Margaret Jean Watson (1979)
§ Theory of Human Caring
§ Education o Dr. Watson was born and raised in a small town in the
Appalachian Mountains of
West Virginia in the
1940’s o 1958-61
§ R.N. Diploma in Nursing
§ Lewis-Gale School of Nursing o 1962-64
§ B.S. in Nursing
§ University of Colorado o 1964-66
§ M.S. in Psychiatric Mental-Health Nursing; Minor Psychology
§ University of Colorado o 1969-70
§ Graduate Work: Social and Clinical Psychology
§ University of Colorado
o 1969-73
§ Ph.D. in Educational Psychology and Counseling § University of Colorado
§ Jean Watson, as many of you know, is a living legend and theorist. She was born in West
Virginia in the 1940’s and received most of her higher education in Colorado.
§ As shown here, she received her RN designation in her home town of Virginia in 1961, while her
Bachelor of Science in Nursing, Master of Science in in Mental-Health Nursing and PhD in
Educational Psychology and Counseling at the University of Colorado.
§ Accomplishments
o International Kellogg Fellowship in Australia o Fulbright
Research Award in Sweden o Six Honorary Doctoral
Degrees
o Including 3 International Honorary Doctorates (Sweden, UK,
Canada) o 1993 National League for Nursing Martha E.
Rogers Award
§ Listed here are many of her accomplishments of distinction, most of which were given for
recognition of her work in making significant contributions to nursing knowledge and the science
of care.
§ Some notable mentions include her six honorary doctoral degrees, three of which are
internationally recognized from Sweden, the UK and Canada.
o Her recent undertaking involves the Centre for Human Caring in Colorado, in which she
is the founder. Here, programs have been established to promote human caring activities
of nursing as a way to branch off from reductionist models of the biomedical approach.
o Dr. Watson founded and directs the non- profit Watson Caring Science Institute,
dedicated to furthering the work of caring, science, and heart-centered Carita‘s Nursing,
restoring caring and love for nurses’ and health-care clinicians’ healing practices
for self and others. o Distinguished Nurse Scholar, recognized by New York University
o Norman Cousins Award in 1999
o Recognition for her commitment to developing; maintaining and exemplifying
relationship-centered care practices
o Founder of the Centre for Human Caring in Colorado o Is a Fellow at the American
Academy of Nursing o Influences
o Her theories are influenced by the Eastern Philosophy viewpoint, seeing the body as a
whole unit, not a sum of parts. This idea links to previous theories to her time, including
those of Nightingale, Leininger and Paterson & Zderad. Because of her background in
psychology, theorists like Carl Rogers and Richard Lazarus also show some influence.
§ Theory of Human Caring o It is the Blueprint for nurses to restore the art of
nursing practice and better care for their patients and themselves
o Nursing has changed dramatically as science and medicine have adapted to meet the
growing demands of our population. It’s increasingly a skilled –based profession with
paper works to accomplish. However, it is important to remember the roots of nursing
which are based on caring and healing principles.
§ Watson’s Motivation for Developing Her Model:
o Education o
Life
Experiences o
Exploration of
Self
§ Major Elements of the Caring Theory o Carative factors, evolving into
Clinical Caritas Processes o Transpersonal Caring Relationships o Caring
occasion/Caring moment
§ Carative Factors o Guides the core of nursing
o Carative factors attempt to “honor the human dimensions of nursing’s work and the inner
life world and subjective experiences of the people we serve” (Watson, 1997, p. 50).
o Contrasts the curative factors of medicine (curative means to cure a disease) o Carative
factors evolve into Caritas factors
o Watson now makes connections between human caring, healing, and even peace in our
world, with nurses as caritas peacemakers when they are practicing human caring for self
and others. Caritas comes from the Latin word meaning “to cherish and appreciate,
giving special attention to, or loving
§ Ten Carative Factors
1. FORMATION OF A HUMANISTIC-ALTRUISTIC VALUE
SYSTEM. The value of altruism (regard for others as a personal action)
is learned at an early age. It is a value shared with parents. One's own life
experiences are learning opportunities to gain insights about dealing with
others. Caring based on humanistic values and altruistic behavior "can be
developed through examination of one's own views, beliefs, interactions
with various cultures and personal growth experiences." This
development is perceived necessary for the nurse's own maturation.
2. INSTALLATION OF FAITH-HOPE. This factor is deemed essential
to both carative and curative processes. To nurses, this provides a basis
for looking into the healing power of belief, or the spiritual dimension,
when curing is not possible. The use of Faith-Hope as a nursing
intervention allows nurses to explore alternative methods of healing, like
meditation. It seems that the goal for this activity is the provision of a
sense of wellbeing through belief systems that are meaningful to the
client.
3. CULTIVATION OF SENSITIVITY TO SELF AND OTHERS.
Nurses promote "health and higher level functioning only when they
perform person-to-person relationships as opposed to manipulative
relationships." There is a need for the nurse to develop and examine one's
own feelings. Through this process, increased sensitivity to others is
developed. The nurse becomes honest and promotes self-growth and self-
actualization. Watson's premise further states "that at the highest level of
nursing, the nurse's human care responses, human care transactions, and
presence in the relationship transcend the physical material world." The
explanation makes it clear that interactions between the nurse and the
client deal with the person's emotional and subjective world as a means
to learn the inner self
4. DEVELOPMENT OF A HELPING-TRUST RELATIONSHIP.
Communication, both verbal and nonverbal, is a mode of accomplishing
a helping-trust relationship to establish rapport and caring.
Characteristics common to this carative factor are congruence, empathy,
warmth and honesty. Positive acceptance of another is most often
expressed by body language, touch and tone of voice. I'm sure that given
your clinical experiences, you can think of many situations to relate to
this fourth carative factor.
5. PROMOTION AND ACCEPTANCE OF THE EXPRESSION OF
POSITIVE AND NEGATIVE FEELINGS. According to Watson, it is
important to facilitate awareness of both negative and positive feelings to
improve on one's level of awareness. Feelings need to be considered in a
caring environment. Being aware of both positive and negative feelings
leads to better understanding of behavior.
6. SYSTEMATIC USE OF THE SCIENTIFIC PROBLEM-SOLVING
METHOD FOR DECISION MAKING. This factor gives notice to the
limitations nurses have in assessing the issue of developing a scientific
base because most of our time is dedicated to the performance of nursing
tasks such as procedures and treatments. Thus, recognition is given to the
use of the systematic problem-solving method in building nursing
knowledge. In the same way, the argument extends to other methods of
knowing like utilizing research-based findings in order to improve
nursing practice and provide holistic care.
7. PROMOTION OF INTERPERSONAL TEACHING-LEARNING.
Through this factor, persons (clients) gain control over their own health
because it provides them with both information and alternatives.
Learning offers opportunities to individualize information dissemination.
The caring nurse focuses on the learning and teaching process, as well as
in understanding the client's perception of the situation. This provides for
a cognitive plan workable within the client's frame of reference.
8. PROVISIONS FOR A SUPPORTIVE, PROTECTIVE AND (OR)
CORRECTIVE MENTAL, PHYSICAL, SOCIOCULTURAL AND
SPIRITUAL ENVIRONMENT. There are two divisions or
categorizations relative to this factor: external variables which include
physical, safety and environmental factors; and internal variables which
refer to mental, spiritual or cultural activities which the nurse may
manipulate for the person's well-being. An interdependence exists
between internal and external factors since the person perceives the
situation in the environment as either threatening or non-threatening.
There are events in a person's life that can arouse a sense of threat. The
person appraises the situation and copes to the best of his ability. The
nurse's assessment capabilities can be valuable in helping the person
appraise the situation and cope with it. The nurse's intervention is aimed
at helping, the person develop a more accurate perception to help
strengthen coping capabilities. Provision of comfort, safety and privacy
are major aspects of this carative factor. A clean and esthetic
environment is considered a basic element. Esthetics is deemed essential
in the promotion of increased self-worth and dignity.
9. ASSISTANCE WITH THE GRATIFICATION OF HUMAN
NEEDS. The hierarchy of human needs is the essence of this carative
factor. It is grounded in a hierarchy of need similar to that of the
Maslow’s. Watsons 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.
10. ALLOWANCE FOR EXISTENTIAL-
PHENOMENOLOGICAL-SPIRITUAL 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 Carative Factors Evolve into Caritas Factors o Carative
§ Faith and hope
§ Helping-trusting, human care relationship
§ Creative problem-solving caring process
§ Expressing positive and negative feelings
§ Transpersonal teaching- learning o Caritas
§ Being authentically present and enabling the beliefs of the one being cared for
and the one giving care
§ Developing and maintaining a trusting, authentic, caring relationship
§ Creative use of self
§ Being present to and supporting the positive and negative feelings with a
connection of a deeper spirit
§ Engaging in genuine teaching-learning experience
§ Transpersonal Caring Relationship o Transpersonal means to go beyond one’s
own ego and reach a deeper spiritual connection while comforting a patient. o
The transpersonal relationship depends on:
§ A commitment from the nurse to enhance and protect human dignity
§ An awareness from the nurse that they have the ability to heal
§ The nurse must go beyond the objective role
§ To preserve and protect a person’s humanity, and dignity
§ Preserve a patient’s spirit to ensure the patient does not become an object o The
nurse’s caring and connection have potential to heal since experience, intention,
and perception are taking place. o Nursing goes beyond an objective assessment
and shows concern for the patient’s own healthcare
o Goal of transpersonal caring relationship protects, enhances, and preserves human dignity,
humanity, wholeness, and inner harmony
§ Caring Occasion/Caring Moment o Caring occasion is the moment when the nurse
and another person come together in such a way that an occasion for human caring is
created. Both persons come together in a human-human transaction. The one caring
for and the one being cared for are influenced by the choices and actions decided
within the relationship
o Watson (1998, 1999) stated that when human caring is created the nurse and
patient come together to create a moment, this is known as the caring
occasion/caring moment
o Watson (1999) feels as though the nurse and the patient must be aware of the
caring moment so as to make appropriate choices and actions, thereby the
nurse without knowing becomes a part of the patients “life history”
§ NURSING METAPARADIGM o Human Being
§ The person is to be valued, cared for, respected and viewed in a holistic way, as
body, mind and spirit o Environment
§ The person’s environment should be conducive to healing and that the person and
their environment are connected.
§ The person’s frame of reference is also something that should be considered, and the
nurse should strive to stay within the person’s frame of reference
§ 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. o Health
§ Health is viewed as overall functioning and distress and disharmony can be caused by
more than just disease processes
§ 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)
o Nursing
§ Watson argues that caring is central to the profession of nursing and that nursing
care should also focus on promoting health and preventing illness.
§ The nurse should focus their care on healing and wholeness as opposed to tasks,
illness and disease
§ How does the theory apply to our nursing practice?
o We agree with Watson and feel that the contact and the bond between two individuals is
the foundation of nursing. We provide this caring and z approach to promote holistic
health and prevent illness.
o A “good” nurse cannot be defined solely by her ability and skills but also by how well
she interacts with the client and family while providing that care.
§ CARING AS THE ESSENCE OF NURSING (JEAN WATSON, 1979) o Watson viewed
caring as the essence of nursing. Caring connotes responsiveness between the nurse and the
person. The nurse co-participates with the person. The purpose of caring is to assist the person in
gaining control and becoming knowledgeable, and in the process promote health changes. If we
have thought of the concept of empowerment while reading this, yes, we can say that it is similar
to that. By allowing the client to be knowledgeable, the nurse provides an environment for better
decision-making, better self-control and, better self-respect. The concept is common to Filipino
culture: “kakayahan" or "patibayin ang kakayahan," meaning assisting the person in gaining
control.
o While it is true that caring as an attribute in nursing has been described and clarified by
many others, there is uniqueness in Watson's science of caring. Basic assumptions for the
science of caring are supported by ten carative factors that provide structure to the
concept of caring. According to Watson, the first three carative factors provide the
philosophical foundation for the science of caring. The remaining seven carative factors
spring from the foundation laid by these first three.
§ Theory of Caring Applied
§ Carative factors used with postpartum women experiencing multiple emotions o Never pass
judgments, provide all patients with the same respect and level of care. o Instill hope in the
mothers that they will be able to care for their babies and return to their “normal” state of health.
o Discuss the patient’s perceptions and feelings towards their birthing/parenting
experiences.
o Provide a trusting relationship where the patient feels that you are committed to helping
them. Advocate for the patient. o Enable the patient to discuss positive and negative
feelings concerning her current healthcare/home situation.
o Use creativity during teaching opportunities and holistic treatments involving pain
management.
o Ensure that their environment is comfortable and enables them to get rest. Ensure that the
patient’s home environment is safe for mother and baby upon return.
o Help patients reach harmony (mind, body, spirit) through holistic and caring modalities.
Promote mother-infant bonding. Assess patient’s support system.
§ “Caring in the nursing profession takes place every time a nurse-to-patient contact is made... That
caring makes a difference to the patient’s sense of well-being. Caring may occur without curing
but curing cannot occur without caring”
§ Strengths & Weakness o S - Can be applied in any area of nursing
o S - Addresses all aspects of the health and illness continuum, and the concepts are
abstract and open to interpretation
o W- Lack of concrete guidelines è do not have specific steps
