WEEK 6-7

Nursing Theoretical Works

A. Nursing Philosophies
1. Nightingales Environmental Theory

Florence Nightingale
 (1820-1920)
 Known as the mother of Modern Nursing
 The lady with the lamp
 Developed and described the first theory of nursing.
 She focused on changing and manipulating the environment in
order to put the patient in the best possible conditions for nature to
act, socialization and hope.
 She believed that in nursing environment, the body could repair
itself. Client’s environment is manipulated to include appropriate
noise, nutrition, hygiene, light, comfort.
 Central to Nightingale’s theory is the concept of environmental
sanitation. It includes proper ventilation, adequate lighting,
cleaniness, adequate warmth, quiet, and diet.

Metaparadigm (Matrix format)

Person Health Environment Nursing

The person is the Health is also living Environment was Nursing is an art of

patient himself. A up to one’s potential viwed as “ those utilizing one’s

passive patient is a to the fullest extent. elements external to environment for his

patient who Disease and illness and which affect the or her own

depends wholly on are viewed as health of the sick recovery”

the nurse for tasks reparative process and healthy oerson”

and control of his that are instituted by and included “

environment. Mother Nature everything from the

herself when the patient’s foof and

 person did not flowers to the

attend to his patient’s verbal and

personal health non-verbal

concerns. interactions”

2. Watson’s Theory of Human Caring

Jean Watson (1979-1985)

Dr. Jean Watson is a nurse theorist who developed “Philosphy and Theory of
Transpersonal Caring” or “Caring Science” and founder of Watson Caring
Science Institute. Get to know about Dr. Watson’s nursing theory, its major
concepts, assumptions, and application to nursing in this study guide.

Biography of Jean Watson

Jean Watson (June 10, 1940 – present) is an American nurse theorist and nursing
professor who is well known for her “Philosophy and Theory of Transpersonal
Caring.” She has also written numerous texts, including Nursing: The Philosophy
and Science of Caring. Watson’s study on caring has been integrated into education
and patient care to various nursing schools and healthcare facilities all over the
world.

 Conceptualize the Human Caring Model (Nursing Human Science

and Human Care). She emphasized that nursing is the application
of the art and human science through transpersonal carting
transactions to help persons achieve mind-body-soul harmony,
which generates self-knowledge, self-control, self-care, and self-
healing. She included health promotion and treatment of illness in
nursing. She believed that a person is a valued being to be cared
for, respected, nurtured, understood and assisted; a fully functional
integrated self.

Theory of Human Caring of Jean Watson

Nowadays, a lot of people choose nursing as a profession. There are many reasons
to consider in becoming a professional nurse, but compassion is often a trait
required of nurses. This is for the reason that taking care of the patients’ needs is
its primary purpose. Jean Watson’s “Philosophy and Theory of Transpersonal
Caring” mainly concerns on how nurses care for their patients, and how that caring
progresses into better plans to promote health and wellness, prevent illness and
restore health.

In today’s world, nursing seems to be responding to the various demands of the

machinery with less consideration of the needs of the person attached to the
machine. In Watson’s view, the disease might be cured, but illness would remain
because, without caring, health is not attained. Caring is the essence of nursing and
connotes responsiveness between the nurse and the person; the nurse co-
participates with the person. Watson contends that caring can assist the person to
gain control, become knowledgeable, and promote health changes

What is Watson’s Theory of Transpersonal

Caring?
According to Watson’s theory, “Nursing is concerned with promoting health, preventing
illness, caring for the sick, and restoring health.” It focuses on health promotion, as
well as the treatment of diseases. According to Watson, caring is central to nursing
practice, and promotes health better than a simple medical cure.

The nursing model also states that caring can be demonstrated and practiced by
nurses. Caring for patients promotes growth; a caring environment accepts a
person as he or she is, and looks to what he or she may become.

Major Concepts
The Philosophy and Science of Caring has four major concepts: human being,
health, environment or society, and nursing.

Society
Society provides the values that determine how one should behave and what goals
one should strive toward. Watson states:

“Caring (and nursing) has existed in every society. Every society has had some people
who have cared for others. A caring attitude is not transmitted from generation to
generation by genes. It is transmitted by the culture of the profession as a unique way of
coping with its environment.”

Human being
Human being is a valued person to be cared for, respected, nurtured, understood,
and assisted; in general a philosophical view of a person as a fully functional
integrated self. Human is viewed as greater than and different from the sum of his
or her parts.

Health
Health is the unity and harmony within the mind, body, and soul; health is
associated with the degree of congruence between the self as perceived and the
self as experienced. It is defined as a high level of overall physical, mental, and
social functioning; a general adaptive-maintenance level of daily functioning; and
the absence of illness, or the presence of efforts leading to the absence of illness.

Nursing
Nursing is a human science of persons and human health-illness experiences that
are mediated by professional, personal, scientific, esthetic, and ethical human care
transactions.

Actual Caring Occasion

Actual caring occasion involves actions and choices by the nurse and the individual.
The moment of coming together in a caring occasion presents the two persons with
the opportunity to decide how to be in the relationship – what to do with the
moment.

Transpersonal
The transpersonal concept is an intersubjective human-to-human relationship in
which the nurse affects and is affected by the person of the other. Both are fully
present in the moment and feel a union with the other; they share a phenomenal
field that becomes part of the life story of both.

Subconcepts

Phenomenal field
The totality of human experience of one’s being in the world. This refers to
the individual’s frame of reference that can only be known to that person.

Self
The organized conceptual gestalt composed of perceptions of the
characteristics of the “I” or “ME” and the perceptions of the relationship of
the “I” and “ME” to others and to various aspects of life.

Time
The present is more subjectively real and the past is more objectively real.
The past is prior to, or in a different mode of being than the present, but it is
not clearly distinguishable. Past, present, and future incidents merge and
fuse.

10 Carative Factors
Watson devised 10 caring needs specific carative factors critical to the caring
human experience that need to be addressed by nurses with their patients when in
a caring role. As carative factors evolved within an expanding perspective, and as
her ideas and values evolved, Watson offered a translation of the original carative
factors into clinical caritas processes that suggested open ways in which they could
be considered.

The first three carative factors are the “philosophical foundation” for the science of
caring, while the remaining seven derive from that foundation. The ten primary
carative factors with their corresponding translation into clinical caritas processes
are listed in the table below.

Carative Factors and Caritas Processes

Carative Factors Caritas Process

1. “The formation of a humanistic-altruistic “Practice of loving-kindness and equanimity

system of values” within the context of caring consciousness”

“Being authentically present and enabling and

2. “The instillation of faith-hope” sustaining the deep belief system and subjective
life-world of self and one being cared for”

3. “The cultivation of sensitivity to one’s self and “Cultivation of one’s own spiritual practices and
to others” transpersonal self going beyond the ego self”

4. “Development of a helping-trust relationship”

“Developing and sustaining a helping trusting
became “development of a helping-trusting,
authentic caring relationship”
human caring relation” (in 2004 Watson website)

“Being present to, and supportive of, the

5. “The promotion and acceptance of the expression of positive and negative feelings as a
expression of positive and negative feelings” connection with deeper spirit and self and the
one-being-cared for”

6. “The systematic use of the scientific problem

“Creative use of self and all ways of knowing as
solving method for decision making” became
part of the caring process; to engage in the
“systematic use of a creative problem solving
artistry of caring-healing practices”
caring process” (in 2004 Watson website)

“Engaging in genuine teaching-learning

7. “The promotion of transpersonal teaching- experience that attends to unity of being and
learning” meaning, attempting to stay within others’
frame of reference”

“Creating healing environment at all levels

8. “The provision of supportive, protective, and (physical as well as nonphysical, subtle
(or) corrective mental, physical, societal, and environment of energy and consciousness,
spiritual environment” whereby wholeness, beauty, comfort, dignity,
and peace are potentiated)”

9. “The assistance with gratification of human “Assisting with basic needs, with an intentional
needs” caring consciousness, administering ‘human
care essentials,’ which potentiate alignment of
 mind body spirit, wholeness, and unity of being
in all aspects of care”

10. “The allowance for existential- “Opening and attending to spiritual-mysterious

phenomenological forces” became “allowance and existential dimensions of one’s own life-
for existential-phenomenological spiritual death; soul care for self and the one-being-
forces” (in 2004 Watson website) cared for”

Watson’s Hierarchy of Needs

Within assisting with the gratification of human needs, Watson’s hierarchy of needs
begins with lower-order biophysical needs or survival needs, the lower-order
psychophysical needs or functional needs, the higher order psychosocial needs or
integrative needs, and finally the higher order intrapersonal-interpersonal need or
growth-seeking need.Watson’s Hierarchy of Needs

Lower Order Biophysical Needs or Survival Needs

Watson’s hierarchy of needs begins with lower-order biophysical needs or survival

needs. These include the need for food and fluid, elimination, and ventilation.

Lower Order Psychophysical Needs or Functional Needs

Next in line are the lower-order psychophysical needs or functional needs.

These include the need for activity, inactivity, and sexuality.

Higher Order Psychosocial Needs or Integrative Needs

The higher order psychosocial needs or integrative needs include the need for
achievement, and affiliation.

Higher Order Intrapersonal-Interpersonal Need or Growth-seeking Need

The higher order intrapersonal-interpersonal need or growth-seeking need is the

need for self-actualization.

Watson’s Theory and The Nursing Process

The nursing process in Watson’s theory includes the same steps as the scientific
research process: assessment, plan, intervention, and evaluation. The assessment
includes observation, identification, and review of the problem, as well as the
formation of a hypothesis. Creating a care plan helps the nurse determine how
variables would be examined or measured, and what data would be collected.
Intervention is the implementation of the care plan and data collection. Finally, the
evaluation analyzes the data, interprets the results, and may lead to an additional
hypothesis.
Analysis
It is undeniable that technology has already been part of nursing’s whole paradigm
with the evolving era of development. Watson’s suggestion of purely “caring”
without giving much attention to technological machinery cannot be solely applied
but then her statement is praiseworthy because she dealt with the importance of
the nurse-patient interaction rather than a practice confined with technology.

Watson stated the term “soul-satisfying” when giving out care for the clients. Her
concepts guide the nurse to an ideal quality nursing care provided for the patient.
This would further increase the involvement of both the patient and the nurse
when the experience is satisfying.

ADVERTISEMENTS

In providing the enumerated clinical Caritas processes, the nurse becomes an

active co-participant with the patient. Thus, the quality of care offered by the nurse
is enhanced.

Strengths
Although some consider Watson’s theory complex, many find it easy to understand.
The model can be used to guide and improve practice as it can equip healthcare
providers with the most satisfying aspects of practice and can provide the client
with holistic care.

Watson considered using nontechnical, sophisticated, fluid, and evolutionary

language to artfully describe her concepts, such as caring-love, carative factors, and
Caritas. Paradoxically, abstract and simple concepts such as caring-love are difficult
to practice, yet practicing and experiencing these concepts leads to greater
understanding.

Also, the theory is logical in that the carative factors are based on broad
assumptions that provide a supportive framework. The carative factors are logically
derived from the assumptions and related to the hierarchy of needs.

Watson’s theory is best understood as a moral and philosophical basis for nursing.
The scope of the framework encompasses broad aspects of health-illness
phenomena. In addition, the theory addresses aspects of health promotion,
preventing illness and experiencing peaceful death, thereby increasing its
generality. The carative factors provide guidelines for nurse-patient interactions, an
important aspect of patient care.

Weakness
The theory does not furnish explicit direction about what to do to achieve authentic
caring-healing relationships. Nurses who want concrete guidelines may not feel
secure when trying to use this theory alone. Some have suggested that it takes too
much time to incorporate the Caritas into practice, and some note that Watson’s
personal growth emphasis is a quality “that while appealing to some may not
appeal to others.”

Conclusion
Watson began developing her theory while she was assistant dean of the
undergraduate program at the University of Colorado, and it evolved into planning
and implementation of its nursing Ph.D. program.

The Philosophy and Science of Caring addresses how nurses express care to their
patients. Caring is central to nursing practice, and promotes health better than a
simple medical cure. Watson believes that a holistic approach to health care is
central to the practice of caring in nursing.

This led to the formulation of the 10 carative factors: (1) forming humanistic-
altruistic value systems, (2) instilling faith-hope, (3) cultivating a sensitivity to self
and others, (4) developing a helping-trust relationship, (5) promoting an expression
of feelings, (6) using problem-solving for decision-making, (7) promoting teaching-
learning, (8) promoting a supportive environment, (9) assisting with gratification of
human needs, and (10) allowing for existential-phenomenological forces. The first
three factors form the “philosophical foundation” for the science of caring, and the
remaining seven come from that foundation.

Describing her theory as descriptive, Watson acknowledges the evolving nature of

the theory and welcomes input from others. Although the theory does not lend
itself easily to research conducted through traditional scientific methods, recent
qualitative nursing approaches are appropriate.

Watson’s theory continues to provide a useful and important metaphysical

orientation for the delivery of nursing care. Watson’s theoretical concepts, such as
use of self, patient-identified needs, the caring process, and the spiritual sense of
being human, may help nurses and their patients to find meaning and harmony
during a period of increasing complexity. Watson’s rich and varied knowledge of
philosophy, the arts, the human sciences, and traditional science and traditions,
joined with her prolific ability to communicate, has enabled professionals in many
disciplines to share and recognize her work.

See Also
You may also like the following nursing theories study guides: 

 Nursing Theories and Theorists – The Ultimate Nursing Theories and Theorists
Guide for Nurses.

External Links
 Nursing: The Philosophy and Science of Caring, Revised Edition

 Nursing: Human Science and Human Care, a Theory of Nursing

  Postmodern Nursing and Beyond, 1e

 Instruments for Assessing and Measuring Caring in Nursing and Health Sciences
(2002)

 By Jean Watson – Caring Science as Sacred Science: 1st (first) Edition

 Watson Caring Science Institute and International Caritas Consortium

 Dr. Jean Watson’s Facebook

References
 Alligood, M., & Tomey, A. (2010). Nursing theorists and their work, seventh edition.
Maryland Heights: Mosby-Elsevier.

 Dr. Watson’s Facebook Page for the photos

 Dr. Jean Watson. (n.d.). Retrieved November 28, 2013, from

https://watsoncaringscience.org/about-us/jean-bio/

 Watson, J. (1979). Nursing: The philosophy and science of caring. In George, J.

(Ed.). Nursing theories: the base for professional nursing practice. Norwalk,
Connecticut: Appleton & Lange.

 Watson, J. (1999). Postmodern nursing and beyond. In McEwen, M. and Wills, E.

(Ed.). Theoretical basis for nursing.  USA: Lippincott Williams & Wilkins.

 Watson, J. (2005). Caring science as a sacred science. In McEwen, M. and Wills, E.

(Ed.). Theoretical basis for nursing.  USA: Lippincott Williams & Wilkins.

 Watson, J. (2006). From carative factors to clinical caritas processes. Retrieved

March 18, 2006, from https://www2.uchsc.edu/son/caring/content/evolution.asp.
In Kozier, B., Erb, G., Berman, A., Snyder, S. (Ed.). Fundamentals of nursing:
Concepts, process, and practice. (7th ed.). Philippines: Pearson Education South
Asia Pte Ltd.
 With contributions by Wayne, G. (for Biography), Vera, M., Ramirez, Q.
https://nurseslabs.com/jean-watsons-philosophy-theory-transpersonal-caring/