Philosophy and

Theory of
Transpersonal Caring
Jean Watson
 “We are the light in institutional
darkness, and in this model we get to
return to the light of our humanity.”

—Jean Watson
 Jean Watson (1979-1985)
 Philosophy and Science of Caring addresses how nurses care for their patients, and
how that act translates into better health plans to help patients recover and gain
optimum level of health.

• Caring can be effectively demonstrated and practiced only intrapersonally.

• Caring results in carative factors that result in the satisfaction of certain
human needs.
• Effective Caring promotes health and individual or family growth
• 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.
 History
and
Background
 Hx and Background
 Born and raised in Welch, West Virginia.
 Education:
• BSN- University of Colorado
• MS- University of Colorado
• PhD.- University of Colorado
 Founder of the original center for human caring
 Fellow of the American Academy of Nursing
 Dean of Nursing at the University of Health Sciences
 Past President of the National League for Nursing
 Hx and Background
 Has undergraduate and graduate degrees in:
 Nursing
 Psychiatric Mental Health Nursing
 PhD in educational psychology and counseling
 International Kellog Fellowship in Australia
 Fullbright Research Award in Sweden
 6 Honorary Doctoral Degrees
 3 International Honorary Doctorates
 “Nursing: The Philosophy and Science of Caring” was published in 1979
 “Nursing: Human Science and Human Care” was published in 1988
Philosophy of
Human Caring
 Philosophy of Human Caring

 Nursing as perceived by Watson is “ Both a human science and an art”

 Human Caring
 Thinking related to intentionality connects with the concepts of
consciousness and energy. If our conscious intentionality is to hold thoughts
that are caring, loving open, kind and receptive, in contrast to an
intentionality to control, manipulate and have power over, the
consequences will be significant .
 Major Elements:
1. Carative Factors
2. The Transpersonal Caring Relationship
3. The Caring Occasion/ Caring Moment
 Philosophy of Human Caring

 Carative Factors
 Guide for the core of Nursing.
 Means caring with love
 Originated from the term “caritas” which means to cherish, appreciate, and
give special attention.
 She uses the term Carative to contrast with conventional medicine’s
curative factors
 Attempts to honor e human dimensions of nursing’s work and the inner life
world and subjective experiences of the people we serve.
Theoretical
Sources
Theoretical Sources

 Watson (1988) defines theory as an "imaginative grouping of knowledge, ideas,

and experiences that are represented symbolically and seek to illuminate a
given phenomenon”

 Watson acknowledges a phenomenological, existential, and spiritual

orientation from the sciences and humanities as well as philosophical and
intellectual guidance from feminist theory, metaphysics, phenomenology,
quantum physics, wisdom traditions, perennial philosophy and Buddhism
Theoretical Sources

 Watson attributes her emphasis on the interpersonal and transpersonal qualities

of congruence, empathy, and warmth to Carl Rogers and more recent writers of
transpersonal psychology.

 In her book, "Caring Science as Sacred Science," Watson describes the wisdom of
French philosopher Emmanuel Levinas (1969) and Danish philosopher Knud
Logstrup (1995) as foundational to her work.
Theoretical Sources

 Watson's main concepts include the 10 carative factors and the transpersonal
healing and transpersonal caring relationship, caring moment, caring occasion,
caring healing modalities, caring consciousness, caring consciousness energy, and
phenomenal file/unitary consciousness.

 Watson expanded the ten carative factors to "caritas" and offered a translation
of the original carative factors into clinical caritas processes that suggest open
ways they could be considered.
Theoretical Sources

 Watson, describes a "transpersonal caring relationship" as foundational to her

theory; it is a "special kind of human care relationship a union with another
person - high regard for the whole person and their being-in-the-world”

 Development and maintenance of the transpersonal relationship is actualized

through the application of the 10 Caritas processes that guide the relationship
and set the foundation for the caring - loving relationship essential to nursing
practice
 Watson’s
Ten Carative
Factors
 Watson’s
Ten Carative Factors

1. The formation of a humanistic-altruistic system of values.

2. The instillation of faith-hope
3. The cultivation of sensitivity to one's self and to others
4. The development of a helping-trust relationship
5. The promotion and acceptance of the expression of positive
and negative feelings.
 Watson’s
Ten Carative Factors

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

decision-making.
7. The promotion of interpersonal teaching-learning.
8. The provision for a supportive, protective, and corrective mental,
sociocultural, and spiritual environment.
9. Assistance with the gratification of human needs.
10. The allowance of existential-phenomenological forces; became
"allowance for existential-phenomenological-spiritual forces"
Major Concepts
and
Definitions
Ten Caritas Processes

 Watson originally based her theory for nursing practice on 10 carative factors.
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 and caring.
Ten Caritas Processes

1. Practice of loving kindness and equanimity toward self and other within
context of (caring consciousness) caritas consciousness.

The formation of a humanistic-altruistic system of values

 Begins developmentally at an early age with values shared with the
parents.
• Mediated through one's 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.
Ten Caritas Processes

2. Being authentically present, enabling, sustaining, and honoring the faith, hope,
and deep belief system and the inner-subjective world of self/other.

Faith-hope
 Essential to both the carative and the curative processes.
Ten Caritas Processes

3. Cultivation of one's own spiritual practices and transpersonal self, going beyond ego
self, opening to others with sensitivity and compassion.

Cultivation of sensitivity to one's self and to others

 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 self-growth and self-actualization, in both the nurse and those
with whom the nurse interacts.
 The nurses promote health and higher-level functioning
Ten Caritas Processes

4. Developing and sustaining a helping-trusting, authentic caring relationship

Establishing a helping-trust relationship

o Strongest tool is the mode of communication
o Characteristics needed in the helping-trust relationship:
a. Congruence
b. Empathy
c. Warmth
Ten Caritas Processes

5. Being present to, and supportive of, the expression of positive and negative
feelings as connection with deeper spirit of self and the one-being-cared for.

The Expression of feelings, both positive and negative

 "feelings 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.
Ten Caritas Processes

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.

The systematic use of the scientific problem-solving method of decision making

 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 a holistic
perspective.
 The science of caring should not be always neutral and objective.
Ten Caritas Processes

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 interpersonal teaching-learning

o The caring nurse must focus on the learning process as much as the
teaching process
o Understanding the person's perception of the situation assists the nurse to
prepare a cognitive plan
Ten Caritas Processes

8. Creating healing environment at all levels, environment of energy and

consciousness, whereby wholeness, beauty, comfort, dignity and peace are
potentiated.

Provision for a supportive, protective and/or corrective mental, physical,

socio cultural and spiritual environment.
 Watson divides these into external and internal variables
 The external and internal environments are interdependent.
 The nurse also must provide comfort, privacy, and safety as part of this
carative factor.
Ten Caritas Processes

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

 It is grounded in a hierarchy of need similar to that of Maslow’s
 She has created a hierarchy which she believes is relevant to the science of
caring in nursing.
 Each need is equally important for quality nursing care and the promotion
of optimal health.
Watson’s Ordering Needs

1. Lower order needs (biophysical needs)

a) The need for food and fluid
b) The need for elimination
c) The need for ventilation

2. Lower order needs (psychophysical needs)

a) The need for activity-inactivity
b) The need for sexuality
Watson’s Ordering Needs

3. Higher order needs (psychosocial needs)

a) The need for achievement
b) The need for affiliation

4. Higher order need (intrapersonal-interpersonal need)

a) The need for self-actualization
Take note!

Research findings
have established a Example
correlation between
emotional distress
and illness. Bulimia, anorexia and
gastro-intestinal ulcers are
just a few of the disorders
that indicate a complex
interaction between the
physiological and
psychological correlates.
Ten Caritas Processes

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

Allowance for existential phenomenological forces

 Phenomenology is a way of understanding people from the way things
appear to them, for their frame of reference
 Existential psychology is the study of human existence using
phenomenological analysis
 Use of
Empirical Evidence
Use of Empirical Evidence

 Watson's research into caring incorporates empiricism but emphasizes

approaches that begin with nursing phenomena rather than with the natural
sciences.

 She investigated metaphor and poetry to communicate, convey, and elucidate

human caring and healing.
 Major
Assumptions
Transpersonal Caring Relationship

 For Watson, the transpersonal caring relationship characterizes a special kind of

human care relationship that depends on:

 The nurse's moral commitment in protecting and enhancing human dignity

as well as the deeper/higher self.
 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.
 The nurse's caring consciousness and connection having the potential to
heal since experience, perception, and intentional connection are taking
place.
Caring Occasion/Caring Moment

 According to Watson, a caring occasion is the moment when the nurse and
another person come together in such a way that an occasion for human caring is
created. Both persons, with their unique phenomenal fields have the possibility to
come together in a human-to-human transaction.

 Not simply a goal for the cared-for, Watson insists that the nurse also needs to be
aware of her own consciousness and authentic presence of being in a caring
moment with her patient.

 The caring occasion becomes "transpersonal" when "it allows for the presence of
the spirit of both---then the event of the moment expands the limits of openness
and has the ability to expand human capabilities"
Theoretical
Assertion
Transpersonal Nursing Caring-Healing

 Nursing's goal is to help persons gain a higher degree of harmony within the
mindbodyspirit, which generates self-knowledge, self-reverence, self-healing,
and self-care processes while allowing for diversity and possibility.

 The greater "the degree of genuineness and sincerity of the nurse within the
context of the caring act, the greater the efficacy of caring”

 Watson emphasizes that act of helping persons while preserving their dignity
and worth regardless of their external and environmental situation
Transpersonal Nursing Caring-Healing

 Within a framework of caring sciences, compassionate human service and

caring are motivated by love.

 Shifting the focus from illness, diagnosis, and treatment to human caring,
healing and transcendence.

 As the essence of nursing, "caring is the most central and unifying focus for
nursing practice”
Transpersonal Nursing Caring-Healing

 Caring as an ethic and moral ideal, encourages the nurse to hold or attempt to
hold the conscious intent to preserve wholeness, potentiate healing: and
preserve dignity, integrity. and life-generating processes at the level of human
nature and universe.

 Watson notes that the transpersonal caring moment honors the premise that:
 "The power of love, faith, compassion, caring
community, and intention, consciousness and access,
to a deeper/higher energy source, etc. one's God, are
as significant sources of healing as our conventional
treatment approaches, and may indeed be more
powerful in the long run"
Watson defines nursing as:

"A human science of people and human health-illness

experiences that are mediated by professional,
personal, scientific, esthetic and ethical human
transactions”
Personhood (Human Being)

 Person is viewed holistically wherein the body, mind and soul are interrelated;
each part a reflection of the whole, yet the whole is greater than and different
from the sum of parts.

 The person possesses three spheres of being--- body, mind, and soul.

 The human being is a valued person in and of himself or herself to be cared for,
respected, nurtured understood and assisted; a fully functional integrated self."

 The soul fully participates in healing. We need to continue to explore the spiritual,
nonphysical, inner, and extrasensory realms to learn of the dynamic and creative
energy currents of the soul's existence and to learn of the inner healing journey
toward wholeness
Health (Health, Illness, and Disease)

 Healing and wholeness become the starting points, the midpoints, and the
open endings for the ongoing, evolving and unfolding of the human condition“

 Health is redefined as the unity and harmony within the body, mind, and soul -
harmony between self and others and between self and nature and openness
to increased possibility.

 Health is a process of adapting, coping, and growing throughout life and

associated with the degree of congruence between self as perceived and self as
experienced.
Health (Health, Illness, and Disease)

 Health is a search to connect with deeper meanings and truths and to embrace
the near and far in the instant and to seize the tangible, manifestly real, and the
divine.

 Illness is a subjective turmoil or disharmony within a person's inner self or soul.

 Illness connotes a felt incongruence within the person such as incongruence

between the self as experienced.

 Illness can lead to disease but they are not necessarily on continuum
Health (Health, Illness, and Disease)

 Disease is associated with disharmony between the person and the environment
or nature.

 The agent for change in terms of healing is the person's internal mental-spiritual
consciousness, which allows the self to be healed.
Environment (Healing Space and Environment)

 The nurse's role in the environment. "Attending to supportive, protective and or

corrective mental, physical, societal, spiritual environments"

 More recently, Watson broadened her focus from the immediate environment to an
energetic, vibrational field integral with the person. The nurse becomes the
environment in which "sacred space" is created.

 Conscious attention to healing space shifts the health care facility from being simply
a place for bodies to be treated to a place in which there is conscious promotion of
mindbodyspirit wholeness; attention to the relationship between stress and illness,
hospital stress factors; and acknowledgement of the key role that emotions and the
senses play in healing.
Environment (Healing Space and Environment)

 Watson describes a caring/love that radiates in a concentric circle from self, to

others, the community and planet, and the universe. Yet, she recognizes the
environmental challenges to concepts of caring, including a diminishing workforce;
admission of more acute patients with complex needs; cultural difference;
economic factors; and organizational, social, and health care policy. All influence the
amount and quality of time a nurse has with her client/patients

 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.
Application by the Nursing Community

 Watson's theory has been applied, and continues to be applied in various fields
of nursing practice, administration and leadership, education, and research. In
practice, Watson's theory has been validated in outpatient, inpatient, and
community.

 On administration and leadership, Watson's theory calls for administrative

practices and business models to embrace caring, even in a health care
environment of increased acuity levels of hospitalized individuals, short hospital
stays, increasing complexity of technology, and rising expectations in the "task"
of nursing.
Application by the Nursing Community

 On education, Watson's writings focus on educating graduate nursing

students and providing them with ontological, ethical, and epistemological
bases for their practice, along with research directions.

 On research, qualitative, naturalistic, and phenomenological methods have

been identified as particularly relevant to the study of caring and to the
development of nursing as a human science
Application by the Nursing Community

 On education, Watson's writings focus on educating graduate nursing

students and providing them with ontological, ethical, and epistemological
bases for their practice, along with research directions.

 On research, qualitative, naturalistic, and phenomenological methods have

been identified as particularly relevant to the study of caring and to the
development of nursing as a human science
Watson's Theory
and the
Nursing Process
Watson's Theory and the Nursing Process

 Assessment
 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.
Watson's Theory and the Nursing Process

 Plan
 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.
Watson's Theory and the Nursing Process

 Intervention
 It is the direct action and implementation of the plan.
 It includes the collection of the data from subjects.
Watson's Theory and the Nursing Process

 Evaluation
 Analysis of the data as well as the examination of the effects of
intervention 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
Reference

Quiambao-Udan, J. (2020).
Theoretical Foundation in
Nursing (2nd Ed.). Manila:
APD Educational Publishing
House.

Theoretical Foundation
in Nursing
Thanks!