Jean Watson: Theory of Human Caring

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Jean Watson Theory of Human Caring Nursing Theory Guide

Dr. Jean Watson is a nurse theorist who developed “Philosphy 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 who is well 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 all over the world.

Early Life

Jean Watson was born Margaret Jean Harmon and grew up in the small town of 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.

Personal Life

Jean Watson, RN, PhD, FAAN, AHN-BC

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.

Education

Jean Watson ardently and quickly progressed through her nursing education earning her bachelor’s degree in nursing in 1964, a master of science in nursing 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

Lecture series celebration, Taken at St Peter's College, New Jersey
Lecture series celebration, Taken at St Peter’s College, New Jersey

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, and administration and leadership. At the center, Watson and others sponsor clinical, educational, and community scholarship activities and projects in human caring. These activities involve national and international scholars in residence, as well as 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.

Henry Ford Hospital research conference
Henry Ford Hospital research conference

Watson served as chairperson and assistant dean of the undergraduate program at the University of Colorado School of Nursing. She was involved in planning and implementation of the nursing PhD program and served as coordinator and director of the PhD 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 the development of 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 on how nurses express care to their patients. Her theory stresses humanistic aspects of nursing as they intertwine with scientific knowledge and nursing practice.

International Hiroshima Conference on Caring and Peace
International Hiroshima Conference on Caring and Peace

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 he or she is, and looks to what he or she may become.

Watson also defined three of the four metaparadigm concepts in nursing including person or human being, health, and nursing. She referred human being as a valued person in and of him or herself 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, meanwhile, 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. And nursing as a science of persons and health-illness experience that are mediated by professional, personal, scientific, and ethical care interactions.

She does not define the fourth metaparadigm concept of 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 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.

Charles Drew University Medicine Dymally School of Nursing, Los Angeles
Charles Drew University Medicine Dymally School of Nursing, Los Angeles

Within assisting with the gratification of human needs, Watson’s hierarchy of needs begins with lower-order biophysical needs or survival needs, which include the need for food and fluid, elimination, and ventilation. Next are the lower-order psychophysical needs or functional needs, which include 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, 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.

Works

Watson has authored 11 books, shared in authorship of six books, and has written countless articles in nursing journals. The following publications reflect the evolution of her theory of caring from her ideas about the philosophy and science of caring.

Nursing: The Philosophy and Science of Caring (1979)

The Philosophy and Science of Caring (1979)

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.

Human Science and Human Care – A Theory of Nursing (1985)

Jean Watson 18This book, published in 1985 and reprinted in 1988 and 1999, 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 by now.

Postmodern Nursing and Beyond (1999)

Watson’s third book was presented as a model to bring nursing practice into the twenty-first century.

Jean Watson 19Watson 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.

Instruments for Assessing and Measuring Caring in Nursing and Health Sciences (2002)

Jean Watson 17This 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, and nurse perceptions of caring, and caring behaviors, abilities, and efficacy.This is Watson’s fourth book.

Caring Science as Sacred Science (2005)

Jean Watson 14Watson’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:

Jean Watson 10 Jean Watson 11 Jean Watson 15

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

Molloy College Division of Nursing's third annual doctoral forum research lecture and poster sessions
Molloy College Division of Nursing’s third annual doctoral forum research lecture and poster sessions

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 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.

Qatar Conference Unified Caring Model for Gulf Countries UAE
Qatar Conference Unified Caring Model for Gulf Countries UAE

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 in recognition of 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 at 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 in 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 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.

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 assist the person to gain control, become knowledgeable, and promote health 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 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 FactorsCaritas 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.

Analysis

It is undeniable that technology has already been part of nursing’s whole paradigm with the evolving era of development. Watson’s suggestion of purely “caring” without giving much attention to technological machinery cannot be solely applied but then 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.

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 Caritas. 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 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 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.

See Also

You may also like the following nursing theories study guides: 

External Links

References

  • 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 http://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 http://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.

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Angelo Gonzalo, BSN, RN
Angelo Gonzalo earned his Nursing degree in the year 2010 and continued his studies at St. Paul University Manila taking up Masters of Arts in Nursing Major in Clinical Management. He worked as an intensive care nurse for more than six years. He advocates for proper training and development of new nurses, quality assurance and compassionate care. He has also been involved in community development for 10 years steering programs on good governance, health, sports, and education. Angelo aims to build a good foundation for aspiring nurses. He would like to impart the importance of understanding nursing theories that he hopes to be translated successfully to practice.

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