Since its establishment as a profession more than a century ago, Nursing has been a source for numerous debates related to its course, methods and development of nursing knowledge. Many nursing definitions and theories have evolved over time. Furthermore it is in a constant process of been redefined. The purpose of this paper is an overview of Jean Watsons Theory of Caring. This theory can be taken into account as one of the most philosophicaly complicated of existent nursing theories.

The Theory of Human Caring, which also has been reffered to as the Theory of Transpersonal Caring, is middle range explanatory theory. (Fawccett, 2000) The central point of which is on the human component of caring and actual encounter between the client and the caregiver. Jean Watson has stated that her work was motivated by her search of a new meaning to the world of nursing and patient care. I felt a dissonnance between nursings (meta) paradigm of caring-healing and health, and mediciness (meta) paradigm of diagnosis and treatment, and concentration on disease and pathology.

Watson, 1997,p. 49) Jean Watsons theory was first published in 1979. Later Watson explained that this work was an attempt to solve some conceptual and empirical problems, with no intention to create a theory. This theory was expanded and formalized in her next book in 1985. Since than Watson continued to refine her ideas through various publications. At his time, the major conceptual elements of the theory are ten Clinical Caritas Processes (originally Carative factors), Transpersonal Caring Relationship, Caring Moment/Occasion and Caring Consciousness.

According to Watsons theory, the human care process is performed through a Transpersonal Caring Relationship guided by the Carative factors, which are based on humanistic altruistic value system. The Theory of Human Caring was initialy based on data about variety of aspects of caring, collected through open ended quistionnaire. The purpose of this research was to evaluate different points of view, expressed by both the clients and registered nurses. In addition to this data, Watsons theory uses broadly recognized work from other disciplines.

Specific philosophers cited by Watson, as sources are Rogers, Whitehead, Gadow, Yalom etc. Furthermore, she also recognises the contribution of the eastern philosophy in her work. According toWatson (1985), her philosophical orientation is existential phemenological, spiritual and methaphysical. She is the first nursing theorist to support the idea of soul and to accentuate the spiritual dimension of human existence. Watson describes nursing as an art and a human science with the major focus being the process of a human care for individuals, families and groups.

According to her beliefs, body, mind and soul are distinquished from each other. Nevertheless, Watson also states that harmony is required among the three to be the highest form of health and that it is the nursing goal to help people to reach this equanimity. This goal can be accomplished through transpersonal relationship. Within the Theory of Human Caring, during transpersonal caring moment, the nurse and the patient gain entry into the lived knowledge of each other.

In order for transpersonal contact to occur both the caregiver and the one being cared for should experience a process of being and becoming, both are influenced by the nature of transaction. (Watson, 1985) Watson defines human caring as a moral ideal, that the nurse should carry during every transaction. According to her theory, that ideal will assure a certain needed behaviour at the time of the caring occasion. Another concepts in Watsons theory are person, health, illness and environment.

Watson defines person not only as a spiritual being, but also as a material physical being that is also a part of nature and the physical world. A person is experiencing and perceiving physiological individual that is able to find meaning and harmony in existence (Watson, 1979, p. 55). Watson beliefs that that the person is not limited by time and space and able to control his physical world. Consequently she refers to environment as the universal or cosmic level of existence and perceives person and environment as a field of connectedness.

Watson, 1985) Furthermore, Watson (1985) defined a connection between health and illness. As it was stated previously, health, according to the Theory of Human Caring is unity and harmony within the mind, body and soul. Moreover, health is also associated with the degree of congruence between the experienced and perceived self. Consequently illness is a disharmony within a persons mind, body and soul, which can lead to disease. Thus, nursing as a discipline has a role of helping a person to find meaning in illness and existence in general.

According to Jean Watson, everything in the universe is connected. Humans cannot be separated from self, other, nature and the larger univers and should be treated as a whole. Watson (1997) is concerned that caring values of nursing and nurses have been submerged within contemporary medical systems, which are dominated by economics. She beliefs that nurses must continuosly question and be open to new possibilities, as well as form and reconsider ancient and new knowledge. There is a well – known gap between theory and practice in nursing.

Encorporating Watsons theory into practice requires an exclusive moral and spiritual pledge from a nurse towards herself and the patient. This writing process brings me to a question. Is every nurse capable to reach this level of commitment? Watson has stated in her publications that her theory framework is difficult to study concretely. However, a practice methology for the application of the theory in practise, has been extracted from Watsons publications. Since than, the number of published reports of the theory has grown.

One of the concepts that received a wide coverage as a research issue in the several past years is caregiver. In 1995 Sandra Weeks made an attempt to investigate future family caregivers points of view regarding their needs. Watsons theory of Human Caring was used as a theoretical framework for this research, while Matthi Questionnaire was used as an assessable tool. The Questionnaire has provided a list of 45 tasks, devided to a several categories, with the major focus on assisting disabled adult and maintaining caregiver and family well being.

This article concentrates on two major ideas of Watsons theory caring as an obstract concept and caring moment as a measurable one. As a hypothesis to this study, Weeks defined a connection between nurses perception of caregivers needs and caring moment, based on the Theory of Human Caring. Caring parallels perceivingPerceiving can lead to an actual caring occasion when the prospective family caregivers educational wants are recognized and met by the nurse. (p. 257) The results of this research have shown that family members of newly disabled adults are faced with uncertainty and burdened with mixed feelings.

The normalization of the daily routine of a disabled adult was acclaimed as the major concern by majority of the prospective family caregivers in the current study. The facts in this research stress out the importance of nurses awareness of the family needs. Moreover, it is essential that the assessment process will occur immediately upon the patients admission and will continue through the hospitalization process into the discharge planning. Furthermore, there is a need to recognize the extent of needs expressed by a patient and a caregiver together as a family and separetly.

As stated by Watson (1985), been sensitive to the feelings and needs of family members, the nurse can better learn the familys beliefs systems, values and worldview. Summing up, adressing the family members needs through a caring process will help them to deal with their loved one illness and achieve a better adaptation to a new role of caregivers. This conclusion is consistent with Watsons (1985,1996) definition of Human Caring Emphasis is placed on helping other(s),, to gain more self knowledge, self control, and even self healing potential, regardless of the health illness condition

In my opinion, this research is consistent with the Watsons theory, where the major focus is not only on individuals, but on families as well. Unquestionably this is a confirmation that the Theory of Human Caring can be incorporated within nursing practice. However, this particular article also rises another question. Do all family members caregivers have the same needs? What will be a predictor of this variance? Piccinato & Rosenbaum (1997) have tried to explore the caregiver personality characteristics in their article.

The purpose of their research was a review of the literature regarding the concept of older caregiver hardiness within Watsons theory of Human Caring. The term of hardiness was said to be complex, existential phenomenological and almost as imposible to measure, as Theory of Human Caring. Nevertheless, the authors have decided to use Watsons theory as a framework for their investigation of the hardiness concept because of its consistency with phenomenological, existential concepts. Examination of various nursing studies, regarding caregiving experience of older adults, has revield its negative effect on the caregiver well being.

The core definition of hardiness used for the purposes of this article describes hardy persons: Hardy persons view change as a challenge and as beneficial to personal development and are considered to possess three interrelated attributes: control, commitment and challenge (p. 34). Hardiness, according to Piccinato & Rosenbaum article, is described as a gathering of personality characteristic that promotes withstanding during stressful life events, which resolves in a positive caregiving experience. There is no exact definition of hardiness in the Theory of Human Caring.

However, the authors tried to extract the definition of self from Watsons terminology and compare it to the three components of hardiness – control, commitment and challenge. Piccinato & Rosenbaum suggestion to nurses is to help facilitate the caregiver hardiness through a transpersonal caring relationship, using Watsons ten Carative factors. According to their findings, caregivers needs should be incorporated into nursing care plans. Through this process the caregivers will be able to achieve spiritual well being and promote healing in their loved ones.

Incorporating Watsons theory in this research article is useful in terms of expanding knowledge about family members as caregivers. However, because this reserch was based on theory, my opinion is that it will require further research in order to determine its use. Two previous articles have explored Watsons theory of Human Caring in terms of family members as caregivers. The conclusions of both articles bring in a question about the carereceivers needs. This issue is explored in Donnas Strickland (1996) article.

The research was done in nursing home settings in order to receive feedback regarding nursing practice, using the Theory of Human Caring as a theoretical framework and as an evaluation tool. The study was conducted among six elderly women, using Lees Glickstein Laughing Spirit , format which is based on a group sessions where each member has an equial opportunity to be fully heard. Each group member, including the reserchers had an opportunity to tell their personal stories, receive a positive feedback and listen to others. Listening under this context was defined as enterning someones phemenological field.

The whole settings were reffered to as Transpersonal Relationship. Several findings came out from the above interactions in the closing session. The subjects of this study have reported that reaching one to another had given them an opportunity to feel connected. Positive feedbacks were compared to reciprocal altruism, which may be compared to Watsons first Carative Factor. Another correspondence with Watsons theory was that the group found it difficult to express themselves because of the phemenological, spiritual context of the experience, which is related to the tens Carative factor.

Both the researchers and the participants felt positively affected by this experience. In spite all this, the group success provided some negative feedbacks as well. All group members felt that those caring moments usually missing in the retirment community between caregivers and elders. Strickland argues that if Watsons theory had been in use in these particular settings, these women would not report an isolation and lack of caring. One may dispute that the above research was applied to a specifically small, chosen group of people, but it is yet another translation of Theory of Human Caring into practice.

Will the results differ in a larger, younger or transcultural group of people? One of the Watsons guideline for the human care process is to consentrate intentionaly on caring, healing and wholeness, rather than on disease (Fawccett, 2000). The practice methodology for this procedure advises the nurse to stay within the others frame of reference, potentiate comfort measures and a sence of well being. The nurse, through a transpersonal caring, enters into patients phemenological field, allowing him to explore his deeper emotions.

Thus, in order to achieve a better understanding and a positive outcome, it is up to the nurse to gain knowledge about the subjective personal meanings of the patients experience before initiating a transpersonal caring occasion. The case study that I have selected for the interpretation of Watsons definitions is a story about Mrs. Chow. In Chinese medical tradition, illness is perceived as a state of disharmony between the individual and the environment. Confucianism, Taoism and Buddhism constitute the essence of the traditional Chinese culture.

Chinese medicine combines both holistic and traditional knowledge. Patients do not express their concerns about prescribed interventions or treatments. Thoughts are expressed politely and with restraint through language that is indirect. Direct eye contact is used with the elderly. A display of emotions is considered a weakness of character. (Geissler, E. M, 1998, p. 53) In traditional Chinese patrilocal society, the elderly used to live with their sons. Daughters, however, moved in with their in laws. Both respect and obligation in Chinese culture require that children take care of their parents.

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