Nursing profession used to be considered following a physicians order but after arrival of nursing theories that are based on model of patient care were essentially biomedical and focus on treating diseases than the patient. The move towards theory based practice has made nursing career more valuable. A nursing theory is a collection of assumptions, concepts, definitions that derives from nursing model and plan useful phenomena by planning relationships between concepts. Jean Watson’s theory is know as human caring that is element of the developmental model, branch of the living tree of nursing theories by Charlotte Tourville and hypothesises that there is maturation towards orderly purpose. The theory of transpersonal caring is a middle range level of theory. According to Watson (1999), nursing theory is defined as an imaginative grouping of knowledge, ideas and experience that are represented symbolically and seek to illuminate a given phenomenon (p.1). Nursing theories refer to knowledge and experience that forms the theoretical part of nursing practice and it consist a number of related subjects that form the grounded base of practice which are applied by nurses in a practical setting. The knowledge that forms a part of nursing theory is derived from experimental learning, research. Jean Watson’s theory is also described as a theory within a model of transpersonal caring. As mentioned in Watson caring science institute (WCSI), Jean Watson stated that, “a model of caring includes a call for both art and science which offers a framework that embraces and intersects with art, science, humanities, spirituality, and new dimensions of mind body spirit medicine and nursing evolving openly as central to human phenomena of nursing practice” (WCSI, 2009, Paras.12). The caring theory has to be read, study and research but the person has to experience it to understand what it is as a result the caring model is “both an invitation and an opportunity to interact with the ideas, experiment with and grow within the philosophy, and living it in personal and professional life” (WCSI, 2009, Paras.12). Human caring theory focuses on caring for purpose of wholeness of humanity, environment, and preserving human dignity. The caring model overall explains that nurses have a critical role in nourishing and sustaining human caring.
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Jean Watson was born in West Virginia and moved to Boulder in 1962 to attend university of Colorado. She earned her bachelor of science in nursing and psychology and continued to her master’s degree in psychiatric mental health nursing. She also did Ph.D. in education psychology and counselling (Nursing theories, 2010). According to Nursing Theories (2010), the Human Caring theory developed in 1979 after war in Vietnam and there was a debate on equal right for women because at the time majority of women were in nursing and society considered it was an obligation of women to take care of the sick and nurture. Women were fighting for their rights to be paid equally and for nursing profession to advance in the medical field. Jean Watson developed her theory to promote nursing as a profession that brings meaning and different health profession. The main element of Watson’s theory contains ten carative factors, transpersonal caring relationship, and caring occasion/caring moment.
Carative factor is one of the elements of Jean Watson’s theory of human caring that contains ten carative factors (see Appendix A). Watson’s ten carative factors evolved and replaced by Caritas process (see appendix B) with a few editing from the carative factors that provides a “framework to hold the discipline and profession of nursing; they were informed by a deeper vision and ethical commitment to the human dimensions of caring in nursing- the art and human science context” (Watson, 2008, p.30). The word Caritas originated from Greek which means to cherish and to give special loving attention. The carative factor or Caritas process are a guide to nursing and “the core to therapeutic healing process and relationships in nursing” (Tourville, 2003, p.28). Watson points out the main principles of transition from carative to caritas as “The core principles form carative to caritas are practice of loving-kindness and equanimity, authentic presence: enabling deep belief of other, cultivation of one’s own spiritual practice- beyond ego, “Being” the caring-healing environment, and allowing for miracles.” (Watson, 2008, p.34), she stresses that those carative to be incorporated for future use for purpose of reconnecting with nightingale theory that is main trunk of the Nursing theory. In International Association for Human caring (IAHC), some of the mentioned elements of Caritas process are respecting patient that allows to open connectedness with environment, self, others, listening to patient creates opportunity for human connection, and being responsive to patients needs and feelings create trusting caring relationship (IAHC,2003).
According to Watson edited by George, the caring occasion/caring moment is when a nurse and patient come together and human caring occurs. When a nurse and other(s) come together with their unique life histories and phenomenal field in human-to-human transaction and is “a focal point in space and time…has a greater field of its own that is greater than the occasion itself…” (George & Julia, 2002, p.410). A caring occasion occurs when a client and nurse share personal experience and open communication, client and nurse create a caring moment.
The third element of the theory is transpersonal caring relationship. Watson described nursing as a profession with caring and love towards a patient on a spiritual level meaning the nurse knowing self and knowing own spirituality will result a better care. When you know your self it is easier to accept others and form a relationship. She believes if a nurse share something of them self with patient and it helps to develop a connection that helps the patient to relate to the nurse. Watson states that the theory is both science and art based that searches through the concepts inter relation for a human science which belongs to nursing that evolves through nurse and patient/client interaction to reach a therapeutic caring. The transpersonal human caring happens between 2 people for instance nurse and a client relationship therapeutic communication which is beyond physical aspect of nursing care as a result it increases healing.
A metaparadigm is a concept in nursing that is used to define nursing by using theoretical definition for the substance and structure of the key bodies of knowledge needed to understand clinical situations (Potter & Perry, 2003, p.70). In nursing, metaparadigm is used to describe concepts of that identify nursing (see fig 1). The four main metaparadigm concepts are nursing and they are Environment, nursing, person and health.
The concept of “person” refers to the individual who is sick as a client rather than a patient. Watson defines a person as a spiritual being and a physical being that is subjective. “A person is experiencing and perceiving physiological individual that is able to find meaning and harmony in existence”(Watson, 1979, p.55). According to the caring theory, a person is to be cared, assisted, listened and valued by a nurse. Watson edited by George mentions that human is a functioning as a whole; there is no division among the mind, body, and spirit (George, 2002).
Jean Watson views health holistically which includes the person’s physical, mental and spiritual self all working together to their fullest ability. Health perception differs from person to person therefore identifying what is healthy and not healthy from patients point of view is important for nurses to properly care to an individual.
Nursing is caring of a patient with medical treatment and harmonic connective bond that is shared between the nurse and patient to regain their health in all aspects. Nurses provide care professionally by interacting with the patient and develop transpersonal relationship. Nursing is not only focused on medical aspect of a patient but also in a holistic way to promote the client’s quality of life. The main focus of nursing profession is promoting health and treating disease and Jean Watson emphasizes holistic caring is central to the practice of caring in nursing (Nursing Theories, 2010).
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Environment is also part of the caritas process that includes a nurse as part of an environment. Environment is anything that surrounds the patient consistent with nightingale’s theory which includes both internal and external environment. The surrounding of a patient is critical in promoting holistic healing in mental, physical, emotional and spiritual aspects of health. According to Watson environment contains “noise, privacy, color, space, smells, and light access to nature that can have an impact on the caring-healing process” (Watson, 1999).
Caring is significant part of nursing, according to Watson, caring is when “the nurse enters into the experience of another person, and another can enter in the nurse’s experience” (Watson, 1989, p.234). Metaparadigm concepts (see Appendix C) provide nursing process which includes a Person, Health, Environment, and Nursing. Watson (1985), describes a person as a “spiritual being” with high degree of consciousness that has autonomy over self. Person can be someone who require nursing assistance in a hospital setting or groups who need health promotion education nursing takes place in this environment that being the hospital or institution, or home. It is the nurse’s responsibility to assess the environment for the purpose of the patient that needs care at the setting. As mentioned above, nursing role is to help person achieve health holistically which includes physical, social, mental, and spiritual aspects. Nurses as care givers their goal is to help the person reach their best state of health. All the four metaparadigm concepts interrelate to form a nursing care by following transpersonal caring theory.
Watson’s caring theory can be applied to any aspects of nursing in different fields. When a nurse is assigned to a patient for certain amount of time to provide care based on the persons need, the nurse will start to build a therapeutic relationship that allows both to share their concerns as a result transpersonal caring occurs. The caring theory can be widely used in mental health setting and it is beneficial for people who are mentally sick that need support like a nurse who cares listens and value their feelings. A psychiatric nurse main task is assessing the patient by interviews, observation, active listening and planning to improve the person’s health to the fullest. Modern nursing is very technical and is task oriented that doesn’t give the nurse enough time to get to know the patient because of economical reason, nurse shortage and negligence. Watson’s theory emphasizes the nurse to take a moment and observe the environment, patient’s state meaning their spiritual, physical, mind. Since Watson’s theory focuses both in the person and family, Nurses have the responsibility to provide care the patients family by considering their needs, expectations, values and beliefs that may affect the care process and this helps the family to deal with the patient and also helps to attain caregiver role. Using the caritas process, provide genuine caring relationship, the nurse engaging in teaching learning by being open with others and supporting patient while experiencing a positive or negative feelings. Practicing the caring theory with all different concepts in every day of nursing career can influence the patients healing process.
In my opinion nursing is promotion of health, prevention of disease, and advocating for patients. When I think of nursing what usually to mind is caring, I believe that caring is a main concept of nursing profession that has been described by Jean Watson as well. Watson describes caring as “Caring can be effectively demonstrated and practiced only interpersonally” (Nursing theories, 2010). As a nursing student, my beliefs regarding nursing care is some what similar to Watson’s theory. One of the similarities is with her transpersonal caring theory which is when a nurse knows her/his self will result to give a better care. I have used this particular element of caring in the past few years of nursing practice when I was not even aware of the caring theory. During clinical time I usually go to patient’s room first thing in the morning and introduce my self to the patient and have a conversation to find out more information about the person as an individual rather than their disease that is available in their files. Watson mentioned in her theory when a nurse and patient share something of them self that helps to develop a good relationship, the patient will establish trust in the nurse as a result the patient is more likely to feel free and ask questions with out any hesitant. Elements of the caring theory are all useful to provide care but what Watson doesn’t talk about is value of nurse’s skill in promoting health. I believe that the skills I am learning now and how I provide care is what is going to allow me be a nurse. In nursing school there is no evaluating system for caring but that doesn’t mean we don’t have to care. To provide a holistic care, I believe that a combination of caring and technical skills is vital to improve a person’s health.
Overall Watson’s theory has different elements, concepts that describe the person, health; environment and nursing that are all interrelated. The main concept of theory of human caring is transpersonal human caring is to bring meaning and focus on nursing as a separate health profession. Watson describes nurses role is to treat patient holistically, create caring relationship with patient, promotion of health through educating, and spending time with patient to create caring moment. Watson has changed the nursing from biomedical model to transpersonal caring by focusing on the mind, spirit and body. In the caring model, caring is explained in relation to maintaining human dignity and humanity in systems and society. Nurses have a bigger role in nourishing human caring when a person’s health is afflicted.
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