GOD is extremely important to healing !

JEAN WATSON--THEORY OF HUMAN

CARING
 INTRODUCTION
• In the domain of the present times, improvements
in health care system have intensified nurse’s
workload and responsibilities, sad but true, nurses
in the present times often forget their caring
attitudes when they are faced with stressful and
difficult situations.
• Despite of this, we nurses must learn how to deal
with the complexities arising in every patient
situation and must find ways of preserving their
caring practice.
• One nursing theory has seemed very important for
this goal-Jean Watson’s theory of human caring.

• Jean Watson view of caring is the most valuable

attribute nursing has to offer to humanity, yet
caring has received less emphasis than other
aspects of the practice of nursing over time.

• In Watson’s view disease might be cured but

illness would still remain because without caring,
health is not fully attained.
• Jean Watson was born in West Virginia, US
• Educated: BSN 1964, MS1966, PhD 1973,fromUniversity of
Colorado,
• Distinguished Professor of Nursing and Chair in Caring Science
at the University of Colorado Health Sciences Center.
• Fellow of the American Academy of Nursing.
• Dean of Nursing at the University Health Sciences Center and
President of the National League for Nursing
• Undergraduate and graduate degrees in nursing and psychiatric-
mental health nursing and PhD in educational psychology and
counseling.
• Six (6) Honorary Doctoral Degrees.
• Research has been in the area of human caring and loss.
• In 1988, her theory was published in “nursing: human science
and human care”.
Jean Watson is a nursing theorist who formulated
the theory of human caring and the 'caritas' processes in
support of this theory. Watson's background is in
nursing and psychology. Through her practice, she
observed the effect of authentic caring on patients and the
resultant health outcomes.
 OVERVIEW OF THEORY
• Jean Watson contends that caring regenerates life
energies and potentiates our capabilities. The benefits
are immeasurable and promote self-actualization on
both a personal and professional level.
• She believes that as a nurse we should promote and
restore health as well as prevent illnesses.
• Each patient is a unique case and should be treated
and cared for as such, including their body, mind,
soul in a holistic healing place.
• This caring process can be demonstrated though the
ten carative factors.
• The Theory of Human Caring also explains that
we are the environment, we believe in miracles, and
we honor the body, mind and spirit of all of our
patients. We have sacred encounters with our patients
which translate to transpersonal caring moments.

DEVELOPMENT OF THEORY
Watson developed her Theory of Human
Caring between 1975-1979. Watson's influence
to develop her Theory of Human Caring was derived
through her own personal views, studies, experiences,
and involvement in academic nursing curriculum
 MAJOR ASSUMPTIONS
This theory makes the following assumptions:
• Caring can be effectively demonstrated and practice only
interpersonally
• Caring involves carative factors that result in the
satisfaction of human needs
• Effective caring promotes health and individual family
growth
• Caring responses accept the person as they are now and as
what they may become
• A caring environment is one that offers the development of
potential while allowing the person to choose the best
action for his or herself at a given point in time.
• Caring is more “healthogenic” than it is curing.
• The practice of caring is central to nursing.
 CARATIVE FACTORS

The structure for the science of caring is built upon the ten
carative factors. These are the nursing interventions that
helps the patient attain/maintain health or at least die a
peaceful death.
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 humanistic- altruistic system of
values:
• Begins developmentally at an early age with values
shared with the parents.
• Mediated through one’s 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.
• The nurse has to treat a person without judgment.
Example:
Two patients came into the ER; one was a victim and the
other was the guilty party. Both would need to receive the
exact same treatment.
2. Instillation of Faith and 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.

Example:
The nurse has a patient that in undergoing cancer. The
patient is starting to give up, but the nurse reassures the
patient that he/she still has hope in their recovery.
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 nurse has to get involved with the patient in order to form a
person to person relationship so that they can promote health and
function in a higher level.
Example:
The nurse has a patient that is a child and deals directly with the
mother who is the child's support system. While caring for the
child the nurse also tends to the mother to maintain a support
system for the child as well as being sensitive and authentic to
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 (being suitable and appropriate)
– Empathy
– Warmth
• The nurse has to communicate with the patient. This is the
most important tool that can establish a genuine
partnership between the patient and nurse.

Example:
The patient is complaining of their back hurting. The nurse
responds by immediately changing their position or
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 generate.
• The nurse has to support the patient's positive and
negative feelings, emotions, and state of well being.

Example:
The patient is extremely emotional. The nurse
responds by calming the patient down by asking
questions to stabilize their sense of well being.
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, that permits
self-correction.
• Based on the nurses knowledge of past experiences with
similar scenarios and their current patients unique
situation, the nurse can develop a plan carefully by
structuring and tailoring the patients need.

Example:
Upon a patient losing their leg, a prosthetic leg is
administered as well as utilizing therapy to fulfill the
patients needs.
7. Promotion of interpersonal teaching-learning:
• The nurse ensures that the teaching and learning process
are equalized in order for the person's perception of the
situation is taken in consideration to prepare for a
cognitive plan.

Example:
The nurse has a patient that has diabetes and does not
know any information of this disease. The nurse has to
inform the patient about the positive and negative
effects of diabetes in order to ensure that the patient can
care for their disease properly
8. Provision for a supportive, protective and /or
corrective mental, physical, socio-cultural and
spiritual environment:
• The nurse has to protect the patient's external and
internal environment by making the patient feel
relaxed, comfortable and safe. In order for this to
happen, the environment will sometimes be
manipulated.

Example:
A patient likes for her door to be closed when she is
changed. The nurse closes the door every time she is
changed to provide the patient with privacy, safety
and comfort.
9. Assistance with the gratification of human needs:
• It is based on a hierarchy of need similar to that of the
Maslow’s.
The nurse needs to comfort the patient by fulfilling their
wants and needs. Every need is just as important for
promoting quality care and optimal health.

Example:
A patient ask the nurse to braid her hair so that she looks
presentable to every guest she encounters with. The nurse
fulfills her needs by braiding her hair every chance she
has.
 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. 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.

The nurse has to accept a person's beliefs while also caring

for them holistically. Understanding a person's religion can
assist them to find the strength to confront life or death.

Example:
The patient accepts that her life is coming to an end. She wishes
that her body would be cremated and her ashes be given to
certain family members. The nurse respects the patient's wishes,
and follows through with her last words.
• All 10 carative factors performed accurately
will lead to a healthy relationship between the
nurse and client to fulfill the goal of promoting
health, restoring health and preventing illness.
This will help the patient to attain or maintain
health or die a peaceful death.
 TRANSPERSONAL CARING RELATIONSHIP
• Transpersonal describes an inter subjective, 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
• The nurse and patient can develop a deep divine relationship
that blends together and promotes overall health and well-
being.
• This process requires the use of “Actions, words, behaviours,
cognition, body language, feelings, intuition, thought, senses,
and the energy field” (Watson & Woodword, 2010).
 GOAL OF TRANS PERSONAL
CARING RELATIONSHIP
• •The nurse has a professional as well as a personal obligation to
not only see the patient as more than an object but to also
protect and assist with improving the patient’s dignity. (Cara,
2003)

• The nurse and the patient are transformed together in this

relationship. (Black, 2014).

• The nurse should be using her professional experience to

promote healing and bonding with the patient. This may include
the use of various communication techniques, both verbal and
non-verbal to achieve a healing and gentle relationship. (Watson
& Woodward, 2010)
Transpersonal caring relationship is a special
kind of human relationship that depends on:
• Nurse’s commitment on protecting and enhancing
human dignity .

• The nurses caring and association have potential to

heal since experience, intension and perception are
taking place.

• Nursing goals beyond an objective assessment and

shows concern for the patients own health care.
 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.
WATSON’S THEORY AND THE FOUR MAJOR CONCEPTS

1. HUMAN BEING/PERSON:
• Human being refers to “….. a valued person to be cared
for, respected, nurtured, understood and assisted; in general
a philosophical view of a person as a fully functional
integrated self.
2. HEALTH:
– Defined as the unity and harmony within the body, mind
and soul. It associates with the congruence between
how we perceive ourselves and what we experience.
– A high level of overall physical, mental and social
functioning
– A general adaptive-maintenance level of daily
functioning
3. ENVIRONMENT:

• Extremely important in healing a person's mental,

physical, social, emotional, spiritual, developmental, and
protective supporting environment for a patient's health
and well being.
• 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 is a complex concept involving development of a
range of knowledge and expertise encompassing
holism, empathy, communication, clinical
competence, technical proficiency, and interpersonal
skills."
• It focuses on health promotion and treatment of
disease. She believes that holistic health care is
central to the practice of caring in nursing.
 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.
 CHARACTERISTIC OF A THEORY

According to Watson’s “a theory is an imaginative grouping

of knowledge, ideas and experiences that are represented
symbolically and seek to illuminate a given phenomenon.
1. Unique in nature: The basic assumptions for the science
of caring in nursing and the ten carative factors that form
the structure for that concepts in unique in Watson’s
theory.
2. Interrelated concepts: The science of caring suggests
that the nurse recognize and assist with each of the
interrelated needs in order to reach the highest order need
of self- actualization.
4. Relatively simple: The theory is relatively simple as it
does not use theories from other disciplines that are
familiar to nursing. She defines trim (orderly) as the
clinical focus, the procedure and the techniques. The
core of the nursing is that which is intrinsic to the nurse-
client interaction that produces a therapeutic result. Core
mechanism are the carative factors.
5. Theories can be the basis for hypothesis that can be
tested: Watsons theory is based on phenomenological
studies that generally ask questions rather than state
hypothesis. Its purpose is to describe the phenomena to
analyze and to gain an understanding. According to
Watson the best method to test this theory is through
field study.
6. Theories can be utilized by practitioners to guide and
improve their practice: Watson’s work can be used to
guide and improve practice. It can provide the nurse
with the most satisfying aspects of practice and can
provide the client with the holistic care so necessary for
human growth and development.
7. Logical in nature: Watson’s work is logical in that the
factors are based on broad assumptions which provide a
supportive framework. These carative factors are
logically derived from the assumptions and related to
the hierarchy of needs.
7. Theories must be consistent with other validated
theories, laws and principles but will leave upon
unanswered questions that need to be investigated.
8. Generalizable.
 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.
• Biophysical needs of the individual are given less
important.
HOW TO INTEGRATE JEAN WATSON’S
THEORY OF CARING INTO NURSING
PRACTICE:
• Establishing a caring relationship with patients.
• Treat patients as holistic beings.
• Display unconditional acceptance.
• Treat patients with positive regard.
• Promote health through knowledge and intervention.
• Spend uninterrupted time with patient .
 CONCLUSION
• Nurses seem to just have compassion in their blood.
Compassion is not a trait that can be taught.
• Watson’s Ten Caritas Processes relate to nursing in a
way that many other theories may not.
• Watson focused on not only the physical aspect of
nursing but providing spiritual and emotional needs
as well.
• It is our duty as nurses to provide not only physical
care to help heal a patient but also to provide
emotional and spiritual support and to respect a
patient’s religion.
 Think about this…….

• “Every time you smile at someone, it is

an action of love, a gift to that person, a
beautiful thing”