Critique of Jean Watson's Theory of Human Becoming - Research Paper Example

CRITIQUE of Jean Watsons Theory of Human Becoming Introduction Jean Watson, Fellow of the American Academy of Nursing, is an eminent of Nursing at the University of Colorado who secured her doctorate in nursing from the same university. She recognized the importance of the nurse-patient relationship as envisaged by Florence Nightingale and came up with her own views which were originally published as ‘The Philosophy and Science of Caring’ in 1979. Her ideas were well received. She continued work on the various aspects of the nurse-patient relationship and her work came to be finally recognized as a fully fledged nursing theory in 1988. Dr. Watson has won international acclaim due to her work and her theory is being taught and practiced in most parts of the world now. She established the Watson Caring Science Institute in 2007, a non-profit organization in Colorado. Major Concepts in Watsons Theory Watson’s main concept is a humane association between the nurse and the patient in order to promote holistic healing. This association covers much wider aspects in which the relationship extends beyond the platonic professional connection between the two. This relationship is established only when a nurse adopts a caring attitude by establishing communication with the patient at the outset and listening to him or her patiently. She should not only be aware of the physical needs of the patients pertinent to the disorder but should also evaluate the psychological and mental status of the patient and establish trust accordingly, fulfilling the emotional needs of the patient. A patient is at his or her vulnerable most when brought to a hospital and the nurse should be capable of addressing all issues unconditionally irrespective of any abnormal behavior of the patient, which might be expressed as non compliance with the doctor’s orders or reluctance to communicate due to personal inhibitions. She should endeavor to create a positive atmosphere in the patient’s immediate environment irrespective of difficulties encountered in doing so. The patient should always be treated with respect and due regard so that positivity develops in the relationship. The nurse should endeavor to educate the patient about the condition he or she is suffering from and assist them in adopting a healthier attitude. The nurse should appear to be a true companion rather than a hurried professional going through the daily routine of duties. Analysis of Major Theory Assumptions Watson claims that establishment of a caring relationship with the patient is only possible if a strong interpersonal bond is developed between the two. Every patient is basically a human being and therefore subject to emotional needs and trust which can be addressed with a multitude of ‘carative factors’. Such factors when brought into play ensure patient health promotion at the individual as well as family level. Appropriate care appreciates the patient’ status not only as he or she is presented in the healthcare facility but also assists the patient to come to terms with the condition he or she might be confronted with in the future. When a true caring environment is established it allows the patient to determine the best action for self at a given point of time in the healing process. The practice of caring is therefore central to the nursing profession as it is ‘healthogenic’ in character as it reinforces the curative processes undertaken to treat the malady. Clarity The juncture at which a nurse practitioner meets the patient is a vital period of time when there is need to establish a caring relationship. The processes and turmoil a patient faces are so empowering that unless he or she is provided reassurance and spiritual guidance, it is most likely that the recovery process might be delayed or the future quality of life of the patient may suffer. All these factors combined together necessitated the administration of therapeutic modalities in a humane environment which were found lacking in the artificial hospital environments created due to the recent changes in the administrative and functional aspects of modern healthcare institutions. Watson feels that establishing trust with the patient and gaining confidence were vital to establish a truly caring environment. A mutually productive relationship is essential for both the nurse as well as the patient where the former learns the art of nursing and the latter learns to cope with the destabilizing phenomenon i.e. the condition one is suffering from. ‘Care’ combines with ‘cure’ to impart truly holistic healing. Reasons for Developing the Theory The healthcare industry has changed remarkably in the last few decades, pulling the focus away from the traditional hospital scenario in which the patient received treatment and then left the premises. The aftermath of trauma, disease and psychological disorders is much worse than the condition itself. Traditionally, patients were left to fend for themselves after the prescribed therapeutic regimen had been administered. Except for the technicalities, the humane angle was totally unrecognized and in fact considered trivial. Under the new guidelines for healthcare, it has become essential for the healthcare personnel, including nursing professionals to ensure that the patient is completely healed and able to reestablish oneself into routine life, for which follow up is necessary. This has widened the horizon of operations of a nursing practitioner in particular, due to high degree of proximity and direct involvement with the patient. When a person suffers from some physical or psychological disorder which needs medical attention, he or she is suddenly catapulted into the cold and awe aspiring environment of a hospital. A patient is an individual at his or her vulnerable most, and in tremendous need of personal attention and care, which may come from any quarters. Watson’s theory assumes eminence in the present era as it has been felt that the 21st century has brought forth new challenges for the nursing profession in terms of building a theoretical framework for understanding what ‘caring’ actually means (Bailey, 2009). In fact numerous theories proposed by experts in the field have been recognized as pertinent to the issue, as it presents itself in the present era of fast changing aspects of modern healthcare delivery to the masses, which have increased not only in numbers, but also in diversity due to the cosmopolitan structure of society. The number of nursing theories recognized at present is astounding as all are pertinent to the aspect of ‘care’ which has been accepted as vital. However, the crux of the theories point towards the fact that caring is a continuous process which evolves along with time and changes in human relationships, perceptions, knowledge and experiences have to be incorporated as and when they crop up and modified according to individual circumstances and course of events. This means that when one cares for a patient, one should not only assist the patient to face the present circumstances with minimal distress, but also prepare him or her for the foreseeable future which might change the quality and type of life depending upon the condition one is suffering from. Watson’s theory has multiple aspects of physical, psychological, social and metaphysical sciences which transcend the narrow boundaries of nursing profession and expand into a social category directed at the preservation of humanity itself through mutual, reciprocal and interactive experiences (Bailey, 2009). Watsons theory seems to be almost a religious discourse although it has been timed for the twenty first century where certain rationalists even suspect the existence of God. However, moral and spiritual values are a concoction of the historical events, developments in arts and sciences and experiences of learned people which have been passed from generation to generation. Given the changes in human perception which have occurred over the centuries, it is likely that further developments in views on life and how human beings should relate to each other in society will occur. Healthcare is a social and cultural responsibility that human beings have developed for peaceful coexistence on this planet. There is no doubt that unless it is practiced with responsibility and devotion by people who have been assigned these duties, it is bound to fail in its primary purpose. Another proponent of the importance of care in nursing practice, Leininger believes that cultural factors play an important part in defining the contexts under which care is comprehended by people in diverse socio economic and geographical locations of the world (Bailey, 2009; Cohen 1991). According to her, the culture care paradigm includes various components which she collectively labeled as social structure factors. These include cultural history of a particular population of people, their geo-environmental factors, religion, politics, life span values, philosophy of living, kinship as well as economics (Bailey, 2009). According to her, these social structure factors determine how care is perceived and practiced. Watson’s theory, on the other hand, is more universal in nature and almost metaphysical in content which may be beyond the comprehension of a young nursing student, who might be more academically oriented as well as lacking the maturity to understand the higher philosophical content of Watson’s theory of ‘caritas’ and ‘transpersonal care’. At a cursory glance, however, Watson’s theory is comprehensible in terms of the basic values it is trying to inculcate in the nursing student. Boundaries are Consistent with Nursing Practice The International Council of Nurses website defines nursing as a profession or activity which "encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in-patient and health systems management, and education are also key nursing roles" (council website). In order to satisfy all these objectives, Watson’s care theory plays a vital role in guiding the modern day nursing student as well as the practitioner how best to satisfy the objectives propounded in the definition. Although boundaries are consistent with nursing practice, where one has specialized education and training to meet clear cut objectives and specific duties in various aspects of healthcare, such as care of the elderly, duties in the emergency room, special surgical wards, after-care of the patient, etc., one has to practice all these in a cooperative and collective effort in order to deliver the services assigned to each section. The patient should not be considered a mere statistic and the object on which the learnt professional skills are to be deployed, but a member of the society who is in dire need of personal care in adverse circumstances. Unless practiced with a philanthropic attitude and close communication with the patient, the duties defined for and expected of a nurse cannot be fulfilled. Watson’s theory makes a clear statement about the transpersonal relationship between the patient and the nurse which involves a high degree of shared spiritual and humane values which affect both parties in a positive manner. To the patient it provides succor and to the nurse an inherent sense of satisfaction and fulfillment of her professional goals. The relationship goes beyond the confines of the hospital environment and percolates into the society itself where it promotes an aura of well being and mutual reliance on each other. This is essential in order to transform the healthcare industry into a humane social organization instead of a cold professional setup which is not congenial for holistic healing of the sufferer. Concepts Stimulate Formulation of Propositions The relationship between the patient and the nurse is characterized by a strong bond between the two, which Jean Watson has tried to address by coming up with her ‘caritas’ theory of nursing. ‘Caritas’, which has been picked up by Watson from the Greek language, literally means to ‘cherish and provide special loving attention’ (Cara, 2003). Caring for the patient has been placed at the top rung in terms of nursing practice by Watson. She feels that the profession has changed remarkably due to the recent advances in delivery of nursing care and administrative upheavals’ at healthcare institutions, which carry the omnipresent risk of dehumanizing the patient to a mere physical entity or a statistical figure resulting in predisposition of the healthcare staff, particularly nurses’ to neglect the caring angle in the process of delivery of their assigned duties. This forms the basis of her ‘carative’ theory which emphasizes the importance of additional effort by the nurse to reinforce the cure of a malady with spiritual assistance. The current focus on evidence based practice and technical excellence with dependence on automation and information technology can prevent the trainee nurses’ to miss the element of personal care altogether. In such a situation, it becomes necessary to inculcate in them the right attitude and humane values which are necessary for the delivery of effective and real healthcare (Walker, 1996). For this to happen, it is necessary that a nursing theory is comprehensible as well as practicable. The principal tenets underlying Watson’s theory of nursing care include not only the person being cared for but the caregiver herself who must endeavor to establish a bond of trust with the patient in a humanistic and spiritual manner so as to make the total experience of the stay in the hospital not seem mechanical and artificial. Watson’s theory has evolved over the time and come to occupy a prominent place in the nursing environment around the world. Carative factors, transpersonal caring relationships and the caring occasion or moment are the basic elements eulogized by Watson (Cara, 2003). The carative factors especially are concerned with the ‘human dimensions’ form the nurse’s perspective and the ‘subjective experiences’ of the patients they serve. Watson stresses on the importance of a nurse’s awareness and realization of the human angle while delivering her services, which forms the basis of her proposed theory. The importance of the nurse’s actions to elicit trust in the patient, incorporating the negative-positive experiences of the entire episode of the relationship in a wholesome manner has been emphasized. Watson has coined the term ‘transpersonal’ to explain the relationship between the nurse and the patient. In this transpersonal relationship, she should be capable of supporting and protecting the patient not only psychologically, but physically and spiritually as well. Watson recommends that there should be a confluence of mind, body and spirit during the delivery of services in which a spiritual experience is felt by both parties. The nurse should be able to inculcate self control, impart knowledge and encourage the patient to adopt a positive attitude congenial to the healing process, irrespective of the external health condition (Cara, 2003). In fact the transaction between the patient and the nurse should not be as per their defined status but more of a ‘human to human’ relationship in which the nursing care involves a combination of professional skills as well as the art of care-giving. The results of adopting a caring attitude can definitely be measured by measurable outcomes as patient compliance will automatically increase in a trustworthy atmosphere. The personal bond with the nurse can assist the patient in taking informed decisions without hesitation. Variables and Assumptions help to Understand and Interpret Propositions The first assumption in Watsons caring model is that caring can be demonstrated and practiced effectively only through interpersonal relationships. This is true for any relationship between two human beings and the patient-nurse relationship is no exception. The patient may be too reserved to communicate true feelings and the nurse might be constrained in explaining the procedures and practices which are to be carried out on the patient, unless trust is established between the two. Another assumption that carative factors need to be identified and practiced in order to satisfy human needs of the patient which may be much more important than the administration of therapeutic procedures in order to ensure holistic healing is also comprehensible as a sound basis for Watson’s propositions. Proper caring is not only essential for the cure of a condition, but it is essential for the promotion of health of the individual and growth in the social environment. Proper care prepares the patient for any eventuality and changes in life pattern after getting cured and gives the person a choice of choosing the best options available to him or her at a given point of time. This prepares the patient for reestablishing himself/ herself in life, after the crisis has passed. Caring has been considered complimentary to curing as it combines the scientific knowledge about a disorder, which cures the disease with human behavioral aspects, which promote psychic healing. The judicious application of both together serves to achieve the purpose of true nursing as suggested by Watson. Theoretical Knowledge Helps Explain and Predict Phenomena A nurse well versed with the technical aspects of her area of operation and field of specialization needs also to have a background of arts, social skills and spiritual values which need to be used in combination while imparting her services. In addition to experience, such skills assist the nursing practitioner to take appropriate and informed decisions when confronted with difficulties while handling particular patients. She can anticipate the future events in course of the holistic healing process and can initiate appropriate measures to prevent any adverse outcomes. Theoretical Knowledge Influences Nursing Practice To understand Watson’s theory, a nursing practitioner needs not only to be proficient in her field of operation or specialization, but needs to be well educated in philosophical and spiritual aspects of life as well. Florence Nightingale’ attitude and professional competence has already been set up as the prime example for one to emulate in this profession, Watson’s theory serves to reinforce the basics under the new light of the advances made in the delivery of healthcare in recent times, which rely heavily on the principles of evidence based practice and super specializations. A well trained nurse should be adequately trained in the field of her specialization and continue to educate herself by participating in continuing education programs. Theoretical knowledge not only enables the nursing practitioner to take informed decisions at critical moments but also inculcates confidence in the patient. In the pursuit of excellence in professional competence, the new generation who have grown up in an environment loaded heavily with individual ambitions to gain employment amidst the cut-throat competition, the humanistic and spiritual angle takes a backstage, which needs to be re-inculcated among modern students of nursing. A prospective nurse should therefore be capable of understanding the intricacies of personal relationships between humans, as they have to interact intimately with patients who are physically incapacitated as well as experiencing a poor morale. This demands qualities of compassion, leadership and a totally committed attitude to serve the patient. If one lacks these qualities, it will be extremely difficult for them to understand the nuances of Watson’s theory and are at risk of being mechanical and bland in their professional practice. References Bailey, D.N. (2009). Caring Defined: A Comparison and Analysis, International Journal for Human Caring, Vol. 13 (1), Pgs.16-31 Cara, C. (2003). A Pragmatic View of Jean Watsons Caring Theory, International Journal for Human Caring, Vol. 7 (3), Pgs.51-61 Cohen, J. A. (1991). Two portraits of caring: a comparison of the artists, Leininger and Watson, Journal of Advanced Nursing, Vol. 16, Pgs. 899-909 Definition of Nursing, accessed November 2, 2010 at: http://www.icn.ch/about-icn/icn-definition-of-nursing/ Walker, C. A. (1996). Coalescing the theories of two nurse visionaries: Parse and Watson, Journal of Advanced Nursing, Vol. 24, Pgs. 988-996 Read More