Jean Watson’s theory of caring is of great value and essential to help guide nursing practice and evaluate care. The theory of caring is concerned with preventing illness, caring for the ill, and restoring health while promoting health through caring. The theory, which may seem complex at first, requires the simple act of caring. Caring for patients facilitates growth while a caring environment allows a patient to feel accepted (Sitzman & Watson, 2014). Watson’s theory of caring should be implemented to help guide daily practice and evaluate daily care. The theory of caring incorporates the concept that caring is the core of nursing and the nurse is the connection of caring for the patient. The nurse can create a caring and healing environment by being present and caring (Sitzman & Watson, 2014). In a time where patient care is shifting away from curative methods and shifting toward patient-centered care, this theory is of great importance. Nurses are treating the whole patient in patient-centered care. This care includes the mind, body and soul. The theory of caring has four major concepts: human being, health, environment and nursing. Human caring is the moral idea of nursing. The goal is to protect and enhance human dignity. As nurses, we commit to caring for patients while being mindful of the moment. Humans and the environment are connected, and unity and harmony must exist within the mind, body, and soul. Watson’s theory reminds nurses that their jobs as healthcare providers are not just to give medication and take vitals, but also to help real, living patients in their journey to healing while providing comfort. The theory suggests that we listen to patients while seeing the person, not the disease, paying attention to what they are doing moment to moment (Monsen, Le, Handler, & Dean, 2017).
Jean Watson’s Background and Contribution to Nursing
Dr. Jean Watson is a nurse, professor, theorist, developer and founder of the nonprofit Watson Caring Science Institute. She has been awarded many awards including the American Academy of Nursing’s Living Legend award. Born in West Virginia in the 1940s, she attended the University of Colorado where she earned her BSN of nursing and her Ph.D. in educational psychology and counseling. Her Theory of Human Caring was created between 1975 and 1979 but was first published in 1988. She has earned 10 honorary doctoral degrees and continues to work in mental health nursing and caring science. She has authored over 20 books about caring and her caring teachings are used by nurses and colleges all over the world. She continues to research human caring and loss. She developed the theory hoping that it would separate nursing science from medical science. Her goal in creating the theory was that it would unite a common ground from nurses all over the world.
The major influence on her career was her own need to develop a deeper understanding of the meaning of life and humanity. Philosophy, psychology, and nursing science had a huge influence on the development of her caring theory. In Jean Watson’s book The Philosophy and Science of Caring, she credits the development of the caring theory to bringing new meaning and dignity to nursing care (Watson, 2008). Watson’s continuation of the caring theory was based on two major life-changing events in her life. The first was an accident that resulted in the loss of her left eye. The second was the loss of her husband after 37 years of marriage. Both factors together led to the genesis of Watson’s theory.
Categorization and Assumptions of Caring Theory
Jean Watson’s theory of caring is considered a grand theory. Grand theories provide the framework under which principles for the nursing practice can be identified. Grand theories are more abstract and are not tested using empirical methods (McEwen & Wills, 2014). Grand theories ultimately provide knowledge and direction to help guide improvements to nursing practice. The theory continues to evolve as moving into a more digitally advanced nursing environment becomes more prevalent. However, the foundation of the theory, which is based on caring, will not change.
Jean Watson’s theory, in relation to the metaparadigm of nursing, focuses on the nurse-patient relationship. A metaparadigm in nursing is defined as a set of theories that address the holistic aspects of the patient, the patients’ health and well-being, the patients’ environment, and the nurse’s interventions and responsibilities (Parker & Tillerson, 2014). The four basic concepts of the nursing paradigm are interconnected and each one contributes to the healing of the patient, both physically and from within. When all aspects of the patient are treated as interconnected parts, this connection contributes to the overall or perceived health of the patient.
Watson’s theory provides the framework to reintroduce the art of genuine care back into nursing practice. The theory is based on formation of transpersonal relationships that should develop between the patient and the nurse (Petiprin, 2016). The transpersonal relationship encourages the nurse to view the patient without preconceived notions. It starts with a foundation of respect, dignity, empathy, and genuine concern for the patient. In this theory, the nurse also has a responsibility to preserve and protect one’s sense of spiritual, mental, and physical wellness. The theory of caring presents seven assumptions:
- Caring can only be effective if it is interpersonal.
- Caring consists of carative factors that result in the satisfaction of certain human needs.
- Effective caring seeks to promote health and growth. That growth can affect the individual or the family.
- Caring responses are given without judgement. Acceptance of the patient starts in their current state and includes what the patient may become.
- A caring environment does not hinder the potential for personal development, but it allows the individual to choose the best action for self at any given time.
- A science of caring should work in conjunction with the science of curing.
- Caring is the foundation of nursing practice.
Concepts of Caring Theory
The theory of caring focuses on eight central concepts. These concepts are the human being, health, nursing, actual caring occasion, transpersonal relationship, phenomenal field, self, and time. These concepts resemble humanistic theories, such as Roger’s person-centered approach and Mayeroff’s Ingredients of Caring theory, in which caring is used to foster growth and self-actualization In Watson’s theory, the human being is defined as being a valuable person who deserves caring, respect, and understanding. A person reaches optimal health when they achieve unity and harmony in mind, body, and spirit and feel that their perceived self matches their experienced self. Nursing is a humanistic science that focuses on persons and health-illness experiences. The human being and the nurse have actual caring occasions, which are intentional moments where the two parties come together to engage in a caring relationship. The transpersonal relationship is one in which the nurse affects the person and the nurse is affected by the person. Each person’s phenomenal field is comprised of an individual’s experiences of being in the world and can only be known by the individual. The self is the perception of characteristics related to self and the perception of self-defined characteristics in relationships with others and other aspects of the world. Present time is subjectively real and the past is objective since it has already happened. Past, present, and future incidents merge and fuse (McEwen & Wills, 2014).
There are 10 carative factors or caritas processes that are important to this theory. These processes are:
- Accepting self-less values and practicing loving kindness with self and others;
- Imparting faith and hope, and respecting the patient as they are;
- Being sensitive to self and others by nurturing individual beliefs and practices;
- Development of helping, trusting and caring relationships;
- Promoting and accepting both positive and negative feelings as an authentic listener;
- Using creative scientific problem-solving methods to implement caring theory;
- Teaching and learning methods that reflect the needs and comprehension level of the learner;
- Creating a healing environment that addresses both physical and spiritual needs while respecting human dignity;
- Assistance with basic human physical, emotional, and spiritual needs;
- Openness to mystery and allowing for miracles to enter.
These factors or processes are essential in creating the therapeutic transpersonal relationship between the nurse and patient. The processes emphasize the necessity of the nurse to not only use them in their patient relationships but also to treat themselves with kindness and to address their physical, emotional, and spiritual needs (Sitzman & Watson, 2014).
The propositions in caring theory revolve around different transpersonal concepts. The first relationship is the transpersonal caring field and its relationship to the unitary field of consciousness, which transcends boundaries of time, environment, and space. The transpersonal caring relationship is a spirit-to-spirit connection that happens during a caring occasion within the unitary field. This n can evolve into a caring moment if the nurse follows the caritas processes, is intentional in the interaction and if the patient feels the nurse is showing authentic personalized caring (Letourneau, et al., 2017).
Caring Theory in Practice
Watson’s theory has been applied in numerous studies. The subjects for this work are varied and include both patient-centered studies and caring theories as it relates to employee relations and theoretical framework for nursing care. Two specific studies are discussed below.
The Elmhurst Hospital Medical Center in New York has incorporated Watson’s Caring Theory into practice by having regular monthly staff meetings about the caring theory. Watson herself presented her theory to the hospital. The nurses at the hospital made a flag that symbolized the hospital’s commitment to caring. The hospital also subscribes to the CARE channel which brings soothing scenes and calming music to patient rooms. In addition, the hospital added a serenity room for staff and started offering yoga, meditation and exercise classes. Another study by Tektas and Olcay (2017) studied the effects of Watson’s caring theory on postpartum women who had suffered a pregnancy loss. The results of the study found that when caritas processes were implemented, the women scored lower on assessment of depression, anxiety, and helplessness. The holistic, respectful view of the patient and focus on creating caring moments is helpful for patients who are grieving a loss.
Integration of Caring Theory into Nursing Practice
Jean Watson’s theory of caring revolves around ten factors that concentrate on creating a foundation in nursing practice. These ten factors of care allow for staff to provide care and cherish patients. This, then, invokes the concept of interest on the basis of love. This concept also creates a harbor of healing for patients and one’s themselves.
In nursing practice, by using this theory, nurses incorporate love and care in both their professional and personal life. Through this form of nursing practice, nurses can provide life-giving care, while receiving life-long satisfaction. This integration and maturity of the nurse, past the present and future, will help the nurse transform himself, and those he serves, including his institution and the profession itself. Furthermore, Jean Watson’s theory of caring and nursing practice paints a picture where nurses view life with reverence and love. Through this viewpoint, nurses must reposition themselves to treat every patient with the same standard. The concept of nursing has incorporated Watson’s ten factors of care by acknowledging them as the core of transpersonal caring (Masters, 2013). As a result, there is a profound association between nurses and questions about theory, nursing, and life. This poses a challenge to practicing nurses to view themselves regarding the ten factors of care and to examine the relationship between personal and professional life, so that they may be able to provide care that incorporates their talents for the service of others.
Effect on Patient Outcomes
Jean Watson’s theory of caring provides a foundation that elaborates on the need to care for people based on kindness and openness. The theory also explains how there are various factors besides science that achieve the goals of nursing. Currently, many patients grumble that there is not enough concern about their illness and treatment and its impacts on the patient’s lifestyle. When providing the opportunity to take a medication for an illness, the patient might want to consider the negative and positive side effects, and after reviewing the potential complications, then the patient might want to proceed with the medication. Furthermore, instead of being told what to do, another patient with diabetes may want to discuss the lifestyle changes such as diet and exercise, taking income and feasibility into account. If the patient has a nurse who is caring, open, and mindful, then the patient will feel more comfortable to open up to discuss such topics. Additionally, the theory of caring also elaborates on the need for a nurse and patient to have a transpersonal connection, where the nurse takes interest in the needs of the patient. The nurse and patient must work together to establish mutual goals, rather than have the nurse impose goals on the patient (Cara, 2013). Since nursing care is viewed more through a subjective lens, nurses must ask open-ended and practical questions that can determine the patient’s state.
Dr. Jean Watson is a nurse, professor, theorist, developer and founder of the Watson Caring Institute. Her Theory of Caring is concerned with preventing illness, caring for the ill, and restoring health while promoting health through caring. Although caring is a simple concept it is not fully guiding current nursing practice. Most nurses are caring by nature. If the Theory of Caring was guiding practice, caring would need to be incorporated fully into the nursing practice. Patient treatment would need to be based on kindness and openness. Providing caring nursing would include speaking with the patient and involving the patient in decisions involving their care. This would include all decisions small to big. When the Caring Theory is guiding practice patients are more willing and open to following instructions. The Caring Theory produces happier patients. When the nurse builds a caring relationship with their patient the patient is more likely to trust the nurse. Patient trust results in positive patient outcomes.
Cara, Chantal. (2013). Continuing educ.: A pragmatic view of Jean Watson’s caring theory. International Journal for Human Caring, 7(3):51-61. Web.
Letourneau, D., Cara, C., & Goudreau, J. (2017). Humanizing nursing care: An analysis of caring theories through the lens of humanism. International Journal for Human Caring, 21(1), 32-40.
Masters, K. (2013). Role development in professional nursing practice. Sudbury, MA: Jones and Bartlett.
McEwen, M & Wills, E.M. (2014). Theoretical basis for nursing (4th ed). Philadelphia, PA: Wolters Kluwer Health.
Monsen, K.A., Le, S. M., Handler, H. E., & Dean, P.J. (2017). We can be more caring: A theory for enhancing the experience of being caring as an integral component of prelicensure nursing education. International Journal for Human Caring, 21(1),9-14.
Parker, R. M., & Lane-Tillerson, C. (2014). Watson’s caring theory and the care of a pediatric cancer patient. JOCEPS: The Journal of Chi Eta Phi Sorority, 58(1), 16-19.
Petiprin, Alice. (2016) Nursing Theory. Web.
Sitzman, K., & Watson, J. (2013). Caring science, mindful practice: Implementing Watson’s human caring theory. Web.
Tektas, K. & Olcay, C. (2017). The effects of nursing care based on Watson’s theory of human caring after a pregnancy loss. Archives of Psychiatric Nursing, 31(5), 440-446.
Watson, J. (2008). Nursing: The philosophy and science of caring revised edition (2nd ed.). Boston: Little, Brown, & Co.