JEAN WATSON'S TRANSPERSONAL CARE THEORY

The Theorist

Margaret Jean Watson

She was born in a small, close-knit town in the Appalachian Mountains of West Virginia in the 1940s. Jean Watson has claimed that her caring theory was developed while she was having a personal experience (Husbands Death) in her life. She molded her professional and personal life in order to develop her theory.

Education Graduated High School in West Virginia Graduated the Lewis Gale School of Nursing in 1961. Baccalaureate degree in Nursing from University of Colorado, Boulder Campus in 1964. Masters Degree in Psychiatric-Mental Health Nursing from University of Colorado, Health Sciences Campus in 1966. Doctorate in Educational Psychology and Counseling from the University of Colorado, Graduate School in 1973.

Employment Dr. Jean Watson is Distinguished Professor of Nursing and holds an endowed Chair in Caring Science at the University of Colorado Health Sciences Center. She is founder of the original Center for Human Caring in Colorado and is a Fellow of the American Academy of Nursing. She previously served as Dean of Nursing at the University Health Sciences Center and is a Past President of the National League for Nursing She is a widely published author and recipient of several awards and honors, including an international Kellogg Fellowship in Australia, a Fulbright Research Award in Sweden

and six (6) Honorary Doctoral Degrees, including 3 International Honorary Doctorates (Sweden, United Kingdom, Quebec, Canada). Published Writer o Nursing: The Philosophy and Science of Caring (1979, 1985) o Nursing: Human Science and Human Care A Nursing Theory (1985, 1988, 1999) o Postmodern Nursing and Beyond (1999)

Achievements Recipient of several awards and honors including: an international Kellogg Fellowship in Australia, a Fulbright Research Award in Sweden and six Honorary Doctoral Degrees, including 3 International Honorary Doctorates (Sweden, United Kingdom, and Quebec). She was the 1993 recipient of the National League for Nursing Martha E. Rogers Award, which recognizes a nurse scholar who has made significant contributions to nursing knowledge that advances the science of caring in nursing and health sciences. New York University recognized her as a Distinguished Nurse Scholar. In 1999, the Fetzer Institute honored her with the national Norman Cousins Award in recognition of her commitment to developing; maintaining and exemplifying relationship-centered care practices.

PHILOSOPHY AND SCIENCE OF CARING

The foundation of Jean Watsons theory of nursing was published in 1979 in nursing: The philosophy and science of caring 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: 1. 2. 3. 4. Caring can be effectively demonstrated and practiced only interpersonally. Caring consists of carative factors that result in the satisfaction of certain human needs. Effective caring promotes health and individual or family growth. Caring responses accept person not only as he or she is now but as what he or she may become. 5. 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. 6. Caring is more healthogenic than is curing. A science of caring is complementary to the science of curing. 7. The practice of caring is central to nursing. CARITAS Process Caritas comes from the Latin word meaning to cherish, to appreciate, to give special attention, if not loving, attention to; it connotes something that is very fine, that indeed is precious Invites nurse to explore the intersection between personal and professional

The Ten Primary Carative factors The structure for the science of caring is built upon ten carative factors. It was first developed in the year 1979. These are: 1. 2. 3. 4. 5. 6. 7. 8. The formation of a humanistic- altruistic system of values. The installation of faith-hope. The cultivation of sensitivity to ones self and to others. The development of a helping-trust relationship The promotion and acceptance of the expression of positive and negative feelings. The systematic use of the scientific problem-solving method for decision making The promotion of interpersonal teaching-learning. The provision for a supportive, protective and /or corrective mental, physical, sociocultural and spiritual environment. 9. Assistance with the gratification of human needs. 10. The allowance for existential-phenomenological forces.

As Jean developed her theory over time, she begin to change these carative factors into clinical caritas processes. These included: 1. Formation of humanistic-altruistic system of values, becomes: "Practice of loving-kindness and equanimity within context of caring consciousness 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 nurses own maturation which then promotes altruistic behavior towards others. 2. Instillation of faith-hope, becomes: "Being authentically present, and enabling and sustaining the deep belief system and subjective life world of self and one-being-cared- for"; It 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, becomes: "Cultivation of one's own spiritual practices and transpersonal self, going beyond ego self"; Explores the need of the nurse to begin to feel an emotion as it presents itself. Development of ones 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. Development of a helping-trusting, human caring relationship, becomes: "Developing and sustaining a helping-trusting, authentic caring 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. Promotion and acceptance of the expression of positive and negative feelings, becomes: "Being present to, and supportive of the expression of positive and negative feelings as a connection with deeper spirit of self and the one-beingcared-for"; According to Watson, feelings alter thoughts and behavior, and they need to be considered and allowed for in a caring relationship. According to her such expression improves ones level of awareness. Awareness of the feelings helps to understand the behavior it engenders.

6. Systematic use of a creative problem-solving caring process, becomes: "creative use of self and all ways of knowing as part of the caring process; to engage in artistry of caring-healing practices"; According to Watson, the scientific problem- solving method is the only method that allows for control and prediction, and that permits self-correction. She also values the relative nature of nursing and supports the need to examine and develop the other methods of knowing to provide an holistic perspective. The science of caring should not be always neutral and objective.

7. Promotion of transpersonal teaching-learning, becomes: "Engaging in genuine teaching-learning experience that attends to unity of being and meaning attempting to stay within other's frame of reference"; The caring nurse must focus on the learning process as much as the teaching process. Understanding the persons perception of the situation assist the nurse to prepare a cognitive plan. 8. Provision for a supportive, protective, and/or corrective mental, physical, societal, and spiritual environment, becomes: "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"; Watson divides these into eternal and internal variables, which the nurse manipulates in order to provide support and protection for the persons mental and physical well-being. The external and internal environments are interdependent. Watson suggests that the nurse also must provide comfort, privacy and safety as a part of this carative factor.

9. Assistance with gratification of human needs, becomes: "assisting with basic needs, with an intentional caring consciousness, administering human care essentials', which potentiate alignment of mind-body-spirit, wholeness, and unity of being in all aspects of care"; tending to both embodied spirit and evolving spiritual emergence; It is grounded in a hierarchy of need similar to that of the Maslows. She 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. Watsons ordering of needs

Lower order needs (biophysical needs) The need for food and fluid The need for elimination The need for ventilation Lower order needs (psychophysical needs) The need for activity-inactivity The need for sexuality Higher order needs (psychosocial needs) The need for achievement The need for affiliation Higher order need (intrapersonal-interpersonal need) The need for self-actualization

10. Allowance for existential-phenomenological-spiritual forces, becomes: "opening and attending to spiritual-mysterious, and existential dimensions of one's own life-death; soul care for self and the one-being-care-for. 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 first three carative factors form the philosophical foundation for the science of caring. The remaining seven carative factors spring from the foundation laid by these first three.

The Metaparadigm

1.

Human being

She adopts a view of the human being as: .. a valued person in and of him or herself to be cared for, respected, nurtured, understood and assisted; in general a philosophical view of a person as a fully functional integrated self. He, human is viewed as greater than and different from, the sum of his or her parts. 2. Health

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) 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.

Acceptance in the Nursing Community

1. Practice Watson is an eternal optimist, and she writes from a deep place about the personal as well as the sacred. The philosophy invites to explore ones curiosities about the origins of his/her call to care. Her writing encourages explorations of questions such as: What calls me to care? What is the root of my caring response? How will I respond? Why do I fail to respond? When is it hard to care? How will I sustain and nurture my caring consciousness? Who will care for me? 2. Education Watson defines her intent to describe the core (Nurse-patient interaction resulting to therapeutic communication) of nursing rather than the trim of nursing (the procedure, task and outcome). With the focus, the framework is not limited to any nursing specialty. Although she emphasizes that the trim are necessary, she believes that the trim cannot be the center of professional model of nursing care. 3. Research Patient outcomes in caring transactions are a potential are for studies. Research and practice shall focus both on subjective and objective patient outcomes to determine whether or not caring is indeed the truest essence of nursing.

Strengths
1. Besides assisting in providing the quality of care that client ought to receive, it also provides the soul satisfying care for which many nurses enter the profession. 2. As the science of caring ranges from the biophysical through the intrapersonal, each nurse becomes an active coparticipant in the clients struggle towards self-actualization. 3. The client is placed in the context of the family, the community and the culture. 4. It places the client as the focus of practice rather than the technology.

Limitations

1. 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. 2. While Watson acknowledges the need for biophysical base to nursing, this area receives little attention in her writings. 3. The ten caratiive factors primarily delineate the psychosocial needs of the person. 4. While the carative factors have a sound foundation based on other disciplines, they need further research in nursing to demonstrate their application to practice.

CASE STUDY

Rico Sandoval, a 39-year old truck driver is admitted to the hospital following an accident which caused the front of his truck to catch fire. He suffered from burns and was rushed to the ER, diagnosed with deep split- thickness and full thickness burns of the anterior chest, arms and hands. His vital signs are as follows: T: 96.2F; PR=140/min; BP=98/60. A rapid infusion of lactated ringers was started and he was also receiving 40% humidified oxygen via facial mask. Lung sounds indicate inspiratory and expiratory wheezing and a persistent cough reveals sooty sputum production. A foley catheter is inserted and initially drains a moderate amount of dark concentrated urine. He is alert and oriented but complains of severe pain associated with the burn injuries.

Analysis: 1. How the client assessment structured? 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. Assessment phase is a opportunity for Formation of a Humanistic-altruistic system of values, Instillation of faith-hope, Cultivation of sensitivity to one's self and to others and Development of a helping-trusting, human caring relationship Watsons theory of caring insists that a holistic approach, assessment may include the social history of the patient, as it allows the interviewer to understand a more complete approach to the patients care. The environment in which patient lives as well as his habits within that environment, help to provide a more complete and potentially more successful plan of care. Watson elaborates assessment as for him, it involves observation, identification and review of the problem; use of applicable knowledge in literature. 2. How the client data is analyzed? Watsons theory analyze data by the formulation of hypothesis; defining variables that will be examined in solving the problem.

Formulation of Nursing Diagnosis such as Ineffective Airway Clearance r/t brochial secretions, Fluid Volume Deficit r/t active volume loss, Risk For Infection r/t Inadequate Primary defense and Pain r/t tissue injury.

3. How the client needs are labeled? Watson indicates that needs are interrelated. The science of caring suggests that the nurse recognize and assist with each of the interrelated needs in order to reach the highest order need of self-actualization. Watsons ordering of needs Higher order needs (psychosocial needs) The need for achievement The need for affiliation

Higher order need (intrapersonal-interpersonal need) The need for self-actualization

Lower order needs (psychophysical needs) The need for activity The need for sexuality

Lower order needs (biophysical needs) The need for food and fluid The need for elimination The need for ventilation

4. How is care planned and delivered? Watson elaborated that planning includes a conceptual approach or design for problem solving. It determines what data would be collected and how on whom. Provision for a supportive, protective, and/or corrective mental, physical, societal, and spiritual environment

Promoting interpersonal teaching-learning Assistance with gratification of human needs

5. How is client response/care evaluated? According to Watson, evaluation includes 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. Watson believes that harmony of Body , mind, and spirit of the caregiver and the patient is one of the greatest outcome of care.

REFERENCES Timber BK. Fundamental skills and concepts in Patient Care, 7th edition, LWW, N Theoretical Foundations of Nursing by Carl Balita, et al. George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton & Lange. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia, Lippincott. Internet Resources http://www.watsoncaringscience.org/ http://www.nursing.ucdenver.edu/faculty/caring.htm ghs.org/uploadedFiles/.../Nursing/Watsons_Theory_of_Caring0806[1].pdf www.humancaring.org/conted/Pragmatic View.pdf Video clips http://www.youtube.com/watch?v=E-gj-Vk1JZk http://www.youtube.com/watch?v=hLRDpQ3x7KQ http://www.youtube.com/watch?v=29fdVOqraQs