Jean Watson's Theory of Human Caring

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.

Description


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.

Assumptions


Watson’s model makes 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 the patient as he or she is now, as well as what he or she may become. (5) A caring environment is one that offers the development of potential while allowing the patient to choose the best action for him or herself at a given point in time. (6) A science of caring is complementary to the science of curing. (7) The practice of caring is central to nursing.

Major Concepts


The Philosophy and Science of Caring has four major concepts: human being, health, environment or society, and nursing.

Society

Society provides the values that determine how one should behave and what goals one should strive toward. Watson states:

“Caring (and nursing) has existed in every society. Every society has had some people who have cared for others. A caring attitude is not transmitted from generation to generation by genes. It is transmitted by the culture of the profession as a unique way of coping with its environment.”

Human being

Human being is 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. Human is viewed as greater than and different from the sum of his or her parts.

Health

Health is the unity and harmony within the mind, body, and soul; health is associated with the degree of congruence between the self as perceived and the self as experienced. It is defined as a high level of overall physical, mental, and social functioning; a general adaptive-maintenance level of daily functioning; and the absence of illness, or the presence of efforts leading to the absence of illness.

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.

Actual Caring Occasion

Actual caring occasion involves actions and choices by the nurse and the individual. The moment of coming together in a caring occasion presents the two persons with the opportunity to decide how to be in the relationship – what to do with the moment.

Transpersonal

The transpersonal concept is an intersubjective human-to-human relationship in which the nurse affects and is affected by the person of the other. Both are fully present in the moment and feel a union with the other; they share a phenomenal field that becomes part of the life story of both.

Subconcepts


Phenomenal field

The totality of human experience of one’s being in the world. This refers to the individual’s frame of reference that can only be known to that person.

Self

The organized conceptual gestalt composed of perceptions of the characteristics of the “I” or “ME” and the perceptions of the relationship of the “I” and “ME” to others and to various aspects of life.

Time

The present is more subjectively real and the past is more objectively real. The past is prior to, or in a different mode of being than the present, but it is not clearly distinguishable. Past, present, and future incidents merge and fuse.

10 Carative Factors


Watson devised 10 caring needs specific carative factors critical to the caring human experience that need to be addressed by nurses with their patients when in a caring role. As carative factors evolved within an expanding perspective, and as her ideas and values evolved, Watson offered a translation of the original carative factors into clinical caritas processes that suggested open ways in which they could be considered.

The first three carative factors are the “philosophical foundation” for the science of caring, while the remaining seven derive from that foundation. The ten primary carative factors with their corresponding translation into clinical caritas processes are listed in the table below.

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”

Watson’s Hierarchy of Needs


Within assisting with the gratification of human needs, Watson’s hierarchy of needs begins with lower-order biophysical needs or survival needs, the lower-order psychophysical needs or functional needs, the higher order psychosocial needs or integrative needs, and finally the higher order intrapersonal-interpersonal need or growth-seeking need.Watson’s Hierarchy of Needs

Lower Order Biophysical Needs or Survival Needs

Watson’s hierarchy of needs begins with lower-order biophysical needs or survival needs. These include the need for food and fluid, elimination, and ventilation.

Lower Order Psychophysical Needs or Functional Needs

Next in line are the lower-order psychophysical needs or functional needs. These include the need for activity, inactivity, and sexuality.

Higher Order Psychosocial Needs or Integrative Needs

The higher order psychosocial needs or integrative needs include the need for achievement, and affiliation.

Higher Order Intrapersonal-Interpersonal Need or Growth-seeking Need

The higher order intrapersonal-interpersonal need or growth-seeking need is the need for self-actualization.

Watson’s Theory and The Nursing Process


The nursing process in Watson’s theory includes the same steps as the scientific research process: assessment, plan, intervention, and evaluation. The assessment includes observation, identification, and review of the problem, as well as the formation of a hypothesis. Creating a care plan helps the nurse determine how variables would be examined or measured, and what data would be collected. Intervention is the implementation of the care plan and data collection. Finally, the evaluation analyzes the data, interprets the results, and may lead to an additional hypothesis.

Strengths


Although some consider Watson’s theory complex, many find it easy to understand. The model can be used to guide and improve practice as it can equip healthcare providers with the most satisfying aspects of practice and can provide the client with holistic care.

Watson considered using nontechnical, sophisticated, fluid, and evolutionary language to artfully describe her concepts, such as caring-love, carative factors, and cartas. Paradoxically, abstract and simple concepts such as caring-love are difficult to practice, yet practicing and experiencing these concepts leads to greater understanding.

Also, the theory is logical in that the carative factors are based on broad assumptions that provide a supportive framework. The carative factors are logically derived from the assumptions and related to the hierarchy of needs.

Watson’s theory is best understood as a moral and philosophical basis for nursing. The scope of the framework encompasses broad aspects of health-illness phenomena. In addition, the theory addresses aspects of health promotion, preventing illness and experiencing peaceful death, thereby increasing its generality. The carative factors provide guidelines for nurse-patient interactions, an important aspect of patient care.

Weakness


The theory does not furnish explicit direction about what to do to achieve authentic caring-healing relationships. Nurses who want concrete guidelines may not feel secure when trying to use this theory alone. Some have suggested that it takes too much time to incorporate the caritas into practice, and some note that Watson’s personal growth emphasis is a quality “that while appealing to some may not appeal to others.”

Conclusion


Watson began developing her theory while she was assistant dean of the undergraduate program at the University of Colorado, and it evolved into planning and implementation of its nursing PhD program.

The Philosophy and Science of Caring addresses how nurses express care to their patients. Caring is central to nursing practice, and promotes health better than a simple medical cure. Watson believes that a holistic approach to health care is central to the practice of caring in nursing.

This led to the formulation of the 10 carative factors: (1) forming humanistic-altruistic value systems, (2) instilling faith-hope, (3) cultivating a sensitivity to self and others, (4) developing a helping-trust relationship, (5) promoting an expression of feelings, (6) using problem-solving for decision-making, (7) promoting teaching-learning, (8) promoting a supportive environment, (9) assisting with gratification of human needs, and (10) allowing for existential-phenomenological forces. The first three factors form the “philosophical foundation” for the science of caring, and the remaining seven come from that foundation.

Describing her theory as descriptive, Watson acknowledges the evolving nature of the theory and welcomes input from others. Although the theory does not lend itself easily to research conducted through traditional scientific methods, recent qualitative nursing approaches are appropriate.

Watson’s theory continues to provide a useful and important metaphysical orientation for the delivery of nursing care. Watson’s theoretical concepts, such as use of self, patient-identified needs, the caring process, and the spiritual sense of being human, may help nurses and their patients to find meaning and harmony during a period of increasing complexity. Watson’s rich and varied knowledge of philosophy, the arts, the human sciences, and traditional science and traditions, joined with her prolific ability to communicate, has enabled professionals in many disciplines to share and recognize her work.

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