1. Jean Watson’s Caring Science and Human Caring Theory Emily Becker Laura Dryjanski Kristen Neigebauer

2. A Brief Background The Theory of Human Caring was developed between 1975 and 1979, first published in 1979 According to Watson, “It was my initial attempt to bring meaning and focus to nursing as an emerging discipline and distinct health profession […]” (Parker, 2001) “[…] I tried to make explicit that nursing’s values, knowledge, and practices of human caring were geared toward subjective inner healing processes and the life world of the experiencing person, requiring unique caring-healing arts and a framework called “carative factors” which complemented conventional medicine but stood in stark contrast to “curative factors” (Parker, 2001)

3. The Basics The philosophy of caring and science examines the relatedness of everything, including: Human Science Human Caring Processes Experiences Phenomena Watson’s Caring Science and Human Caring Theory blends the sciences and humanities Watson likes to cite Eastern Philosophy and the foundations of Buddhism Focus on holism

4. A Three Part Foundation According to Watson (2001), there are three main conceptual elements comprising her theory: 1.) The Carative Factors/Caritas Process 2.) The development and utilization of the transpersonal caring relationship 3.) The caring occasion or caring event

5. Carative Factors Goal was to guide the “core” of nursing In contrast to medicine’s “curative factors” Interdependent Used to “honor the human dimensions of nursing’s work and the inner life world and subjective experiences of the people we serve” (Watson,2007) First three factors are the philosophical foundation for the science of caring The final seven build upon these Transitioned to the “caritas processes”, expanding on the original factors

6. “It is when we include caring and love in our work and our life that we discover and affirm that nursing, like teaching, is more than just a job; it is also a life-giving and life-receiving career for a lifetime of growth and learning” (Parker, 2001).

7. Original 10 Carative Factors Formation of a humanistic-altruistic system of values Instillation of faith-hope Cultivation of sensitivity to one’s self and to others Development of a helping-trusting, human caring relationship Promotion and acceptance of the expression of positive and negative feelings (Watson, 1985)

8. Carative Factors Continued Systematic use of a creative problem-solving caring process Promotion of transpersonal teaching-learning Provision for a supportive, protective, and/or corrective mental, physical, societal, and spiritual environment Assistance with gratification of human needs Allowance for existential-phenomenological-spiritual forces (Watson, 1985)

9. Moving Forward As Watson continued her work, the 10 Carative Factors transitioned to the 10 “Caritas Processes” Caritas meaning “to cherish” (Greek) The processes allow for the intersecting of the personal and professional aspects of nursing care Gives us clues as to who/what Watson views as the person, health, environment, and nursing

10. 10 Caritas Processes Practice of loving kindness and equanimity within the context of caring consciousness Being authentically present, and enabling and sustaining the deep belief system and subjective life world of self and one-being-cared-for Cultivation of one’s own spiritual practices and transpersonal self, going beyond ego self, opening to others with sensitivity and compassion (Parker, 2001)

11. 10 Caritas Processes Continued Developing and sustaining a helping-trusting, authentic caring relationship Being present to, and supportive of, the expression of positive and negative feelings as a connection with deeper spirit of self and the one-being-cared-for Creative use of self and all ways of knowing as part of the caring process; to engage in artistry of caring-healing practices (Parker, 2001)

12. 10 Caritas Processes Continued Engaging in genuine teaching-learning experience that attends to unity of being and meaning, attempting to stay within other’s frames of reference Creating healing environment at all levels Assisting with basic needs, with an intentional caring consciousness, administering ‘human care essentials’, which potentiate alignment of mindybodyspirit, wholeness, and unity of being in all aspects of care, tending to both embodied spirit and evolving spiritual emergence (Parker, 2001)

13. 10 Caritas Processes Continued Opening and attending to spiritual-mysterious, and existential dimensions of one’s own life-death; soul care for self and the one-being-cared-for (Parker, 2001)

14. The Person A complex, holistic being; an evolving soul People have value, meaning Not an object, and cannot be separated from self, other, nature, or the larger universe Impacted and influence by the surrounding environment A human being has complex needs including physical, psychological, psychosocial A person is to be cared for, nurtured, and both valued and respected

15. The Person Continued Comprise of three ‘spheres of being’: mind, body, and spirit “[…] a valued person in and of him or herself is 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, 1985) “The core of human caring theory is about human caring relationships and the deeply human experiences of life itself, not just health-illness phenomena, as traditionally defined within medicine” (Fawcett, 2002).

16. The Environment Driven by Curative Factors/ Caritas Process 8 and 9 Should be conducive to holistic healing Designed to be comfortable, not the typical hospital environment An open system containing both internal (mental, spiritual, and cultural) and external (physical, environmental, and safety) variables that we as caregivers can manipulate Can serve to expand the person’s “awareness and consciousness”, to promote mind-body-spirit healing, wholeness, and well-being (Watson, 1999) Is comprised of“[…] noise, privacy, light, access to nature, color, space and smells that can have an impact on the caring-healing process” (Watson, 1999)

17. Environment Continued “The person is split apart and the soul is replaced with narcissism of self or denied all together. The human soul is further destroyed with a depersonalized, manmade environment, advanced technology, and robot treatment for cure, delivered by strangers in a strange environment” (Watson, 1988) The typically employed medical model reduces humans to body systems, individual cells or atoms, in order to treat and cure Calls for a balance between the high tech environments of the typical hospital setting with a high touch environment To “[…] transform the environment into one in which healing can occur” (Ryan, 2005)

18. Health Holistic- “When the human being is considered from a holistic perspective, health implies harmony and balance among the various dimensions of human experience- physical, emotional, mental, spiritual, and so on” (Parker, 2001) defined as a high level of overall physical, mental, spiritual, and social well-being and functioning Can be defined as the absence of illness, but health can be obtained even when physical wholeness cannot be obtained Adaptive-maintenance in daily functions, harmony

19. Nursing Driven by most Curative Factors/ Caritas Process “This caring science seeks to honor the depth, humility, connection, compassion, responsibility, and concern for human welfare and optimal human development/evolution” (Watson, 2008) Watson defines as “A human science of persons and human health-illness experiences that are mediated by professional, personal, scientific, esthetic, and ethical human transactions” (Watson, 1985) “[…] being present, attentive, conscious, and intentional as the nurse works with another person” (Fawcett, 2002) “Nurses and practitioners who are literate with caring relationships are capable of having loving, caring, kind, and sensitively meaningful, personal connections with an increasingly enlightened public: a public seeking wholeness and spiritual connections for their wellbeing, not just sterile, depersonalized medical technological interventions, void of human-to-human caring relationships” (Watson, 2009) Comprised of loving kindness, caring, compassion, gentleness, calmness, wholeness/healing Occurs during the caring event

20. Nursing Continued Starts with an authentic presence Connection with another person A spiritual practice, a calling Both a science and an art Acknowledges science, art, intuitive, cultural, and spiritual knowledge Like Carper, also acknowledges and places high value on aesthetic, ethical, and personal ways of knowing Caring is just as valuable and essential to our patients as curing Nursing is complimentary to curing You can have caring without curing, but you cannot have true curing without caring

21. Nursing Continued Caring affects self and others Bidirectional relationship, we also benefit, learn The transpersonal care/transpersonal relationship is central to Watson’s theory and what she calls of nurses A true presence Moving toward a unitary-transformative perspective from a more general, multiple paradigm view

22. Nursing Continued Nursing’s tasks according to Watson “Healing our relationship with self and other/s, and our place in the wider universe; Finding meaning in our own life and health-illness concerns, as we re-awaken to our profound compassionate, caring and healing service in the world; Understanding and transforming our own and other’s suffering; Deepening our understanding and acceptance of impermanence, the expanding-contracting of all life cycles (birthing-dying/the dark and light), including preparing for our own death” (Watson, 2002) Waton’s definition of caring is often incongruent with current hospital systems and policy

23. The Transpersonal Caring Relationship Occurs during the ‘caring event’, central to Watson’s view of nursing Calls the nurse to go beyond the objective, physical assessment with concern for the person’s deeper, subjective well-being The nurse “[…] seeks to connect with and embrace the spirit or soul of the other, through the process of caring and healing and being in authentic relation, in the moment” (Parker, 2001) Goal is to protect, enhance, and preserve the person’s dignity, humanity, wholeness, inner harmony, and overall well-being Can be nurtured by movements, gestures, facial and bodily expressions, the sharing of information, touch, sound, etc.

24. The Caring Event “Two persons (nurse and other) together with their unique life histories and phenomenal field in human care transaction comprise an event” (Watson, 1985) “An event, such as an actual occasion of human care, is a focal point in space and time from which experience and perception are taking place, but the actual occasion of caring has a field of its own that is greater than the occasion itself” (Watson 1985) Implementation of nursing actions Every encounter has the opportunity to be a caring occasion

25. Implications for Nursing Practice Need for an extensive understanding and appreciation of the caritas process Very complex, can be difficult to understand No defined parameters Reality: Nurses generally like her theory, emphasis on care and compassion Values aspects of nursing central to why nurses become nurses and not doctors How realistic is the implementation of this theory in current practice with constrains such as “Working conditions that inhabit caring are lack of accountability for nurses, poor staffing, unreasonable workloads, and poor patient care” (Quinn et al 2003)

26. Implications for Nursing Practice Continued Person: Our healthcare system acknowledges that humans are holistic beings, but often treats them more as objects Environment: Sterile, non-home-like, not conducive to healing

27. Implications for Nursing Continued Health: Generally accepted as overall physical, emotional, psychosocial, psychological, etc. Implementing practices to better achieve this Ex: Child Life, complimentary medicine, music therapy Still falling short, placed on back burner, first to be forgotten Nursing: Congruent with how most nurses feel about nursing care Grounded in the discipline of nursing and nursing science Incongruent with current institution standards, policy, and how nursing is actually implemented

28. Discussion of Implications for Nursing

29. References Bevis, E. O., & Watson, J. (1989). Toward a caring curriculum: a new pedagogy for nursing. New York, New York: National League for Nursing Press. Fawcett, J. (2002) The nurse theorists: 21st century updates- Jean Watson. Nursing Science Quarterly, 15(3), 214- 219) Parker, M. E. (2001). Nursing theories and nursing practice. Philadelphia, PA: F. A. Davis Company. Quinn, J., Smith, M., Swanson, K., Ritenbaugh, C., Swanson, K., & Watson, J. (2003) Research guidelines for assessing the impact of the healing relationship in clinical nursing. Alternative Therapies, 9(3). A65-A79. Ryan, L. (2005). The journey to integrate Watson’s Caring Theory with clinical practice. International Journal of Human Caring, 9(3), 26-30. Watson, J. (1979). Nursing: The philosophy and science of caring. Boston: Little Brown. Watson, J. (1985). Nursing: Human Science and Human Care. Connecticut, USA: Appleton-Century-Crofts. Watson, J. (1997). The theory of human caring: Retrospective and prospective. Nursing Science Quarterly, 10(1), 49-52. Watson, J. (1999). Postmodern nursing and beyond. Toronto, Canada: Churchill Livingstone. Watson, J. (2000). Via negativa: Considering caring by way of non-caring. The Australian Journal of Holistic Nursing, 7(1), 4-8. Watson, J. (2001). Jean Watson: Theory of human caring. In M.E. Parker (Ed.), Nursing theories and nursing practice (pp. 343-354). Philadelphia: Davis. Watson, J. (2002). Guest editorial: Nursing: Seeking its source and survival. ICU NURS WEBJ Issue 9, pp 1-7 Spring.