Bishwajit Mazumder

Nursing Instructor
Dhaka Nursing College, Dhaka
E. mail: mbishwa@rocketmail.com
CHAPTER 1
INTRODUCTION
Jean Watsons theory of human caring was developed between 1975-1979
by Jean Watson, a distinguished professor of nursing at Colorado university(recipient
of the highest faculty award for scholarly work).Jean Watson is one of the few nursing
theorist who consider not only the cared but the caregiver. Caring does not just
physical care but also spiritual care.
Watson bases her theory for nursing practice on the following 10 carative
factors. Each has a dynamic phenomenological component that is relative to the
individuals involved in the relationship as encompassed by nursing. Watsons theory
continues to provide a useful and important metaphysical orientation for the delivery
of nursing care. It involves guiding and seeing that moves through being, knowing
and doing, and seeing that moves the personal through the professional(Watson,
1998).
Watson developed the carative factors from a humanistic philosophy that is
central to caring for others and is founded on a growing scientific base. These factors
provide a scientific-humanistic framework for the implementation of caring behaviors
and intervention in nursing education, practice, and research(Watson,1988).
Throughout this conducting seminar I have been realized
that this
transpersonal caring theory has important implications for future clinical nursing
practice, research, and education because of the integration of nursing theory and
nurse caring behaviors with environmental factors that positively affect patient
satisfaction.
Which leads to a greater sense of strength, power, and human capacity for
finding the meanings in existence and illness. I think this theory is very useful for all
nurses to provide quality nursing care as well as very helpful for developing research
based education and nursing practice in all over the world.

The framework
The human potential for self-healing and transcendence to higher levels of
consciousness informs Watson's vision for nursing, which is "to help persons gain a
higher degree of harmony" through a transpersonal caring relationship. She
characterizes this relationship as one of mutuality in which the whole nurse engages
with the whole client, each bringing her or his own experience and meaning to an
actual caring occasion. Watson values and attaches importance to both the nurse and
the client in the transpersonal caring relationship. The value and importance is both
the client's and the nurse's subjectivity. Human caring, according to Watson, is based
on human values such as "kindness, concern, and love of self and others." Watson's
carative factors focus on the transpersonal caring relationship. Carative factors relate
to interpersonal communication as the basis for the therapeutic relationship. One of
the nursing activities that the client and nurse may decide will be helpful for the client
in achieving health goals. The carative factor related to transpersonal teachinglearning. Although an understanding that the nurse and client both teach and learn
from each other is implicit in the label for this carative factor, teaching-learning is
concerned with enhancing a client's response to health concerns. Watson categorized
human needs in terms of biophysical needs such as food and fluids, elimination, and
ventilation; psychophysical needs such as activity, rest, and sexuality; psychosocial
needs such as achievement and affiliation; and intrapersonal-interpersonal needs such
as self-actualization.

Figure 4. Dynamics of Human Caring Process, Including Nurse-Patient

Transpersonal
Dimension. Illustration by Mel Gabel, University of Colorado,
Biomedical Communications
Department. Reprinted, with permission, from Watson (1985/1999).
The 5 concepts
- The Self: denotes the organized consistent conceptual gestalt composed
of perceptions of the characteristics of the I and me and the perceptions of the
relationships of the I and me to others and to various aspects of life, together with
the values attached to those perceptions. It is a fluid and changing gestalt, a process,
but at any moment a specific entity. Ones self is a process; an unending process
wherein new experience is turned into knowledge, each psychological moment shapes
the next psychological moment. In addition to the self as it is; there is an ideal self
that the person would to be. The highest sense of the self connotes the spiritual self,
the geist, soul, or the essence of the persons self with the potential forms of
consciousness entirely different from our walking consciousness (Watson, 1988)
- The phenomenal field is the individuals frame of reference that can be
known only to the person. It can never be known to another except through

empathetic inference and then can never be perfectly known. How a person
perceives and responds in a given situation depends upon the phenomenal field
(subjective reality) and not just upon the objective conditions or external reality
(Watson, 1988)
- An actual caring occasion of human care: is a focal point in space and
time from which experience and perception are taking place, but the actual occasion
of caring has a field of its own that is greater than the occasion itself. An actual caring
occasion involves action and choice both 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. It thereby
increase the range of certain events that could occur in space and time at the moment
as well as in the future. The moment of the caring occasion becomes part of the past
life history both persons and presents both with new opportunities (Watson, 1988)
- Transpersonal caring: Transpersonal caring seeks to connect with and
embrace the spirit or soul of the other through the process of caring and healing and
being in authentic relation, in the moment. The caring healing modalities within the
context of transpersonal caring consciousness potentiate harmony, wholeness. Unity
of being by releasing some of the disharmony the blocked energy that interferes with
the natural healing process; thus the nurse helps another through this process to access
the healing within in the fullest sense of Nightingales view of surviving (Watson,
1988)
- The Caritas processes: Caritas comes from the Greek work meaning to
cherish, to appreciate, to give special attention, if not loving attention. Caritas
process is an emerging model of transpersonal caring (Watson, 2007). This
integrative expanded perspective is both postmodern, in that it transcends
conventional industrial, static models of nursing, while simultaneously evoking both
the past and the future. Invites nurse to explore the intersection between personal and
professional; to translate their unique talents, interests, and gifts into human service of
caring and healing, for self and others
Caritas process is decidedly spiritual dimension and an overt evocation of love and
caring merge into a new paradigm for the next millennium.

CHAPTER 2
Application of the theory into clinical practice
1. The case study:
Mr. John

a 55-year-old

Caucasian man who will undergo his 5th

amputation. Gangrene has ravaged both feet and legs. And he has pain in agony of his
both leg. He is scheduled for an above knee amputation of his right leg, because the
last amputation did not heal properly. He was taken care by Mrs Ann during his past
hospitalizations, therefore she know him quite well, they connected right away after
their first meeting, he shared with her his life story. He knows her as a person, he
doesnt consider her as just an other nurse, she is his nurse, she care for him and she
is committed helping him through his ordeal
It is December 5th, Mrs. Ann welcome him as he is admitted onto the unit. He
returns a faint smile, he is depressed, due to part of his leg has to be amputated some
more. He lives alone, his wife died 2 years ago and his family lives out of state. While
she helps him settle in his room, she arrange his environment so that he can feel at
ease, she ask about himself, his feelings, and his priorities for his care plan and
hospitalization. As she install the bedpan delicately underneath him, he say to her,
Look at me, I cant even manage by myself anymore! I feel like a piece of meat in this
bed! Will this surgery work this time or is it a waste of time and money?. She is
troubled by his comment and ask him to clarify. He doubt that losing his legs also
made him lose this respect. He continues to say, if only you knew me back then,
when I was walking and working. Without my legs, I am no longer the same guy! He
thought distortion that losing his legs made him different. He self blame that he no
longer has social recognition and usefulness (Cara, 2003).

2. The nursing process:

Application The theory of Human caring to care of the case study

CHAPTER III
The strengths and weakness of the theory
1. The strengths of the theory:
+ This theory is significant to nurses in the development of a caring behavior.
+ It provides a systematic framework for nursing practice: We have used the
framework to assess the patient, make nursing diagnosis and after that give nursing
intervention.
+It specifies the relationship between human caring and nursing from which nursing
can take care of patients needs.
+ The idea of the theory is congruent with the concepts of enhancing health and
sustaining a helping-trusting for patient.
+ The concepts is clear and it helps to identify symptoms and help the patient
resolve them.
+ The theory focus is on interconnectedness of the patient and nurse. Nurses play a
vital role in patients life. Hence, it helps the nurse to understand the power
of human caring.

+ The concept of the theory is very broad therefore; nurses can

apply it to all fields of nursing and help nursing dynamics of the
caring process.
+ The theory provides a corrective mental, physical, societal, and
spiritual environment, which creates a healing environment at all
levels.
+The theory allowance for existential-phenomenological-spiritual
forces

which

results

to

opening

and

attending

to

spiritual-

mysterious.
+ The theory provides a humanistic-altruistic system of values,
resulting to the practice of loving-kindness and equanimity within
the context of caring consciousness.

2. The weakness of the theory:

+ The concepts of the theory are very broad: Some of the concepts seam
some how vague and at the same time overlapping which may
cause confusion.
+ The theory states that: mind and soul are not confined to the
physical universe. Therefore, difficult to apply in nursing practice.
+ Some concepts are too broad to practice; hence, the application
of the theory is very difficult especially for the novice.

CHAPTER IV

Recommendation for further application

- Watson theory mainly gives emphasis on mind- body and spirit, its fully depend on
humans mind and thinking for loving, kindness, sharing of individuals needs and
hopes. Watsons transpersonal caring process as mentioned about spiritual needs. We
know that, for a human being every person mostly dependent upon their religion and
their God. However, as the concepts of the theory is applied in a hypothetical case and
it is to serve academic purpose only, so it is not applicable for the same case in exact
fashion. Still then, it has pragmatic significance in application into our real field.
- Nurses maintain the environment (cleanliness, nourishment, light, sound, fresh air
etc.) to provide the optimal environment for patient to recover.

- Nurses step in and help patients provide for their own needs (eg. activities of daily
living) when the patient is unable to provide for those needs himself. As the patient
recovers, the patient does more and more of those things himself until he reaches the
point at which he can take care of himself.
- Understanding the culture of the patient (particularly related to health care practices,
dietary traditions, etc.) is integral to providing high quality patient care.
- Watson theory is really insightful about what a therapeutic nurse/patient relationship
can be and that great nursing is an art and a science.
- Continuous improvement of caring by using outcomes to improve practices through
more mindful interventions
- Identifying areas of weakness and strength in caring processes and interventions in
order to stimulate self-correction and models of excellence in practice
- Increasing our knowledge and understanding between caring relationships and
health and healing
- Stimulating new directions for nursing, caring, and health sciences.

CHAPTER V

Students learning experiences:

By application we have realized that everything in the universe is
connected and Watson theorys very necessary in our job. In our opinion, the life have
many issues to be resolved as jobs, money, disease, povertyThis problems arent
difficult to solve but the most difficult to solve that is the soul, spirit. Humans body is
confined in space and time but the mind and soul are not confined to the physical
universe and people can transcend the physical world. The goal of nursing is to help
persons gain a higher degree of harmony of the mind, body, and soul which generates
self-knowledge, self-reverence, self-healing, and self-care processes while allowing
increasing diversity. When we apply case study we know that everyone have to put
self on patients. The Watsons theory of caring emphasizes more on spirituality
domain. It has a wider scope of achieving wholesome and holistic care. Otherwise,

with only physical care will limit human to an object which is immoral and the care is
incomplete. Its application can be generalized beyond any bound of persons stand of
socio-economic status and illnesses. The experience gained from the theory is the
facts that health is unity and harmony within the mind, body and soul that is the
harmony I (self as Perceived) = ME (self as experienced) will not achieve by
excluding the spiritual component in the totality of care and consequently lead to I
ME= the illness. In this path, care is morally or ethically spelled for human caring
and this comes from the union of human spirit by engaging ones mind, body, and
soul (spirit) with another person. These transpersonal processes help in finding
meaning in illness, suffering and pain. This again helps in gaining self knowledge,
self control, self care, self healing and harmony in the universe as human self. This
theory of caring provides forum for interaction between nurse (care provider) and the
patient (care recipient), which in turn develop loving and compassionate practice in
the context of caring consciousness through spiritual transaction of the two human
self. The Watsons theory of human care explores the natural healing measure through
the essence of realization.
We will use clinical Caritas process application in the patients care. If a
people have problems about their health such as feel unhappy, disappointed, not want
to communicate with friends, family and social. We need to understand the clients
needs and have to listen, ask, touch, smileby showing clients great kindness, soft
voice, friendly smile, a thoughtful attitude ectIt can never be known to another
except through empathic inference, however, we can never be perfectly known about
clients. Therefore, if we try to learn clients phenomenal field by paying attention to
client, we can know about patients situation and we can help the patient improve
their life.

Conclusion
In conclusion, Watson theory focused on body, mind , spirit and soul to bring
harmony. The theory does not consider the cure a final objective, once it happens
transpersonally with the nurses self involved with the patients self , both aiming to

reach a state where mind , body, spirit can be one ,bringing the self healing process as
a result of care , not its main objective.
The clinical caritus process emerged from the theoretical search for nursing
care that would transcend the medical diagnosis, the disease where it happens, not to
limit the care to a physical body or a disease , but go behind , to transcends a material
and to active care plenitude.
While the nurse patient relationship provides the foundation for nursing, it
is fundamental component that remains the essence of what nursing and nursing
practice is all about. Patient are well aware of and able to articulate the types of
interaction they prefer to have nurses and the behaviors that specially convey caring
to them . As primary caregiver to the patients, nurses must be aware of the
significance of their interaction of the patients because the unlimited impact on a
patient outcomes. It is suggest that the empirically derived personalized nurse caring
theory be utilized by nurses and those interested in nursing to better understand,
develop and support this most scared relationship that occurs between a patient and
nurse.

References
George, J. B. (2002). Nursing Theories: The Base for Professional
Nursing Practice. Upper Saddle River, New Jersey.
Watson, J. (2007). Nursing: Human Science and Human Care A Theory
of Nursing. Sudbury: Jones and Bartlett Publishers.
Watson, J. (1988). Nursing: Human Science and Human Care A Theory
of Nursing. New York: National League for Nursing.
Alligood, M. R. (2010). Nursing Theory: Utilization & Application (4th
Eds). Missouri: Mosby Elsevier

Cara, C. (2003). A pragmatic view of Jean Watsons caring theory.

International Journal for Human Caring, 3, 51-61