Jean Watson  Caring is the essence of
nursing and the most
Theory of central and unifying
focus of nursing practice
Human  Nursing is concerned
with promoting health,
Caring preventing illness,
caring for the sick, and
Background restoring health.
 Born on June 10 1940 Major Concepts
in West Virginia 1. Carative Factors
Education 2. Transpersonal Caring
 Graduated Bachelor of Relationship
Science in Nursing at 3. Caring Occasion and
the University of caring moment
Colorado in 1966. A. Watson's 10 Carative
 Master's Degree in Factors
Psychiatric-Mental  Formation of a
Health Nursing humanistic-altruistic
 Got her Ph.D. in system of values
Education Psychology o Begins at an early age
and Counselling at the with values shared
University of Colorado with the parents,
in 1973 o Own life experiences,
Profession/Jobs learning one gain and
 Professor at the exposure to
University of Colorado humankind
Health Sciences o Necessary to the
Center nurse’s own
 Founder of Center for maturation promotes
Human Caring in altruistic behavior
Colorado towards others
 Fellow of the American  Instillation of faith-
Academy of Nursing hope
 Dean of Nursing at the o When modern science
University Health has nothing further to
Sciences Center offer the person, the
 Past President of the nurse can continue to
National League for use faith- hope to
Nursing provide a sense of
 Author well-being through
Awards beliefs that are
 received a Kellogg meaningful to the
Fellowship in Australia individual.
 Fulbright Research  Cultivation of
Award in Sweden sensitivity to one’s
 Six Honorary Doctoral self and to others
Degrees, including o Development of one’s
three International own feelings is needed
Honorary Doctorates to interact genuinely
(Sweden, UK, Quebec, and sensitively with
Canada) others.
Book Published  Development of
 First book, The helping-trust, human
Philosophy, and caring relationship
Science of Caring o Strongest tool is the
(1979) mode of
 Second book, Human communication, which
Science and Human establishes rapport
Care and caring
o Published in 1985 and o Characteristics are
reprinted in 1988 and Congruence,
1999 Empathy, and Warmth
 Her third book, o Communication
Postmodern Nursing includes verbal, non-
and Beyond(1999) verbal, and listening
which connotes
Theory of Human empathetic
Caring understanding
 Promotion and
acceptance of the
expression of positive
and negative feelings
o Feelings alter thoughts
and behavior, and they
need to be considered
and allowed for in a
caring relationship
o Increases one’s level
of awareness
o Awareness of the
feelings helps to
understand the
behavior it cause
 Systematic use of a
creative problem-
solving caring process
o Allows for control and
prediction, and permits
self-correction.
 Promotion of
transpersonal
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
 Provision for a
supportive, protective,
and or corrective
mental, physical,
societal, and spiritual
environment
o The nurse manipulates
the external and
internal variables to
provide support and
protection for the
person’s mental and
physical well-being
o External and Internal
environments are
interdependent
 Assistant with the
gratification of human
needs
o Watson created a
hierarchy of needs
similar to that of
Maslow’s
o Each need is equally
important for quality
nursing care
o All needs deserve to
be attended to and
valued
 Allowance for
existential-
phenomenological
spiritual forces
o The nurse assists the
person to find strength
or courage to confront
life or death
 oLater, Watson
introduced the concept
of “Clinical Caritas”
to replaced her
Carative factors.
Watson's Ordering of
Needs
 Lower 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
and inactivity
o The need for sexuality
 Higher order needs
( Psychosocial needs)
o The need for
achievement
o The need for affiliation
 Higher order need
(intrapersonal-
interpersonal need)
o The need for self-
actualization
B. Transpersonal
Caring Relationship
 An intersubjective
(shared by one
conscious mind), human
to human relationship
that encompasses two
individuals, both the
nurse and the patient in
a given moment.
 It protects, enhances,
and preserves human
dignity, humanity,
wholeness, and inner
harmony
C. Caring
Occasion/ Caring
Moment
 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.
Myra Estrin
Levine (1920-
1996) "The
Conservation
Model"
Background
 Born in Chicago,  Conservation of
Illinois Energy
 Born on 12 December o Refers to balancing
1920 energy input and
 Died on March 20, 1996 output to avoid
Education excessive fatigue
 Graduated at Cook  Examples:
County School of  Adequate rest and
Nursing in 1944 sleep
 Obtained Bachelor of  Maintenance of
Science in Nursing at adequate nutrition
the University of  Regular pattern of
Chicago in 1949 exercise
 Earned her Master of  Conservation of
Science in Nursing Structural Integrity
degree at Wayne State o Refers to maintaining
University in 1962 or restoring the
 She received an structure of the body
honorary doctorate preventing physical
from Loyola University breakdown and
in 1992 promoting healing
Work Experience  Examples:
 Private Duty Nurse  Provide a range of
 Oncology Nurse motion (ROM)
 Civilian Nurse for the exercises to a
US Army at the bedridden patient to
Gardiner General prevent deformities
Hospital  Turn the
 Administrative unconscious patient
Supervisor at at regular intervals to
University of Chicago prevent pressure
 Director of Nursing at sore or bed sores
Drexel Home in  Maintenance of
Chicago patient’s personal
 Nursing Faculty at hygiene to prevent
University of Illinois, infection
Chicago and Tel Aviv  Diaper change and
University in 1962 good perianal care
 Author on infants to prevent
 Published 77 articles rashes
one is “ An  Conservation of
Introduction to Clinical Personal Integrity
Nursing” o Recognizes the
3 Major Concepts individual as one who
strives for recognition,
on Conservation respect, self-
Model awareness, selfhood,
Conservation and self-determination
 Examples:
 Keeping together of the
life system  Recognize and
 Achieving a balance of protect patient’s
energy supply and privacy and space
demand needs
 Individuals are able to  Assisting the patient
confront obstacles, to maintain good
adapt accordingly, and body image after
maintain their breast surgery
uniqueness  Providing the patient
 GOAL: Health and the adequate information
strength to confront about procedures to
be done to him
disability
 PRIMARY FOCUS:  Conservation of Social
Integrity
Keeping together of the
wholeness of the o An individual is
individual
 The goal is accomplish
recognized as one
who has family and
through the 4
Conservation Principles
friends, community,
workplace and school,
religion, personal
choices, political
system, cultural and
 ethnic heritage, and a most primitive 3. Who is able to benefit to
nation response the fullest extent during
 Examples:  Inflammatory: illness from the
 Helping the individual Response intended physicians knowledge
to preserve his or her to provide for and skill
place in a family, structural integrity 4. Whose behavior does
community, and and the promotion of not give evidence of
society healing unnecessary trauma as
 Allowing visits from  Stress: Response a consequence of
family members in developed over time illness
times of and is influenced by Johnson’s
hospitalization each stressful
 Supporting spiritual experience Behavioral
needs and religious encountered by the Subsystem:
practices of patients person  Attachment or
Adaptation  Perceptual: Involves affiliative subsystem
 Is achieved through the gathering information o social inclusion;
“frugal, economic, from the environment intimacy; attachment
contained, and and converting it into and formation of
controlled use of a meaningful strong social bond;
environmental experience provides survival and
resources by the Wholeness security
individual in his or her  Exists when the  Dependency
best interest interaction or constant subsystem
 Every individual has a adaptations to the o approval; attention or
unique range of environment permit the recognition; physical
adaptive responses assurance of integrity assistance (helping or
 The response will vary  Unceasing interaction of nurturing response)
by heredity, age, gender the individual organism  Ingestive subsystem
or illness experiences with its environment o has to do with when,
o Characteristics does represent an open how, what, how much,
 Historicity: Refers field system and under what
to the belief that  And a condition of conditions we eat
adaptive responses health, wholeness,  Eliminative subsystem
are partially based exists when there is the o addresses when, how,
on personal and interaction or constant and under what
genetic past history. adaptations to the conditions we
 Specificity: This environment eliminate; social and
refers to the fact that
each system that Dorothy psychological factors
influence the biological
makes up a human
being has unique Johnson 
aspect of this system
Sexual subsystem
stimulus-response Behavior System o both biological and
pathways. Model social factors affect
 Redundancy: the behavior; serves
 Client is a living open
Describes the belief system the biological
that if one system of  A collection of requirements for
the pathway is behavioral subsystems procreation and
unable to ensure that interrelate to form a reproduction; gender
adaptation, then behavioral system role identity, courting
another pathway and mating
 GOAL: to restore, to
may be able to take  Aggressive
maintain, or attain
over and complete subsystem
behavioral integrity,
the job. o related to behavior
system stability,
o Organismic concerned with self
adjustment and
Response adaptation, efficient and and social protection
 A change in behavior effective functioning of and self-preservation;
of an individual the system to prevent people and their
during an attempt to illness. property be respected
adapt to the and protected; one
environment 4 Goals of Nursing
that generates a
 Help individuals to to assist the defensive response
protect and maintain patient: from the individual
their integrity 1. Whose behavior when life or territory is
 They co-exist commensurate with threatened
 Four Types of social demands  Achievement
Response 2. Who is able to modify subsystem
 Flight or fight: An his behavior in ways o attempts to manipulate
instantaneous that it supports the environment;
response to real or biological imperatives
imagined threat,
 efforts to gain mastery is a purposeful
o language and
and control adaptive response, emotions
 Restorative physically, 4 Major Concepts:
subsystem emotionally, and  Energy field
o concerned with rest, socially to internal and it is an inevitable part
o
sleep, external stimuli in of life.
comfort/freedom from order to maintain o The human and
pain stability and comfort environment both have
Johnson’s Model  Nursing an energy field that is
o has a primary goal that
on Health: is to foster equilibrium
open i.e. energy can
Representation of freely flow between
within the individual humans and the
Johnson’s Model: GOAL concerned with the
—SET—CHOICE OF environment
organized and  Openness
BEHAVIOR—BEHAVIOR integrated whole major o the human field and
 Goal focus is on maintaining
o the ultimate the environment field
a balance in the are constantly
consequence of behavior system when exchanging energy.
behaviors illness occurs in an  Pattern
 Set individual o is defined as the
o a tendency to act in a
certain way in a given Martha distinguishing
characteristic of an
situation; plays a
major role in making Rogers energy field perceived
as a single wave; it is
choices and actions Overview of an abstraction that
taken
 Choice Behavior
Roger’s Theory: gives identity to the
o refers to the alternate Science of Unitary field.
o Patterning is the
behaviors the person Human Beings dynamic or active
considers in any given  belief of the coexistence process of the life of a
situation; influenced by of the human and the human being that is
age, sex, culture, and environment has greatly accessible to the
socioeconomic status influenced the process senses
 Action of change toward better o Example:
o the observable health.
 person’s
behavior of the person  science of unitary
experiences,
Each subsystem human beings
expressions,
comprises of five
has 3 functional assumption, four major
perceptions,
requirements: physical, mental,
concepts and three
social, and spiritual
1. The system must be major principles.
data.
“protected” from 5 Major  Pan Dimensionality
noxious influences with
which the system Assumptions: o nonlinear domain
cannot cope  Wholeness without spatial or
2. Each subsystem must o human being is temporal attributes;
be “nurtured” through considered as a united the idea of a nonlinear
the input of appropriate whole domain provides a
supplies from the  Openness framework for
environment o a person and his understanding
3. Each subsystem must environment are paranormal
be “stimulated” for use continuously phenomena. Rogers
to enhance growth and exchanging energy (1992) even asserted
prevent stagnation with each other that within the Science
 Unidirectionality of Unitary Human
The 4 Major Beings, psychic
o the life process of
Concepts: human beings evolves phenomena become
 Human being irreversibly and “normal” rather than
as having 2 major
o unidirectional (ex: birth “paranormal.” Reality
systems the biological to death) is pan-dimensional.
system and the  Pattern and o Example:
behavioral system Organization  Distance healing
 Society o pattern identifies (helping people with
o relates to the individuals and reflects the power of the
environment their innovative mind)
individual’s behavior is wholeness.  Healing power of
influenced by the  Sentence and Thought prayer
vents in the o humans are the only  Therapeutic touch
environment  Phantom pain,
organisms able to
 Health  Precognition
think, imagine, have
 Dejá Vu
  Intuition to produce a positive o Activities that
 Tacit knowing environment.) individuals perform
 Mystical experiences Roger’s Theory and independently to
 Clairvoyance, maintain life, health,
 Telepathic Nursing and well-being
experiences Metaparadigm o Example:
Homeodynamic  Unitary Human Being  showering, eating,
(person) moving, etc.
Principles o open systems which  Self-care agency
 Suggests the way of continuously interact o the ability of
perceiving human w/ environment. individuals to practice
beings. Refers to the o A person cannot be self-care activities,
balance between the
viewed as parts, it which can be affected
dynamic life process
should be considered by their environment
and environment
as a whole. or health
3 Principles of  Environment considerations
Homeodynamic: o it includes the entire o Example:
 Resonancy
energy field other than  age, developmental
o the constant change
a person; these state, sociocultural
inflow of energy field energy fields are orientation, available
from a lower to irreducible, not limited resources, etc.)
higher frequency; a by space and time,  Therapeutic self-care
flow of energy identified by their demand
between people and pattern and o the actions performed
everything around organization for some duration to
them;  Health meet the specific
o Putting it into o not clearly defined by deficits identified in the
Practice: Nurses Rogers. patient
might incorporate o It is determined by the Self-care requisites
activities such as art
interaction between  actions directed towards
and music to assist a
energy fields i.e. the provision of self-
patient who is ill in an
humans and care; 3 categories
attempt to help them
environments; bad  Universal self-care
adjust to change
interaction or requisites
inflow.
misplacing of energy o activities of daily living
 Helicy
leads to illness o Example
o any small change in
 Nursing  (air, food,
any of the o exists to serve people; elimination, activity
environmental fields
both science & art; the and rest, prevention
causes a ripple
direct and overriding of hazards,
effect, which creates
responsibility to the promotion of
larger changes
society normalcy, and social
in other fields;
change is constant
and unpredictable;
Dorothea interaction)
 Developmental self-
o Putting it into Orem care requisites
o Associated with
Practice: as a nurse,  Self-Care Deficit
even the smallest of developmental
Nursing Theory processes, derived
our actions can make  practice of activities that
a difference, from a condition, or
individuals initiate and associated with an
including the perform on their behalf
simplest of things event
in maintaining life, o Example:
such as spending health, and well-being.
time with our  adjusting to a new
 based upon the job, adjusting to body
patients, and the way philosophy that all
we speak to them. changes
patients wish to care for  Health deviation of
 Integrality themselves.
o human and self-care requisites
 can recover more o Required in conditions
environmental quickly and holistically if
energy fields that are of illness, injury, or
they are allowed to
mutually and disease
perform their self-care
continuously o Example:
to the best of their
changing--we affect  seeking medical
ability.
our environment and assistance,
our environment
3 Components of awareness of
affects us; person Orem’s General disease conditions,
and environment Theory: carrying out
become one field prescribed
Theory of self-care
(meditation, music or measures, modify
includes:
humor can be used activities, learning to
 Self-care
 live with the effects
of disease condition
Theory of self-care
deficit
 specific when nursing is
needed because the
person cannot carry out
self-care;
 5 methods of helping
o (acting for and doing
for others, guiding
others, supporting
another, providing an
environment to
promote patient’s
ability, teaching
another)
Theory of nursing
systems
 describes how the
patient’s self-care needs
will be met by the nurse,
the patient, or both; 3
classifications.
 Wholly compensatory
system
o the patient is
dependent; the nurse
is expected to
accomplish all the
patient’s self-care
activities.
o Example:
 Spinal Cord Injury
(Paralysis),
Cerebrovascular
Accident (Stroke)
 Partially
compensatory
systems
o the patient can meet
some needs; both
the nurse and the
patient engage in
meeting self-care
needs.
o Example:
 Fracture on the left
lower leg with cast
and appendectomy
 Supportive-educative
system
o the patient can meet
self-care requisites
but needs assistance
with decision making,
knowledge, and skills
to learn self-care.
o Example:
 First-time pregnant
mothers, Diabetes
Mellitus