Abstract
This paper discusses and analyzes the background, content, applicability, and feasibility of Jean Watson’s middle-range nursing theory, known as the Theory of Human Caring. This theory is based on the concepts perpetuating the tradition of transpersonal and humanistic psychologists, such as Abraham Maslow and Carl Rogers. It considers caring as a living human interaction based on integration and unity of all dimensions of human existence that are body, mind, and spirit.
The paper discusses the experience of applying theory-based concepts both in the entire hospital’s nursing activities and in the particular caring program. These examples confirm the high applicability and effectiveness of the theory in nursing areas such as clinical practice, education, administration, and research. The theory can provide the classic nursing approach with specific transpersonal, meditative, and other spiritual techniques.
Introduction
Middle-range nursing theories include particular abstract concepts and notions, and at the same time, are applicable to nursing practice. Jean Watson started developing a Theory of Human Caring more than 35 years ago (Clark, 2016, para. 2). This nursing theory has an extensive conceptual grounding based on the ideas of humanist philosophy as well as transpersonal and existential-humanist psychology. It has evolved over time and now could be considered as a specific ethical-philosophical paradigm or science model. Therewith, this theory concerns many aspects of the application of its insights in nursing activities and is currently in extensive use. Jean Watson has an undergraduate and graduate degree in psychiatric-mental health nursing and nursing education as well as a doctorate in educational psychology and counseling from the University of Colorado (Watson, 2016).
The theory was initially published in 1979, followed by many other books and articles devoted to it. Jean Watson is a widely published author, a guest at numerous conferences and seminars around the world (Watson, 2016). Her nursing theory has had a significant impact in this field and is still discussed by nursing theorists, scientists, and practitioners.
Summary of the Theory
The theory focuses on the experiential aspects of caring and addresses them from existential-personal and transpersonal-spiritual perspectives. Researchers state that “it asserts that a human being cannot be healed as an object” and is an inseparable “part of his/her self, environment, nature, and the larger universe” (Ozan, Okumus, & Lash, 2015, p. 26). According to the theory, the caring should be based on the integration and unity of all dimensions of human existence, specifically body, mind, and spirit. The central thesis of the theory is to shift the emphasis from objective characteristics of nursing to subjective ones, including experiential and spiritual.
The theory describes in detail the ideal features of caring, revealing many dimensions of the subjective experience of caring between caregiver and patient. Initially, Jean Watson formulated ten carative factors, which were then reformulated into the Caritas processes (Ozan et al., 2015). The factors describe the fundamental ideals of nursing, while the processes reflect the attitudes that the caregiver should be guided by.
For instance, the “humanistic – altruistic system of values” factor corresponds to the “practicing loving-kindness/compassion and equanimity for self/other” process (Ozan et al., 2015, p. 27). When factors and processes are summed up, they include, among other things, maintaining an authentic presence, cultivating spiritual and meditative practices, freely expressing emotions, and allowing them to be, meeting primary human needs. They also reflect a multidisciplinary approach to problem-solving, establishing caring relationships, research and teaching, and creating a caring environment.
The theory considers caring not as a professional relationship between an employee and a client, but as a living human interaction. According to Ozan et al. (2015), it “consists of four basic concepts: healing processes, interpersonal maintenance of the relationship, the caring moment, and awareness of healing” (p. 26). The caring moment is a unique concept of a theory that defines a meaningful, deliberate, and a conscious encounter of two human beings with each of their phenomenal fields of subjective perception. It is the place where all human interactions, including caring, occur.
Conception and visions of Watsons’ theory are rooted in transpersonal and humanistic psychology. Researchers state that the development of this theory was largely influenced by several thinkers such as “Abraham Maslow, Carl Rogers, and Pierre Teilhard de Chardin” (Clark, 2016, para. 13). Jean Watson identified hierarchy of needs of Abraham Maslow as a description of all the necessary aspects of caring. The patient should be satisfied with physiological needs, feel safe, accepted, and loved, and develop his or her higher spiritual potential according to the need for self-actualization, which is a metaparadigm concept.
Another such concept is Carl Rogers’ empathy, which manifests itself in the theory as acceptance and loving kindness. According to Clark (2016), “De Chardin focused on inter-relating science and faith, and he proposed that humans are moving toward higher forms of consciousness” (para. 22). This is consistent with Jean Watson’s multidisciplinary scientific and spiritual approach, as well as her position on developing awareness in caring that may transcend patients’ suffering.
Applicability
The applicability and the experience in the implementation of middle-range nursing theories are crucial in determining their value and usefulness. Brandao, Martins, Peixoto, Lopes, and Primo (2017) note the significant gap between theory and practice and a certain amount of unsuccessful experience in applying specific nursing theories. The authors argue that middle-range nursing theories should play an intermediary role in establishing a connection between concrete work hypotheses and the grand nursing theories (Brandao et al., 2017). Watson’s theory meets this criterion because it has implementation experience and is highly applicable.
The theory can be applied in a wide range of nursing fields such as clinical practice, education, administration, and research. According to Norman, Rossillo, and Skelton (2016), there is a successful experience of implementing Jean Watson’s theory in creating a healing environment in a particular hospital. The hospital nursing staff received intensive education during the learning sessions organized by Caritas coaches. These sessions were based on a training methodology according to which each Caritas process is matched by activity descriptions and specific examples. For instance, the “creativity” Caritas process corresponds to the “creative problem solving” and “small group discussion and report” (Norman et al., 2016, p. 403).
Staff members studied a Caritas language and learned the practices of loving kindness that were applied not only to patients but also to each other, which greatly influenced the administrative processes in the hospital.
Conducting learning sessions based on theory has resulted in positive working outcomes. There have been cases where a “nurse discovered that one of her patients was angry” and spent time with him listening to his concerns and allowing him “to express his anger about his diagnosis” (Norman et al., 2016, p. 404). Such cases have been described not only concerning the nurse-patient relationships but also regarding the relationships between the working staff. Norman et al. (2016) remarked an increased patient and staff member satisfaction. Thus, this experience of applying the theory can be considered successful.
However, the research article of these authors does not exhaust the experience of describing the theory implementation. Ozan et al. (2015) explored “theory-based approaches to the holistic care of women with unsuccessful IVF [in vitro fertilization] treatment” in their study (p. 26). A caring and healing system was developed for women with failed IVF under Jean Watson’s theory. It included three caring moments: “face-to-face interview before and after the pregnancy test,” “telephone interview upon a failed treatment,” and “face-to-face interview upon a failed treatment” (Ozan et al., 2015, p. 28).
Each moment was matched by specific Caritas processes that guided nurses in communicating with patients. Analysis of the protocols of audio recordings of telephone and in-person conversations made during the research demonstrated that these methods helped women to overcome unsuccessful IVF (Ozan et al., 2015). Moreover, the conceptions and approaches of the theory provided the nurses with convenient and effective professional guidance.
Thus, Watson’s theory was developed and enriched in the course of research efforts. Its concepts, such as caring moments, carative factors, and Caritas processes, have proven to be applicable in nursing clinical practice, intra-organizational relations of health care workers, as well as in educational settings. Based on the studies mentioned above, it should be concluded that it is applicable to both individual nursing programs and researches and entire health care institutions.
Feasibility
As has been demonstrated previously, Jean Watson’s theory is easy to put into practice due to pragmatically oriented concepts that can be applied to nursing activities. Also, specific methodological instruments and concepts can enrich and increase the efficiency of post-graduate nursing education. This will allow the advanced practice nurses to use additional techniques and approaches in accordance with notions of caring moments, carative factors, and Caritas processes, as well as mind-body-soul integration. It should be noted that theory is cognitively simple to understand, but it contains a large amount of information, and therefore requires special training.
The major problem with the implementation of this theory is that it may require certain financial and organizational resources, and it may be complicated to calculate the exact benefits of its application. For example, conducting educational arrangements under the relevant methodology in the hospital amounted to $3,000 per staff member (Norman et al., 2016, p. 408). At the same time, according to Norman et al. (2016), “an accurate account of the financial benefit of the caring behaviors of nurses in various practice settings in a hospital is difficult” (p. 408). Nevertheless, the studies confirm the effectiveness of applying the theory to specific nursing activities and the improvement of their quality.
This theory can clearly extend the classic nursing approach, including certain transpersonal, meditative, and other spiritual techniques. For instance, researchers give an example of a mindfulness technique for nurses that requires them “to close the eyes, take several deep breaths, cleanse the external world, and then make contact with the patient” (Norman et al., 2016, p. 406). These methods are innovative for traditional patient care, but they are expected to be of great benefit.
Conclusion
The Theory of Human Caring by Jean Watson treats caring as a process of human interaction and uses many concepts rooted in transpersonal and humanistic psychology to describe and characterize it. There are several evidences that a theory is applicable and effective in areas of nursing activity such as clinical practice, research, administration, and education. This paper describes the examples of the successful application of innovative solutions of the theory in practice. Due to its pragmatically oriented concepts, this theory may be implemented both in ordinary and advanced nursing practice.
References
Brandao, M. A. G., Martins, J. S. A., Peixoto, M. D. A. P., Lopes, R. O. P., & Primo, C. C. (2017). Theoretical and methodological reflections for the construction of middle-range nursing theories. Texto Contexto Enferm, 26(4). Web.
Clark, C. S. (2016). Watson’s human caring theory: Pertinent transpersonal and humanities concepts for educators. Humanities, 5(2). Web.
Norman, V., Rossillo, K., & Skelton, K. (2016). Creating healing environments through the theory of caring. AORN Journal, 104(5), 401-409.
Ozan, Y. D., Okumus, H., & Lash, A. A. (2015). Implementation of Watson’s theory of human caring: A case study. International Journal of Caring Sciences, 8(1), 25-35.
Watson, J. (2016). Watson caring science institute. Health Sciences Library Photograph Collection and Special Collections, University of Colorado, Anschutz Medical Campus; Publications. Web.