Dr. Jean Watson is an American nursing scholar born in West Virginia, who completed her undergraduate degree in nursing and psychology, her master’s degree in psychiatric-mental health nursing, and her Ph.D. in educational psychology and counseling at the University of Colorado. Dr. Watson has received several national and international honors, and honorary doctoral degrees. She has published numerous works describing her philosophy and theory of human caring, which are studied by nurses in various parts of the world. Care is an essential activity that underlies all social life. In the 1970s, Jean Watson, sought to transform nursing into a profession based on scientific caring. According to Jean Watson’s theory of nursing, caring should be acknowledged as the professional specialty of nursing and treated by the medical profession as equally significant as curing. Jean Watson’s theory has assumed a great deal of significance in recent times due to the works of nursing theorists such as Leininger (1988) and Benner (1994), who have attempted to build on this theory in more humanistic ways, by bringing attention to the point that communication and interpersonal understanding are very important in nursing. This sort of focus has also underlined the importance of supervisory tasks such as counseling and listening. With the advent of changes in healthcare delivery systems, nurses of today face increasing workloads and responsibilities and as such Jean Watson’s theory of caring is seen to be theoretically crucial to understanding and improving the practice of nursing as a profession (Fine, 2007). Watson sees caring as the “ethical and moral ideal of nursing that has humanistic and interpersonal qualities” and believes that nursing as an art is lived, expressed and co-created in the caring moment (Daly et al, 2005, p. 115).
Jean Watson, with her book Nursing: The Philosophy and Science of Caring (1979) were one of the first nurse theorists to address the concept of caring as the focus of a nursing theory (Kim and Kollak, 2006). According to her, the work is an outcome of her quest for bringing new meaning and dignity to the world of nursing and patient care. Watson’s theory (2001) has three major elements: the carative factors, the transpersonal caring relationship, and the caring occasion/caring moment. Watson (2001) explained that the word “caritas” originates from the Greek vocabulary, meaning to cherish and to give special loving attention. Watson first developed the carative factors in 1979, and later revised them in 1985 and 1988. The term carative was used by Jean Watson to contrast it with conventional medicine’s curative factors (Cara, 2003). Her carative factors attempt to recognize and honor the human dimensions of nursing and the people it serves. In all, the carative factors are comprised of 10 elements: “the formation of a humanistic-altruistic system of values; the instillation of faith-hope; the cultivation of sensitivity to one’s self and others; the development of a helping-trust relationship; the promotion and acceptance of the expression of positive and negative feelings; the systematic use of the scientific problem-solving method for decision making; the promotion of interpersonal teaching-learning; the provision for a supportive, protective, and (or) corrective mental, physical, sociocultural, and spiritual environment; assistance with the gratification of human needs and finally, the allowance for existential-phenomenological forces” (Rosenberg, 2006, p. 54)
As Jean Watson’s theory evolved, she introduced the concept of clinical caritas processes which have now replaced her carative factors. These processes have a spiritual dimension. Translation of the carative factors into clinical caritas processes happens in the following ways: by practicing the art of loving kindness and caring; by being authentically present when caring for others, by cultivating spiritual practices, by transcending the ego and self interests, opening to others with sensitivity and compassion, developing and sustaining a helping-trusting, authentic caring relationship, being supportive of the expression of positive and negative feelings as a way of connecting with the patient, by using oneself creatively in the caring process, by engaging in artistry of caring-healing practices, engaging in genuine teaching-learning experience, creating healing environment at all levels, assisting with basic needs, with an intentional caring consciousness and opening and attending to spiritual experiences (Watson, 2001, p. 347)
The second major element in Watson’s theory is the transpersonal caring relationship which depends on the nurse’s caring consciousness (Cara, 2003). In the act of transpersonal caring, there is a spiritual connection between the one caring and the one cared-for that aims at spiritual transcendence of suffering and has a quest for meaning and wholeness (Watson, 2001). The term “transpersonal” means to go beyond one’s ego and it is through selflessness that the nurse will be able to reach deeper spiritual connections that have the potential to heal. The goal of a transpersonal caring relationship is to protect, enhance and preserve the patient’s dignity and inner harmony (Cara, 2003). Watson initially viewed transpersonal caring as a one sided approach. However, in 2003 and 2004, Watson revised her model and included the ethical philosophies of Levinas and Logstrup in which caring is seen as more relational. In this model, Watson holds that human existence is based on interrelatedness and caring is an ethical imperative of being human and a basis of relationships (Kim and Kollack, 2006).
According to Watson (1988), a caring occasion is the moment when the nurse and another person can bond specially so that an occasion for human caring is created (Cara, 2003). Both persons, have their unique phenomenal fields and hence the possibility to come together in a human-to-human transaction. According to Watson, a phenomenal field corresponds to “the person’s frame of reference or the totality of human experience consisting of feelings, bodily sensations, thoughts, spiritual beliefs, goals, expectations, environmental considerations, and meanings of one’s perceptions—all of which are based upon one’s past life history, one’s present moment, and one’s imagined future” (Cara, 2003, 55). Thus the caring moment is also a moment that needs that the caregiver must be aware of her consciousness and authentic presence of being in a caring moment with her patient. Moreover, it is possible that both of the participants of a caring moment can be influenced by the choices and actions within the relationship thereby making it a more personal moment. The caring occasion becomes “transpersonal” when it allows for the presence of the spirit of both allowing them to connect beyond perceived personal limits.
Maria Rodriguez suffers from rheumatoid arthritis and yet she is the primary caregiver of her 66 year old mother who is suffering from metastatic cancer. This aggravates her physical condition and she gets admitted in hospital with a bleeding ulcer. If Jean Watson were to be the nurse, understanding that she has her phenomenology, she will first try to communicate with Maria and her neighbor to understand the circumstances under which she fell ill. When Maria complains of epigastric pain, Watson would be immediately empathetic and will be attentive to her (carative factor 1). She will want to relieve Maria of the pain and hence she will encourage her to have a positive outlook and instill faith in her (CF 2). She will understand that when a person is in pain, she needs help and hence Watson will ensure that she does not go to the bathroom alone (CF 9). This would have ensured that Maria did not fall in the bathroom. Then, after leading her back to bed, Watson would have tried to give her some medications for pain relief. Once Maria is free from pain, Watson would talk to her slowly and find out more about her. She would gather details of Maria’s life. This will allow her to understand that stress is the real cause behind the bleeding ulcer. The comfort that Watson offers Maria, by listening and communicating with her, can help her form a bond with Maria (CF 3). She will counsel her that she cannot be the primary caregiver for her mother when she is herself suffering from rheumatoid arthritis (CF 5). Maria feels that she is worn out because of caring for her mother. But in reality, she is also suffering from rheumatoid arthritis and has pressures due to employment problems. By allowing her to talk about the positive and negative feelings, Watson can give her a healing environment (CF 4). Later, by calling in the physician for prompt care and by ensuring that she is treated for her ulcer and rheumatoid arthritis and counseled professionally, Watson can give her the corrective, mental and physical environment to get back her health (CF 7). Finally, four days later when Maria’s health condition stabilizes and she reveals to the nurse that a friend had given her some sacred things. Jean Watson would be open to spiritual experiences and will affirm that these objects can cure Maria. For Watson, spirituality upholds a foremost importance in the nursing profession. She ascertains that the care of the soul remains the most powerful aspect of the art of caring in nursing (Watson, 1997). This, according to Jean Watson would infuse in Maria, hope and courage to face the future. Moreover, by sharing her belief, Jean Watson will be allowing a caring moment to happen.
Watson (1988) holds that a person has three dimensions – mind, body and spirit – that are influenced by the concept of self. In the case of Maria, it would be impossible for Jean Watson to see her without the context of her environment and hence she inquires about her family environment and other personal issues. In Watson’s later work, she opines that the healing space or environment plays a significant role in the healing process and hence she will ensure that Maria’s room is a soothing, healing and sacred place.
Jean Watson’s nursing theory of caring is very useful and practical in the healthcare context. Watson’s theory is practical as it views humans as experiencing subjects in ongoing change and includes the interconnectedness between humans and the world. Thus it has subjective, interactive and interdependence dimensions. The mind and body are considered related and according to the theory, nurses should adopt a holistic approach in caring for patients. By focusing on communication and counseling, Watson’s theory helps the patient to be aware of the root causes of his illness and to take corrective measures. By encouraging the forming of a transcendental bond with the patients, this approach ensures that the nurse becomes more approachable to the patient helping in the health maintenance of the patient. Above all, the patient needs to be treated for his illness and this approach by taking a holistic perspective can provide the best options for total health restoration. Thus it is not an exaggeration to say that Jean Watson’s theory helps in health promotion, maintenance and restoration.
Cara, Chantal. Continuing Education: A Pragmatic View of Jean Watson’s Caring Theory. International Journal for Human Caring, 2003, 7 (3): 51-61
Daly, John; Speedy, Sandra; Jackson, Debra; Lambert, A. Vickie and Lambert, E. Clinton (2005). Professional Nursing: Concepts, Issues, and Challenges. Springer Publications, New York.
Fine, Michael (2007). The Social Division of Care. Australian Journal of Social Issues, 2007, 42 (2), p. 137+
Kim, Suzie Hesook and Kollak, Ingrid (2006). Nursing Theories: Conceptual and Philosophical Foundations. Springer Publications, New York, 2006.
Rosenberg, Susan (2006). Utilizing the Language of Jean Watson’s Caring Theory within a Computerized Clinical Documentation System. Computers, Informatics, Nursing.
Watson, J. (1988). Nursing: Human science and human care. A theory of nursing (2nd printing), National League for Nursing, New York.
Watson, J. (1997). The theory of human caring: Retrospective and prospective. Nursing Science Quarterly, 1997, 10(1), 49-52.
Watson, Jean (2001). Jean Watson: Theory of human caring. In M.E. Parker (Ed.), Nursing theories and nursing practice (pp. 343-354). Davis Publishers, Philadelphia, 2001.