Jean Watson's Philosophy of Nursing

Introduction
y y y y

y

y

y y y y

y y y

Born: West Virginia Educated: BSN, University of Colorado, 1964, MS, University of Colorado, 1966, PhD, University of Colorado, 1973 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 Dr. Watson has earned undergraduate and graduate degrees in nursing and psychiatric-mental health nursing and holds her PhD in educational psychology and counseling. 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). Her research has been in the area of human caring and loss. The foundation of Jean Watson¶s theory of nursing was published in 1979 in nursing: ³The philosophy and science of caring´ In 1988, her theory was published in ³nursing: 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:
y y y y y y y

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. 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. Caring is more ³ healthogenic´ than is curing. A science of caring is complementary to the science of curing. The practice of caring is central to nursing.

The ten primary carative factors The structure for the science of caring is built upon ten carative factors. 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 one¶s 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.

The first three carative factors form the ³philosophical foundation´ for the science of caring. The remaining seven carative factors spring from the foundation laid by these first three. 1. The formation of a humanistic- altruistic system of values
y y y

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 nurse¶s own maturation which then promotes altruistic behavior towards others.

2. Faith-hope
y y

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
y y y

y

Explores the need of the nurse to begin to feel an emotion as it presents itself. Development of one¶s own feeling is needed to interact genuinely and sensitively with others. Striving to become sensitive, makes the nurse more authentic, which encourages selfgrowth 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. Establishing a helping-trust relationship
y

Strongest tool is the mode of communication, which establishes rapport and caring.

y

She has defined the characteristics needed to in the helping-trust relationship. These are: o Congruence o Empathy o Warmth Communication includes verbal, nonverbal and listening in a manner which connotes empathetic understanding.

y

5. The expression of feelings, both positive and negative
y y y

According to Watson, ³feelings alter thoughts and behavior, and they need to be considered and allowed for in a caring relationship´. According to her such expression improves one¶s level of awareness. Awareness of the feelings helps to understand the behavior it engenders.

6. The systematic use of the scientific problem-solving method for decision making
y y y

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 interpersonal teaching-learning
y y

The caring nurse must focus on the learning process as much as the teaching process. Understanding the person¶s perception of the situation assist the nurse to prepare a cognitive plan.

8. Provision for a supportive, protective and /or corrective mental, physical, sociocultural and spiritual environment
y

y y

Watson divides these into eternal and internal variables, which the nurse manipulates in order to provide support and protection for the person¶s mental and physical wellbeing. 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 the gratification of human needs
y y y y

It is grounded in a hierarchy of need similar to that of the Maslow¶s. 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.

Watson¶s ordering of needs
y

y

y

y

Lower order needs (biophysical needs) o The need for food and fluid o The need for elimination o The need for ventilation Lower order needs (psychophysical needs) o The need for activity-inactivity o The need for sexuality Watson¶s ordering of needs o Higher order needs (psychosocial needs) o The need for achievement o The need for affiliation o Higher order need (intrapersonal-interpersonal need) o The need for self-actualization Research findings have established a correlation between emotional distress and illness. According to Watson, the current thinking of holistic care emphasizes that: o Factors of the etiological component interact and produce change through complex neuro-physiological and neuro-chemical pathways o Each psychological function has a physiological correlate o Each physiological component has a psychological correlate

Example: Bulemia, anorexia and gastro-intestinal ulcers are a just few of the disorders that indicate a complex interaction between the physiological and psychological. 10. Allowance for existential-phenomenological forces
y y y

y

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

Watson describes ten "Caritas Processes". Originally "Carative Factors" she redefines these essential "core values": Formation of humanistic-altruistic system of values, becomes: "Practice of loving-kindness and equanimity within context of caring consciousness 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"; 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"; Development of a helping-trusting, human caring relationship, becomes: "Developing and sustaining a helping-trusting, authentic caring relationship"; 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-being-cared-for"; 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"; Promotion of transpersonal teaching-learning, becomes: "Engaging in genuine teachinglearning experience that attends to unity of being and meaning attempting to stay within other's frame of reference"; 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"; Assistance with gratification of human needs, becomes: "assisting with basic needs, with an intentional caring consciousness, administering µhuman care essentials', which potentiate alignment of mindbodyspirit, wholeness, and unity of being in all aspects of care"; tending to both embodied spirit and evolving spiritual emergence; Allowance for existentialphenomenological-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-carefor.

Watson¶s theory and the four major concepts 1.
y

Human being She adopts a view of the human being as: ³«.. 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.
y y y y

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) Environment/society
y

3.

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. Nursing

4.
y y y

According to Watson ³ 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«.. ³A human science of persons and human health-illness experiences that are mediated by professional, personal, scientific, esthetic and ethical human transactions´.

Watson¶s theory and nursing process
y

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. Watson elaborates the two processes as: Assessment

1.
y y y

Involves observation, identification and review of the problem; use of applicable knowledge in literature. Also includes conceptual knowledge for the formulation and conceptualization of framework. Includes the formulation of hypothesis; defining variables that will be examined in solving the problem. Plan

2.
y

It helps to determine how variables would be examined or measured; includes a conceptual approach or design for problem solving. It determines what data would be collected and how on whom. Intervention
y y

3.

It is the direct action and implementation of the plan. It includes the collection of the data.

4.
y

Evaluation 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. It may also generate additional hypothesis or may even lead to the generation of a nursing theory.

y

Watson¶s work and the characteristic of a theory
y

y

y

y y y y y

According to Watson, ³a theory is an imaginative grouping of knowledge, ideas and experiences that are represented symbolically and seek to illuminate a given phenomenon´ She views nursing as, ³«.both a human science and an art and as such it cannot be considered qualitatively continuous with traditional, reductionistic, scientific methodology´. She suggests that nursing might want to develop its own science that would not be related to the traditional sciences but rather would develop its own concepts, relationships and methodology. Theories can interrelate concepts in such a way as to create a different way of looking at a particular phenomenon The basic assumptions for the science of caring in nursing and the ten carative factors that form the structure for that concept is unique in Watson¶s theory. She describes caring in both philosophical and scientific terms. Watson also 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.

Theories must be logical in nature
y y y

Watson¶s work is logical in that the factors are based on broad assumptions which provide a supportive framework. With these carative factors she delineates nursing from other professions These carative factors are logically derived from the assumptions and related to he hierarchy of needs.

Theories should be relatively simple yet generalizable
y y y y y

The theory is relatively simple as it does not use theories from other disciplines that are familiar to nursing. The theory is simple relatively but the fact that it de-emphasizes the pathophysiological for the psychosocial diminishes its ability to be generalizable. She discusses this in the preface of her book when she speaks of the ³trim´ and the ³core´ of nursing. She defines trim as the clinical focus, the procedure and the techniques. The core of the nursing is that which is intrinsic to the nurse-client interaction that produces a therapeutic result. Core mechanisms are the carative factors.

Theories can be the basis for hypotheses that can be tested
y

y y y

Watson¶s theory is based on phenomenological studies that generally ask questions rather than state hypotheses. Its purpose is to describe the phenomena, to analyze and to gain an understanding. Theories contribute to and assist in increasing the general body within the discipline through research implemented to validate them According to Watson the best method to test this theory is through field study. An example is her work in the area of loss and caring that took place in Cundeelee, Western Australia and involved a tribe of aborigines.

Theories can be utilized by practitioners to guide and improve their practice
y y y y y

Watson¶s work can be used to guide and improve practice. It can provide the nurse with the most satisfying aspects of practice and can provide the client with the holistic care so necessary for human growth and development. Theories must be consistent with other validated theories, laws and principles but will leave open unanswered questions that need to be investigated Watson¶s work is supported by the theoretical work of numerous humanists, philosophers, developmentalists and psychologists. She clearly designates the theories of stress, development, communication, teachinglearning, humanistic psychology and existential phenomenology which provide the foundation for the science of caring.

Strengths
y

y y

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. As the science of caring ranges from the biophysical through the intrapersonal, each nurse becomes an active coparticipant in the client¶s struggle towards selfactualization. The client is placed in the context of the family, the community and the culture. It places the client as the focus of practice rather than the technology.

Limitations
y

y y y

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

Summary
y y y

Watson¶s theory Its seven assumptions The ten carative factors

y y y y y

Watson¶s theory and the four major concepts Watson¶s theory and the nursing process Watson¶s work and the characteristic¶s of the theory Strengths Limitations

Research related to Watson¶s theory
y y y

y y y

Saint Joseph Hospital in Orange, California has selected Jean Watson¶s theory of human caring as the framework base for nursing practice. The effectiveness of Watson's Caring Model on the quality of life and blood pressure of patients with hypertension. J Adv Nurs. 2003 Jan;41(2):130-9. This study demonstrated a relationship between care given according to Watson's Caring model and increased quality of life of the patients with hypertension. Further, in those patients for whom the caring model was practised, there was a relationship between the Caring model and a decrease in patient's blood pressure. The Watson Caring Model is recommended as a guide to nursing patients with hypertension, as one means of decreasing blood pressure and increase in quality of life. Martin, L. S. (1991). Using Watson¶s theory to explore the dimensions of adult polycystic kidney disease . ANNA Journal, 18, 403-406 . Mullaney, J. A. B. (2000). The lived experience of using Watson¶s actual caring occasions to treat depressed women . Journal of Holistic Nursing, 18(2), 129-142 Martin, L. S. (1991). Using Watson¶s theory to explore the dimensions of adult polycystic kidney disease . ANNA Journal, 18, 403-406

Conclusion
y y y y

Watson provides many useful concepts for the practice of nursing. She ties together many theories commonly used in nursing education and does so in a manner helpful to practioners of the art and science of nursing. The detailed descriptions of the carative factors can give guidance to those who wish to employ them in practice or research. Using her theory can add a dimension to practice that is both satisfying and challenging.