The system of caring is undergoing several changes in modern society. Hospital care is changing and depends on the financial well-being of individuals and technological advancement. Professional nursing is an art and applied science. Nursing which is traditionally known as being a caring profession is also undergoing changes and has been replaced by a computerized system. Practicing as a Nurse in modern society can be both emotionally challenging and rewarding. Nursing involves the care of people throughout the continuum of life and provides an essential service to humankind.
In 1859, Florence Nightingale the founder of modern nursing expressed her meaning of nursing as “the goal of nursing is to put the patient in the best condition for nature to act upon him primarily by altering the environment” (top-career-resumes.com, 2005). While physicians take care of a patient’s physical well-being, nurses play important roles as consolers, comforters, and counselors. Patients are more comfortable sharing their true feelings with a nurse than their physicians. As a nurse provides care to patients 24 hours a day, 7 days a week, nurses are perhaps the best friend of a patient. This research intends to bring out a literature review on Jean Watson’s nursing theory and explain its implications for different disciplines in addition to nursing.
Watson (2002) has stated:
Caring, once glimpsed through empirical measures, whether they be qualitative or quantitative, may help us to see what has been long hidden from our public consciousness as well as our science. More specifically, the purposes for the use of formal measurement tools in nursing research on caring include:
- Continuous improvement of caring by using outcomes to improve practices through more mindful interventions
- Benchmarking structures and settings whereby caring is more manifest
- Tracking levels and models of caring in care settings against routine care practices
- Evaluating consequences of caring vs. non-caring for both nurses and patients
- Creating a “report card” model of a unit or an institution in a critical area of practice
- 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
- Empirically validating extant caring theories, as well as generating new theories of caring, caring relationships, and health practices
- Stimulating new directions for nursing, caring, and health sciences, including interdisciplinary/ transdisciplinary research.
There are several definitions for caring given by Watson. She attributes her significance on interpersonal qualities in Care to Rogerian theories (Bennett, Porter, & Sloan, 1989). Watson has always emphasized that nursing is about ‘transcendental’ relationships that nurse and patient develop, and therefore, the patient acknowledges the caring relationship. She explains that caring is not only physical but also embraces “the mind-body-spirit as it reclaims the embodied spirit as the focus of its attention…both art and aesthetics, of being as well as knowing and doing.” (Watson, 1999). In other words, she emphasizes the religious aspects of caring as mind-body-spirit is given prime importance.
The philosophical concepts of being and the importance of the relational aspects of nursing, which Watson explains, are foundational to the concept of caring (Watson, 1999, Watson & Smith, 2002). In her book entitled – Nursing: The philosophy and science of Caring, first published in 1979 Watson brought out ‘ten carative’ factors that were necessary to the perceptive of the science of Care.
The carative factors include factors such as “the formation of a humanisticaltruistic system of values, the installation of faith-hope, the cultivation of sensitivity to one’s self and to others, the gratification of human needs and the allowance for existential /phenomenological forces” (Watson, 1985). The most significant aspect is that Watson uses the phrase ‘science of caring’ again and again and emphasizes the science of the carative factors.
It is a multi-concept notion of ‘Care’ applicable in various fields such as education and not simply a single concept of compassion. In other words, Watson’s concept of caring is applied not only in the field of nursing but also in other fields such as animal caring, educational institutions, environmental stewardship, etc. In fact today clinical nurses and academic programs all over the world use Watson’s published works on the philosophy and theory of human caring and the art and science of caring in nursing.
Nutrition is one of the necessities in the fulfillment of human needs. Without going into any detail such a food group, balanced diets, and needs across the life span, Watson in the 13 pages has lucidly covered the need for food and fluid and is a remarkable outcome of nutrition. A skill to synthesize material from the sciences and apply these principles to the area of nutrition simply means that the need for long explanations about food and the patient is unnecessary (Watson, 1985).
Watson has given the great significance of the transpersonal and the need for transformation of the self that goes beyond time and space and has linked it to spiritual growth. In her book Philosophy and Science of Caring (1985) it is said that a suggestive theme of the significance of personal growth is in the carer. It is as it were a spiritual meeting that brings together the past and the present creating harmony and healing (Watson, 1999).
In the book entitled Caring Science as Sacred Science (2005) specifically meant for the postgraduate student and those interested in the Care paradigm, it is said that the combination of the science seems that science is used in a very general sense – and ‘art’ of nursing that is not used specifically is an interesting one. Increasing knowledge of caring cannot be understood, it is a philosophical ethical-epistemic endeavor that requires constant explanation and development of theory, philosophy, and ethics, along with diverse methods of caring inquiry that inform caring healing practices (Watson, 2005).
Watson has further developed the notion of intentionality and a caring healing consciousness into the area of noetic science that explores the nature and potentials of consciousness using multiple ways of knowing such as intuition, feeling reason, and the senses. In the model of Intentional Transpersonal Caring-Healing Watson describes a process by which “individuals maintain their ability to cultivate and manifest deep values, beliefs, and meaningfulness in the midst of suffering and disease.”
In this article, she describes the notion of being able to “cultivate” and “maintain” a caring attitude. According to Watson’s model, if a nurse is not caring, she is able to cultivate Care, and the Caring nurse is able to maintain a Care attitude. This is possible through a set of standard exercises which is given to help the nurse in cultivating an intentional caring consciousness and practice (Watson, 2002). Such kinds of practices can be linked to the field of personality development.
Love and caring are among the most essential components and shared humanity of nurse and patient. The idea of the Caring Moment is juxtaposed to a radiating field of cosmic love. Here the philosophical debate is deep and thought-provoking. The theoretical notion of transpersonal caring is summarized as being able to make a difference, the transformative power of caring, the circularity of caring, and the spirit energy of thought and choice. These “practicalities” of caring are not recent knowledge rather they include listening, being non-judgmental, and honoring each person (Watson, 2003).
Though there are several nursing theorists such as Tomey & Alligood who argue the bedside, home, and community environments and some touch on the cultural and spiritual aspects of nursing care, it is only Watson’s work on caring that drives all attention in its consideration of holism, human-ness, and spirit. To care holistically is to work with the whole mind, body, and spirit. In other words, the term coined by Watson, the “mindbodyspirit” of a person, a human is associated with the wider environment. Besides, Watson (1999) also recommends holistic nurses to learn the best way to restock their energy and attend to their need for “regular spiritual, contemplative, meditative centering practice”.
The human spiritual dimension is a significant part of the human self. Watson (1999) describes in her work in Postmodern nursing and beyond, the aim of “promoting a fully embodied spirit (in the personal, expanded notion of what being human means)” in nursing. Watson’s work portrays her vision of a future especially in the 21st century where people, by and large, will be more concerned in seeking inner knowledge, subjective, spiritual, and human knowledge and expanding the concept beyond science, of what it means to be fully human.
There are several other fields in which Watson’s concepts are used and have gained popularity. For instance, Galt, in her work on caring in the field of pharmacy, has recommended precise behaviors in the professional arena and the personal arena that could describe pharmacist caring (Galt, 2000). Caring behaviors could be “to act directly to fulfill any healthcare-related needs expressed by the patient” or even just “to pray for the patient.”
Theory of Human Caring, though it focuses on the human component of caring and the moment-to-moment encounters between the one giving care and the one cared for, it is also applicable to other fields. The theory consists of an explanation of transpersonal caring and a taxonomy of interventions referred to as carative factors. The deeper analysis of Watson’s work reveals that the theory is based on various fields of science such as metaphysical, spiritual-existential, and phenomenological orientation that links to Eastern philosophy.
This Eastern orientation of Watson’s theory becomes more understandable from the philosophical monism statement that Watson emphasizes, “Care and love are the most universal, the most tremendous, and the most mysterious of cosmic forces: they comprise the primal and universal psychic energy.” (Watson, 1985).
In other words, Watson views the nursing process as an innovative problem-solving process encompassing assessing, planning, intervening, and evaluating. She emphasizes that this process of caring requires the “full use of self and all domains of knowledge, including empirical, aesthetic, intuitive, effective, and ethical knowledge” (Watson, 1989).
In simple terms, Watson says that Western medicine has become too mechanistic and impersonal in today’s world. She stresses that the medical practice has overlooked the spiritual side of life at great cost to Western culture (Watson, 1985). Bringing back the spiritual side of life is part of the process of creating “… a philosophy of moral commitment toward protecting human dignity and preserving humanity.” (Watson, 1985).
Human beings are spiritual in nature and the soul is believed to be eternal. “The soul, then, exists for something larger, greater and more powerful than physical life as we know it…” (Watson, 1985). However, the problem with mankind is that we think we are just material, physical beings. This lack of awareness may create dissonance among the mind, body, and soul or between the person and the world. Such incongruence often leads to worry, hopelessness, sickness, and disease (Watson, 1985). “Illness is subjective turmoil or disharmony within a person’s inner self or soul… or disharmony in the mind, body, and soul…” (Watson, 1985).
Bennett, P. M., Porter, B. D., & Sloan, R. S. (1989). Jean Watson: Philosophy and Science of Caring. In Marriner-Tomey (Ed.), Nursing Theorists and Their Work (Second Edition ed., pp. 164-173). St Louis: C.V. Mosby Company.
Galt KA. (2000) The need to define ‘care’ in pharmaceutical care: An examination across research, practice and education. Am J Pharm Educ.;64: 223-233.
top-career-resumes.com, (2005) Nursing Jobs – Hot Employment Prospects for Nurses. Web.
Watson, J. (1985). Nursing. The philosophy and science of caring. Boulder: Colorado Associated University Press.
Watson, J. (1989). Transformative thinking and a caring curriculum. In E. O. Bevis & J. Watson (Eds.), Toward a caring curriculum: a new pedagogy for nurses. (pp. 51-61). New York: National League for Nursing.
Watson, J. (1999). Post modern nursing and beyond. London: Churchill Livingstone.
Watson, J. (2002). Assessing and measuring caring in nursing and health science. New York: Springer Publishing Company.
Watson, J. (2003). Love and Caring: Ethics of Face and Hand – An Invitation to Return to the Heart and Soul of Nursing and our Deep Humanity. Nurse Administration Quarterly, 27(3), 197-202.
Watson, J. (2005). Caring Science as Sacred Science. Philadelphia: F.A.DAVIS Company.
Watson, J., & Smith, M. C. (2002). Caring science and the science of unitary human beings: a trans-theoretical discourse for nursing knowledge development. Journal of Advanced Nursing, 37(5), 452-461.