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 Table of Contents
Transpersonal
Introduction
Caring

History &
Background

Theoretical Major
Sources Concepts

The Ten Carative

Factors

Nursing
Metaparadigm
Critique
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 INTRODUCTION
“We are the light in institutional
darkness, and in this model we get to
return to the light of our humanity”

J. Udan, 2020. Theoretical

Foundation in Nursing

Many people enters the nursing field because

they see it as a career that cares about the
needy ones. Compassion is often a trait required
of nurses, since taking care of patients’ needs is
their primary purpose. Watson’s theory
addresses how nurses care for their patients
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Jean Watson and how that caring translates into better health
plan to help patient get healthy.

History and Background
• Margaret Jean Watson was born and grew
up in Welch, West Virginia
• Education: BSN, University of Colorado,
1964; MSN, University of Colorado, 1966;
PhD, University of Colorado, 1973
• Dr. Watson is a Professor of Nursing and
holds endowed Chair in Caring Science at
the University of Colorado Health Sciences
Center
• Founder of the Human Caring Center in
Colorado and a Fellow of the American
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Academy of Nursing; Past President of the
National League for Nursing
• Her research has been in the area of
human caring and loss
• The foundation of her theory was
published in 1979, “Nursing: The Philosophy
and Science of Caring”
• In 1988, Watson’s theory was published in
“Nursing: Human Science and Human Care”
• She believed that the main focus in nursing
is on carative factors. That for nurses to
develop humanistic philosophies and value
system, a strong liberal arts background is
necessary
• Her philosophy and values system has a
solid foundation for the science of caring
 Theoretical Sources
• Watson’s work has been called a
philosophy, blueprint, ethic paradigm,
worldview, treatise, conceptual model,
theory
• Defines theory as an imaginative grouping
of knowledge, ideas and experiences that
are represented symbolically and seek to
illuminate a given phenomenon
• Watson cites as background for her theory
nursing philosophies and theorists
including Nightingale, Henderson,
Leininger, Peplau, Rogers, Neuman and
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work of Gadow in which a nursing
philosopher and health care ethicist
• Watson expanded the ten carative factors
to “caritas” and offered a translation of the
original carative factors into clinical
caritas processes that suggest open ways
they could be considered
• “Transpersonal caring relationship” is the
foundation of her theory; a special kind of
human relationship
• Development and maintenance of the
transpersonal relationship is actualized
through the application of the 10 Caritas
Processes that guide the relationship and
set the foundation for the caring – loving
relationship essential to nursing practice

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. Additionally, 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
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person as they are and looks to what they
may become.
THE TEN CARATIVE FACTORS:
1. The formation of a humanistic-altruistic system of
values
2. The instillation of faith and 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 corrective
mental, physical, sociocultural and spiritual environment
9. Assistance with the gratification of human needs
10. The allowance of existential-phenomenological forces;
became “allowance for existential-phenomenological
spiritual forces” (in 2004 Watson website)
 Major Concepts
● Watson devised 10 caring needs specific ● The first three carative factors are the
carative factors critical to the caring “philosophical foundation” for the
human experience that need to be science of caring, while the remaining
addressed by nurses with their patients seven derive from that foundation. The
when in a caring role. As carative factors ten primary carative factors with their
evolved within an expanding perspective, corresponding translation into clinical
and as her ideas and values evolved, caritas processes are listed below.
Watson offered a translation of the
original carative factors into clinical
caritas processes that suggested open
ways in which they could be considered.
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 Carative Factors Caritas Process
Major Concepts
1. “The formation of a humanistic- “Practice of loving-kindness and equanimity within the context of caring
altruistic system of values.” consciousness.”
✓ Begins developmentally at an early age with values shared with
parents
✓ Mediated through one’s 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. “The instillation of faith-hope.” “Being authentically present and enabling and sustaining the deep belief
system and subjective life-world of self and one being cared for.”
✓ Is essential to both the carative and 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
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through beliefs which are meaningful to the individual

 Carative Factors Caritas Process
Major Concepts
3. “The cultivation of sensitivity to one’s “Cultivation of one’s own spiritual practices and transpersonal self going
self and others.” beyond the ego-self.”
✓ 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
whom the nurse interacts
✓ The nurse promote health and higher level function only when they
form person-to-person relationship

4. “Development of a helping-trust “Developing and sustaining a helping trusting, authentic caring

relationship” became “development of a relationship.”
helping-trusting, human caring relation” ✓ Strongest tool is the mode of communication which establishes
(in 2004 Watson website) rapport and caring
✓ Defined the characteristics needed in the helping-trust relationship, as
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follows: congruence, empathy, warmth

✓ Communication includes verbal, nonverbal and listening in a manner
which connotes empathetic understanding
 Carative Factors
Major Concepts
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” became “systematic use of a
creative problem solving caring process”
(in 2004 Watson website)
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Caritas Process
“Being present to, and supportive of, the expression of positive and
negative feelings as a connection with deeper spirit and self and the one-
being-cared for.”
✓ “feelings alter thoughts and behavior and they need to be considered
and allowed for in caring relationship”
✓ Such expression improves one’s level of awareness
✓ Awareness of the feelings helps to understand the behavior it
engenders
“Creative use of self and all ways of knowing as part of the caring
process; to engage in the artistry of caring-healing practices.”
✓ The scientific problem-solving method is the only method that allows
for control and prediction and that permits self-correction
✓ She values the relative nature of nursing and supports the need to
examine and develop the other methods of knowing to provide a
holistic perspective
✓ The science of caring should not be always neutral and objective
 Carative Factors Caritas Process
Major Concepts
7. “The promotion of transpersonal “Engaging in genuine teaching-learning experience that attends to the
teaching-learning.” unity of being and meaning, attempting to stay within others’ frame of
reference.”
✓ 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. “The provision of the supportive,
protective, and (or) corrective mental,
physical, societal, and spiritual
environment.”
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“Creating healing environment at all levels (physical as well as the
nonphysical, subtle environment of energy and consciousness, whereby
wholeness, beauty, comfort, dignity, and peace are potentiated)”
✓ It is divided into external 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
✓ Watson suggests that the nurse also must provide comfort, privacy

and safety as part of this carative factor

 Carative Factors
Major Concepts
9. “The assistance with the gratification of
human needs.”
10. “The allowance for existential-
phenomenological forces” became
“allowance for existential-
phenomenological spiritual forces” (in
2004 Watson website)
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Caritas Process
“Assisting with basic needs, with an intentional caring consciousness,
administering ‘human care essentials,’ which potentiate alignment of
mind-body-spirit, wholeness, and unity of being in all aspects of care.”
✓ It is grounded in a hierarchy of need similar to Maslow’s.
✓ She said that each need is equally important for quality nursing care
and the promotion of optimal health . All the needs deserve to be
attended and valued
“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”
✓ 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
✓ The nurse assists the person to find the strength or courage to
confront life or death
 Watson’s Ordering of Needs
● Lower Order Needs
(BIOPHYSICAL NEEDS)
- The need for food and fluid
- The need for elimination
- The need for ventilation
• Lower Order Needs
(PSYCHOPHYSICAL NEEDS)
- The need for activity-inactivity
- The need for sexuality
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● Higher Order Needs
(PSYCHOSOCIAL NEEDS)
- The need for achievement
- The need for affiliation
● Higher Order Needs
(INTRAPERSONAL-
INTERPERSONAL NEEDS)
- The need for self - actualization
 Nursing Metaparadigm ❑ Health (Illness and Diseases)

- Health is the unity and harmony within

❑ Personhood (Human Being) the mind, body, and soul; health is
associated with the degree of
- Human being is a valued person to be
congruence between the self and the
cared for, respected, nurtured,
self as experienced. It is defined as a
understood, and assisted; in general, a
high level of overall physical, mental, and
philosophical view of a person as a fully
social functioning; a general adaptive-
functional integrated self. A human is
maintenance level of daily functioning;
viewed as greater than and different
and the absence of illness, or the
from the sum of his or her parts.
presence of efforts leading to the
- The person possesses the three absence of illness.
spheres of being; body, mind and soul
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 Nursing Metaparadigm ❑ Nursing

- The goal of nursing is to help persons gain a

❑ Environment (Healing Space) higher degree of harmony within mind, body,
spirit which generates self-knowledge, self-
- It is focused on stress, comfort,
reverence, self-healing and self-care
privacy, safety and clean aesthetic
processes while allowing for diversity and
surroundings
possibility
- The nurse’s role in the environment:
- “The greater the degree of genuineness and
“Attending to support, protect and or
sincerity of the nurse within the context of
correct mental, physical, societal and
the caring act, the greater the efficacy of
spiritual environment”
caring” – Watson, 1985
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 ❑ Nursing
● Actual Caring Occasion
- The actual caring occasion involves actions
and choices by the nurse and the individual.
The moment of coming together on 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
other person. Both are fully present in the
moment and feel a union with the other; they
share a phenomenal field that becomes part of
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both a life story.

 Critique
✓ Clarity ✓ Generality

- Her theory used nontechnical, - It is understood as a moral and

sophisticated, fluid and evolutionary
language. It is abstract and simple concepts
✓ Simplicity
- More about being than doing and the nurse
must internalize thoroughly if it is to be
actualized in practice
- Viewed as existential-phenomenological
nature of work is considered particularly for
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philosophical basis for nursing which
encompasses broad aspects of health
and illness phenomena that promotes
health, prevention of illness and
peaceful death thereby increasing its
generality. The caritas processes
provides guidelines for nurse-patient
interaction.

nurses who have limited liberal arts

background
 Critique

✓ Empirical Precision (Accessibility) ✓ Derivable Consequences (Importance)

- Described as descriptive; Watson - It continues to provide useful and

acknowledges the evolving nature of important metaphysical orientation for
the theory and welcomes input from the delivery of nursing care.
the others
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