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Introduction
In 1988, her theory was published in “nursing: human science and human care”.
Watson believes that the main focus in nursing is on carative factors. She believes
that for nurses to develop humanistic philosophies and value system, a strong liberal
arts background is necessary.
This philosophy and value system provide a solid foundation for the science of caring.
A humanistic value system thus under grids her construction of the science of caring.
She asserts that the caring stance that nursing has always held is being threatened
by the tasks and technology demands of the curative factors.
The seven assumptions
Watson proposes even assumptions about the science of caring. The basic assumptions are:
5. The promotion and acceptance of the expression of positive and negative feelings.
6. The systematic use of the scientific problem-solving method for decision making
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:
Congruence
Empathy
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”.
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”.
Watson’s theory and nursing process
Watson points out that nursing process contains the same steps as the scientific
research process. They both try to solve a problem. Both provide a framework for
decision making. Watson elaborates the two processes as:
1. Assessment
Involves observation, identification and review of the problem; use of applicable
knowledge in literature.
Also includes conceptual knowledge for the formulation and conceptualization of
framework.
Includes the formulation of hypothesis; defining variables that will be examined in
solving the problem.
2. Plan
It helps to determine how variables would be examined or measured; includes a
conceptual approach or design for problem solving. It determines what data would
be collected and how on whom.
3. Intervention
It is the direct action and implementation of the plan.
It includes the collection of the data.
4. Evaluation
Analysis of the data as well as the examination of the effects of interventions based
on the data. Includes the interpretation of the results, the degree to which positive
outcome has occurred and whether the result can be generalized.
It may also generate additional hypothesis or may even lead to the generation of a
nursing theory.
Watson’s work and the characteristic of a theory
According to Watson, “a theory is an imaginative grouping of knowledge, ideas and experiences that are
represented symbolically and seek to illuminate a given phenomenon”
She views nursing as,
“….both a human science and an art and as such it cannot be considered
qualitatively continuous with traditional, reductionistic, scientific methodology”.
She suggests that nursing might want to develop its own science that would not be
related to the traditional sciences but rather would develop its own concepts,
relationships and methodology.
Theories can interrelate concepts in such a way as to create a different way of looking
at a particular phenomenon
The basic assumptions for the science of caring in nursing and the ten carative factors
that form the structure for that concept is unique in Watson’s theory.
With these carative factors she delineates nursing from other professions
These carative factors are logically derived from the assumptions and related to he
hierarchy of needs.
Theories should be relatively simple yet generalizable
The theory is relatively simple as it does not use theories from other disciplines that
are familiar to nursing.
The theory is simple relatively but the fact that it de-emphasizes the
pathophysiological for the psychosocial diminishes its ability to be generalizable.
She discusses this in the preface of her book when she speaks of the “trim” and the
“core” of nursing.
She defines trim as the clinical focus, the procedure and the techniques.
The core of the nursing is that which is intrinsic to the nurse-client interaction that
produces a therapeutic result. Core mechanisms are the carative factors.
Theories can be the basis for hypotheses that can be tested
Watson’s theory is based on phenomenological studies that generally ask questions
rather than state hypotheses. Its purpose is to describe the phenomena, to analyze
and to gain an understanding.
Theories contribute to and assist in increasing the general body within the discipline
through research implemented to validate them
According to Watson the best method to test this theory is through field study.
An example is her work in the area of loss and caring that took place in Cundeelee,
Western Australia and involved a tribe of aborigines.
Theories can be utilized by practitioners to guide and improve their practice
The client is placed in the context of the family, the community and the culture.
It places the client as the focus of practice rather than the technology.
Limitations
Given the acuity of illness that leads to hospitalization, the short length stay , and the
increasing complex technology, such quality of care may be deemed impossible to
give in the hospital.
While Watson acknowledges the need for biophysical base to nursing, this area
receives little attention in her writings.
The ten caratiive factors primarily delineate the psychosocial needs of the person.
While the carative factors have a sound foundation based on other disciplines, they
need further research in nursing to demonstrate their application to practice.
Summary
Watson’s theory
Strengths
Limitations
Research related to Watson’s theory
Saint Joseph Hospital in Orange, California has selected Jean Watson’s theory of human caring as
the framework base for nursing practice.
The effectiveness of Watson's Caring Model on the quality of life and blood pressure of patients
with hypertension. J Adv Nurs. 2003 Jan;41(2):130-9.
This study demonstrated a relationship between care given according to Watson's Caring model
and increased quality of life of the patients with hypertension. Further, in those patients for
whom the caring model was practised, there was a relationship between the Caring model and a
decrease in patient's blood pressure. The Watson Caring Model is recommended as a guide to
nursing patients with hypertension, as one means of decreasing blood pressure and increase in
quality of life.
Martin, L. S. (1991). Using Watson’s theory to explore the dimensions of adult polycystic kidney
disease . ANNA Journal, 18, 403-406 .
Mullaney, J. A. B. (2000). The lived experience of using Watson’s actual caring occasions to treat
depressed women . Journal of Holistic Nursing, 18(2), 129-142
Martin, L. S. (1991). Using Watson’s theory to explore the dimensions of adult polycystic kidney
disease . ANNA Journal, 18, 403-406
Conclusion
Watson provides many useful concepts for the practice of nursing.
She ties together many theories commonly used in nursing education and does so in a manner
helpful to practioners of the art and science of nursing.
The detailed descriptions of the carative factors can give guidance to those who wish to employ
them in practice or research.
Using her theory can add a dimension to practice that is both satisfying and challenging.
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