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Introduction
In the present age of modernization health care system in the world around is undergoing massive changes in structure as well as application. While this process continues most of the patients are exposed to dehumanization from the individuals who are bound to impart care and well being. Therefore, it is a necessity that the nurses who are the proponents of health care should make conscious effort to maintain patient caring according to the vision and practical approach of Jean Watson. Caring is the inherent element of human heritage which is emphatically founded on empathy and compassion and as such it is the duty and responsibility of a nurse to extend care to the patients identifying it as the lifes mission and meaning in its entirety. Watsons theory of caring is purely based on this principle and it is applicable to every nurse who commits to the field of nursing (Cara, n.d.).
Background of Watsons theory
Jean Watson who was born in West Virginia has contributed much to the human caring and loss. Her theory of nursing was brought to light in the year 1979 with the publication of her book titled The philosophy and science of caring . The caring theory was formulated in order to bring innovation and dignity in the nursing field and to generate a new approach to the quality of care given to the patients. The theory which was well acclaimed by one and all is consisted of clinical and empirical studies and experiences. Her thoughts about human life, health and death and the quantum and quality of caring and healing became the guiding factors for her to come up with the theory. The ethical bond that existed between nursing and the society has motivated Watson to originate the care theory so that the problems that undermined health care could be solved (Watsons theory and the four major concepts). Her theories are inspired by the Eastern philosophy that considers body as a whole entity and the works of Carl Rogers and Richard Lazarus.
As per Watsons theory of caring, nursing is an important division of human science that is centered largely on the procedure of care for individuals and families, and also the different societal groups. Watsons care theory, as such, has its basis on humanism originated from metaphysics. The main aim of nursing is to help the patient in getting concord in the mindset, body and soul which is satiated with the help of caring transactions (McCance, Mckenna, Boore 1999) including transpersonal caring. The occurrence of transpersonal caring can be identified when there is an actual caring event or occasion that expresses apprehension for the inner life, wherein the patient is considered as whole and complete irrespective of illness (Vance, 2003).
The four concepts
Human being: Human being is a valued individual to be taken care of and nurtured. A person should be honored, understood and assisted. It is because a person is an integrated self with full functional abilities and is more than a single part or organ and is greater than what it is (Watsons theory and the four major concepts).
Health: Health comprises of physical, mental and social functioning which has adaptive maintenance nature, and absence of illness. Here, absence of illness also indicates the presence of exertion of attempts that removes the illness (Watsons theory and the four major concepts).
Environment and society: The act and processing of care and nursing have existed in all of the societies from the beginning of humanity. The caring approach as seen today does not convey at all from one generation to the next generation. It is transitted and carried through the culture pertained to ones profession as a means to adapt to the environment (Watsons theory and the four major concepts).
Nursing: Nursing is related to promotion of health. It prevents and removes illnesses and extends care to the sick towards restoration of health. It concentrates mainly on the advancement of health care and treatment of various illnesses. The practice of caring in nursing is established on the concept of holistic health care. Nursing, therefore, is defined as the science of humans and their health as well as illnesses that are subjected through professional, scientific, aesthetic and personal transactions along with human transactions built on ethics (Watsons theory and the four major concepts).
Application of Watsons theory in nurse-patient interaction (Caring moment)
Watsons theory of caring, when put into practice, gives the practitioner a holistic humanitarian vision of the patient which preserves human dignity and wholeness. This theory advocates a social podium and value oriented system interlinked with humanism, spiritual and aesthetic components for human caring which results in the balancing of cure through medication and the caring potential of the nurse. It provides the nurse with scientific and professional knowledge and insight on the role a nurse performs (Hagedorn, 2004).
In nursing, as per Watsons theory, caring develops when a nurse-to-patient contact is established. The moment the nurse steps into the realm of the patient and understands him/her to be a caring person, the real nursing begins, and this makes change in the patients feeling of well being. Caring can happen sans curing but curing will never take place without caring. Nurses care for patients with this belief, and all the while thinking that hope and commitment are the essentials for caring (Vance, 2003).
Vance (2003) states
I am a field nurse in a for-profit hospice organization. Caring is a central concept to the delivery of hospice care. The patients we encounter are in a variety of settings, such as; own home, nursing home, retirement center, family home, or a friends home. They are often frightened with the knowledge of their imminent death and in unfamiliar surroundings. They rely on the nurse and the delivery of care to help them feel physically better. As a hospice nurse we also view the patient as a spiritual being. That means reaching out to the patient and forming a deeper connection to the spiritual self. It means becoming one (Vance, 2003).
Context of caring moment
The caring nurse and the patient are interconnected (Watson, 1997), and the nurse secures herself tranquility about own mortality and becomes at ease with the recognition of life cycles and prepares for own death. A nurse is guided by caring, empathy, tenderness etc. for own self and for others (Vance, 2003), and the caring moment resulting in action and choice can begin when the nurse and the patient come closer with their histories of life. Everything that counts from thereon like the action of the nurse, verbal expressions, behavior, feelings, cognition and a hoard of related factors contribute to the origination of transpersonal caring that links with the patient. The closeness and interaction extend the opportunity to the nurse and the patient to determine their involvement in that caring moment and to know what each of them wants (Hagedorn, 2004).
The patients view of the health condition and its influence on his or her life is essential to process a caring bond between the nurse and the patient. Questions regarding the medication and treatment taken, and how it affected the life style etc., are determining factors of a caring moment. Visual data and plans are quite helpful aspects for an effective development of caring moment. The nurse may also need to incite the patient to a debate on the cultural, social and emotional elements that decides on their health status. During the course of caring interaction there would be a frequent change in both of their approach depending upon their needs and interests with respect to the cultural and personal variables (Hagedorn, 2004).
Analysis of major theory assumptions related to person, health, nursing, and environment
The four major assumptions of Watsons caring theory are:
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Person,
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Health,
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Environment,
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Nursing
Person
Watson through her caring theory defines person as an entity having three components viz., mind, body, and spirit which are influenced by the self who makes choices. This definition emphasizes the relationship between person and environment. Therefore, the healing environment can widen the awareness and consciousness of the person and promote the unity and wholeness of the trinity of mind-body-spirit towards healing. This is the reason for Watsons recognition of the room of the patient as a comforting, healing and holy place (Cara, n.d.).
The mind is associated with emotions, memories and intelligence. The mind is the gateway to the body and the spirit. The spirit is the soul or inner self which can be considered as the essence of the person. It coexists with present, past and future at the same time and hence spirituality has a major role to play in the nursing profession. Care of the spirit is the most important part of the caring in nursing. Another aspect of Watsons assumption is the respect for the preferences and decisions of the other person (Cara, n.d.).
Health
According to the theory of Watson, health does not limit to mere absence of disease. The persons status of health or illness is a significant subjective experience and therefore, it is associated with his or her concord within the mindset, body and spirit connected to the level of agreement between ones self that perceives, and the other self that experiences. While one experience own real self, there exists greater harmony within the mind-body-spirit set. The outcome of this harmony is the acquiring of higher level of health (Cara, n.d.).
Nursing
The performance of nursing is described as the human science of individuals and human health, wherein the illness experiences are reconciled by human care transactions such as professional, scientific, aesthetic and ethical factors. Watson opines that nursing is science as well as an art. However, such artistries and creativity are generally not in agreement with the policy and procedure of a medical institution. To be an artist is only the partial role in extending caring for the patients as well as the families belonging to them. The artistic area of nursing is translated as the development of transpersonal caring in the healing modalities that correspond to the adoption of measures for giving comfort to lessen stress, strain, pain and suffering along with the promotion of well being and healing. In her attempt in devising the caring theory Watson agrees with the views of other scholars of nursing and admits that caring is the total essence of nursing and that it is the moral ideal of the nurse in maintaining the human dignity. It is a unique way of building relationships with ones self, the others and wider environment demanding a commitment for caring the person (Cara, n.d.).
Environment
Caring and nursing have existed and still existing in all of the societies of the world. The caring attitude is not passed on from one generation to another. It is conveyed by the culture that is inherent with the profession as a mode of adaption to the environment. Moreover, human beings are considered as systems of integration which are linked to the environment. Therefore, the physical and non physical environment brings quality in care and healing. Nurses possess maximal control over every environment, but they lack responsibility for safeguarding the environment and correct the patient towards its betterment. Environment should be acknowledged as functional place that promotes healing (Watson, 2007).
Utilization of Watsons carative factors in the transpersonal relationship. Apply a minimum of four carative factors
Watson applies the carative factors as a tool of directives for the core of nursing. The word carative is applied to denote the difference in conventional curative elements. These factors honor the nursing profession and the inner world and the experiences of the patients. Altogether there are 10 carative factors which are utilized in the following manner, according to (Watson, 1988).
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Humanistic-altruistic value system
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Faith-Hope
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Sensitivity to self and others
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Helping-trusting, human care relationship
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Expressing positive- negative feelings
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Creative problem-solving caring process
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Transpersonal teaching and learning
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Supportive, protective, and/or corrective mental, physical, societal, and spiritual environment
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Human needs assistance
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Existential-phenomenological-spiritual forces (Watson, 1988).
Out of these ten carative factors, the first 5 carative factors are utilized in the following manner:
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Humanistic-altruistic value system: It is the practice of loving kindness and composure in imparting caring consciousness (Watson, 1988).
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Faith-Hope: This is to present in oneself and maintaining the belief system and the world of own self and that of the patient cared for (Watson, 1988).
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Sensitivity to self and others: It is meant to cultivate spirituality and transpersonal self which are exhibited to others with feelings and compassion (Watson, 1988).
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Helping-trusting, human care relationship: This is aimed at developing and retaining a caring relationship based on helping-trusting modality (Watson, 2001).
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Expressing positive- negative feelings: The exposure of positive or negative feelings is utilized as a link to the deeper spirit of ones self and of the one cared for (Watson, 2001).
Transpersonal Caring Relationship
The transpersonal caring bond is identified as a special type of human care relationship and it depends on the moral commitment in safeguarding and promoting human dignity and ones deeper self. The caring consciousness of the nurse is conveyed to maintain and respect the spirit avoiding a situation of disregarding the moral standard of an object. The caring consciousness and the link have the potential to cure as there is experience, perception and intentional relationship. This explains the way the nurse compasses an objective assessment expressing concerns to the subjective and meaning of the persons in connection with their health care status. This approach proves the uniqueness of the person and the nurse in exhibiting the mutuality of the two persons which forms the basis of the relationship. The transpersonal caring relationship aims protection, enhancement and maintenance of dignity and humanity along with wholeness and inner concord (Cara n.d.).
Personal reflections on caring moment
I am revealing my experience in adopting Watsons theory of caring a few days ago. Though I am a nursing student, on week days I used to assist a scarcely furnished clinic attending odd jobs there. Last week as I was in the front room of the clinic a gentleman stepped in. I have seen him earlier peeping in and going back without asking for treatment. When he came in I wanted to know why he used to leave without waiting for the treatment or telling about his complaints. So I started talking to him in order to initiate the contact and to build trust with him. After much persuasion, and taking him into confidence, I suggested him to place his foot on the chair so that I could remove his shoes and inspect the complaint. Shyly he obeyed me looking from the corner of his eyes. But he was unable to place his foot there and we did not have room for him to lie down. Though I was a little nervous, I managed to sit on the floor. I put a paper on the floor so that he could place his foot there. When I took off his shoes it pained him. But I continued talking intentionally without giving any serious attention to it. On inspection, I was stunned to see that his toes were stuck to the socks and was in a very bad shape. I brought a basin with some warm water in it and soaked the socks and foot. Though it took nearly one hour, it was timeless for me, as I was involved in the task. During the conversation he revealed that he was really afraid to come in and show his feet as the clinician might tell him to cut off his feet. I removed the socks and found too many sores on his foot especially, the toes. I put ointment on the wounds and wrapped it and offered new socks which I found in the racks. He was glad and very thankful to me and told me that he would come again for the treatment (Hagedorn, 2004).
After two days when he came, the newly appointed doctor of our clinic sent him to a VA hospital. They treated him well and he became cured of the sores but they removed his two toes. But he did not complain about that. After the discharge from the hospital he came to the clinic to see me and showed me his foot with a smile. He told me that he had no fear after his first talk with me as it gave him the confidence to face any grave situation like removing his feet or toes. When he left I sat on the floor thinking why some people need empathy and understanding in getting over the problems. It seems to me now that he lacked the power to get the trouble over by facing the inevitable. My interaction with him, and my way of putting confidence in him has worked the miracle. I suggest that this should be the way a nurse uses the opportunity to establish the contact with a patient. My experience with him was a mutual give and take of confidence and transfer of power from within ourselves which benefitted both of us. Though his acceptance, and my authentic presence near him developed a mutual helping and trusting relationship which culminated in his satisfactory curing of his feet (Hagedorn, 2004).
References
Cara, C. (n.d.) A Pragmatic View of Jean Watsons Caring Theory. Web.
Hagedorn, M.I.E. ( 2004) The Art of Caring as a Philosophical Model for Nurse Practitioner Praxis, Topics in Advanced Practice Nursing, Medscape, eJournal;4(4) Web.
McCance, T.V.; McKenna, H. P.; Boore, J. R. P. (1999). Caring: theoretical perspectives of relevance to nursing. Journal of Advanced Nursing, Dec99, 30(6), 1388-1396.
Vance, T. (2003) Caring and the Professional Practice of Nursing, RN Journal. Web.
Watson, J. (1997). The theory of human caring: Retrospective and prospective. Nursing Science Quarterly. 10(1), 49-52.
Watson, J. (1988). Nursing: Human science and human care. A theory of nursing, 2nd ed., New York: National League for Nursing.
Watson, J. (2001). Jean Watson: Theory of human caring, M.E. Parker (Ed.), Nursing theories and nursing practice (pp. 343-354). Philadelphia: Davis.
Watson, J. (2007) Watsons theory of human caring and subjective living experiences: Carative factors/Caritas processes as a disciplinary guide to the professional nursing practice, Watsons theory and the four major concepts, Texto Contexto Enferm, Florianópolis, 16(1): 129-35. Web.
Watsons theory and the four major concepts, Jean Watsons Philosophy of Nursing, 2011. Web.
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