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Watsons Theory of Caring

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    Jean Watson’s Theory of Human Caring Nursing is a profession that has been synonymous with the word caring. I decided to choose nursing as my profession because I felt I had a calling to help others in need, knowing I am able to make a difference in my patient’s lives. The broad definition of caring has been theorized by the philosophy of Jean Watson and has been the primary character of the nursing role model. Caring has been the core of all nursing actions and is defined by Watson as “the ethical and moral ideal of nursing that has interpersonal and humanistic and humanistic qualities” (Alligood, 2010, p. 11). In order to follow Watson’s theory nurses must view the patient holistically and possess a wide range of knowledge, empathy, communication, interpersonal skills, and competence. Watson believes that nurses should implement her ten carative factors, or caritas, into their everyday practice. These caring processes are suggested to be the underlying sacred and spiritual elements of caring (Alligood, 2010). This paper will capture a detailed look at Jean Watson’s philosophy and theory of human caring by describing one caring moment that I have encountered with one of my patients.

    I will then describe how I integrated the carative factors into the transpersonal relationship that occurred between me and the patient. Watson developed the theory of human caring in the late 1970’s during her employment as a professor at the University of Colorado School for Nursing (Fitzpatrick & Whall, 2005). It was there where she received her doctorate in Educational Psychology and Counseling. Watson wrote several books on her theory of human caring that suggest nurses to focus on the paradigm of healing and caring.

    Her theory was developed on the basis of deep human life experiences and human caring relationships suggesting nurses to be focused on helping the patient achieve harmony within the body, mind, and soul through a transpersonal caring relationship (Suliman, Welmann, Omer, & Thomas, 2009). Watson suggests that through these caring interactions the nurse has a primary focus on one element of the nursing metaparadigm; to assist the person as a whole.

    This is achieved by having the patient explore the significance of their personal health-related experience to gain a higher degree of inner harmony to promote knowledge and healing (Fitzpatrick & Whall, 2005). Watson described the subjective concept and experience of health to be “the unity and harmony within the body, mind, and soul and a harmony between self and others and between self and nature and openness to increased possibility” (Alligood, 2010, p. 122). When a patient focuses on health, it reflects their motivation to develop their spiritual self, develop deeper meaning, and balance one’s life to promote healing (Alligood, 2010).

    The concept of environment was viewed by Watson to create an energetic environment conducive to healing and to create a “sacred space” for patients to endure while in the health care facility. Nurses promote wholeness of the mind, body, and spirit by assisting the patient to acknowledge stress factors and emotional setbacks through these sacred spaces to assist with healing. As nurses, we are responsible to make significant changes by altering the environment making it conducive to the patient’s comfort level and promote healing.

    Watson views the nursing element of the metaparadigm as being both an art and science, with caring to be the essence of the nursing profession (Alligood, 2010). There are 3 major elements of Watson’s caring theory; the carative factors (caritas), the transpersonal caring relationship, and the caring moment. The carative factors are created for the intent for “developing and sustaining a helping-trusting, authentic caring relationship” between the nurse and the patient (Lachman, 2012, p. 112). Watson’s clinical caritas provide a framework that merges spirituality with the sacred dimensions of human caring.

    There are ten elements that encompass Watson’s carative factors that serve as the foundation for the practice of nursing with a holistic approach. According to Cara (2003), the carative factors created by Watson include these ten elements: 1. Humanistic-altruistic system of values. 2. Faith-Hope. 3. Sensitivity to self and others. 4. Helping-trusting, human care relationship. 5. Expressing positive and negative feelings. 6. Creative problem-solving caring process. 7. Transpersonal teaching-learning. 8. Supportive, protective, and/or corrective mental, physical, societal, and spiritual environment. 9. Human needs existence. 10.

    Existential-phenomenological-spiritual forces (p. 52). The transpersonal caring relationship involves the nurse making a conscious effort to connect with the patient. This involves the nurse’s moral commitment to protect the patient’s dignity and to consider them as whole. The nurse primarily focuses more on caring and healing instead of the disease process. Lastly, the caring moment is the connection of the nurse and patient together in unity to create a caring interaction (Lachman, 2012). It is when the nurse and patient are in a given moment in time and space, becoming part of one’s life history (Fitzpatrick & Whall, 2005).

    One of the reasons I am proud that I chose nursing as my career and profession is because of the many rewarding benefits it has given me throughout my years of practice. It has always been a gratifying experience for me starting out in health care when I worked as a nursing assistant at a very young age, knowing that I am able to share these caring and personal experiences between me and my patients. There have been quite a few caring moments throughout my career in health care, but the most memorable is the one that I have shared with Joanne, a fifty five year-old patient who was an acutely sick patient in the intensive care unit.

    Joanne had dark brown hair, brown eyes, and was a very compliant patient even though she was on a ventilator. She was in the unit for several weeks with a rare diagnosis that the physicians had difficulty classifying. Joanne had not been my patient in the past, even though I was familiar with her from helping out my colleagues with her care. The day I had the pleasure of having her as my patient was the day she was weaned off the ventilator and extubated. As a result of my positive motivation, her persistent efforts from aggressive pulmonary toileting had her quickly weaned to nasal cannula within a few hours.

    I met her personal and physical needs by making the room very tidy as she requested and lightly released the covers from her feet while in bed. Regardless that she had a very large support system and family who visited often, she remained very depressed and discounted her progress. That particular day I was very focused on her personal well-being since I felt that it was something that may have been neglected due to the high attention to her physical illness. Physical therapy came to the bedside and with their assistance we put her out of bed to the chair.

    Joanne stated she was feeling physically well but was still depressed that she is this ill at such a young age. The first carative element of Watson’s theory is the formation of the humanistic-altruistic value system. I touched her hand and sat next to her with only silence, giving her my full attention and caring presence as we both took a few moments to reflect with silence. I tried my best to be aware of my physical body language and choice of words (Alligood, 2010). The second element that I integrated into my caring moment with Joanne is Watson’s third carative factor of cultivating sensitivity to self and others.

    After the prolonged silence I noticed she had tears rolling down her face showing evidence of her fear and uncertainty. I gave reflection on how I can attend to Joanne’s spiritual needs (Alligood, 2010). I grabbed her hand and sat with silence once again for a brief moment and then nodded and smiled to assure her that I am able to be trusted and make her feel comfortable to discuss her worries. During my third element of my caring moment, I then included Watson’s fourth carative factor of development of a helping-trusting relationship.

    I reflected on ways I could help Joanne voice her concerns with me so that I can help her achieve inner harmony (Alligood, 2010). As a result of my empathetic attitude and non-verbal cues Joanne felt more comfortable talking to me about what has been upsetting her. She was concerned about her discharge and what her children and soon to have grandchildren will think of her if she is unable to play and care for them. There were many concerns about her quality of life post discharge. I continued to listen to her concerns without interruption.

    Once she finished voicing her concerns and a brief moment of silence, I allowed her to ask me any specific questions on her discharge planning and plan of care. When her family members visited, they seemed to have many concerns on her illness and discharge planning so I educated them on the process and plan of care. I notified the social worker to speak with them in addition to my discussion. Then I thought this would be an appropriate time to include my fourth and final element of Watson’s eighth carative factor; to provide a supportive, protective, and/or corrective mental, physical, societal, and spiritual environment.

    This led me to ask myself what was important to make my patient more at ease and comfortable (Alligood, 2010). Joanne and her family were a very religious Roman Catholic family, so I asked her if she would like me to call the chaplain to visit and pray with her. I also made her environment and surroundings comfortable by lowering the next room’s excessively loud television and providing privacy by closing the curtain partially and turning off the lights. I felt that making these small changes in the environment would be conducive for rest and healing.

    Watson believes that the nurse creates “sacred space” by “creating a healing environment at all levels” (Alligood, 2010, p. 123). Upon personal reflection, the only minor thing I could have incorporated into my caring moment was to have asked her if she wanted me to pray with her. I am not as much as a religious person as she is but I feel that she would have liked me to join her in prayer when the chaplain visited. Sharing prayer time would have enhanced a deeper, spiritual connection between us.

    I also reflected that I incorporated all elements of the nursing metaparadigm into the caring moment by caring for her holistically addressing her person, environment, health, and nursing aspects of her care. Furthermore, the caring moment that I shared with Joanne gives me incentive to strive to incorporate Watson’s caring caritas into my everyday practice. This caring interaction is personally sacred to me and makes me feel proud to know that I have made a difference by living in the moment with my patient. During this interaction I have learned that sometimes non-verbal actions are more powerful than words.

    Whether it is the way I sat in silence and eagerly listened, or just by the way I held my patient’s hand that made a difference in the charisma and empathy that I portrayed in my caring actions. It was a rewarding experience to connect with Joanne on a spiritual level without words. Watson’s philosophy believes that nurses who are sufficient in their caring skills and relationships are more capable of maintaining a loving and meaningful connection. This will achieve wholeness and a spiritual awakening to help accomplish the ultimate goal of optimum health (Watson, 2009).

    As a result of my caring interaction, I received a formal compliment from Joanne and her family from the patient representative upon her follow-up. I was commended with a small reward of appreciation from my institution and fortunately, Joanne and I still keep in touch through social media. Every now and then I receive kind words from her telling me about how much I have made a difference in her life and how grateful she is for having me as her nurse. It is the personal rewards like these that keep me motivated to strive and make a positive, caring connection with my patients every day.

    Nursing is a lifetime journey that is an art, science, and a gift to know that I am able to make a difference in the lives of my patients one by one. References Alligood, M. R. (2010). Nursing theory: utilization and application (4th ed. ). Retrieved from The University of Phoenix eBook Collection database. Cara, C. (2003). A pragmatic view of Jean Watson’s caring theory. International Journal for Human Caring, 7(3), 51-61. Fitzpatrick, J. , & Whall, A. (2005). Conceptual models of nursing: analysis and application (4thed. ). Retrieved from The University of Phoenix eBook Collection database.

    Lachman, V. D. (2012). Applying the ethics of care to your nursing practice. Ethics, Law, and Policy, 21(2), 112-116. Suliman, W. A. , Welmann, E. , Omer, T. , & Thomas, L. (2009). Applying Watson’s nursing theory to assess patient perceptions of being cared for in a multicultural environment. Journal of Nursing Research (Taiwan Nurses Association), 17(4), 293-300. Watson, J. (2009). Caring science and human caring theory: transforming personal and professional practices of nursing and health care. Journal of Health & Human Services Administration, 31(4), 466-482.

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