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Jean Watson: Theory of Human Caring

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Transcript of Jean Watson: Theory of Human Caring

Dr. Jean Watson:
Theory of Human Caring

Jean Watson PhD, RN, AHN-BC, FAAN
Theory of Human Caring :
Dr. Jean Watson is Distinguished Professor and Dean Emerita
of the University of Colorado Denver College of Nursing and Anschutz Medical Center, where she held an endowed Chair in Caring Science for 16 years (WCSI, 2013). She founded the Center for Human Caring in Colorado and is a Fellow of the American Academy of Nursing (WCSI, 2013). More recently, Dr. Watson is the Founder and Director of the non-profit foundation: Watson Caring Science Institute (WCSI, 2013). Dr. Watson attended the University of Colorado at Boulder, earning her BSN in 1964, an M.S. in psychiatric and mental health nursing in 1966, and a Ph.D. in educational psychology and counseling in 1973 (McEwen & Wills, 2011). She holds ten
honorary Doctoral Degrees, seven from international universities (Sweden,
United Kingdom, Spain, British Colombia and Quebec, Canada, Japan) (WCSI, 2013).
Dr. Watson is widely published, and received several awards, including a
Kellogg Fellowship in Australia, and a Fulbright Research
award to Sweden (WCSI, 2013). Her works on the theory of human caring
and the art and science of nursing, are widely used in clinical and
academic nursing education, and her caring models are
implemented into nursing and patient care in a
variety of clinical settings (WCSI, 2013).
Theory of Human Caring: Major Concepts
1.
Human Being
: “….. 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” (Watson, 1999).
2.
Health:
Unity, harmony and high level of mental, physical and social function; presence of illness and adaptive harmony with daily function; harmony between
perceived and experienced self (McEwen & Wills, 2011), (Current Nursing, 2012).
3.
Time:
Time is not necessarily linear, but past present and future can meld. Yet past can be experienced more objectively and present more subjectively (McEwen & Wills, 2011).
4.
Nursing:
A human science of persons and human health -- illness experiences
that are mediated by professional, personal, scientific, esthetic,
and ethical human care transactions
5.
Self:
Organized conceptual "I" or "Me" (McEwen & Wills, 2011).
6.
Transpersonal:
An intersubjective human-to-human relationship in
which both or all people are affected, fully present and
share a phenomenal field (McEwen & Wills, 2011).
7.
Phenomenal Field:
The total and only frame of reference
that is the experience of being in the world;
unique to each individual (McEwen & Wills, 2011).

1
. Successful application of human caring theory in hospital settings to achieve "magnet status" (high level of patient and staff satisfaction) (Clarke, Watson & Brewer, 2009)

2.
One study defines the relationship between Human Caring Theory and increased quality of life for patients with hypertension in Saudi Arabia. Although some cultural and language barriers existed, this study showed and positive correlation with quality of life and a negative correlation between blood pressure with use of Watson’s Caring model (Erci, Sayan, Tortumluoglu, Kiliç, Sahin & Güngörmüş, 2003)

The Woman Behind the Theory
Applying Human Caring Theory to Clinical Practice
Caritas process #1
, “Embrace altruistic values and practice loving kindness
with self and others”:Using language that supports and respects the patient, the
nurse and the nursing profession; avoiding clinical and nonclinical language that dishonors or disparages self, patient or experience (Watson, 2008). This does not mean you are not allowed to be negative or in a bad mood, but working not to inflict or aim it at yourself or patients, rather directing or releasing it in order to move on and/or learn from such feelings. One practice is that of “centering” or focusing on feelings and emotions in order to be more aware of each moment (Watson, 2008).

Caritas process #2
, “Instill faith and hope, honor others and be authentically present”: Simply enabling hope in a patient. This can take the form of being present for someone who is isolated or alone that encourages their own expression of “healing words” whether through prayer, song, talk; supporting and restoring their belief in themselves (Watson, 2008).

Caritas process #3
, “Be sensitive to self and others by nurturing individual beliefs and practices”: This is sort of an extension of #2, as it holds the nurse’s own belief and practices as important as well. Encouraging yourself to “think your thoughts and
feel your feelings” and truly understand and cultivate your beliefs and spiritual
practices (Watson, 2008). Even if you are not connected to a religion or
spiritual practice, simply guiding yourself into a mindfulness practice
of watching your thoughts and breathing
will support this caritas process.


Caring Science Sacred Science Reflection
The following are considered the
seven major meta-paradigm concepts
Meditations & Inspirational Videos From Dr. Jean Watson
Blessing Meditation for Nurses
Personal Meditation
Million Nurse Meditation
Eternal Now: Caring Moment
Overview of Caring Science
References:
Within these concepts, the Human Caring Model is broken down into ten caritas processes (Watson, 2013):
1. Embrace altruistic values and Practice loving kindness with self and others.
2. Instill faith and hope, honor others and be authentically present.
3. Be sensitive to self and others by nurturing individual beliefs and practices.
4. Develop helping, trusting, caring relationships.
5. Promote and accept positive and negative feelings as you authentically listen
to another’s story.
6. Use creative scientific problem-solving methods for caring decision making.
7. Share teaching and learning that addresses the individual needs and
comprehension styles.
8. Create a healing environment for the physical and spiritual self which respects
human dignity.
9. Assist with basic physical, emotional, and spiritual human needs.
10. Open to mystery and Allow miracles to enter.
(Watson, 2013)
Evaluation of Theory
using Chinn and Kramer's (2008) two-phase process
Applying Human Caring Theory to Clinical Practice
Caritas process #4,
“Develop helping, trusting, caring relationships”: Relationship can take the form of nurse-patient, nurse-family, nurse-community, etc (Watson, 2008). Many of the aforementioned processes can add to and enrich this caritas process -- mindfulness, hope, etc (Watson, 2008). Ideas for deepening practice include making time to listen to and hear a patient's “story” and truly being interested in their words; making time in your day for undivided attention to cultivate this “relationship”. Even minutes can extend the respect and care that are so needed in healthcare settings. It may help to consciously tell yourself to have at least one “caring moment” per day or per patient, in order to consciously develop this process (Watson, 2008)

Caritas process #5
, “Promote and accept positive and negative feelings as you authentically listen to another’s story”: Once again, other caritas processes can be used to support this. Embracing values and respecting the patient go far in enabling expression of authentic emotions (Watson, 2008). A more concrete way of thinking about this is working allow for silence during times of strong emotion; instead of filling silence with nervous chatter, false reassurance or intent to redirect the conversation to less emotional topics, allow time and space for the patient to feel and express. Sometimes even a few minutesis all that is needed to offer this opening into insight and reflection.

Caritas process #6
, “Use creative scientific problem-solving methods for caring decision making”: Utilizing evidence-based-practice while employing an analytical and critical mindset is essential. Taking time to read and uncover the most up to date research while keeping a critical eye on your own clinical experience and training with regard to evaluating evidence-based-practice facilitates true best practice methods (Watson, 2008).
Applying Human Caring Theory to Clinical Practice
Caritas process #7
, “Share teaching and learning that addresses the individual needs and comprehension styles”: As Watson (2008) writes, “One of the core skills in this process is being able to genuinely access, stay within, and work from the other person’s frame of reference rather than one’s own frame of reference point”. During a busy day or shift it is easy to forget this process and approach patient teaching in such a way that is most time convenient for the nurse. Assess learning style, reading and education level before choosing and engaging in patient education can be a powerful first step.

Caritas process #8
, “Create a healing environment for the physical and spiritual self, which respects human dignity”: Infusing meaning to daily nursing tasks while learning to honor and respect each individual patient; attending to basic toileting, bathing and personal grooming, while withholding utmost respect (Watson, 2008). Also ensuring safety,privacy, human dignity and clean esthetic surroundings; performing your tasks in a skilled and attentive manner, fiercely deterring unnecessary talk of patient’s condition with unnecessary individuals, avoiding labels and exposure of patients body, and attending to even small details (straightening-up tray tables, clean and organized instruments, etc) in patient's room or surrounding, respectively (Watson, 2008)

Caritas process #9
, “Assist with basic physical, emotional, spiritual human needs”: One example is the significance of ventilation; focus on breath to help patient and self (nurse) release and be aware of emotions, which significantly affects the heart-lung system functioning of the body (Watson, 2008). These can be viewed as “sacred nursing acts” (Watson, 2008). This can be a blend of attending to vitals signs, applying oxygen and awareness of breath and body (Watson, 2008). Also staying aware or a patients continued need for play, relaxation, beauty, creativity, etc (Watson, 2008). Offering someone a book, engaging in a card game, inviting conversations about goals and dreams all support this process.

Caritas process #10
, “Open to mystery and Allow miracles to enter”: The nurse supports and is open to the patients hope for a miracle. Beyond the nurses own belief system, this process focuses on the patients course of change and mental-spiritual-physical learning through their experience of dis-ease. This concepts pulls from the idea that modern science can not offer the answers to the meaning of each patient's experience (Watson, 2008). As the nurse, you will use the tools of medicine and nursing as necessary, but not let it overshadow the meaning that patient has the potential to glean. Consciously holding this idea firmly in your day to day practice is an investment in this and all of the above caritas processes.
Theory of Human Caring:
3.
Cara & O'Reilly (2008) seek to bring Human Caring Theory into clinical realm through reflective practice for nursing staff; understanding it's use with a pragmatic approach.

4
. DiNapoli, Nelson, Turkel & Watson (2010) define examples of patient statements used to evaluate and measure each of the ten caritas processes in clinical practice; further defining meaning within clinical practice.

note: More examples of research on page 178 of McEwen & Wills (2011).

Research & Practice, cont'd
Research & Practice
Theory Evaluation (continued)
Critical Reflection of Theory
Critiques
Psychosocial needs are generally given priority over biophysical needs (Current Nursing, 2012)

May present practical difficulties when employed in clinical setting due to conflict with current health care system (Grace & Grace, 2009)

More studies and research are needed to evaluate full benefits to patient and nurse (Current Nursing, 2012), (Grace & Grace, 2009)

Some may find her concepts, definitions and explanations too esoteric and cumbersome for day to day clinical use (Alligood & Tomey, 2010)



The Development ofCaring Science
Discussion Questions
Reflections and Responses to the Theory of Human Caring
Theory Description
1.
Purpose:
A descriptive theory of caring, integrating the spiritual and ehtical aspects of nursing and
outlining nursing as a science of human caring (McEwen & Wills, 2011; Watson, 2008)
2.
Concepts:
Watson (2008) clearly outlines seven major meta-paradigm concepts, including three of the
metaparadigm concepts of nursing, human being, health, and nursing (McEwen & Wills, 2011; Watson, 2008).
The remaining concepts include: time, self, transpersonal and phenomenal field (McEwen & Wills, 2011; Watson, 2008).
3.
Definitions:
The seven concepts of Watson’s theory are well defined, and their meaning is conveyed through
the development of the ten carritas processes, which further describe the practice
of caring science (McEwen & Wills, 2011; Watson, 2008).
4.
Relationships:
The seven metaparadigm concepts and the ten caritas processes of Watson’s theory of human caring reflect the relationships of the theory. For example, two relationships of the theory: 1) A transpersonal caring relationship transcends the ego of both practitioner and patient, allowing a caring field to open up space to be in the moment, present (McEwen & Wills, 2011, p. 176). 2) Practitioners communicate transpersonal caring through their “energetic patterns of consciousness, intentionality, and authentic presence in a caring relationship” (McEwen & Wills, 2011, p. 177).
5.
Structure:
The relationships are clearly connected, and together they support the theory of human caring, and form the basis for caring science. The structure of this theory is abstract, broad, yet reflects the interactive
process nursing theories (McEwen & Wills, 2011; Watson, 2008).
6.
Assumptions:
Watson’s theory assumes that caring and love are universal, mysterious, and comprised of primal and psychic energy – presupposing oneness, wholeness, unity and connectedness of human beings (McEwen & Wills, 2011; Watson, 2008). It assumes that nurses’ caring can affect human development, and that nurses make social, moral and scientific contributions to other humans. Watson assumes that human caring ideology is imperative in contemporary nursing practice and society as a whole, in order to balance the increase in extreme curative-based treatment that
often overwhelms concern for cost of the human experience (McEwen & Wills, 2011; Watson, 2008).
This theory assumes a diversity of knowing, with various forms of evidence, and the
caring science model includes these diverse perspectives
(McEwen & Wills, 2011 p.175; Watson, 2008).
1.
Semantic clarity
-Watson has given each concept in her theory a clear and specific definition that delineates precisely how these concepts are to be used and understood. Relationships between the concepts are also outlined and used uniformly.
2.
Semantic consistency
-Concepts are used consistently and are congruent with their definitions. Watson strives to create an intelligible basis for each concept or idea and use them systematically.
3.
Structural clarity
- The connections and reasoning within the theory are essentially comprehensible, but may pose a quandary to those who are more challenged by esoteric or abstruse approaches.
4.
Structural consistency
- Watson uses the ten caritas processes as a blueprint to organize her Theory of Human Caring. Discussion of concepts and clinical relevance follow this unvarying structure, which can be seen in her published works and application of theory.
5.
Simplicity or complexity:
The theory of human caring is complex in its abstraction and broad philosophical world-view, however the theory is overall relatively simple, with the 10 caritas processes serving as the focus for nurses and scientific investigation (McEwen & Wills, 2011).
6.
Generality:
The Theory of Human Caring encompasses a broad range of experiences and phenomena, including many abstract concepts, such as consciousness, energy fields, spirit, and authentic presence (McEwen & Wills, 2011; Watson, 2008) Along with the more abstract concepts, this theory can be applied to discrete tasks within nursing, tangible experiences and processes of healing, as outlined in the caritas processes.
7.
Accessibility:
This theory is highly accessible, as the concepts are broad, and strive to encompass a range of experience and diverse environments, however the broad and spiritual-based concepts can be overwhelming, and it is the caritas processes that break down the theory into a digestible, and researchable, format. The ability to empirically identify phenomena within the theory has continuously progressed, with increased research into caring science.
8.
Importance:
The concepts of caring science have been applied to a variety of patient populations, including the elderly, HIV/AIDS patients, and morbidly obese patients, and implemented through nursing in a variety of settings, including hospitals that are vying for Magnet status (Clarke, Watson, & Brewer, 2009; McEwen & Wills, 2011). Watson’s theory has been employed into nursing education at the University of Colorado School of Nursing at the BSN, MSN and PhD levels, and also in direct clinical practice and research at the Center for Human Caring (McEwen & Wills, 2011; WCSI, 2013). There is ongoing research designed to test, apply and quantify Watson’s Theory of Human Caring, and both quantitative and qualitative methods are used to research caring science (McEwen & Wills, 2011)

The Theory of Human Caring: Future Development

Reflection and implications for the disipline and practice of nursing
Review the ten caritas processes and reflect on one that you use in your nursing practice through the lens of Dr. Watson’s Theory of Transpersonal Caring.
How does quantified research of caring science move the discipline of nursing forward? Does quantified research help or harm the holistic and nursing-specific field of caring science?
The fast-paced, high-tech, and overburdened health care delivery system of the 21st century has highlighted a struggle within the nursing profession for identity and survival as a discipline (Watson & Foster, 2003). There is conflict between the human caring model of nursing, which often is what attracted nurses to the profession, and the task-oriented, biomedical model, and system demans that now consume nursing practice (Watson & Foster, 2003). Nurses who are unable to practice within a context of human caring are at high risk for burnout, and can to themselves and their patients appear hardened, robotic, and oblivious (Watson & Foster, 2003).

In order to increase and maintain validity and respect in the biomedical model of modern health care, nursing has at times trivialized wholistic nursing care, instead focusing on empiricism as the corse purpose and base for nursing knowledge (Sitzman, 2002). However, in recent years there has been a shift towards refocusing on holistic care as a nursing strength, and developing evidence for practice based on holistic models, including caring science (Sitzman, 2002).

Chinn and Kramer (2008) suggest that including personal knowing (interbeing and mindfulness) in nursing knowledge development and education will propel nursing into an integrated and effective holistic practice, "By shifting to a balance in the development of all the fundamental knowledge
patterns, a sense of purpose can develop that is grounded in the whole of knowing that shapes and
directs nursing practice" (Sitzman, 2002 p.3).

Watson (2008) purposes that in order to grow and mature as a profession, nursing must fully integrate the healing arts and caring practices. She also states that this practice will need to be a shared experience with healthcare providers from every discipline, as working together will be the only way to realize full healing potential for every person (Watson, 2008).
Watson’s Theory of Caring is one of the more recently
developed grand nursing theories, first published in 1979, revised in 1985, and further developed in recent publications in 2005
and 2008 (McEwen & Wills, 2011).

The Caritas Processes draw from the Latin caritas
meaning "cherish, to appreciate, to give special attention, if
not loving attention" (Alligood & Tomey, 2010). They feed directly into nourishing the "caring moment", which is the transcendent interaction between the nurse and patient creating
new opportunities for healing,
caring and connections (Watson, 2008)
Think of a time in your life when you felt that someone truly cared for you. Also, think of a time when you demonstrated deep care for someone else. Talk about the major characteristics of those interactions and if/how they coincide with human caring theory concepts (Alligood & Tomey, 2010).
Note: please choose one question to reflect upon in your post.
(Lukose, 2011 p.28)
Alligood, M. R., & Tomey, A. M. (2010). Nursing theorists and their work. (7 ed.).
Maryland Heights, MO.: Mosby Elsevier.

Carolyn Brown et.al. (2005). Caring in Action: The patient care facilitator role. International Journal
Human Caring 9(3), 51-58.

Clarke, P. N., Watson, J., & Brewer, B. B. (2009). From Theory to Practice: Caring Science According to Watson and Brewer.
Nursing Science Quarterly, 22(4), 339–345. doi:10.1177/0894318409344769

Current Nursing. (2012). Nursing theories: Jean Watson’s Philosophy of Nursing. Retrieved from http://currentnursing.com/
nursing_theory/Watson.html

DiNapoli, P., Nelson, J., Turkel, M., & Watson, J. (2010). Measuring the caritas process: Caring factor survey. . Internation Journal Human
Caring, 14(3), 15-20. Retrieved from http://watsoncaringscience.org/files/PDF/Final PDF of IAHC article_CFS 2010.Vol14.Iss3.pdf

Erci, B., Sayan, A., Tortumluoglu, G., Kiliç, D., Sahin, O., & Güngörmüş, Z. (2003). The effectiveness of watson's caring model on the quality of life
and blood pressure of patients with hypertension. Journal of Advanced Nursing, 41(2), 130-9. Retrieved from http://watsoncaringscience.org/
files/PDF/Suliman 2009 Applying Watsons theroy multicultural.pdf

Grace, P., & Grace, P. J. (2009). Nursing ethics and professional responsibility in advanced practice. Jones & Bartlett Learning.

Kate Bent, et.al. (2005). Being and Creating Caring Change in a healthcare system. International Journal Human Caring 9(3), 20-25.

Lukose, A. (2011). Developing a Practice Model for Watson’s Theory of Caring. Nursing Science Quarterly, 24(1), 27–30. doi:10.1177/0894318410389073

McEwen, M., & Wills, E. M. (2011). Theoretical basis for nursing (3rd ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

Sitzman, K. L. (2002). Interbeing and Mindfulness: A Bridge to Understanding Jean Watson’s Theory of Human Caring. Nursing Education
Perspectives, 23(3), 118–123.

Watson, J. (2008). Nursing: the philosophy and science of caring (Rev. ed.). Boulder, Colo: University Press of Colorado.

Watson, J., & Foster, R. (2003). The Attending Nurse Caring Model ®: integrating theory, evidence and advanced caring-
healing therapeutics for transforming professional practice. Journal of Clinical Nursing, 12(3), 360–365. doi:10.1046/
j.1365-2702.2003.00774.x

Watson, J. (2013). Watson caring science institute & international caritas consortium. Retrieved from
http://watsoncaringscience.org/

WCSI. (2013). Dr. Jean Watson | WATSON CARING SCIENCE INSTITUTE &
INTERNATIONAL CARITAS CONSORTIUM. Watson Caring Science.
Retrieved June 13, 2013, from http://watsoncaring
science.org/about-us/jean-bio/

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