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Watson’s Theory of Transpersonal Care

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    Nursing has in the last century made a lot of progress thus it has become recognized as a profession as well as an academic discipline. One of these accomplishments was the development, articulation, and testing of various nursing theories. It has been made more meaningful and significant by the theory based practice which has shifted the focus of nursing from vocational to an organized profession. With the development of these theories, nursing has emerged as an independent practice still working closely with the medical profession but no longer dependent upon it.

    There has been a realization of a knowledge base which has assisted in guiding professional nursing practice. Not only does the theory guide the nursing practice, but research and education as well, resulting in a continually evolving body of knowledge. Most of the theoretical works done by nurses have the intention of making nursing a recognized profession; profession in the sense that nurses should professionally deliver care to their patients. As nurses, we may choose to use one particular theory in our practice but more frequently we use a combination of several different theorists in our practice.

    Jean Watson refers to the human being as “a valued person in and of him or herself to be cared for, respected, nutured, 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” (Watson, 1979). Her theory and concepts focus on the relationship between patient and nurse and the promotion of unity and harmony within the mind, body, and soul. According to Watson, caring which is manifested in nursing has existed in every society. However a caring attitude is not transmitted from generation to generation.

    Instead it’s transmitted by the culture of the nursing profession as a unique way of coping with its environment. Jean Watson grew up during the 1940’s and 1950s in the small town of Welch, West Virginia. Watson graduated from the Lewis Gale School of Nursing in 1961, and then continued her nursing studies at the University of Colorado at Boulder. She earned her bachelor’s degree in 1964, a Master’s degree in psychiatric and mental health nursing in 1966, and a Ph. D in educational psychology and counseling in 1973. She served as Dean of Nursing at the University Health Science Center and was the President of the National League for Nursing.

    She is a fellow of the American Academy of Nursing. Her books include The Philosophy and Science of Caring which was published in 2008. She currently holds an endowed chair at the University of Colorado, and in 2008, she created the Watson Caring Science Institute to help spread her nursing theory and ideas. The center has impacted nurses and colleges around the world and continues to serve doctoral students today. She established the doctoral program at the University of Colorado and in 1998; she was recognized as a Distinguished Nurse Scholar by New York University (Alligood &Tomey, 2010).

    The theory of human caring was developed in 1979, and includes three major elements. They are the the carative factors, the transpersonal caring relationship, and the caring occasion/caring moment. These elements are listed below. Carative Factors (Watson, 1988, p. 97). 1. Formation of humanistic-altruistic system of values 2. Instillation of faith-hope 3. Cultivation of sensitivity to self and others 4. Helping-trusting, human care relationship 5. Expressing positive and negative feelings 6. Creative problem-solving process 7. Promotion of transpersonal teaching-learning 8.

    Supportive, protective, and/or corrective, mental, physical, societal, and spiritual environment 9. Humans needs assistance 10. Existential-phenomenological-spiritual forces These ten carative factors provide nurses with the appropriate interventions to care for their patients and acts as a guide for nurses. Watson orders the needs. Lower-order biophysical needs include food and fluid, elimination, and ventilation. Lower-order psychophysical needs include activity-inactivity and sexuality. Higher-order psychosocial needs include achievement, affiliation, intrapersonal need, and self- actualization.

    As Watson’s own ideas and values changed and grew so did her carative factors. Watson, expanded the carative factors to a closely related concept, caritas, a Latin word that means to cherish, to appreciate, to give special attention, if not loving attention (Alligood & Tomey, 2010). Caritas Processes (as cited in Alligood, M. & Tomey, A. , 2010, p. 97) 1. Practice of loving-kindness and equanimity within the context of caring consciousness 2. Being authentically present and enabling and sustaining the deep belief system and subjective life-work of self and one being cared for 3.

    Cultivation of one’s own spiritual practices and transpersonal self- going beyond the ego self 4. Developing and sustaining a helping trusting authentic caring relationship 5. 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. Creative use self and all ways of knowing as part of the caring process; to engage in the artistry of caring-healing practices 7. Engaging in genuine teaching-learning experience that attend to unity of being and meaning, attempting to stay within others’ frame of reference 8.

    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. 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. Opening and attending spiritual-mysterious and existential dimensions of one’s life-death; soul care for self and the one-being-cared-for Transpersonal Caring Relationship

    Another major part of Watson’s theory is the transpersonal caring relationship. Watson (2005) defines this as the foundation of the work, transpersonal caring conveys a concern for the inner life world and subjective meaning of another who is fully embodied, but transpersonal care also goes beyond “ego self and beyond the given moment, reaching to the deeper connections to spirit and with the broader universe”(p. 8). Thus transpersonal caring relationship moves beyond ego-self and radiates to spiritual, even cosmic concerns and connections that tap into healing possibilities and potentials.

    Transpersonal caring seeks to connect with and embrace the spirit or soul in other through the processes of caring and healing and being in authentic relation, in the moment. Caring moment/Caring Occasions A caring occasion, occurs whenever the nurse and another come together with their unique life histories and phenomenal fields in point in space and time. A caring moment involves an action and choice by both the nurse and the other. The nurse is part of the patient’s experience and the patient is part of the nurse’s experience. According to Watson, caring, which is manifested in nursing, has existed in every society.

    However, a caring attitude is not transmitted from generation to generation. Instead, it’s transmitted by the culture of the nursing profession as a unique way of coping with its environment. Caring for patients promotes grown; a caring environment accepts a person as he or she is, and looks to what he or she may become. This is why I went into nursing. My own personal assumptions of this theory coincide with what Watson has stated. I believe all people, whether they are nurse or not are caring individuals. It is a trait that we are born with however some of us are better than others.

    I feel it is a privilege to become part of my patient’s lives. I feel the majority of nurse’s care but have had interactions with nurses where I felt I would have done things differently. When reviewing Watson’s theory I believed that this is the one that describes my own theory of nursing. Her theory outlines crucial aspects of caring relationships we must establish in order to have good outcomes for our patients. Below is Watson’s Caring Concept Map (Watson, 1999, p. 119). I currently am an Emergency Room nurse at the community hospital.

    I find this map describes my intervention perfectly when I have my first encounter with my patient. When coming into the emergency room patients are scared, unsure and have many questions. We need to view the patient as a whole not as a certain problem. We are concerned with the whole patient not just body but their mind and spirit as well. Watson even goes on so far to say that the care of the soul remains the most powerful aspect of the art of caring in nursing (Watson, 1997). If we can establish a transpersonal caring relationship with our patients we can calm their fears and help them be able to relax.

    By asking them questions about their families, jobs and any other hobbies they become more open and honest to us. They can see we genuinely care about them as a whole person. They will trust us and believe that we want to help them. When it comes time for the teaching process they will be more “in tune” to what we are saying. Per Watson the nurse must be willing to “share” themselves. They must give 100% to this patient nurse relationship. The same is true for the patient. Some patients may not be able to express themselves as others will.

    They be depressed, suicidal and may just want their treatment and to leave as soon as possible. The true connection between nurse and patient may never be achieved. If we are able to break through to them the real healing will begin and they may have healthier outcomes in the end. Watson identified several basic assumptions for her theory of caring. Assumptions (Watson, 1979, p. 8) 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. . Caring responses accept a person not only as he or she is now but as what he or she may become. 5. A caring environment is one that offers the development of potential while allowing the person to choose the best action for himself or herself at any given point in time. 6. Caring is more “healthogenic” than is curing. The practice of caring integrates biophysical knowledge with knowledge of human behavior to generate or promote health and to provide ministrations to those who are ill. A science of caring is therefore complementary to the science of curing. 7. The practice of caring is central to nursing.

    I would definitely agree with these assumptions in regards to her theory. As stated earlier I believe all nurses “care” to some degree. Some may care more than others and their attitude may strengthen with experience or lessen. I just had a major change in my career. I went from a supervisor of the Intensive care/stepdown unit to the emergency room as a staff nurse. My caring for patients has strengthened tremendously. I “cared” for my staff but they didn’t need me like the patients did. I now appreciate my new job so much it comes out as a strong “caring” sense due to me missing my patient care.

    The metaparadigm of nursing entails four basic components, person, health, environment, and nursing. In Watson’s theory the person is viewed as subjective and unique, not objective, predictable and calculating. The person is to be valued, cared for, respected, nurtured, understood and assisted. The environment is crucial to the holistic healing (mental, physical, social, emotional, spiritual, developmental, protective, supportive environments), which is conducive to patients health and wellbeing. The environment is usually designed as a home-like environment but these “systems still fall short as healing spaces”(Watson, 1988,p. 9). Health is viewed holistically, as the unity between the physical, social, mental and spiritual self, with all parts working together in harmony and functioning to their full capacity. Health is perceived by the patient and is influenced by their own unique life experiences. Finally nursing is a caring, meaningful and harmonic connective bond that is shared between the nurse and the patient. Nursing is providing caring, professional, and thoughtful interactions to restore and promote holistic health and to prevent illness.

    As per Watson she wants us all to be reminded that human caring is a serious endeavor and requires knowledge and skill and personal growth. According to Watson there have been “serious concerns about caring being named within nursing’s metaparadigm”(p. 219). I believe Watson’s theory can be practiced in any nursing setting. For advanced practice nursing this would be applicable. A major component of their job is health promotion. Nurse practitioners work on education and prevention with patients. They need to enter into a transpersonal relationship with these patients. They need to develop a “bond” why would the patient listen to just anyone.

    We need to become that trusted friend and advisor to our patients. Develop a relationship that goes above and beyond. By truly caring we will both receive the satisfaction and we will help our patients have a greater quality of life. Watson’s theory is essential in education and research. We tend to get caught up in our skills needed to perform the job when we need to be caring and look at each person as an individual. We need to look at the different levels of learning and implement that caring relationship. Today’s nursing practice is very much influenced by the theories created by Dr. Watson.

    Applying Watson’s theory not only allows for nurses to better care for themselves as whole beings as well. By following Watson’s Carative factors, nurses are able to look at the patient as a whole living, breathing, thinking, feeling person-not just a bed number or a lab report value. When Watson’s theories are applied in acute and chronic health care settings it provides a guide to help articulate what nursing is ad does, beyond task orientation. I know I will continue with this theory. Allirgood, M. , & Tomey, A. (2010). Nursing Theorists and Their Work (7th ed. ). Maryland Heights, MO: Mosby.

    Watson, J. (1979). Nursing: The philosophy and Science of Caring. Boston: Little, Watson, J. (1988). Nursing: Human Science and Human Care. A theory of Nursing. (2nd printing). New York: National League for Nursing Watson,J. (1997). Artistry of caring: Heart and soul of nursing. In D. Marks-Maran & P. Rose (Eds. ), Nursing: Beyond art and sciences (pp. 54-62). Boulder, CO: Colorado Associated University Presss. Watson, J. (1999). Postmodern Nursing and Beyond. Toronto, Canada: Churchill Livingstone. Watson, J. (2005). Caring Science as Sacred Science. Philadelphia: F. A. Davis

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