Jean Watsons Theory of Human Caring - Term Paper Example

Jean Watson’s Theory of Human Caring Jean Watson’s theory centres on helping people to gain a higher degree of harmony within the mind, body and soul. This goal is achieved through caring transactions. Watson describes transpersonal caring as an ideal of intersubjectivity in which both persons, the patient and the nurse are involved. (Watson J, 1999) Transpersonal caring involves the caring moment in which the patient and nurse actually come together with his or her individual history and phenomenal fields. The caring moment becomes a focal point in time and space. (McClendon, 2005) Watson states that the caring moment involves intent on the part of the nurse and the client. The two people must intend that a therapeutic interaction would take place. This interaction opens up possibilities for healing and human connection at a deeper level. (Watson, J & Foster, R. L, 2003) This theory’s goal is to protect, enhance and preserve humanity by helping a person meaning in illness, suffering pain and existence. Watsons description of caring is that it is a value and an attitude that has to become a will, an intenion or a commitment that manifests itself in concrete acts. (McCance, McKenna, Boore 1999) It is a human science of persons and human health-illness experiences that are mediated by professional, personal, scientific, aesthetic and ethical human care transactions. ‘Caritas’ comes from the Latin word meaning to cherish, to appreciate, to give special attention, if not loving, attention to, it connotes something that is very fine, that indeed is precious. (Watson, J. 2003). The ten ‘caritas’ carative factors are as follows: 1. Formation of humanistic-altruistic system of values. 2. Instillation of faith-hope. 3. Cultivation of sensitivity to one’s self and to others. ‘Cultivation of one’s own spiritual practices and transpersonal self, going beyond ego self’ 4. Development of a helping-trusting, human caring relationship. ‘Developing and sustaining a helping-trusting, authentic caring relationship’ 5. Promotion and acceptance of the expression of positive and negative feelings. ‘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’ 6. Systematic use of a creative problem-solving caring process. ‘ Creative use of self and all ways of knowing as part of the caring process, to engage in artistry of caring-healing practices’ 7. Promotion of transpersonal teaching-learning. ‘Engaging in genuine teaching-learning experience that attends to unity of being and meaning attempting to stay within other’s frame of reference’ 8. Provision for a supportive, protective, and/or corrective mental, physical, societal, and spiritual environment. ‘Creating healing environment at all levels, physical as well as non-physical, subtle environment of energy and consciousness, whereby wholeness, beauty, comfort, dignity, and peace are potentiated’ 9. Assistance with gratification of human needs. 10. Allowance for existential-phenomenological-spiritual forces. Transpersonal caring relationships are the foundation of the theory. Transpersonal conveys a concern for the inner life world which goes beyond the ego self and beyond the given moment, reaching to the deeper connections to spirit. Thus transpersonal caring relationship moves beyond ego-self and radiates to spiritual, even cosmic concerns and connections that tap into healing possibilities and potentials. (Watson, J. 2003). Transpersonal caring seeks to connect with and embrace the spirit or soul of the other through the processes of caring and healing and being in authentic relation, in the moment. Caritas conveys that is love, allowing love and caring coming together for a new form of deep transpersonal caring. (Watson, J. 2003). This relationship between love and caring connotes inner healing for self and others, extending to nature, and the larger universe, unfolding and evolving within a cosmology that is both metaphysical and transcendent with the co-evolving human in the universe (Watson, J. 1998). Case Study: A 41-year-old married man Mr. John, father of three, was referred to the Gastrointestinal (GI) service. His past medical history included the diagnosis of bowel cancer 9 months ago. The tumour was located within the ascending colon and extended into the mucosal lining. John underwent a bowel resection involving the removal of the terminal ileum, ileocecal valve, ascending colon, and part of the transverse colon. The pathology report cited clear margins and chemotherapy was therefore not prescribed postoperatively. He remained well until approximately four months ago when John presented to the hospital with acute abdominal obstruction caused by a retroperitoneal mass compressing the bowel. The surgery involved the removal of approximately 90% of the stomach, duodenum, and proximal four feet of small bowel. The liver appeared to be clear; however, his spleen and left kidney were removed, as part of the tumour was adhered to these organs. The surgical team was able to remove most of the cancer. The oncology team recommended a course of chemotherapy for three months to shrink the tumour, which might increase the length of John’s life, but would not, in all likelihood, cure him. John had received two courses of chemotherapy and suffered side effects. This had resulted in a reduced oral intake and a significant weight loss of greater than 15 kg in the past two months. Considering John’s surgical and oncological history, it was important to determine realistic goals for care. An accurate assessment of his current health status provides the baseline for planning the most appropriate interventions. Jean Watson Theory of Human Caring explores a holistic approach to nursing. In this theory, Watson seeks to blend nursing as science and art. Whereas there is a scientific basis for the practice of nursing, it is the “body, mind, and spirit” of both the ‘caregiver’ the nurse and ‘care receiver’ the patient, that has the greatest impact on the outcome of care. This theory contends that the nurse’s care for a patient extends beyond human contact and focuses instead on the soul of the patient. The values of respect, reverence, and autonomy are central to this theory. Watson states, however, that the guiding value of the model is the idea that caring is the moral ideal of nursing with a concern for the preservation of humanity, dignity, and fullness of self. Watson’s conviction is that when a nurse cares for a patient, the nurse enters into the “life space” of that patient and detects his or her condition at a spiritual level. (Watson, 2005) The nurse connects with the patient at a deep spiritual level, sometimes only for a moment, and that “connectedness” allows both the nurse and patient to heal. The emphasis of this theory and its ascribed method of caring is focused on the care of the whole patient rather than the pathology and treatment of the patient’s disease. Communication between the patient and the nurse is less verbal and more with touch, gestures, and sounds. The “healing” may need to be at a ‘spiritual’ at ‘metaphysical’ level before physical healing actually begin. (Alligood, Tomey, 2002) As mentioned before, John was married with two small children. His wife was supportive and was the primary caregiver. The family was religious, and John considered this life on earth important for him, he believed there was a better place after this life. John’s faith offered him comfort, however, he struggled with leaving his wife and children, and for those reasons, he felt he must continue to “fight this disease.” The family was involved in a supportive church community and as a result, there was much activity within the home by the church family, providing both spiritual and emotional support. The extended family was also supportive and lived nearby. John did not smoke, drink alcohol, or used illegal drugs. Watson Theory of Caring (1999) insists that the social history of the patient, be considered, as it allowed the interviewer to understand a more complete approach to the patients’ care. Details, such as the environment in which John lived as well as his habits within that environment, helped to provide a more complete and potentially more successful plan of care. Meal preparation time, for instance, was an important consideration for someone who was weak and in poor health. John felt well enough to prepare food, but too weak to eat it because of the energy expended in preparation. Because of his inability to work and resulting financial burden, his food choices may be limited. All of these are issues that must be considered when determining the nutritional intervention outside of simply the physical aspect. The food ingested by John over the course of a day may be dependent on many factors: desire, preferences, hunger, and availability of food, social environment, and emotional attachment. The nurse must accurately assess the patient’s physical needs and combine those needs with the patient’s preferences, social environment, nutrition availability, and emotional needs. (Watson, J. 2006). The nurse must recognize, accurately detect, and connect with the inner condition of spirit of patient through genuine presenting and being centered in the caring moment by her actions, words, behaviors, cognition, body language, feelings, intuition, thought, senses, the energy field, and so on, all contribute to transpersonal caring connection. The nurse’s ability to connect with patient at this transpersonal spirit- to- spirit level is translated via movements, gestures, facial expressions, procedures, information, touch, sound, verbal expressions and other scientific, technical, aesthetic, and human means of communication, into nursing human acts or intentional caring-healing modalities. (Watson, J. 2006) Clearly understanding John’s goal of care was important. John was not disease free. He had great difficulty taking anything orally. He was in pain. He had a wife and three small children. He does not want to die. What were his immediate and intermediate goals, with both nutrition support and quality of life? A holistic approach to John’s care, his goal setting, and finally, his decisions regarding interventions and care were explored. The nurse must have a deep appreciation of the patient’s definition of life; the quality of his life; and the things, actions, and events that make his life important. John’s primary goal was to maintain his quality of life and secondarily to enhance the length of his life, then he would need to evaluate each recommendation in the light of how it would affect his activities of daily living, the impact on his family, and to what end it would adjust the course of his therapy and, ultimately, his life. Transpersonal caring calls for an authenticity of being and becoming an ability to be present to self and patient in a reflective frame. (Watson, J. 2006) The transpersonal nurse must have the ability to center consciousness and intentionality on caring, healing, and wholeness, rather than on disease, illness and pathology. With the help of the curative factors described in Watson’s theory (1999) I developed the helping-trust relationship with John. It required me to be willing to support whatever decision he made. When the evidence in favour of intervention or, alternatively, against nutrition support was presented to him, he and his family took decision, weighing the evidence presented considering their values and belief system. The helping-trust relationship between the nurse and the patient supported the patient’s decision, regardless of what it was. Caring is a form of using expressive touch in a way that purposefully directs compassion and an intention to help toward the patient needing care. It is a unique exchange between the person in the helping role and the person in need of help. Through this exchange both benefit. Therapeutic touch is based on the assumption that human beings are, in a sense, energy fields, and that personal energy extends beyond the physical body. During times of illness and stress, the energy fields become unbalanced. The nurse’s role is to smooth and rebalance the patient’s energy. Physical healing is important, however without spiritual healing; optimal care and healing cannot be achieved. (Watson, J. 1999) John was deeply religious, and the acknowledgement of it in his and his family’s lives, without criticism from the staff, allowed for a supportive spiritual environment. Moral commitment, intentionality and caritas consciousness by the nurse protected, enhanced and potentiated human dignity, wholeness and healing whereby allowing the patient to create his own meaning for existence. The conscious will of the nurse affirms the subjective and spiritual significance of the patient while seeking to sustain caring in the midst of threat and despair, biological or institutional. (Watson, J. 2006). In this case study, it was accepted that nutrition support would not cure the underlying disease. It did, however, support John’s physical body well enough for him to continue to receive chemotherapy, an intervention advocated by the oncology team because this met the goals of the client. Utilizing Watson theory, I was guided to care for the patient holistically by providing the therapy required and by giving the best possible care. It was important to the patient and his family that they achieve their personal goals as John’s disease progressed. The ability to empathise and understand the patient’s reality as well as perceiving their feelings was developed by actively listening to the patient. This encouraged the patient to acknowledge that somebody was there to pay attention to what he was saying. I also learnt the value of showing respect towards everyone under my care and that portraying a positive attitude towards patients improved communication. The power of Watsons caring theory is in its ability to help nurses reconnect with themselves, their patients, and their peers. Caring theory affords “reminders of what we already know at some deep human, experiential level, but continually pass over in our day-to-day living” (Watson J, 2003). The longevity of caring theory lies in its ability to empower nurses to make a difference in the lives they touch. References Alligood, M. R., & Tomey, A. M. (2002). Nursing theory: Utilization and application. St. Louis: Mosby. McCance, T.V., McKenna, J.P. & Boore, (1999). Caring: theoretical perspectives of relevance to nursing. Journal of Advanced Nursing, 30(6) McClendon, P. (2005). Discovery of Connections Societal Needs, Nursing Practice, and Caring-Healing Theory: My story. International Journal for Human Caring. 9(4) Watson, J. (1979). Nursing: The philosophy and science of caring. Boulder, CO: Colorado: Associated University Press. Watson, J. (1999). Nursing. Human science and human care. A theory of nursing. Sudbury, MA: Jones & Bartlett. Watson, J. (2002). Intentionality and caring-healing consciousness: A practice of transpersonal nursing. Holistic Nursing Practice, 16(4), 12-19. Watson, J. (2003). Love and caring. Ethics of face and hand—An invitation to return to the heart and soul of nursing and our deep humanity. Nursing Administration Quarterly, 27, 197-202. Watson, J., & Foster, R. L (2003) The attending nurse caring model: Integrating theory, evidence, and advanced caring healing therapeutics for transforming professional practice. Journal of Clinical Nursing, 12, 360-365. Watson, J. (2005). Jean Watson and the theory of human caring. Retrieved May 17, 2006 Watson, J. (2006). Caring theory as an ethical guide to administrative and clinical practices. Nursing Administration Quarterly, 30(1), 48-55. Read More