Watson's Philosophy and Science of Caring

Introduction

• Theorist - Jean Watson was born in West Virginia, US
• Educated: BSN, University of Colorado, 1964, MS, University of Colorado, 1966, PhD, University of Colorado, 1973
• Distinguished Professor of Nursing and Chair in Caring Science at the University of Colorado Health Sciences Center.
• Fellow of the American Academy of Nursing.
• Dean of Nursing at the University Health Sciences Center and President of the National League for Nursing
• Undergraduate and graduate degrees in nursing and psychiatric-mental health nursing and PhD in educational psychology and counseling.
• Six (6) Honorary Doctoral Degrees.
• Research has been in the area of human caring and loss.
• In 1988, her theory was published in “nursing: human science and human care”.

The seven assumptions

1.  Caring can be effectively demonstrated and practiced only interpersonally.

2.  Caring consists of carative factors that result in the satisfaction of certain human needs.

3.  Effective caring promotes health and individual or family growth.

4.  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.

The ten primary carative factors

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

2.  The installation 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.

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 /or corrective mental, physical, socio-cultural 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 “philosophical 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

• 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

• 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

• 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 only when they form person to person relationship.

4. Establishing a helping-trust relationship

• Strongest tool is the mode of communication, which establishes rapport and caring.
• Characteristics needed to in the helping-trust relationship are:
• Congruence
• Empathy
• Warmth

• Communication includes verbal, nonverbal and listening in a manner which connotes empathetic understanding.

5. 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”.
• Awareness of the feelings helps to understand the behavior it engenders.

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

• The scientific problem- solving method is the only method that allows for control and prediction, and that permits self-correction.
• The science of caring should not be always neutral and objective.

7.  Promotion of interpersonal teaching-learning

• 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, socio-cultural and spiritual environment

• 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 well-being.
• The external and internal environments are interdependent.
• Nurse must provide comfort, privacy and safety as a part of this carative factor.

9. Assistance with the gratification of human needs

• It is based on a hierarchy of need similar to that of the Maslow’s.
• 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

• 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 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.

Watson’s theory and the four major concepts

1.     Human being

• Human being refers to “….. 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 adds the following three elements to WHO definition of health:
• 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

• “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”. 

Watson’s theory and nursing process

• 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.

1.      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.

2.      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.

3.      Intervention

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

4.      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.

Watson’s theory and the characteristic of a theory

1.  Logical in nature.

2.  Relatively simple

3.  Generelizable

4.  Based on phenomenological studies that generally ask questions rather than state hypotheses.

5.  Can be used to guide and improve practice.

6.  Supported by the theoretical work of numerous humanists, philosophers, developmentalists and psychologists.

Strengths

• This theory places client 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

• Biophysical needs of the individual are given less important.
• The ten caratiive factors primarily delineate the psychosocial needs of the person.
• Needs further research to apply in practice.

Research related to Watson’s theory

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

• Watson provides many useful concepts for the practice of nursing.
• She ties together many theories commonly used in nursing education.
• The detailed descriptions of the carative factors can give guidance to those who wish to employ them in practice or research.

References

1.  Timber BK. Fundamental skills and concepts in Patient Care, 7th edition, LWW, New Yok.

2.  George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton & Lange.

3.  Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins.

4.  Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia,  Lippincott.

5.  Taylor Carol,Lillis Carol (2001)The Art & Science  Of Nursing Care 4th ed. Philadelphia,  Lippincott.

6.  Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. London Mosby Year Book.

7.  Vandemark L.M. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse –therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15

8.  Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006 Jul;19(3):225

9.  Cheng MY. Using King's Goal Attainment Theory to facilitate drug compliance in a psychiatric patient. Hu Li Za Zhi. 2006 Jun;53(3):90-7.

Delaune SC,. Ladner PK, Fundamental of nursing, standard and practice, 2nd edition, Thomson, NY, 2002.

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