THEORY OF CARINGBY JEAN WATSON

Conceptual Framework of the Theory

THE TEN PRIMARY CARATIVE FACTORS *The structure for the science of caring is built upon ten carative factors. These are: *The first three carative factors form the “philosophical foundation” for the science of caring. The remaining seven carative factors spring from the foundation laid by these first three.

1. The formation of a humanistic- altruistic system of values

* Begins developmentally at an early age with values shared with the parents. * Mediated through ones own life experiences, the learning one gains and exposure to the humanities. * Is perceived as necessary to the nurse’s own maturation which then promotes altruistic behavior towards others.

2. Faith-hope

* Is essential to both the carative and the curative processes. * When modern science has nothing further to offer the person, the nurse can continue to use faith-hope to provide a sense of well-being through beliefs which are meaningful to the individual.

3. Cultivation of sensitivity to one’s self and to others

* Explores the need of the nurse to begin to feel an emotion as it presents itself. * Development of one’s own feeling is needed to interact genuinely and sensitively with others. * Striving to become sensitive, makes the nurse more authentic, which encourages self-growth and self-actualization, in both the nurse and those with whom the nurse interacts. * The nurses promote health and higher level functioning only when they form person to person relationship.

4. Establishing a helping-trust relationship

* Strongest tool is the mode of communication, which establishes rapport and caring. * She has defined the characteristics needed to in the helping-trust relationship. These are: o Congruence o Empathy o Warmth *Communication includes verbal, nonverbal and listening in a manner which connotes empathetic understanding.

5. The expression of feelings, both positive and negative

* According to Watson, “feelings alter thoughts and behavior, and they need to be considered and allowed for in a caring relationship”. * According to her such expression improves one’s level of awareness. * Awareness of the feelings helps to understand the behavior it engenders.

6. The systematic use of the scientific problem-solving method for decision making

* According to Watson, the scientific problem- solving method is the only method that allows for control and prediction, and that permits self-correction. * She also values the relative nature of nursing and supports the need to examine and develop the other methods of knowing to provide an holistic perspective. * The science of caring should not be always neutral and objective.

7. Promotion of interpersonal teaching-learning

* The caring nurse must focus on the learning process as much as the teaching process. * Understanding the person’s perception of the situation assist the nurse to prepare a cognitive plan.

8. Provision for a supportive, protective and /or corrective mental, physical, socio-cultural and spiritual environment

* Watson divides these into eternal and internal variables, which the nurse manipulates in order to provide support and protection for the person’s mental and physical well-being. * The external and internal environments are interdependent. * Watson suggests that the nurse also must provide comfort, privacy and safety as a part of this carative factor.

9. Assistance with the gratification of human needs

* It is grounded in a hierarchy of need similar to that of the Maslow’s. * She has created a hierarchy which she believes is relevant to the science of caring in nursing. * According to her each need is equally important for quality nursing care and the promotion of optimal health. * All the needs deserve to be attended to and valued. Watson’s ordering of needs * Lower order needs (biophysical needs) o The need for food and fluid o The need for elimination o The need for ventilation * Lower order needs (psychophysical needs) o The need for activity-inactivity o The need for sexuality * Watson’s ordering of needs o Higher order needs (psychosocial needs) o The need for achievement o The need for affiliation o Higher order need (intrapersonal-interpersonal need) o The need for self-actualization * Research findings have established a correlation between emotional distress and illness. According to Watson, the current thinking of holistic care emphasizes that: o Factors of the etiological component interact and produce change through complex neuro-physiological and neuro-chemical pathways o Each psychological function has a physiological correlate o Each physiological component has a psychological correlate

Example:

Bulemia, anorexia and gastro-intestinal ulcers are a just few of the disorders that indicate a complex interaction between the physiological and psychological.

10. Allowance for existential-phenomenological forces

* Phenomenology is a way of understanding people from the way things appear to them, from their frame of reference. * Existential psychology is the study of human existence using phenomenological analysis. * This factor helps the nurse to reconcile and mediate the incongruity of viewing the person holistically while at the same time attending to the hierarchical ordering of needs. * Thus the nurse assists the person to find the strength or courage to confront life or death.

THE TRANSPERSONAL CARING RELATIONSHIP

For Watson (1999), the transpersonal caring relationship characterizes a special kind of human care relationship that depends on:

*The nurse’s moral commitment in protecting and enhancing human dignity as well as the deeper/higher self.

*The nurse’s caring consciousness communicated to preserve and honor the embodied spirit, therefore, not reducing the person to the moral status of an object.

*The nurse’s caring consciousness and connection having the potential to heal since experience, perception, and intentional connection are taking place.

This relationship describes how the nurse goes beyond an objective assessment, showing concerns toward the person’s subjective and deeper meaning regarding their own health care situation. The nurse’s caring consciousness becomes essential for the connection and understanding of the other person’s perspective. This approach highlights the uniqueness of both the person and the nurse, and also the mutuality between the two individuals, which is fundamental to the relationship. As such, the one caring and the one cared-for, both connect in mutual search for meaning and wholeness, and perhaps for the spiritual transcendence of suffering (Watson, 2001). The term “transpersonal” means to go beyond one’s own ego and the here and now, as it allows one to reach deeper spiritual connections in promoting the patient’s comfort and

healing. Finally, the goal of a transpersonal caring relationship corresponds to protecting, enhancing, and preserving the person’s dignity, humanity, wholeness, and inner harmony.

CARING OCCASION/CARING MOMENT

According to Watson (1988b, 1999), a caring occasion is the moment (focal point in space and time) when the nurse and another person come together in such a way that an occasion for human caring is created. Both persons, with their unique phenomenal fields, have the possibility to come together in a human-to-human transaction. For Watson (1988b, 1999), a phenomenal field corresponds to the person’s frame of reference or the totality of human experience consisting of feelings, bodily sensations, thoughts, spiritual beliefs, goals, expectations, environmental considerations, and meanings of one’s perceptions—all of which are based upon one’s past life history, one’s present moment, and one’s imagined future.

Not simply a goal for the cared-for, Watson (1999) insists that the nurse, i.e., the caregiver, also needs to be aware of her own consciousness and authentic presence of being in a caring moment with her patient. Moreover, both the one cared-for and the one caring can be influenced by the caring moment through the choices and actions decided within the relationship, thereby, influencing and becoming part of their own life history. The caring occasion becomes “transpersonal” when “it allows for the presence of the spirit of both—then the event of the moment expands the limits of openness and has the ability to expand human capabilities” (Watson, 1999, pp. 116-117).

THE SEVEN ASSUMPTIONS

Watson proposes seven assumptions about the science of caring. The basic assumptions are: * Caring can be effectively demonstrated and practiced only interpersonally. * Caring consists of carative factors that result in the satisfaction of certain human needs. * Effective caring promotes health and individual or family growth. * Caring responses accept person not only as he or she is now but as what he or she may become.

* 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 a given point in time. * Caring is more “ healthogenic” than is curing. A science of caring is complementary to the science of curing. * The practice of caring is central to nursing.

WATSON’S THEORY AND THE FOUR MAJOR CONCEPTS

1. Human being * She adopts a view of the 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. He, human is viewed as greater than and different from, the sum of his or her parts”.

2. Health * Watson believes that there are other factors that are needed to be included in the WHO definition of health. She adds the following three elements: * 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 that leads its absence)

3. Environment/society * According to Watson caring (and nursing) has existed in every society. A caring attitude is not transmitted from generation to generation. It is transmitted by the culture of the profession as a unique way of coping with its environment.

4. Nursing * According to Watson “ nursing is concerned with promoting health, preventing illness, caring for the sick and restoring health”. * It focuses on health promotion and treatment of disease. She believes that holistic health care is central to the practice of caring in nursing. * She defines nursing as….. “A human science of persons and human health-illness experiences that are mediated by professional, personal, scientific, esthetic and ethical human transactions”.

Bibliography:

http://currentnursing.com/nursing_theory/Watson.html

http://en.wikipedia.org/wiki/Jean_Watson

http://www.nurses.info/nursing_theory_person_watson_jean.htm

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