Dr. Jean Watson is a nurse theorist who developed “Philosophy and Theory of Transpersonal Caring” or “Caring Science” and founder of Watson Caring Science Institute. Get to know about Dr. Watson’s nursing theory, its major concepts, assumptions, and application to nursing in this study guide.
Biography of Jean Watson
Jean Watson (June 10, 1940 – present) is an American nurse theorist and nursing professor known for her “Philosophy and Theory of Transpersonal Caring.” She has also written numerous texts, including Nursing: The Philosophy and Science of Caring. Watson’s study on caring has been integrated into education and patient care to various nursing schools and healthcare facilities worldwide.
Jean Watson was born Margaret Jean Harmon and grew up in Welch, West Virginia, in the Appalachian Mountains. She was the youngest of eight children and was surrounded by an extended family–community environment. Watson attended high school in West Virginia and then the Lewis Gale School of Nursing in Roanoke, Virginia, where she graduated in 1961.
After her graduation in 1961, Jean Watson married her husband, Douglas, and moved west to his native state of Colorado. In 1997, she experienced an accidental injury that resulted in the loss of her left eye, and soon after, in 1998, her husband, whom she considers as her physical and spiritual partner, and her best friend passed away and left Watson and their two grown daughters, Jennifer and Julie, and five grandchildren.
Watson states that she is “attempting to integrate these wounds into my life and work. One of the gifts through the suffering was the privilege of experiencing and receiving my own theory through the care from my husband and loving nurse friends and colleagues.” These two personal life-altering events contributed to writing her third book, Postmodern Nursing and Beyond.
Jean Watson ardently and quickly progressed through her nursing education, earning her bachelor’s degree in nursing in 1964, a master of science in psychiatric and mental health nursing in 1966, and a Ph.D. in educational psychology and counseling in 1973, all from the University of Colorado at Boulder.
Career and Appointments
After Jean Watson concluded her doctoral degree, she has served in both faculty and administrative positions in the School of Nursing faculty, University of Colorado Health Sciences Center in Denver. In 1981 and 1982, she pursued international sabbatical studies in New Zealand, Australia, India, Thailand, and Taiwan.
In the 1980s, Watson and colleagues established the Center for Human Caring at the University of Colorado, the nation’s first interdisciplinary center committed to using human caring knowledge for clinical practice, scholarship, administration, and leadership. At the center, Watson and others sponsor clinical, educational, and community scholarship activities and human caring projects. These activities involve national and international scholars in residence and international connections with colleagues around the world, such as Australia, Brazil, Canada, Korea, Japan, New Zealand, the United Kingdom, Scandinavia, Thailand, and Venezuela, among others. Activities such as these continue at the University of Colorado’s International Certificate Program in Caring Healing, where Watson offers her theory courses for doctoral students.
Watson served as chairperson and assistant dean of the undergraduate program at the University of Colorado School of Nursing. She was involved in the planning and implementing of the nursing Ph.D. program and served as coordinator and director of the Ph.D. program between 1978 and 1981. From 1983 to 1990, she was Dean of University of Colorado School of Nursing and Associate Director of Nursing Practice at University Hospital. During her deanship, she was instrumental in developing a post-baccalaureate nursing curriculum in human caring, health, and healing that led to a Nursing Doctorate (ND), a professional clinical doctoral degree that in 2005 became the Doctor of Nursing Practice (DNP) degree.
Between 1993 and 1996, Watson served as a member of the Executive Committee and the Governing Board and as an officer for the NLN, and she was elected president from 1995 to 1996.
In 2005, she took a sabbatical for a walking pilgrimage in the Spanish El Camino. And in 2008, Watson created a non-profit foundation: Watson Caring Science Institute, to further the work of Caring Science in the world.
Philosophy and Theory of Transpersonal Caring
Watson’s Philosophy and Science of Caring is concerned with how nurses express care to their patients. Her theory stresses the humanistic aspects of nursing as they intertwine with scientific knowledge and nursing practice.
The nursing model states that “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. She believes that a holistic approach to health care is central to the practice of caring in nursing.
According to her theory, caring can be demonstrated and practiced by nurses. Caring for patients promotes growth; a caring environment accepts a person as they are and looks to what they may become.
Watson also defined three of the four metaparadigm concepts in nursing, including the person or human being, health, and nursing. She referred to the human beings as a valued person in and of themselves to be cared for, respected, nurtured, understood, and assisted; in general, a person’s philosophical view as a fully functional integrated self. A human is viewed as greater than and different from the sum of his or her parts. Meanwhile, health is defined as a high level of overall physical, mental, and social functioning, a general adaptive-maintenance level of daily functioning, the absence of illness, or the presence of efforts leading to the absence of illness. And nursing is a science of persons and health-illness experience mediated by professional, personal, scientific, and ethical care interactions.
She does not define the fourth metaparadigm concept of the environment but instead 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.
10 Carative Factors
Watson’s 10 carative factors are: (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 the 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.
In assisting with the gratification of human needs, Watson’s hierarchy of needs begins with lower-order biophysical needs or survival needs, including the need for food and fluid, elimination, and ventilation. Next are the lower-order psychophysical needs or functional needs, including the need for activity, inactivity, and sexuality. The higher-order psychosocial needs or integrative needs include the need for achievement and affiliation. And finally, the higher-order intrapersonal-interpersonal need or growth-seeking need, which is self-actualization.
The nursing process outlined in Watson’s model contains the same steps as the scientific research process: assessment, plan, intervention, and evaluation. The assessment includes observation, identification, and review of the problem and 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.
Watson has authored 11 books, shared in the authorship of six books, and has written countless nursing journal articles. The following publications reflect her theory of caring from her ideas about the philosophy and science of caring.
Watson’s first book was developed from her notes for an undergraduate course taught at the University of Colorado. Her early work embraced the 10 carative factors but evolved to include “caritas,” making explicit connections between caring and love. This book was reprinted in 1985 and translated into Korean and French.
Published in 1985 and reprinted in 1988 and 1999, this book addressed her conceptual and philosophical problems in nursing. Her second book has been translated into Chinese, German, Japanese, Korean, Swedish, Norwegian, Danish, and probably other languages.
Watson’s third book was presented as a model to bring nursing practice into the twenty-first century.
Watson describes two personal life-altering events that contributed to her writing. In 1997, she experienced an accidental injury that resulted in the loss of her left eye, and soon after, in 1998, her husband died. Watson states that she is “attempting to integrate these wounds into my life and work. One of the gifts through the suffering was the privilege of experiencing and receiving my own theory through the care from my husband and loving nurse friends and colleagues.” This book has been translated into Portuguese and Japanese.
This is a collection of 21 instruments to assess and measure caring, received the American Journal of Nursing Book of the Year Award. This book provides all the essential research tools for assessing and measuring caring for those in the caring professions. Watson’s text is the only comprehensive and accessible collection of instruments for care measurement in clinical and educational nursing research. The measurements address quality of care, patient, client, nurse perceptions of caring, and caring behaviors, abilities, and efficacy. This is Watson’s fourth book.
Watson’s fifth book describes her personal journey to enhance understanding about caring science, spiritual practice, the concept and practice of care, and caring-healing work. In this book, she leads the reader through thought-provoking experiences and the sacredness of nursing by emphasizing deep inner reflection and personal growth, communication skills, use of self-transpersonal growth, and attention to both caring science and healing through forgiveness, gratitude, and surrender. It received the American Journal of Nursing 2005 Book of the Year Award.
Recent books include Measuring Caring:
International Research on Caritas as Healing (Nelson & Watson, 2011), Creating a Caring Science Curriculum (Hills & Watson, 2011), and Human Caring Science: A Theory of Nursing (Watson, 2012).
Awards and Honors
Jean Watson has been active and hardworking in many community programs during her career. She has been a founder and a member of the Board of Boulder County Hospice and numerous other collaborations with area health care facilities. She has received several research grants and advanced education federal grants and awards and numerous university and private grants, and extramural funding for her faculty and administrative projects and scholarships in human caring.
In 1992, the University of Colorado School of Nursing honored Watson as a distinguished professor of nursing. She received six honorary doctoral degrees from universities in the United States and three Honorary Doctorates in international universities, including Göteborg University in Sweden, Luton University in London, and the University of Montreal in Quebec, Canada. She received the National League for Nursing (NLN) Martha E. Rogers Award, which recognizes nurse scholars’ significant contributions to advancing nursing knowledge and knowledge in other health sciences in 1993. In 1997, the NLN awarded her an honorary lifetime certificate as a holistic nurse. Finally, in 1999, Watson assumed the nation’s first Murchison-Scoville Endowed Chair of Caring Science and currently is a distinguished professor of nursing.
Watson was recognized as a Distinguished Nurse Scholar by New York University in 1998. And in 1999, she received the Fetzer Institute’s National Norman Cousins Award to recognize her commitment to developing, maintaining, and exemplifying relationship-centered care practices.
She is a Distinguished and/or Endowed Lecturer at national universities, including Boston College, Catholic University, Adelphi University, Columbia University-Teachers College, State University of New York, and universities and scholarly meetings in numerous foreign countries.
Her international activities also include an International Kellogg Fellowship in Australia in 1982, a Fulbright Research and Lecture Award to Sweden and other parts of Scandinavia in 1991, and a lecture tour in the United Kingdom 1993. Watson has been involved in international projects and has received invitations to New Zealand, India, Thailand, Taiwan, Israel, Japan, Venezuela, Korea, and other places. She is featured in at least 20 nationally distributed audiotapes, videotapes, and/or CDs on nursing theory.
In 2010, Watson received an Honorary Doctor of Sciences in Nursing from the University of Victoria in British Columbia, Canada.
Theory of Human Caring of Jean Watson
Nowadays, a lot of people choose nursing as a profession. There are many reasons to consider 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 how nurses care for their patients and how that caring progresses into better plans to promote health and wellness, prevent illness and restore health.
In today’s world, nursing seems to be responding to the various demands of the machinery with less consideration of the needs of the person attached to the machine. In Watson’s view, the disease might be cured, but illness would remain because, without caring, health is not attained. Caring is the essence of nursing and connotes responsiveness between the nurse and the person; the nurse co-participates with the person. Watson contends that caring can help the person gain control, become knowledgeable, and promote healthy changes.
What is Watson’s Theory of Transpersonal Caring?
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 they are and looks to what they may become.
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 offers the development of potential while allowing the patient to choose the best action for themselves at a given point in time. (6) The science of caring is complementary to the science of curing. (7) The practice of caring is central to nursing.
The Philosophy and Science of Caring have four major concepts: human being, health, environment or society, and nursing.
The 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. The culture of the profession transmits it as a unique way of coping with its environment.”
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. A human is viewed as greater than and different from the sum of his or her parts.
Health is the unity and harmony within the mind, body, and soul; health is associated with the degree of congruence between the self 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 is a human science of persons and human health-illness experiences mediated by professional, personal, scientific, esthetic, and ethical human care transactions.
Actual Caring Occasion
The actual caring occasion involves actions and choices by the nurse and the individual. The moment of coming together on a caring occasion presents the two persons with the opportunity to decide how to be in the relationship – what to do with the moment.
The transpersonal concept is an intersubjective human-to-human relationship in which the nurse affects and is affected by the other person. Both are fully present in the moment and feel a union with the other; they share a phenomenal field that becomes part of both’s a life story.
The totality of human experience of one’s in the world. This refers to the individual’s frame of reference that can only be known to that person.
The organized conceptual gestalt is 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 various aspects of life.
The present is more subjectively real, and the past is more objectively real. The past is before 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 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 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 the unity of being and meaning, attempting to stay within others’ frame of reference.”|
|8. “The provision of the supportive, protective, and (or) corrective mental, physical, societal, and spiritual environment.”||“Creating healing environment at all levels (physical as well as the nonphysical, subtle environment of energy and consciousness, whereby wholeness, beauty, comfort, dignity, and peace are potentiated)”|
|9. “The assistance with the 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
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 and 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.
It is undeniable that technology has already been part of nursing’s whole paradigm with the evolving era of development. Watson’s purely “caring” suggestion without giving much attention to technological machinery cannot be solely applied. Her statement is praiseworthy because she dealt with the importance of the nurse-patient interaction rather than a practice confined with technology.
Watson stated the term “soul-satisfying” when giving out care for the clients. Her concepts guide the nurse to an ideal quality nursing care provided for the patient. This would further increase the involvement of both the patient and the nurse when the experience is satisfying.
In providing the enumerated clinical Caritas processes, the nurse becomes an active co-participant with the patient. Thus, the quality of care offered by the nurse is enhanced.
Although some consider Watson’s theory complex, many find it easy to understand. The model can guide and improve practice as it can equip healthcare providers with the most satisfying aspects of practice and 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 Caritas. Paradoxically, abstract and simple concepts such as caring-love are difficult to practice, yet practicing and experiencing them 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. Also, 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.
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.”
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 implementing its nursing Ph.D. 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 the 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 theory’s evolving nature 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 the 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.
- Nursing: The Philosophy and Science of Caring, Revised Edition
- Nursing: Human Science and Human Care, a Theory of Nursing
- Postmodern Nursing and Beyond, 1e
- Instruments for Assessing and Measuring Caring in Nursing and Health Sciences (2002)
- By Jean Watson – Caring Science as Sacred Science: 1st (first) Edition
- Watson Caring Science Institute and International Caritas Consortium
- Dr. Jean Watson’s Facebook
- Alligood, M., & Tomey, A. (2010). Nursing theorists and their work, seventh edition. Maryland Heights: Mosby-Elsevier.
- Dr. Watson’s Facebook Page for the photos
- Dr. Jean Watson. (n.d.). Retrieved November 28, 2013, from https://watsoncaringscience.org/about-us/jean-bio/
- Watson, J. (1979). Nursing: The philosophy and science of caring. In George, J. (Ed.). Nursing theories: the base for professional nursing practice. Norwalk, Connecticut: Appleton & Lange.
- Watson, J. (1999). Postmodern nursing and beyond. In McEwen, M. and Wills, E. (Ed.). Theoretical basis for nursing. USA: Lippincott Williams & Wilkins.
- Watson, J. (2005). Caring science as a sacred science. In McEwen, M. and Wills, E. (Ed.). Theoretical basis for nursing. USA: Lippincott Williams & Wilkins.
- Watson, J. (2006). From carative factors to clinical caritas processes. Retrieved March 18, 2006, from https://www2.uchsc.edu/son/caring/content/evolution.asp. In Kozier, B., Erb, G., Berman, A., Snyder, S. (Ed.). Fundamentals of nursing: Concepts, process, and practice. (7th ed.). Philippines: Pearson Education South Asia Pte Ltd.
With contributions by Wayne, G. (for Biography), Vera, M., Ramirez, Q.