, it has also faced
criticism. Some scholars argue that the abstract nature of the theory makes it challenging to
operationalize in clinical practice. Additionally, there is ongoing debate about the
universality of caring and its applicability across diverse cultural contexts.

Looking ahead, future research may focus on refining and adapting Watson's theory to better
address the evolving needs of healthcare delivery. By incorporating insights from
interdisciplinary fields such as psychology, sociology, and anthropology, nurses can continue
to advance the practice of human caring in the 21st century.

In conclusion, Jean Watson's Theory of Human Caring provides a profound framework for
understanding the essence of nursing and the importance of cultivating authentic caring
relationships. By embracing the principles of compassion, empathy, and mindfulness, nurses
can truly make a difference in the lives of their patients, fostering healing and promoting
holistic well-being.

Results:

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Data analysis showed that the mean scores of caregiver sense of coherence and well-being
from pre-intervention to post-intervention were significantly increased in the intervention
groups (p < 0.001). At the same time, there were no significant differences in the control
groups.

Conclusion:

The health promotion program based on Watson’s human caring theory facilitated ongoing
intrapersonal, and holistic caring and improved the sense of coherence and well-being in
caregivers of persons with schizophrenia. Hence, this intervention is recommended for
developing healing care programs.
Caregivers of persons with schizophrenia, who are often their family members, face many
difficult situations during their caretaking [1]. Results of studies in Iran indicated that
caregivers of persons with schizophrenia experience a broad spectrum of care pressure that
can cause the caregiver’s health problems [2–8]. Caregivers’ physical and mental health is
influences in the quality of home-based care. Thus, paying attention to caregivers’ health is
vital in treating individuals with schizophrenia [9]. Despite suffering from various physical
and mental problems related to the caregiving role, caregivers of individuals with
schizophrenia often do not receive supportive healthcare services to assist them in their well-
being [10]. Family caregivers of individuals with schizophrenia must be empowered to
improve resilience and acceptance in caring for these individuals [11]. The findings suggest
that interventions to strengthen the Sense of coherence (SOC) are necessary to support and
promote the well-being of family caregivers who care for persons with schizophrenia
[12, 13]. The SOC concept has been widely adopted within healthcare research. It is
described as an internal resource that helps a person deal with stressful situations and feel
that life is comprehensible, manageable, and meaningful [14]. There is ample evidence
demonstrating relationships between the sense of coherence and well-being [12, 15, 16].
Individuals with a greater sense of coherence are more likely to respond to a stressor with
adaptive strategies, thus enhancing the likelihood of a positive outcome to the situation and
reducing the chance of detrimental effects on health and well-being [16]. It has been clarified
that a relationship exists between SOC and caregivers' burden, health, and coping behavior.
Thus, using SOC is effective for grasping the ability to care, ascertaining the support of the
needs, and improving the well-being of caregivers of persons with schizophrenia [13].
Caregivers' well-being can be improved by identifying the causes of stress in family
caregivers' daily lives and advocate them to cope with stress by emphasizing empowerment,
capacity building, resilience, stress-reducing, and strength-based interventions [17]. A recent
systematic literature review has investigated the effectiveness of psycho-educational
interventions for mitigating burden and improving health outcomes of caregivers of people
with schizophrenia. The findings revealed the interventions in some of those studies were
helpful, and some were not. The interventions in most of these studies were performed in
group training without considering the individuals’ needs and conditions and were not
theory-based [18]. Many researchers point towards the possible need for a holistic approach
that includes ongoing measures to support overall well-being and a healthy sense of
coherence [10, 19–21]. In the present study, an intervention program based on a well-known

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nursing theory was utilized, which facilitated ongoing individualized, holistic, and
intrapersonal caring between the participants and the researchers who worked with them.

Theoretical nursing frameworks and nursing theories can be helpful as guides for facilitating
excellence in relation to nursing practice and therapeutic interventions [22]. During the past
three decades, special attention has been paid to humanistic theories in nursing. One of these
theories is the human caring theory, which Jean Watson introduced in 1975. Watson (1979)
used the definition of health provided by the World Health Organization (WHO) and defined
health as physical, mental, and social well-being and compatibility for having the highest
daily living activity. Watson (1988) also described health as the harmony among mind, body,
and soul. Accordingly, health refers to homogeneity between the self as perceived and the
self as experienced. In other words, a lack of harmony among mind, body, and soul results in
a lack of sense of coherence, eventually leading to anxiety and internal turmoil. This can be
followed by disappointment, fear, and discomfort, resulting in disease if continued.
According to Watson, the most effective care is performed interpersonally [23].
Philosophically, Watson’s theory aligns with the contemporary approach toward promoting
individuals’ and families’ health in the community [24]. Therefore, it can be employed for
taking care of patients’ caregivers [25].

Moreover, this theory is culturally compatible with nursing in different cultures, nations, and
countries. In other words, it has been effectively applied in varied settings and populations
[26]. Using Watson’s Human Caring Theory as a framework for professional practice
supports productive, meaningful, and compassionate care in multiple dimensions of human
health [27]. According to Watson, care is the core of nursing and includes interpersonal
attempts to enhance and maintain health, humanity, and well-being. In this theory, health can
be achieved through care based on Carative factors and Caritas processes (compassion,
dignity, love, attention, and authentic presence) [26]. The Carative factors in Watson’s
Human Caring Theory are as follows: 1) a humanistic-altruistic system of values, 2)
installation of faith-hope, 3) cultivation of sensitivity to one’s self and to others, 4)
developing a helping-trusting, human caring relationship, 5) promotion and acceptance of the
expression of positive and negative feelings, 6) use of a creative problem-solving, caring
process, 7) promotion of transpersonal teaching–learning, 8) provision of a supportive,
protective, and/or corrective mental, physical, societal, and spiritual environment, 9)
assistance with the gratification of human needs, and 10) allowance for existential-
phenomenological-spiritual forces [26].

The primary aim of this study was to investigate the impact of a health promotion program
based on Watson’s human caring theory on the sense of coherence among caregivers of
individuals with schizophrenia. The secondary aim was to investigate its impact on
caregivers’ well-being.

References:
1. von Kardorff E, Soltaninejad A, Kamali M, Eslami SM. Family caregiver burden in mental
illnesses: the case of affective disorders and schizophrenia - a qualitative exploratory study. Nord J

7|Page
Psychiatry. 2016;70(4):248–254. doi: 10.3109/08039488.2015.1084372. [PubMed]
[CrossRef] [Google Scholar]
2. Haghgoo A, Zoladl M, Afroughi S, Rahimian H, Mirzaee MS. Assessment of the Burden on
Family Caregivers of Patients with Mental Disorders Hospitalized in Shahid Rajai Hospital in
Yasuj, 2016. Assessment. 2017;5(2). 10.21859/ijpn-05026.
3. Koolaee AK. Models and methods of clinical research: mental health of older caregivers of
schizophrenia patients in Iran. Middle East J Age Ageing. 2010;83(2252):1–8. [Google Scholar]
4. Malakouti SK, Nouri ghasemabadi R, Naghaviravandi M, Ahmadi abhari S, Nasr esfahani M,
Afgheh S, et al. The burden of caregivers of chronic mental patients and their needs to care and
therapeutic services. Hakim Res J. 2003;6(2):1–10. [Google Scholar]
5. Navidian A, Kermansaravi F, Rigi SN. The effectiveness of a group psycho-educational program
on family caregiver burden of patients with mental disorders. BMC Res Notes. 2012;5(1):399.
doi: 10.1186/1756-0500-5-399. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
6. Sharif F, Shaygan M, Mani A. Effect of a psycho-educational intervention for family members on
caregiver burdens and psychiatric symptoms in patients with schizophrenia in Shiraz. Iran BMC
psychiatry. 2012;12(1):48. doi: 10.1186/1471-244X-12-48. [PMC free article] [PubMed]
[CrossRef] [Google Scholar]
7. Soltaninejad A. Family caregivers’ quality of life: the case of schizophrenia and affective
disorders (A mixed method study).PhD Thesis. 2017. [Google Scholar]
8. Soltaninejad A, von Kardorff E, Kamali M, Eslami shahrbabaki M. Development and Validation
of a Questionnaire to Measure Quality of Life in Caregivers of Patients with Schizophrenia and
Affective Disorders (SAC-QoL). Iranian Journal of Psychiatry. 2017;11(2). 10.5812/ijpbs.9195.
9. Chan SW. Global perspective of burden of family caregivers for persons with
schizophrenia. Arch Psychiatr Nurs. 2011;25(5):339–349.
doi: 10.1016/j.apnu.2011.03.008. [PubMed] [CrossRef] [Google Scholar]
10. Stanley S, Balakrishnan S, Ilangovan S. Psychological distress, perceived burden and quality of
life in caregivers of persons with schizophrenia. J Ment Health. 2017;26(2):134–141.
doi: 10.1080/09638237.2016.1276537. [PubMed] [CrossRef] [Google Scholar]
11. Sustrami D, Yusuf A, Fitryasari R, Suhardiningsih AS, Arifin H. Determinants of burden in
family caregivers of individuals with schizophrenia: a systematic review. J Psychosoc Nurs Ment
Health Serv. 2023;61(2):38–43. doi: 10.3928/02793695-20220804-02. [PubMed]
[CrossRef] [Google Scholar]
12. López-Martínez C, Orgeta V, Frías-Osuna A, del-Pino-Casado R. The mediating role of sense of
coherence on mental health outcomes in carers of older dependent relatives: A longitudinal
study. Int J Geriatric Psychiatry. 2021;36(5):722–30. doi: 10.1002/gps.5472. [PubMed]
[CrossRef] [Google Scholar]
13. Mizuno E, Iwasaki M, Sakai I, Kamizawa N. Sense of coherence and quality of life in family
caregivers of persons with schizophrenia living in the community. Arch Psychiatr
Nurs. 2012;26(4):295–306. doi: 10.1016/j.apnu.2012.01.003. [PubMed] [CrossRef] [Google
Scholar]
14. Antonovsky A. Unraveling the mystery of health: new perspectives on mental and physical well
being. San Francisco, CA: Jossey-Bass; 1987. [Google Scholar]
8|Page
15. Kristofferzon M-L, Engström M, Nilsson A. Coping mediates the relationship between sense of
coherence and mental quality of life in patients with chronic illness: a cross-sectional study. Qual
Life Res. 2018;27:1855–1863. doi: 10.1007/s11136-018-1845-0. [PMC free article] [PubMed]
[CrossRef] [Google Scholar]
16. Pallant JF, Lae L. Sense of coherence, well-being, coping and personality factors: further
evaluation of the sense of coherence scale. Personality Individ Differ. 2002;33(1):39–48.
doi: 10.1016/S0191-8869(01)00134-9. [CrossRef] [Google Scholar]
17. Tebb SS, Berg-Weger M, Rubio DM. The Caregiver Well-Being Scale: developing a short-form
rapid assessment instrument. Health social work. 2013;38(4):222–230.
doi: 10.1093/hsw/hlt019. [PubMed] [CrossRef] [Google Scholar]
18. Silaen EA, Dewi FIR, Satyadi H, editors. How Psychoeducational Intervention Effects on
Burden in Caregivers of Schizophrenia: A Systematic Literature Review. 1st Tarumanagara
International Conference on Medicine and Health (TICMIH 2021). Jakarta: Atlantis Press; 2021.
3.Analyze How the nursing theories Human Caring are being applied on The field.
Discuss the positive & negative effects of the theory application and identity areas of
problem and suggestions for improvement….

Nursing theories of human caring, such as Jean Watson's Theory of Human Caring, are
applied in various ways in the field:

Establishing Therapeutic Relationships: Nurses use caring behaviors to establish trust and
rapport with patients, fostering a therapeutic relationship that supports healing and well-
being.

Holistic Care: Nurses assess and address patients' physical, emotional, social, and spiritual
needs, recognizing the interconnectedness of these dimensions in promoting health.

Promoting Patient Dignity and Respect: Nurses honor the inherent worth and dignity of
each patient, treating them with respect and compassion regardless of their condition or
background.

Facilitating Healing Environments: Nurses create healing environments that are conducive
to patients' well-being, promoting comfort, safety, and tranquility.

Enhancing Communication: Nurses use therapeutic communication techniques to convey

empathy, active listening, and understanding, which helps patients feel valued and supported.

Advocacy and Empowerment: Nurses advocate for patients' rights and preferences,
empowering them to participate in decision-making about their care and promoting
autonomy and self-determination.

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Caring for the Caregiver: Nurses recognize the importance of self-care and compassion for
themselves and their colleagues, understanding that caring for others requires maintaining
personal well-being.

Positive Effects:
1. Patient-Centered Care: Human caring theory encourages healthcare providers to prioritize
the holistic needs of patients, leading to more personalized and comprehensive care.
2. Improved Patient Outcomes: When patients feel cared for on a deeper level, it can
positively impact their emotional well-being, leading to better recovery and health outcomes.
3. Enhanced Nurse Satisfaction: Practicing human caring theory can increase job satisfaction
among nurses by allowing them to connect more deeply with patients, fostering a sense of
purpose and fulfillment.
4. Increased Trust and Communication: Building strong nurse-patient relationships based on
care and empathy can enhance trust and communication, leading to better collaboration in
treatment plans.

Negative Effects:
1. Time Constraints: The application of human caring theory may be limited by time
constraints in busy healthcare settings, leading to challenges in providing the level of
personalized care advocated by the theory.
2. Subjectivity: Caring is a subjective concept, and different healthcare providers may
interpret and implement it differently, potentially leading to inconsistencies in care delivery.
3. Emotional Toll: Investing emotionally in patient care can take a toll on healthcare
providers, leading to burnout and compassion fatigue, particularly if adequate support
systems are not in place.
4. Lack of Evidence-Based Practice: Some critics argue that human caring theory lacks
empirical evidence compared to more traditional medical models, which may hinder its
widespread adoption and acceptance.

Areas of Problem and Suggestions for Improvement:

1. Education and Training: Healthcare professionals need comprehensive education and
training in human caring theory to effectively apply it in practice. Continuous training
programs can help reinforce its principles and address any misconceptions.
2. Resource Allocation: Healthcare organizations should allocate sufficient resources,
including time and staffing, to support the implementation of human caring theory in clinical
settings.
3. Integration with Technology: Leveraging technology can help streamline administrative
tasks and free up more time for healthcare providers to focus on building meaningful
relationships with patients.
4. Research and Evaluation: Further research is needed to assess the impact of human caring
theory on patient outcomes and healthcare provider well-being. Evaluation metrics should be

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developed to measure the effectiveness of its implementation and identify areas for
improvement.

By addressing these challenges and implementing these suggestions, healthcare

organizations can better integrate human caring theory into practice, ultimately enhancing
the quality of care provided to patients.

Overall, nursing theories of human caring guide nurses in providing compassionate, patient-
centered care that addresses the holistic needs of individuals and promotes healing and well-
being.

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