MARGARET JEAN WATSON

“Caring in nursing conveys physical acts, but embraces the mind-body-spirit as it reclaims the
embodied spirit as its focus of attention.”
 Philosophy and Science of Caring
 It addresses how nurse care for their patients, and how that caring translates into better health
plan to help patients get healthy.
 Metaparadigm in Nursing:
A. Person
 Human being is a valued person in and of him to be cared for, respected, nurtured, understood
and assisted.
 It is a philosophical view of a person as a fully functional integrated self.
 Describes person as a being-in-the-world who holds three spheres of being – mind, body & spirit –
that are influenced by the concept of self and who is unique and free to make choices.
B. Health
 Refers to the unity and harmony within the mind, body and soul. Also associated with the degree
of congruence between self as perceived and as experienced.
 In addition to WHO’s definition, she includes 3 elements:
1. A high level of over-all physical, mental and social functioning.
2. A general adaptive-maintenance level of daily functioning.
3. The absence of illness (or the presence of efforts that lead to its absence).
C. Environment
 Provides the values that determine how one should behave and what goals one should strive
toward.
 Thus, “Caring (and nursing) has existed in every society. Every society has some people who have
cared for others. A caring attitude is not transmitted form generation by genes. It is transmitted by
the culture of the profession as a unique way of coping with its environment.
D. Nursing
 A human science of people and human health-illness experiences that are mediated by
professional, personal, scientific, aesthetic and ethical human care transactions.
 Major Elements of Watson’s Theory
1. The Carative Factors
 Guides the core of nursing. Derived from humanistic perspective combined with scientific
knowledge base.
 It honors the human dimensions of nursing’s work and the inner life world and subjective
experiences of the people we serve.
 Comprised of 10 elements. Since the initial publication of the theory, the factors have evolved
into what are now described as the 10 caritas processes that include a decidedly spiritual
dimension and overt evocation of love & caring (Watson, 2008). One essential shift from
carative to caritas is the explication of Caritas Consciousness, defined as “an awareness and
intentionality” that forms the foundation for the caritas nurse (Watson, 2008, p. 43)
 The 10 Caritas Processes
1) Practice of loving kindness & equanimity toward self and other within context of (caring
consciousness) caritas consciousness.
*Formation of a humanistic-altruistic system of values – refer to the satisfaction one gets
through giving & extension of the sense of self. These values are learned early in life but
can be influenced by nurse educators or mediated through one’s own life experiences, the
learning one gains and exposure to the humanities.
2) Being authentically present, enabling, sustaining, and honoring the faith, hope and deep
belief system and the inner-subjective world of self / other.
*Instillation of faith & hope – it describes the nurse’s role in helping the patient adopt
health-seeking behaviors through wellness promotion. Is essential to both the carative &
curative processes. When modern science has nothing more 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 one’s own spiritual practices and transpersonal self, going beyond ego self,
opening to others with sensitivity & compassion.
*Cultivation of sensitivity to one’s self and others – refers to the recognition of feelings
that lead to self-actualization through self-acceptance. As nurses become more aware of

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 and acknowledge their feelings and sensitivity, they become more authentic, true &
sensitive to the needs of patients. The nurses promote health and higher level functioning
only when they form person-to-person relationship.
4) Developing and sustaining a helping-trusting, authentic caring relationship.
*Development of a helping-trusting, human caring relationship – ensures promotion of
acceptance of the extension of both positive and negative feelings. It involves empathy,
congruence, non-possessive warmth and effective communication. Communication
includes verbal, nonverbal & listening in a manner which connotes empathetic
understanding.
5) Being present to, and supportive of, the expression of positive and negative feelings as a
connection with deeper spirit of self and the one-being-cared for.
*Promotion and acceptance of the expression of positive & negative feelings – is a risk-
taking experience for both the nurse & the patient. It is a must for a nurse to appreciate
differences in individual intellectual and emotional understandings of a situation.
6) Creative use of self and all ways of knowing as part of the caring process to engage in
artistry of caring-healing practices / caritas.
*Systematic use of a creative problem-solving caring process – this highlights the
importance of the nursing process in the provision of holistic nursing care to patients.
7) Engaging in genuine teaching-learning experience that attends to unity of being and
meaning, attempting to stay within others’ frames of reference.
*Promotion of transpersonal teaching –learning – differentiates the caring aspect of
nursing from the curing dimension. It entails informing the patient and empowering him
for wellness and health.
8) Creating healing environment at all levels (physical as well as non-physical), subtle
environment of energy and consciousness, whereby wholeness, beauty, comfort, dignity
and peace are potentiated.
*Provision for supportive, protective, and corrective mental, physical, societal and spiritual
environment – highlights the importance of internal & external environments on the
health & illness of man. Watson suggests that the nurse must also provide comfort, privacy
and safety as part of this carative factor.
9) Assisting with basic needs, with an intentional caring consciousness, administering “human
care essentials”, which potentiate alignment of mindbodyspirit, wholeness, and unity of
being in all aspects of care; tending to both the embodied spirit and evolving spiritual
emergence.
*Assistance with the gratification of human needs – describes the role of the nurse in
promoting wellness & health through the achievement of basic human needs according
the Maslow’s hierarchy of needs.
10) Opening and attending to spiritual---mysterious and existential dimensions of one’s own
life-death; soul care for self and the one-being-cared-for (Watson, 2001, p. 347).
*Allowance for existential-phenomenological-spiritual forces – refers to the understanding
of a phenomena of human existence by providing thought-provoking experiences that lead
to a better understanding of the self & others. The nurse assists the person to find the
strength or courage to confront life or death.
Phenomenology – a way of understanding people from the way things appear to them, for
their frame of reference.
Existential psychology – study of human existence using phenomenological analysis.

 The concept of clinical caritas processes was introduced replacing the carative factors.
“Caritas” Greek vocabulary meaning to cherish and to give special loving attention.
 Watson considers this process the most difficult to understand and can be best understood
through her own words: “Our rational minds and modern science do not have all the answers
to life and death and all the human conditions we face: thus we have to open to unknowns we
cannot control, even allowing for what we may consider a “miracle” to enter our life and work.
This process also acknowledges that the subjective world of the inner-life experiences of self
and other is ultimately a phenomenon an ineffable mystery, affected by many, many factors
that can never be fully explained.”

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 2. Transpersonal Caring Relationship
 Characterizes a special kind of human care relationship which depends on:
a) The nurse’s moral commitment in protecting & enhancing human dignity as well as the
deeper/higher self.
b) 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.
c) The nurse’s caring consciousness and connection having the potential to heal since
experience, perception and intentional connections are taking place.
 Transpersonal means to go beyond one’s own ego and the here & now, as it allows one to
reach deeper spiritual connections in promoting the patient’s comfort & healing.
 Goal is to protect, enhance and preserve the person’s dignity, humanity, wholeness and inner
harmony.

3. Caring Occasion
 The moment when the nurse and another person come together in such a way that an
occasion for human caring is created.

 In the science of caring, Watson proposed 7 assumptions:

1. Caring can be effectively demonstrated and practiced only interpersonally.
2. Effective caring promotes health and individual or family growth.
3. Caring responses accept a person not only as he or she is now but as what he or she may become.
4. 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.
5. Caring is more “healthogenic” that is curing. The practice of caring integrates biophysical
knowledge with knowledge of human behavior to generate or promote health and to provide care
to those who are ill. A science of caring is therefore complimentary to the science of curing.
6. The practice of caring is central to nursing.
7. Focus of nursing is on the carative factors.