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Jean Watsons theory of caring science, with the concepts of transpersonal caring relationship,
caring moment, and the 10 carative factors, is strongly based on sincerity, genuineness, love,
and humanistic values as her efforts to bring the world of nursing to its roots. This theory is
widely integrated in nursing curriculum, being applied in clinical settings to monitor caring
behaviors of staffs as well as to improve the quality of care, and being developed through
studies. This paper aims to provide historical biography of the theorist, description and
critique of the theory, as well as to determine its implication in nursing community. The
opportunity for this theory to be applied in Indonesia is also provided.
Keywords: Jean Watsons theory, caring science
quantum physics, wisdom traditions, perennial philosophy, and Buddhism. Her work was
influenced by some nursing theorists, such as Nightingale, Henderson, Leininger, Peplau,
Rogers, Newman, and also by the work of Gadow, a nursing philosopher and health care
ethicist.
From Nightingale, Watson connected the sense of deep commitment and calling
(which answers the question, 'what calls us to care?') to an ethic of human service. She agreed
on Carl Rogers' phenomenological approach that nurses are not there to manipulate and
control but rather to understand, as mostly influential thought at the time when therapeutic
control and manipulation of the patient are considered as norm (Alligood, 2014).
In her first book entitled "Nursing: The Philosophy and Science of Caring", Watson
originally intended to formulate an integrated bachelor nursing curriculum, but instead she
developed carative factors which according to her the core of nursing (Sourial, 1996). In her
fifth book "Caring Science as Sacred Science", Watson emphasizes for nurses to have deep
inner reflection and personal growth, communication skills, and use of self-transpersonal
growth. She also invites nurses to sustain and deepen own and others' humanity as moral and
ethical starting point for professional caring (Watson, 2012). Therefore, any technical skills
commonly aimed at cure are reframed as sacred acts conducted with a caring consciousness
and completed in a way that respects the person as embodied spirit (McEwen & Wills, 2007).
Purpose
The purpose of the theory is to address some of the philosophical, conceptual and
empirical problems that confront nursing, to clarify the human care process in nursing, and to
maintain the concept of person in nursing (Cohen, 1991).
Concepts and Definitions
WATSONS THEORY OF CARING SCIENCE
WATSONS
THEORY
OF
CARING SCIENCE
ideal of nursing
that has
interpersonal
and humanities qualities without setting aside the
importance of empirical factors in knowledge and skills. She defined caring science as an
evolving philosophical-ethical-epistemic field of study, grounded in the discipline of nursing,
which reintroduces spirit and sacred dimensions back into nurses' work, and allows for
unification between metaphysics and the material-physical world of modern science (Watson,
2012).
Watson's main concepts of caring science include transpersonal caring relationship,
caring occasion/caring moment and the 10 carative factors. Transpersonal caring relationship,
as described by Watson, is a "special kind of human care relationship, a spiritual union
between two people, which highly respects for the whole person and their being-in-theworld" (Alligood, 2014). In the transpersonal caring relationship, the nurse enters into
another person's experiences, and another can enter into the nurse's experiences.
The caring occasion/caring moment can be an existential turning point for the nurse
for choosing to "see" the patient. It is an informed action guided by an intentionality and
consciousness of how to "really present" in the moment. In a caring occasion/caring moment,
the nurse "read" the field, beyond the outer appearance of the patient and the patient's
behavior.
The 10 carative factors are considered as the essential aspects of caring in nursing,
which guide nurses to practice professionally instead of functioning as technicians or
medical-skilled workers. Carative means caring with love, which is a deeper and expanded
dimension of nursing (McEwen & Wills, 2007). Watson then broadened the carative factors
to a closely related concept, caritas (a word derived from Latin that means "to cherish, to
appreciate, to give special attention"). She provided a translation, more fluid language of the
original carative factors into clinical caritas processes which allow nurse practitioners to use
WATSONS THEORY
OFof
CARING
straightforward
elicitation
love andSCIENCE
caring. The original 10 carative factors are as stated
WATSONS
THEORY
OFreal,
CARING
communications),
being
honest,SCIENCE
genuine, and authentic.
Promoting and accepting the expression of positive and negative feelings and
emotions. The caring relationship can go deeper, more honest and authentic if nurses allow
themselves to focus on feelings and emotional aspects of an event during the caring process.
It can be achieved through listening to another person's story and honoring another person's
feeling. It may be the nurse who is the only one who listens to and honors anothers story and
all the feelings that come up with it. Indeed, sharing of feelings is a risk-taking experience for
both nurse and patient. By doing so, the nurse must be prepared for either positive or negative
feelings.
Systematic use of the scientific problem-solving method for decision making.
Nursing process is a systematic, creative problem-solving method in dealing with patients'
response to illness. Being creative means involving all knowledge, instincts, intuition,
aesthetics, technology, skills, empirics, ethics, personal, and even spiritual knowing.
Transpersonal teaching-learning. Nursing is about caring, which is a separate
WATSONS
OFresponsibility
CARING SCIENCE
concept
fromTHEORY
curing. The
to achieve and maintain health and wellness is on the7
patient. The nurse has a role to facilitate with teaching-learning techniques that are designed
to enable patients to provide self-care, determine personal needs, and provide opportunities
for their personal growth. Things to keep in mind are that "teaching" is not merely conveying
information, and "learning" is not merely receiving information and data from the patient, but
it involves caring relationship as a context, that nurse should work from the patients frame of
reference, grasping the meaning and significance of the information for the person, as well as
the readiness of the patient to be the best teacher for themselves.
Provision of supportive, protective, and/or corrective mental, physical, societal,
and spiritual environment. Internal and external environments have influence on health and
Caritas Processes
Practice of loving-kindness and equanimity
within the context of caring consciousness
Transpersonal teaching-learning
Watson (as cited in McEwen & Wills, 2007) described metaparadigm concepts of
nursing (person, health, environment, and nursing) as stated below.
Person. Person is viewed holistically wherein the body, mind, and soul are
interrelated; each part is a reflection of the whole, yet the whole is greater than and different
from the sum of the parts.
10
increased possibility; which is a process of adapting, coping, and growing throughout life.
Disease is associated with disharmony between body, mind, and soul or disharmony between
the person and nature; which makes the person less open to diversity.
Environment. Environment is defined as a healing space, a sacred space in which
there is conscious promotion of the wholeness between the body, mind, and soul; instead of
simply a place for bodies to be treated.
Nursing. Nursing consists of knowledge, thought, values, philosophy, commitment,
and action; with some degree of passion. Nursing's goal is using caring moment to help
person to gain a higher degree of harmony within the body, mind, and soul; which generates
self-knowledge, self-reference, self-healing, and self-care processes while allowing for
diversity and possibility.
Relationships
Watson linked her concepts by the relational proposition that states "transpersonal
caring relationship is the full actualisation of the carative factors in a human-to-human
transaction". She also argued that if transpersonal caring relationship can be established, "the
patient is better able to have a release of some of the disharmony of the body, mind, and soul
and be able to release pent-up energy for his or her own healing process" (Sourial, 1996). The
goal of nursing, as defined in metaparadigm concepts, is achieved through transpersonal
caring relationship (McCance, McKenna, & Boore, 1999).
The caring occasion/caring moment becomes transpersonal when "two persons (nurse
and patient) together with their unique life histories and perceptions able to see and connect
with the spirit of others, becomes part of the life history of both persons, involves learning of
2012).
Structure
12
Simplicity
Some scholars find that Watson's theory is easy to understand and to apply in practice,
because Watson draws on a number of disciplines, which she feels are familiar to nurses, to
formulate her theory (Alligood, 2014). But some others consider her theory complex. It is not
unusual because nurses may not have all of the liberal arts background to provide the
foundation for understanding some of Watson's principles (McCance et al., 1999).
Generality
Watson's theory is classified into grand nursing theory since the scope of the
framework encompassess broad aspects of health-illness phenomena. The theory is global
and abstract and therefore it is not unusual to find unclear linkages between concepts.
Watson's theory allows to develop from it more middle-range theories, especially with respect
to the 10 carative factors (Cohen, 1991).
Accessibility
Since Watson's theory is derived from many disciplines and it utilizes terms or
concepts that are not immediately familiar to many nurses, an understanding of Eastern
philosophy and/or phenomenology is almost required before the model could be utilized. In
spite of this, this theory has broad applicability. It addressess the core of nursing (therapeutic
nurse-patient relationship), not the trim of nursing (procedure, tasks, technique), and applies
to all aspects of health and illness (Cohen, 1991). The theory was found to be applicable to
nurses and patients in all settings including both ambulatory and acute care, at all phases of
development (Caruso, Cisar, & Pipe, 2008). Despite being developed for individuals,
Watson's theory is proposed as a nursing framework that is philosophically congruent with
contemporary global approaches to community health and health promotion (Rafael, 2000).
WATSONS
THEORY
OF that
CARING
SCIENCE
13
although Watson
suggests
a combination
of qualitative-quantitative study may be useful
(Alligood, 2014).
Importance
Watson's theory is derived from many disciplines, therefore it provides a very useful
metaphysical, philosophical and spiritual dimension to nursing. Her 10 carative factors
provide a framework by which nursing can redeem itself from a curative role and highlight its
distinctive caring role. This theory incorporates important aspects of patient safety, as well as
gives attention to nurses to care for themselves (Caruso et al., 2008). With respect to
education, this theory stresses the importance of the role of humanities, spirituality, and art as
the vital part in nursing education curricula (Cohen, 1991).
Implementation of the Theory
WATSONS
Practice THEORY OF CARING SCIENCE
14
Watson's theory can help nurse practitioner to look back on his or her lived experience
that accumulates and gathers interpretive significance as it is remembered; and help to
establish and maintain future caring relations by answering these kind of questions (McEwen
& Wills, 2007): 1) What health event brings this person to health facility?; 2) What
information do I need to know in taking care of this person?; 3) Can I find new ways of
caring?; 4) Can I encourage to find hope?; 5) How can I enter this person's private space?; 6)
What specific forms of caring will best acknowledge, affirm, and sustain?; 7) How can I
enable this person to express his or her concern?; 8) How must this person be feeling?; 9)
What is the uniqueness of this person?; 10) How has this event affected his or her life pattern
and role?
Watsons theory has been validated in outpatient, inpatient, and community health
clinical settings with various populations. A model called "Attending Nurse Caring Model
References
WATSONS
CARING
SCIENCE
Alligood, M.THEORY
R. (2014).OF
Nursing
theorists
and their work. St. Louis: Mosby Elsevier.
20
Caruso, E. M., Cisar, N., & Pipe, T. (2008). Creating a healing environment: An innovative
educational approach for adopting Jean Watson's Theory of Human Caring. Nursing
Administration Quarterly, 32(2), 126-132.
Chinn, P. L., & Kramer, M. K. (2008). Integrated theory and knowledge development in
nursing: Mosby Elsevier St. Louis^ eMissouri Missouri.
Cohen, J. A. (1991). Two portraits of caring: a comparison of the artists, Leininger and
Watson. Journal of Advanced Nursing, 16(8), 899-909.
Cossette, S., Cote, J. K., Pepin, J., Ricard, N., & D'Aoust, L-X. (2006). A dimensional
structure of nursepatient interactions from a caring perspective: refinement of the
Caring NursePatient Interaction Scale (CNPI-Short Scale). Journal of Advanced
Nursing 55(2), 198214
Cossette, S., Pepin, J., Cote, J. K., & de Courval, F. P. (2008). The multidimensionality of
caring: a confirmatory factor analysis of the Caring NursePatient Interaction Short
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21
(2014).
Dr.
Jean
Watson.
Retrieved
http://watsoncaringscience.org/about-us/jean-bio/
December
2,
2014,
from