MARGARET JEAN WATSON

“Theory of Human Caring”

EDUCATION

o Dr. Watson was born and raised in a small town in the Appalachian Mountains of West
Virginia in the 1940’s
1958-61

o R.N. Diploma in Nursing

o Lewis-Gale School of Nursing

1962-64

o B.S. in Nursing
o University of Colorado
1964-66

o M.S. in Psychiatric Mental-Health Nursing; Minor Psychology

o University of Colorado
1969-70

o Graduate Work: Social and Clinical Psychology

o University of Colorado

1969-73

o Ph.D. in Educational Psychology and Counseling

o University of Colorado
o Jean Watson, as many of you know, is a living legend and theorist. She was born in
West Virginia in the 1940’s and received most of her higher education in Colorado.
o As shown here, she received her RN designation in her home town of Virginia in 1961,
while her Bachelor of Science in Nursing, Master of Science in in Mental-Health Nursing
and PhD in Educational Psychology and Counseling at the University of Colorado.

o International Kellogg Fellowship in Australia

o Fulbright Research Award in Sweden
o Six Honorary Doctoral Degrees
o Including 3 International Honorary Doctorates (Sweden, UK, Canada)
o 1993 National League for Nursing Martha E. Rogers Award
o Listed here are many of her accomplishments of distinction, most of which were given
for recognition of her work in making significant contributions to nursing knowledge
and the science of care.
 o Some notable mentions include her six honorary doctoral degrees, three of which are
internationally recognized from Sweden, the UK and Canada.
o Her recent undertaking involves the Centre for Human Caring in Colorado, in which
she is the founder. Here, programs have been established to promote human caring
activities of nursing as a way to branch off from reductionist models of the biomedical
approach.
o Dr. Watson founded and directs the non- profit Watson Caring Science Institute,
dedicated to furthering the work of caring, science, and heart-centered Carita‘s
Nursing, restoring caring and love for nurses’ and health-care clinicians’ healing
practices for self and others.
o Distinguished Nurse Scholar, recognized by New York University
o Norman Cousins Award in 1999
o Recognition for her commitment to developing; maintaining and exemplifying
relationship-centered care practices
o Founder of the Centre for Human Caring in Colorado
o Is a Fellow at the American Academy of Nursing
o Influences
o Her theories are influenced by the Eastern Philosophy viewpoint, seeing the body as a
whole unit, not a sum of parts. This idea links to previous theories to her time, including
those of Nightingale, Leininger and Paterson & Zderad. Because of her background in
psychology, theorists like Carl Rogers and Richard Lazarus also show some influence.

Theory of Human Caring

o It is the Blueprint for nurses to restore the art of nursing practice and better care for
their patients and themselves
o Nursing has changed dramatically as science and medicine have adapted to meet
the growing demands of our population. It’s increasingly a skilled –based profession
with paper works to accomplish. However, it is important to remember the roots of
nursing which are based on caring and healing principles.
Watson’s Motivation for Developing Her Model:

o Education
o Life Experiences
o Exploration of Self

Major Elements of the Caring Theory

o Carative factors, evolving into Clinical Caritas Processes

o Transpersonal Caring Relationships
o Caring occasion/Caring moment
Carative Factors

o Guides the core of nursing

o Carative factors attempt to “honor the human dimensions of nursing’s work and the
inner life world and subjective experiences of the people we serve” (Watson, 1997, p.
50).
o Contrasts the curative factors of medicine (curative means to cure a disease)
o Carative factors evolve into Caritas factors
o Watson now makes connections between human caring, healing, and even peace in
our world, with nurses as caritas peacemakers when they are practicing human caring
for self and others. Caritas comes from the Latin word meaning “to cherish and
appreciate, giving special attention to, or loving
Ten Carative Factors

1.FORMATION OF A HUMANISTIC-ALTRUISTIC VALUE SYSTEM. The value of altruism (regard

for others as a personal action) is learned at an early age. It is a value shared with
parents. One's own life experiences are learning opportunities to gain insights about
dealing with others. Caring based on humanistic values and altruistic behavior "can be
developed through examination of one's own views, beliefs, interactions with various
cultures and personal growth experiences." This development is perceived necessary for
the nurse's own maturation.

2. INSTALLATION OF FAITH-HOPE. This factor is deemed essential to both carative and

curative processes. To nurses, this provides a basis for looking into the healing power of
belief, or the spiritual dimension, when curing is not possible. The use of Faith-Hope as a
nursing intervention allows nurses to explore alternative methods of healing, like
meditation. It seems that the goal for this activity is the provision of a sense of wellbeing
through belief systems that are meaningful to the client.

3.CULTIVATION OF SENSITIVITY TO SELF AND OTHERS. Nurses promote "health and higher
level functioning only when they perform person-to-person relationships as opposed to
manipulative relationships." There is a need for the nurse to develop and examine one's
own feelings. Through this process, increased sensitivity to others is developed. The nurse
becomes honest and promotes self-growth and self-actualization. Watson's premise
further states "that at the highest level of nursing, the nurse's human care responses,
human care transactions, and presence in the relationship transcend the physical
material world." The explanation makes it clear that interactions between the nurse and
the client deal with the person's emotional and subjective world as a means to learn the
inner self

4.DEVELOPMENT OF A HELPING-TRUST RELATIONSHIP. Communication, both verbal and

non- verbal, is a mode of accomplishing a helping-trust relationship to establish rapport
and caring. Characteristics common to this carative factor are congruence, empathy,
warmth and honesty. Positive acceptance of another is most often expressed by body
language, touch and tone of voice. I'm sure that given your clinical experiences, you can
think of many situations to relate to this fourth carative factor.
5.PROMOTION AND ACCEPTANCE OF THE EXPRESSION OF POSITIVE AND NEGATIVE
FEELINGS. According to Watson, it is important to facilitate awareness of both negative
and positive feelings to improve on one's level of awareness. Feelings need to be
considered in a caring environment. Being aware of both positive and negative feelings
leads to better understanding of behavior.

6.SYSTEMATIC USE OF THE SCIENTIFIC PROBLEM-SOLVING METHOD FOR DECISION MAKING.

This factor gives notice to the limitations nurses have in assessing the issue of developing a
scientific base because most of our time is dedicated to the performance of nursing tasks
such as procedures and treatments. Thus, recognition is given to the use of the systematic
problem-solving method in building nursing knowledge. In the same way, the argument
extends to other methods of knowing like utilizing research-based findings in order to
improve nursing practice and provide holistic care.

7.PROMOTION OF INTERPERSONAL TEACHING-LEARNING. Through this factor, persons

(clients) gain control over their own health because it provides them with both
information and alternatives. Learning offers opportunities to individualize information
dissemination. The caring nurse focuses on the learning and teaching process, as well as
in understanding the client's perception of the situation. This provides for a cognitive plan
workable within the client's frame of reference.

8.PROVISIONS FOR A SUPPORTIVE, PROTECTIVE AND (OR) CORRECTIVE MENTAL, PHYSICAL,

SOCIOCULTURAL AND SPIRITUAL ENVIRONMENT. There are two divisions or categorizations
relative to this factor: external variables which include physical, safety and environmental
factors; and internal variables which refer to mental, spiritual or cultural activities which
the nurse may manipulate for the person's well-being. An interdependence exists
between internal and external factors since the person perceives the situation in the
environment as either threatening or non-threatening. There are events in a person's life
that can arouse a sense of threat. The person appraises the situation and copes to the
best of his ability. The nurse's assessment capabilities can be valuable in helping the
person appraise the situation and cope with it. The nurse's intervention is aimed at
helping, the person develop a more accurate perception to help strengthen coping
capabilities. Provision of comfort, safety and privacy are major aspects of this carative
factor. A clean and esthetic environment is considered a basic element. Esthetics is
deemed essential in the promotion of increased self-worth and dignity.

9.ASSISTANCE WITH THE GRATIFICATION OF HUMAN NEEDS. The hierarchy of human needs
is the essence of this carative factor. It is grounded in a hierarchy of need similar to that of
the Maslow’s. Watsons 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.
10.ALLOWANCE FOR EXISTENTIAL-PHENOMENOLOGICAL-SPIRITUAL FORCES. 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 Carative Factors Evolve into Caritas Factors

Carative

o Faith and hope

o Helping-trusting, human care relationship
o Creative problem-solving caring process
o Expressing positive and negative feelings
o Transpersonal teaching- learning

Caritas

o Being authentically present and enabling the beliefs of the one being cared for and the
one giving care
o Developing and maintaining a trusting, authentic, caring relationship
o Creative use of self
o Being present to and supporting the positive and negative feelings with a connection of
a deeper spirit
o Engaging in genuine teaching-learning experience
Transpersonal Caring Relationship

o Transpersonal means to go beyond one’s own ego and reach a deeper spiritual
connection while comforting a patient.
The transpersonal relationship depends on:

o A commitment from the nurse to enhance and protect human dignity

o An awareness from the nurse that they have the ability to heal
o The nurse must go beyond the objective role
o To preserve and protect a person’s humanity, and dignity
o Preserve a patient’s spirit to ensure the patient does not become an object
o The nurse’s caring and connection have potential to heal since experience, intention,
and perception are taking place.
o Nursing goes beyond an objective assessment and shows concern for the patient’s
own healthcare
o Goal of transpersonal caring relationship protects, enhances, and preserves human
dignity, humanity, wholeness, and inner harmony
Caring Occasion/Caring Moment

o 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 come
together in a human-human transaction. The one caring for and the one being cared
for are influenced by the choices and actions decided within the relationship
o Watson (1998, 1999) stated that when human caring is created the nurse and patient
come together to create a moment, this is known as the caring occasion/caring
moment
o Watson (1999) feels as though the nurse and the patient must be aware of the caring
moment so as to make appropriate choices and actions, thereby the nurse without
knowing becomes a part of the patients “life history”

Human Being

o The person is to be valued, cared for, respected and viewed in a holistic way, as body,
mind and spirit

Environment

o The person’s environment should be conducive to healing and that the person and
their environment are connected.
o The person’s frame of reference is also something that should be considered, and the
nurse should strive to stay within the person’s frame of reference
o 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.
Health

o Health is viewed as overall functioning and distress and disharmony can be caused by
more than just disease processes
o 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)

Nursing

o Watson argues that caring is central to the profession of nursing and that nursing care
should also focus on promoting health and preventing illness.
o The nurse should focus their care on healing and wholeness as opposed to tasks, illness
and disease
 o A “good” nurse cannot be defined solely by her ability and skills but also by how well
she interacts with the client and family while providing that care.

CARING AS THE ESSENCE OF NURSING (JEAN WATSON, 1979)

o Watson viewed caring as the essence of nursing. Caring connotes responsiveness

between the nurse and the person. The nurse co-participates with the person. The
purpose of caring is to assist the person in gaining control and becoming knowledgeable,
and in the process promote health changes. If we have thought of the concept of
empowerment while reading this, yes, we can say that it is similar to that. By allowing the
client to be knowledgeable, the nurse provides an environment for better decision-
making, better self-control and, better self-respect. The concept is common to Filipino
culture: “kakayahan" or "patibayin ang kakayahan," meaning assisting the person in
gaining control.
o While it is true that caring as an attribute in nursing has been described and clarified by
many others, there is uniqueness in Watson's science of caring. Basic assumptions for the
science of caring are supported by ten carative factors that provide structure to the
concept of caring. According to Watson, the first three carative factors provide the
philosophical foundation for the science of caring. The remaining seven carative factors
spring from the foundation laid by these first three.
Theory of Caring Applied

-Carative factors used with postpartum women experiencing multiple emotions

o Never pass judgments, provide all patients with the same respect and level of care.
o Instill hope in the mothers that they will be able to care for their babies and return to their
“normal” state of health.
o Discuss the patient’s perceptions and feelings towards their birthing/parenting
experiences.
o Provide a trusting relationship where the patient feels that you are committed to helping
them. Advocate for the patient.
o Enable the patient to discuss positive and negative feelings concerning her current
healthcare/home situation.
o Use creativity during teaching opportunities and holistic treatments involving pain
management.
o Ensure that their environment is comfortable and enables them to get rest. Ensure that
the patient’s home environment is safe for mother and baby upon return.
o Help patients reach harmony (mind, body, spirit) through holistic and caring modalities.
Promote mother-infant bonding. Assess patient’s support system.
“Caring in the nursing profession takes place every time a nurse-to-patient contact is made...
That caring makes a difference to the patient’s sense of well-being. Caring may occur
without curing but curing cannot occur without caring”
Strengths & Weakness

o S - Can be applied in any area of nursing

o S - Addresses all aspects of the health and illness continuum, and the concepts are
abstract and open to interpretation
o W- L