Practical Use of Theory

Practical Use of Theory

Jean Watson’s (2008) Philosophy and Science of Caring, a recent publication, builds on her previous work, Nursing: Human Science and Human Care: A Theory of Nursing. This theory is one of the newest of nursing’s grand theories, having only been completely codified in 1979, revised in 1985 (Watson, 1988), and broadened and advanced more recently (Watson, 2005, 2008). Watson called her earlier work a descriptive theory of caring and stated that it was the only theory of nursing to incorporate the spiritual dimension of nursing at the time it was first conceptualized. The theory was both deductive and inductive in its origins and was written at an abstract level of discourse. Practical Use of Theory

It is somewhat difficult to categorize Watson’s work with the works of other nursing theorists. It has many characteristics of a human interaction model, although it also incorporates many ideals of the unitary process theories, which are discussed in  Chapter 9 . Watson (2005) has always described the human as a holistic, interactive being and is now explicit in describing the human as an energy field and in explaining health and illness as manifestations of the human pattern (Watson, 2008), two tenets of the unitary process theories. Parse (2004) points out, however, that although theorists profess belief in unitary human beings, other definitions and relationships still separate theories from the interactive process paradigms and the unitary process nursing paradigms. Based on overall considerations, the philosophy and science of caring reflects the interactive process nursing theories. Practical Use of Theory

Background of the Theorist

Jean Watson was born in West Virginia and attended Lewis Gale School of Nursing in Roanoke, Virginia. She earned a bachelor’s degree in nursing, a master of science degree in psychiatric–mental health nursing, and a doctorate in educational psychology and counseling, all from the University of Colorado (Neill, 2002). Watson is an internationally published author, having written many books, book chapters, and articles about the science of human caring (Watson, 1994, 1996, 1999, 2005, 2008). Practical Use of Theory

Watson is the former Dean of the School of Nursing at the University of Colorado, and she founded and directed the Center for Human Caring at the Health Sciences Center in Denver. She has received numerous awards and honors (Neill, 2002) and is currently Distinguished Professor of Nursing and Dean Emerita at the University of Colorado Denver College of Nursing and Anschutz Medical Center, “where she held an endowed chair in Caring Science for 16 years. She is a fellow of the American Academy of Nursing and past president of the National League for Nursing” (Watson Caring Science Institute and International Caring Consortium [WCSIICC], 2013). Some of her honors include Fetzer Institute Norman Cousins Award; an International Kellogg Fellowship in Australia; a Fulbright research award in Sweden; and 10 honorary doctoral degrees, including those from Sweden, United Kingdom, Spain, British Columbia and Quebec in Canada, and from Japan (WCSIICC, 2013). Practical Use of Theory

Philosophical Underpinnings of the Theory

Watson (1988) noted that she drew parts of her theory from nursing writers, including Nightingale and Rogers. She also used concepts from the works of psychologists Giorgi, Johnson, and Koch, as well as concepts from philosophy. She reported being widely read in these disciplines and synthesized a number of diverse concepts from them into nursing as a science of human caring. In a recent work, Watson (2005) continues to “bridge paradigms and point toward transformative models for the 21st century” (p. 2).

Major Assumptions, Concepts, and Relationships

The value system that permeates Watson’s (1988, 2008) theory of human caring includes a “deep respect for the wonders and mysteries of life” (1988, p. 34) and recognition that spiritual and ethical dimensions are major elements of the human care process. A number of assumptions are both stated and implicit in her theory. Additionally, several concepts were defined, refined, and adapted for it. From this, 10 carative factors were developed ( Box 8-4 ; Watson, 1985, 2008). Practical Use of Theory

Box 8-4: Watson’s 10 Carative Factors

· 1. Humanistic–altruistic system of values

· 2. Faith–hope

· 3. Sensitivity to self and others

· 4. Developing helping–trusting, caring relationship

· 5. Expressing positive and negative feelings and emotions

· 6. Creative, individualized, problem-solving caring process

· 7. Transpersonal teaching–learning

· 8. Supportive, protective, and/or corrective, mental, physical, societal, and spiritual environment

· 9. Human needs assistance

· 10. Existential-phenomenologic and spiritual forces

Source: Watson (1999, 2005).

Assumptions

Watson (2008) describes the tenets of caring science and sacred science. She proposed that caring and love are universal and mysterious “cosmic forces” that comprise the primal and universal psychic energy. Further, she believes that health professionals make social, moral, and scientific contributions to humankind and that nurses’ caring ideal can affect human development. Further, she believes that it is critical in today’s society to sustain human caring ideals and a caring ideology in practice, as there has been a proliferation of radical treatment and “cure techniques,” often without regard to costs or human considerations. Practical Use of Theory

Explicit assumptions that were derived for Watson’s (2005) work include:

·  An ontologic assumption of oneness, wholeness, unity, relatedness, and connectedness.

·  An epistemologic assumption that there are multiple ways of knowing.

·  Diversity of knowing assumes all, and various forms of evidence can be included.

·  A caring science model makes these diverse perspectives explicitly and directly.

·  Moral-metaphysical integration with science evokes spirit; this orientation is not only possible but also necessary for our science, humanity, society-civilization, and world-planet.

·  A caring science emergence, founded on new assumptions, makes explicit an expanding unitary, energetic worldview with a relational human caring ethic and ontology as its starting point (Watson, 2005, p. 28).

Concepts

Watson (1988) defined three of the four metaparadigm concepts (human being, health, and nursing). She coined several other concepts and terms that are integral to understanding the science of human caring ( Table 8-7 ). Her 10 carative factors are caring needs specific to human experiences that should be addressed by nurses with their clients in the caring role. She continues to value those carative factors (Watson, 2008). The carative factors are listed in  Box 8-4 . Practical Use of Theory

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Table 8-7: Major Concepts of the Science of Human Caring

Relationships

Watson has refined and updated the relationships of the theory, bringing them closer to her current way of understanding human caring and spirituality. Her continued study has involved lengthy examination of her beliefs about caring, spirituality, and human and energy fields (Watson, 2005, 2008). The following are some of the relationships of the theory:

·  A transpersonal caring field resides within a unitary field of consciousness and energy that transcends time, space, and physicality.

·  A transpersonal caring relationship connotes a spirit-to-spirit unitary connection within a caring moment, honoring the embodied spirit of both practitioner and patient within a unitary field of consciousness.

· A transpersonal caring relationship transcends the ego level of both practitioner and patient, creating a caring field with new possibilities for how to be in the moment. Practical Use of Theory

·  The practitioner’s authentic intentionality and consciousness of caring has a higher frequency of energy than noncaring consciousness, opening up connections to the universal field of consciousness and greater access to one’s inner healer.

·  Transpersonal caring is communicated via the practitioner’s energetic patterns of consciousness, intentionality, and authentic presence in a caring relationship.

·  Caring-healing modalities are often noninvasive, nonintrusive, natural-human, energetic environmental field modalities.

·  Transpersonal caring promotes self-knowledge, self-control, and self-healing patterns and possibilities.

·  Advanced transpersonal caring modalities draw upon multiple ways of knowing and being; they encompass ethical and relational caring, along with those intentional consciousness modalities that are energetic in nature (e.g., form, color, light, sound, touch, vision, scent) that honor wholeness, healing, comfort, balance, harmony, and well-being (Watson, 2005, p. 6). Practical Use of Theory

Usefulness

Watson’s works on the Theory of Human Caring and the Art and Science of Human Caring are used by nurses in diverse settings; for example, Brockopp and colleagues (2011) details an evidence-based, practice-based practice model rounded in Watson’s theory of caring. The 10 carative factors are explicated throughout the hospital to provide a framework for nursing activities in this magnate hospital. The outcomes include 34 research projects, 9 published articles, and 9 funded research studies. Furthermore, the nurses “maintain high levels of work satisfaction, strong retention rates and a large percentage of associate-degree nurses return to school for baccalaureate degrees” (p. 511).

Hills and colleagues (2011) developed a text to promote caring science curriculum in nursing, which they called an emancipatory pedagogy for nursing. It is based on Watson’s science of caring and explores an alternative method of student evaluation. Lukose (2011) developed a practice model for Watson’s theory of caring that “can be used by nurse educators to teach staff nurses and students” (p. 27). Noel (2010) reviewed Watson’s theory of human caring for occupational health and nursing and found it relevant in that context. The author also found that other disciplines are using the theory of human caring as their guiding principle in contact with people. Practical Use of Theory

The University of Colorado School of Nursing implemented the model not only in its education programs (BSN, MSN, and PhD), but also in clinical practice at the Center for Human Caring (Watson, 1988). In addition, the School of Nursing at Georgia Southern University in Statesboro taught both undergraduate courses and the nurse practitioner program from the human caring philosophy (Watson, 1988). Writings that detail how Watson’s work is used in nursing education include Bevis and Watson (1989), Leininger and Watson (1990), and Watson (1994). Furthermore, schools around the world are using Watson’s science of caring in nursing education. They include Scandinavia (Wicklund-Gustin & Wagner, 2013), Japan (Ishikawa & Kawano, 2012), and throughout the United States in nursing curricula (Hills et al., 2011). Numerous nationwide community caring projects have made a difference in such areas as immediate care for victims of natural disasters, veterans returning from Iraq and Afghanistan, and homeless people (J. Laroussini, personal communication, March 2013) Practical Use of Theory