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Caring and the Professional Practice of Nursing
by Teresa Vance, RN
Caring and nursing have always been thought of synonymously. Most individuals choose nursing as a profession because of their desire to care for other individuals. Caring as a central concept has led to the development of several caring theories. Two well known theories were developed in the 1970’s, Leininger’s Theory of cultural care and Jean Watson’s Theory of human caring (McCance, McKenna, Boore 1999).Jean Watson defines caring as a science. She states; Caring is a science that encompasses a humanitarian, human science orientation, human caring processes, phenomena, and experiences. Caring science includes arts and humanities as well as science. A caring science perspective is grounded in a relational ontology of being-in-relation, and a world view of unity and connectedness of all. Transpersonal Caring acknowledges unity of life and connections that move in concentric circles of caring-from individual, to others, to community, to world, to Planet Earth, to the universe. Caring science investigations embrace inquiry that are reflective, subjective and interpretative as well as objective-empirical; Caring science inquiry includes ontological, philosophical, ethical, historical inquiry and studies. In addition, caring science includes multiple epistemological approaches to inquiry including clinical and empirical, but is open to moving into new areas of inquiry that explore other ways of knowing, for example, aesthetic, poetic, narrative, personal, intuitive, kinesthetic, evolving consciousness, intentionality, metaphysical-spiritual, as well as moral-ethical knowing. Caring science is an evolving new field that is grounded in the discipline of nursing and evolving nursing science, but more recently includes other fields and disciplines in the Academy, for example, Women/Feminist studies, Education, Ecology, Peace Studies, Philosophy/Ethics, Arts and Humanities, Mindbodyspirit Medicine. As such, caring science is rapidly becoming an Interdisciplinary Transdisciplinary field of study. It has relevance to all the health, education human service fields and professions (Watson 2003).
Caring behaviors are defined as; Behaviors evidenced by nurses in caring for patients.The top ten caring behaviors, derived from nursing literature are; attentive listening, comforting, honesty, patience, responsibility, providing information so the patient can make an informed decision, touch, sensitivity, respect, calling the patient by name (Taber’s 1993).
Some Caring behaviors are evident in other professions. Law enforcement is noted for their honesty and respect. Psychologists are comforting and require attentive listening skills to help their patients. Teachers must possess patience, attentive listening, sensitivity, and great responsibility to mold our children into productive adults. The lists of professions are endless.
Madeleine Leininger subscribed to the central tenet that “care is the essence of nursing and the central, dominant, and unifying focus of nursing” (Leininger 1991). Watson describes nursing as a human science, with the major focus being the process of human care for individuals, families, and groups. Her theory is based on a form of humanism and has its origins in metaphysics (philosophy of being and knowing) (McCance, Mckenna, Boore 1999).
The goal of nursing with Watson’s theory is centered around helping the patient gain a higher degree of harmony within the mind, body, and soul. It is achieved through caring transactions. Watson’s ten carative factors, referred to as interventions of the theory, are presented in table one. (McCance, McKenna, Boore 1999). It also involves the transpersonal caring relationship. Transpersonal caring is demonstrated in an event or actual caring occasion.
Transpersonal conveys a concern for the inner life. The patient is viewed as whole and complete, regardless of illness or disease (Watson 2003). The transpersonal nurse seeks to connect with, embrace the spirit or soul of the patient, through the processes of caring and healing (Watson 2003).
Caring and the Professional Practice of Nursing-Part 2
by Teresa Vance, RN
Caring in the nursing profession takes place every time a nurse-to-patient contact is made. The nurse enters the world of the patient in order to come to know the patient as a caring person, and that it is from this “epistemology” that the caring of nursing unfolds (Schoenhofer 2002). That caring makes a difference to the patient’s sense of well being. Caring may occur without curing but curing cannot occur without caring (Watson 2003).
It is with that belief that nurses care for patients in the hope that we contribute to the cure or wellbeing of that patient.
Hope and commitment are ingredients of caring. Hope is described as more than mere wishful thinking, but as an awareness of the moment alive with possibilities (Schoenhofer 2002).Hope may be the only crutch a patient has to keep their optimism. Nurses care enough to honor that hope and support the patient. We view that patient as whole and complete. The second carative factor of Jean Watson’s ten carative factors is faith-hope (see table one).
Hope is guided by our commitment as nurses to our patients. It is also clouded with preconceived beliefs and morals that we are reared with.I am a field nurse in a for-profit hospice organization. Caring is a central concept to the delivery of hospice care. The patients we encounter are in a variety of settings, such as, own home, nursing home, retirement center, family home, or a friend’s home. They are often frightened with the knowledge of their imminent death and in unfamiliar surroundings. They rely on the nurse and the delivery of care to help them feel physically better.As a hospice nurse we also view the patient as a spiritual being. That means reaching out to the patient and forming a deeper connection to the spiritual self. It means becoming one.
The one caring and the one being cared for are interconnected (Watson 1997). It’s experiencing human connection at a deeper level than a physical interaction (Watson 2003)
The nurse must have an inner peace with her own mortality. The nurse must be comfortable with death and dying and possess a deep understanding and acceptance of all life cycles and be prepared for their own death (Watson 2002). Caring is directed to a pain free death with dignity and a belief of a spiritual transformation or journey after death.Caring centers on the person, preserving dignity and humanity. It is a commitment to alleviate another’s vulnerabilities by providing attention and concern for each human life (Watson 2002). Hospice is holistic focused caring. Our goal is to offer the dying patient the opportunity to die in the comfort of their own home surrounded by those who care. The dying patient in the nursing home is offered the opportunity to die with a caring nurse holding their hand. Often the nursing home patient has no family or living relatives that can share in the dying experience. The hospice nurse will be the one to care for the dying patient and ease his journey. This relates to the carative factor number eight of Jean Watson’s ten carative factors, it states; supportive, protective, and/or corrective mental, physical, societal and spiritual environment, and that is what we hope to achieve with the dying patient (see table one).Hospice also cares for the family. Caring approaches to nursing affect the nurse and the family being cared for. This can be very challenging with dysfunctional families. Our focus is always centered on the patient while dealing with the family. We must be guided by caring, compassion, tenderness, gentleness, loving kindness, and equanimity for self and others.
Caring in hospice goes beyond the actual death. Bereavement contact is done on a routine basis for a year after the death. Nurses often attend services for the deceased to say goodbye and receive closure with that patient and family.
Caring and the Professional Practice of Nursing-Part 3
by Teresa Vance, RN
I’ve related most of my understanding of the caring model to hospice care because that is my area of expertise. However, the caring models are used in a variety of settings, such as, major hospitals, organizations, feminists groups, and major universities. A model of caring includes a call for both art and science. It offers a framework that embraces and intersects with art, science, humanities, spirituality, and new dimensions of mindbodyspirit medicine (Watson 2003). Caring can save the life of a patient, offer a death with dignity, and convey trust and commitment to patients, families, and staff.
Nursing is a caring profession that is honored as the spiritual, spirit-filled practice that it is. I believe it is a calling for a special spiritual person who cares about the spirituality of others. Little girls care for their dolls; boys care for their trucks; parents care for their children; sons and daughters care for elderly parents; and nurses care for the sick.
The humanistic nature of nursing is reflected in the caring model. Caring is the central concept in the discipline of nursing. I would not want to imagine nursing without the concept of caring. Would you?____________________________
Table 1 Watson’s 10 Carative Factors (McCance, McKenna, and Boore 1999)
1. Humanistic-altruistic system of values2. Faith-hope3. Sensitivity to self and others4. Helping-trusting, human care relationship5. Expressing positive and negative feelings6. Creative problem-solving caring process7. Transpersonal teaching-learning8. Supportive, protective, and/or corrective mental, physical, societal and spiritual environment9. Human needs assistance10. Existential-phenomenological-spiritual forces
Introduction to Nursing Theories
This page was last updated on February 21, 2011
INTRODUCTION
Each discipline has a unique focus for knowledge development that
directs its inquiry and distinguishes it from other fields of study.
(Smith & Liehr, 2008).
Nursing knowledge is the inclusive total of the philosophies,
theories, research, and practice wisdom of the discipline.As a
professional discipline this knowledge is important for guiding
practice.(Smith & Liehr, 2008).
Theory-guided, evidence-based practice is the hallmark
of any professional discipline.
Nursing is a professional discipline (Donaldson & Crowley, 1978).
Nursing theory is the term given to the body of knowledge that is
used to support nursing practice
Almost 90% of all Nursing theories are generated in the last 20
years.
Nursing models are conceptual models, constructed of theories
and concepts
M E T A P A R A D I G M S I N N U R S I N G
1. Person
Recipient of care, including physical, spiritual, psychological, and
sociocultural components.
Individual, family, or community
2. Environment
All internal and external conditions, circumstances, and influences
affecting the person
3. Health
Degree of wellness or illness experienced by the person
4. Nursing
Actions, characteristics and attributes of person giving care
COMPONENTS OF A THEORY
A theory is a group of related concepts that propose action that guide
practice. A nursing theory is a set of concepts, definitions, relationships, and
assumptions or propositions derived from nursing models or from other
disciplines and project a purposive, systematic view of phenomena by
designing specific inter-relationships among concepts for the purposes of
describing, explaining, predicting, and /or prescribing..
Based on the knowledge structure levels the theoretical works in nursing can
be studied under the following headings:
Metaparadigm (Person, Environment, Health & Nursing) – (Most
abstract)
Nursing philosophies.
Conceptual models and Grand theories.
Nursing theories and Middle range theories (Least abstract)
DEFINITIONS
D e f i n i t i o n s
Theory
o a set of related statements that describes or explains
phenomena in a systematic way
Concept
o a mental idea of a phenomenon
o Concepts are the building blocks—the primary elements—
of a theory.
Construct-
o a phenomena that cannot be observed and must be
inferred
o Constructs are concepts developed or adopted for use in a
particular theory. The key concepts of a given theory are
its constructs.
Proposition
o a statement of relationship between concepts
Conceptual model-
o made up of concepts and propositions
o They epresent ways of thinking about a problem or ways of
representing how complex things work the way that they
do.
o Different Frameworks will emphasize different variables
and outcomes and their interrelatedness.( Bordage, 2009)
o Models may draw on a number of theories to help
understand a particular problem in a certain setting or
context. They are not always as specified as theory.
Variables
o Variables are the operational forms of constructs. They
define the way a construct is to be measured in a specific
situation.
o Match variables to constructs when identifying what needs
to be assessed during evaluation of a theory-driven
program.
NURSING PHILOSOPHIES
Theory
Key emphasis
Florence Nightingale’s Legacy of caring
Focuses on nursing and the patient environment relationship.
Ernestine Wiedenbach: The helping art of clinical nursing
Helping process meets needs through the art of individualizing care.Nurses should identify patients ‘need-for –help’ by:
Observation Understanding client behaviour Identifying cause of discomfort Determining if clients can resolve
problems or have a need for help
Virginia Henderson’s Definition of Nursing
Patients require help towards achieving independence.Derived a definition of nursing
Identified 14 basic human needs on which nursing care is based.
Faye G.Abedellah’s Typology of twenty one Nursing problems
Patient’s problems determine nursing care
Lydia E. Hall :Care, Cure, Core model
Nursing care is person directed towards self love.
Jean Watson’s Philosophy and Science of caring
Caring is moral ideal: mind -body – soul engagement with one and other.
Caring is a universal, social phenomenon that is only effective when practiced interpersonally considering humanistic aspects and caring.
Patricia Benner’s Primacy of caring
Caring is central to the essence of nursing. It sets up what matters, enabling connection and concern. It creates possibility for mutual helpfulness.
Caring creates - possibilities of coping possibilities for connecting with and concern for others, possibilities for giving and receiving help
Described systematically five stages of skill acquisition in nursing practice – novice, advanced beginner, competent, proficient and expert.
CONCEPTUAL MODELS AND GRAND THEORIESDorothea E. Orem’s Self care deficit theory in nursing
Self–care maintains wholeness.
Three Theories:
Theory of Self-Care
Theory of Self-Care Deficit
Theory of Nursing Systems
Wholly compensatory (doing for the patient)
Partly compensatory (helping the patient do for himself or herself)
Supportive- educative (Helping patient to learn self care and emphasizing on the importance of nurses’ role
Myra Estrin Levine’s: The conservation model
Holism is maintained by conserving integrity
Proposed that the nurses use the principles of conservation of:
Client Energy Personal integrity Structural integrity Social integrity A conceptual model with three nursing
theories – Conservation Redundancy Therapeutic intention
Martha E.Roger’s: Science of unitary human beings
Person environment are energy fields that evolve negentropically
Martha proposed that nursing was a basic scientific discipline
Nursing is using knowledge for human betterment.
The unique focus of nursing is on the unitary or irreducible human being and the environment (both are energy fields) rather than health and illness
Dorothy E.Johnson’s Behavioural system model
Individuals maintain stability and balance through adjustments and adaptation to the forces that impinges them.
Individual as a behavioural system is composed of seven subsystems.
Attachment, or the affiliative subsystems – is the corner stone of social organisations.
Behavioural system also includes the
subsystems of dependency, achievement, aggressive, ingestive-eliminative and sexual.
Disturbances in these causes nursing problems.
Sister Callista: Roy‘s Adaptation model
Stimuli disrupt an adaptive system
The individual is a biopsychosocial adaptive system within an environment.
The individual and the environment provide three classes of stimuli-the focal, residual and contextual.
Through two adaptive mechanisms, regulator and cognator, an individual demonstrates adaptive responses or ineffective responses requiring nursing interventions
Betty Neuman’s : Health care systems model
Reconstitution is a status of adaptation to stressors
A conceptual model with two theories “Optimal patient stability and prevention as intervention”
Neuman’s model includes intrapersonal, interpersonal and extrapersonal stressors.
Nursing is concerned with the whole person.
Nursing actions (Primary, Secondary, and Tertiary levels of prevention) focuses on the variables affecting the client’s response to stressors.
Imogene King’s Goal attainment theory
Transactions provide a frame of reference toward goal setting.
A conceptual model of nursing from which theory of goal attainment is derived.
From her major concepts (interaction, perception, communication, transaction, role, stress, growth and development) derived goal attainment theory.
· Perceptions, Judgments and actions of the patient and the nurse lead to reaction, interaction, and transaction (Process of nursing).
Nancy Roper, WW.Logan and A.J.Tierney A model for nursing based on a model of living
Individuality in living.
A conceptual model of nursing from which theory of goal attainment is derived.
Living is an amalgam of activities of living (ALs).
Most individuals experience significant life events which can affect ALs causing actual and potential problems.
This affects dependence – independence continuum which is bi-directional.
Nursing helps to maintain the individuality of person by preventing potential problems, solving actual problems and helping to cope.
Hildegard E. Peplau: Psychodynamic Nursing Theory
Interpersonal process is maturing force for personality.
Stressed the importance of nurses’ ability to understand own behaviour to help others identify perceived difficulties.
The four phases of nurse-patient relationships are:
1. Orientation 2. Identification 3. Exploitations 4. Resolution
The six nursing roles are:
1. Stranger 2. Resource person 3. Teacher 4. Leader 5. Surrogate 6. Counselor
Ida Jean Orlando’s Nursing Process Theory
Interpersonal process alleviates distress.
Nurses must stay connected to patients and assure that patients get what they need, focused on patient’s verbal and non verbal expressions of need and nurse’s reactions to patient’s behaviour to alleviate distress.
Elements of nursing situation:
1. Patient
2. Nurse reactions
3. Nursing actionsJoyce Travelbee’s Human To Human Relationship Model
Therapeutic human relationships.
Nursing is accomplished through human to human relationships that began with: The original encounter and then progressed through stages of
Emerging identities
Developing feelings of empathy and sympathy, until the nurse and patient attained rapport in the final stage.
Kathryn E. Barnard’s Parent Child Interaction Model
Growth and development of children and mother–infant relationships
Individual characteristics of each member influence the parent–infant system and adaptive behaviour modifies those characteristics to meet the needs of the system.
Ramona T.Mercer’s :Maternal Role Attainment
Parenting and maternal role attainment in diverse populations
A complex theory to explain the factors impacting the development of maternal role over time.
Katharine Kolcaba’s Theory of comfort
Comfort is desirable holistic outcome of care.
Health care needs are needs for comfort, arising from stressful health care situations that cannot be met by recipients’ traditional support system.
These needs include physical, psycho spiritual, social and environmental needs.
Comfort measures include those nursing interventions designed to address the specific comfort needs.
Madeleine Leininger’s
Transcultural nursing, culture-care theory
Caring is universal and varies transculturally.
Major concepts include care, caring, culture, cultural values and cultural variations
Caring serves to ameliorate or improve human conditions and life base.
Care is the essence and the dominant, distinctive and unifying feature of nursing
Rosemarie Rizzo Parse’s :Theory of human becoming
Indivisible beings and environment co-create health.
A theory of nursing derived from Roger’s conceptual model.
Clients are open, mutual and in constant interaction with environment.
The nurse assists the client in interaction with the environment and co creating health
Nola J.Pender’s :The Health promotion; model
Promoting optimum health supersedes disease prevention.
Identifies cognitive, perceptual factors in clients which are modified by demographical and
biological characteristics, interpersonal influences, situational and behavioural factors that help predict in health promoting behaviour
CONCLUSION
The conceptual and theoretical nursing models help to provide knowledge to
improve practice, guide research and curriculum and identify the goals of
nursing practice. The state of art and science of nursing theory is one of
continuing growth. Using the internet the nurses of the world can share ideas
and knowledge, carrying on the work begun by nursing theorists and continue
the growth and development of new nursing knowledge. It is important the
nursing knowledge is learnt, used, and applied in the theory based practice for
the profession and the continued development of nursing and academic
discipline
Jean Watson's Philosophy of Nursing
This page was last updated on July 27, 2011
I n t r o d u c t i o n
Theorist was born in West Virginia, US
Educated: BSN, University of Colorado, 1964, MS, University of Colorado,
1966, PhD, University of Colorado, 1973
Distinguished Professor of Nursing and endowed Chair in Caring Science at
the University of Colorado Health Sciences Center.
Fellow of the American Academy of Nursing.
Previously, Dean of Nursing at the University Health Sciences Center and
President of the National League for Nursing
Undergraduate and graduate degrees in nursing and psychiatric-mental
health nursing and PhD in educational psychology and counseling. She has
six (6) Honorary Doctoral Degrees.
Her research has been in the area of human caring and loss.
In 1988, her theory was published in “nursing: human science and human
care”.
T h e s e v e n a s s u m p t i o n s
Caring can be effectively demonstrated and practiced only interpersonally.
Caring consists of carative factors that result in the satisfaction of certain
human needs.
Effective caring promotes health and individual or family growth.
Caring responses accept person not only as he or she is now but as what he
or she may become.
A caring environment is one that offers the development of potential while
allowing the person to choose the best action for himself or herself at a given
point in time.
Caring is more “ healthogenic” than is curing. A science of caring is
complementary to the science of curing.
The practice of caring is central to nursing.
T h e t e n p r i m a r y c a r a t i v e f a c t o r s
1. The formation of a humanistic- altruistic system of values.
2. The installation of faith-hope.
3. The cultivation of sensitivity to one’s self and to others.
4. The development of a helping-trust relationship
5. The promotion and acceptance of the expression of positive and negative
feelings.
6. The systematic use of the scientific problem-solving method for decision
making
7. The promotion of interpersonal teaching-learning.
8. The provision for a supportive, protective and /or corrective mental, physical,
socio-cultural and spiritual environment.
9. Assistance with the gratification of human needs.
10. The allowance for existential-phenomenological forces.
The first three carative factors form the “philosophical foundation” for the science of
caring. The remaining seven carative factors spring from the foundation laid by these
first three.
1. The formation of a humanistic- altruistic system of values
Begins developmentally at an early age with values shared with the parents.
Mediated through ones own life experiences, the learning one gains and
exposure to the humanities.
Is perceived as necessary to the nurse’s own maturation which then promotes
altruistic behavior towards others.
2. Faith-hope
Is essential to both the carative and the curative processes.
When modern science has nothing further to offer the person, the nurse can
continue to use faith-hope to provide a sense of well-being through beliefs
which are meaningful to the individual.
3. Cultivation of sensitivity to one’s self and to others
Explores the need of the nurse to begin to feel an emotion as it presents
itself.
Development of one’s own feeling is needed to interact genuinely and
sensitively with others.
Striving to become sensitive, makes the nurse more authentic, which
encourages self-growth and self-actualization, in both the nurse and those
with whom the nurse interacts.
The nurses promote health and higher level functioning only when they form
person to person relationship.
4. Establishing a helping-trust relationship
Strongest tool is the mode of communication, which establishes rapport and
caring.
Characteristics needed to in the helping-trust relationship are:
o Congruence
o Empathy
o Warmth
Communication includes verbal, nonverbal and listening in a manner which
connotes empathetic understanding.
5. The expression of feelings, both positive and negative
“Feelings alter thoughts and behavior, and they need to be considered and
allowed for in a caring relationship”.
Awareness of the feelings helps to understand the behavior it engenders.
6. The systematic use of the scientific problem-solving method for decision making
The scientific problem- solving method is the only method that allows for
control and prediction, and that permits self-correction.
The science of caring should not be always neutral and objective.
7. Promotion of interpersonal teaching-learning
The caring nurse must focus on the learning process as much as the teaching
process.
Understanding the person’s perception of the situation assist the nurse to
prepare a cognitive plan.
8. Provision for a supportive, protective and /or corrective mental, physical, socio-
cultural and spiritual environment
Watson divides these into eternal and internal variables, which the nurse
manipulates in order to provide support and protection for the person’s mental
and physical well-being.
The external and internal environments are interdependent.
Nurse must provide comfort, privacy and safety as a part of this carative
factor.
9. Assistance with the gratification of human needs
It is based on a hierarchy of need similar to that of the Maslow’s.
Each need is equally important for quality nursing care and the promotion of
optimal health.
All the needs deserve to be attended to and valued.
Watson’s ordering of needs
Lower order needs (biophysical needs)
o The need for food and fluid
o The need for elimination
o The need for ventilation
Lower order needs (psychophysical needs)
o The need for activity-inactivity
o The need for sexuality
Higher order needs (psychosocial needs)
o The need for achievement
o The need for affiliation
o Higher order need (intrapersonal-interpersonal need)
o The need for self-actualization
10. Allowance for existential-phenomenological forces
Phenomenology is a way of understanding people from the way things appear
to them, from their frame of reference.
Existential psychology is the study of human existence using
phenomenological analysis.
This factor helps the nurse to reconcile and mediate the incongruity of viewing
the person holistically while at the same time attending to the hierarchical
ordering of needs.
Thus the nurse assists the person to find the strength or courage to confront
life or death.
W a t s o n ’ s t h e o r y a n d t h e f o u r m a j o r c o n c e p t s
1. Human being
Human being refers to “….. 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”.
2. Health
Watson adds the following three elements to WHO definition of health:
o A high level of overall physical, mental and social functioning
o A general adaptive-maintenance level of daily functioning
o The absence of illness (or the presence of efforts that leads its
absence)
3. Environment/society
According to Watson, caring (and nursing) has existed in every society.
A caring attitude is not transmitted from generation to generation.
It is transmitted by the culture of the profession as a unique way of coping
with its environment.
4. Nursing
“Nursing is concerned with promoting health, preventing illness, caring for the
sick and restoring health”.
It focuses on health promotion and treatment of disease. She believes that
holistic health care is central to the practice of caring in nursing.
She defines nursing as…..
“a human science of persons and human health-illness experiences that are
mediated by professional, personal, scientific, esthetic and ethical human
transactions”.
W a t s o n ’ s t h e o r y a n d n u r s i n g p r o c e s s
Nursing process contains the same steps as the scientific research process.
They both try to solve a problem. Both provide a framework for decision
making.
1. Assessment
Involves observation, identification and review of the problem; use of
applicable knowledge in literature.
Also includes conceptual knowledge for the formulation and conceptualization
of framework.
Includes the formulation of hypothesis; defining variables that will be
examined in solving the problem.
2. Plan
It helps to determine how variables would be examined or measured; includes
a conceptual approach or design for problem solving. It determines what data
would be collected and how on whom.
3. Intervention
It is the direct action and implementation of the plan.
It includes the collection of the data.
4. Evaluation
Analysis of the data as well as the examination of the effects of interventions
based on the data.
Includes the interpretation of the results, the degree to which positive
outcome has occurred and whether the result can be generalized.
It may also generate additional hypothesis or may even lead to the generation
of a nursing theory.
W a t s o n ’ s w o r k a n d t h e c h a r a c t e r i s t i c o f a t h e o r y
1. The basic assumptions for the science of caring in nursing and the ten
carative factors that form the structure for that concept is unique in Watson’s
theory.
2. Watson’s work is logical in that the factors are based on broad assumptions
which provide a supportive framework.
3. The theory is relatively simple as it does not use theories from other
disciplines that are familiar to nursing. The theory is simple relatively but the
fact that it de-emphasizes the pathophysiological for the psychosocial
diminishes its ability to be generalizable.
4. Watson’s theory is based on phenomenological studies that generally ask
questions rather than state hypotheses.
5. Watson’s work can be used to guide and improve practice.
6. Watson’s work is supported by the theoretical work of numerous humanists,
philosophers, developmentalists and psychologists.
S t r e n g t h s
This theory places client in the context of the family, the community and the
culture.
It places the client as the focus of practice rather than the technology.
L i m i t a t i o n s
While Watson acknowledges the need for biophysical base to nursing, this
area receives little attention in her writings.
The ten caratiive factors primarily delineate the psychosocial needs of the
person.
While the carative factors have a sound foundation based on other
disciplines, they need further research in nursing to demonstrate their
application to practice.
R e s e a r c h r e l a t e d t o W a t s o n ’ s t h e o r y
The effectiveness of Watson's Caring Model on the quality of life and blood pressure of
patients with hypertension. J Adv Nurs. 2003 Jan;41(2):130-9.
This study demonstrated a relationship between care given according to
Watson's Caring model and increased quality of life of the patients with
hypertension. Further, in those patients for whom the caring model was
practised, there was a relationship between the Caring model and a decrease
in patient's blood pressure. The Watson Caring Model is recommended as a
guide to nursing patients with hypertension, as one means of decreasing
blood pressure and increase in quality of life.
Martin, L. S. (1991). Using Watson’s theory to explore the dimensions of adult
polycystic kidney disease . ANNA Journal, 18, 403-406 .
Mullaney, J. A. B. (2000). The lived experience of using Watson’s actual caring
occasions to treat depressed women . Journal of Holistic Nursing, 18(2), 129-142
Martin, L. S. (1991). Using Watson’s theory to explore the dimensions of adult
polycystic kidney disease . ANNA Journal, 18, 403-406
C o n c l u s i o n
Watson provides many useful concepts for the practice of nursing.
She ties together many theories commonly used in nursing education.
The detailed descriptions of the carative factors can give guidance to those
who wish to employ them in practice or research.
Watson describe Human being should be valued should be nurture and respected.Health likewise in WHO. Absence of disease, should be complete as a whole healthy.Environment is the ability to cope up to a new environment.Nursing she believes that a holistic is central to effective care.Promoting and obtaining health is the main focused.
