LEARNING THEORY GROUP PRESENTATION: JEAN WATSON

1. LEARNING THEORY GROUP PRESENTATION: JEAN WATSON By: April Bilbe, Ashley Denhartigh, Barb Hulwick, Dana Raymer & Deborah Schaefer [Photograph of Jean Watson]. (2010). 4th Annual Envision Conference Nursing: The Art and Science of Caring. Oakland University, Rochester, MI.

2. Questions & Problems to Solve • Why are we doing this assignment? • Why did we choose Jean Watson’s Theory of Caring? • Evaluate: What is Jean Watson’s Theory of Caring? • What are the origins of Jean Watson’s Nursing Model? • What is Jean Watson’s historical background? • What are Jean Watson’s philosophic values re: nursing and knowledge? • What influenced Jean Watson’s Philosophy? • Information & concepts: How does this model define the four global concepts? • What is our interpretation & inference and what are some possible implications & consequences? • When could this model be used in practice? • What are the 10 Carative Factors? • What is an example of a case study?

3. Why are we doing this assignment?

4. The Purpose of This Project is to: • Compare and contrast nursing models, chosen at random, by peers. • Practice working effectively in on-line groups. • Demonstrate the use of the critical thinking process using the elements of reasoning.

5. Why did we choose Jean Watson’s Theory of Caring?

6. Some of us have seen Jean speak in person. Witnessing her passion and talents as a speaker really made her stand out. • No matter the specialty realm, all nurses can relate to relationships and caring.

7. Evaluate: What is Jean Watson’s Theory of Caring?

8. Andrews & Arnerich (2008) state: • The philosophy of caring and science examines the relatedness of ALL and includes human science, human caring processes, experiences and phenomena. • Caring is a moral ideal: mind-body-soul, engagement with another.

9. What are the Origins of Jean Watson’s Nursing Model?

10. Watson’s Motivation for Developing Her Model: • Education • Life Experiences • Exploration of Self

11. What is Jean Watson’s historical background?

12. Historical Background O According to Jesse (2010), during an undergraduate course Watson studied Yakom’s 11 CarativeFactors, which led her to develop her own 10 Curative factors. O Her first book Nursing: The Philosophy and Science of Caring (1979) was developed off of the notes from these studies (p. 93). O Life experiences were the motivation for her third book, Post Modern Nursing and Beyond (1999). O Jesse (2010) explains that both the tragic experience of losing her husband and the loss of her left eye allowed her to experience her own theory at work, as the people around her cared for her during these troubling times (p.93). O Watson’s fifth book Caring Science as Sacred Science (2005) describes her own life’s passage. O “This book leads the reader through thought-provoking experiences and the sacredness of nursing by emphasizing deep inner reflection and personal growth, communication skills, use of self-transpersonal growth, and attention to both caring science and healing through forgiveness, gratitude , and surrender” (Jesse, 2010, p. 93). O As a dedicated learner, Watson’s continual education has led her to think deeply about nursing and the science of caring. O Her own life experiences have shaped what her theory is today.

13. What are Jean Watson’s philosophic values re: nursing & knowledge development?

14. Watson calls for joining of science with humanities so that nurses will have a strong liberal arts background and will understand other cultures as a requisite for using Care Science and a mind-body-spirit framework” (Jesse, 2010, p. 96).

15. The nurse must connect with the patient on a spiritual level through sincere presence. • Jesse (2010) states (pp. 97-98) Watson believes this connection is made through: • Words • Behaviors • Body Language • Feelings • Thoughts • Senses • Intuition • Movements • Gestures • Facial Expressions • Information

16. “A caring moment involves an action and choice by both the nurse and the other. The moment of coming together presents them with the opportunity to decide how to be in the moment and in the relationship as where as what to do with and during the moment. If the caring moment is transpersonal, each feels a connection with the other at the spirit level, thus it transcends time and space, opening up new possibilities for healing and human connection at a deeper level than physical interaction” (WCSI, 2009, “Caring Science Ten Caritas Processes,” para. 7).

17. “The nurse’s own life history, previous experiences, opportunities for focused study, having lived through or experienced various human conditions, and having imagined others’ feelings in various circumstances are valuable teachers for this work…” (Jesse, 2010, p. 98).

18. “Caring in the nursing profession takes place every time a nurse-to-patient contact is made... That caring makes a difference to the patient’s sense of well being. Caring may occur without curing but curing cannot occur without caring” (Vance, 2003, para. 1).

19. What Influenced Jean Watson’s Philosophy?

20. Theorists • Florence Nightingale, Henderson, Leininger, Peplaw, Rogers, Newman, and Gadow (Jesse, 2010, p. 94) • Jesse (2010) states “She describes a close connection with ‘Nightingale’s sense of ‘calling,’ guided by a deep sense of commitment and a covenantal ethic of human service’ (Watson, 2007a)” (p. 94)

21. Philosophy Influence Continued • Philosophers • Carl Rogers, Maslow, Heidegger, Erickson, Kierkegaard, Emmanuel Levinas, KnudLogstrup, Selye, Lazarus, Rumi, Whitehead, de Chardin, Sartre, and ThichNahtHanh (Jesse, 2010, p. 94) Although influenced by the work of others, Watson based much of her work off of her own ideas, values, and beliefs about life, health, and healing (Jesse, 2010, p. 94).

22. Information and concepts: How does this model define the four global concepts?

23. Human Being • A nursing model that takes into account both the art and science of nursing-considering mind, body and spirit of the patient and the nurse • A caring process-The privilege that nurses have to uphold the commitment to present compassionate human caring to society and humanity • Ten Caritas process- Be sensitive to self and others by nurturing individual beliefs and practices

24. Environment • The Caring Theory is groundwork for healing practices-it can be practiced in many settings; nurse, group, system, organization, curriculum and population needs • Many Magnet hospitals, one of those being John C. Lincoln North Mountain Hospital, have adapted Jean Watson’s caring model as a framework to guide their practice • Caring in nursing is culturally diverse. The caring model can be practiced across all nursing practices as a vital method to study and explain the nursing knowledge

25. Health • Caring Science-Uphold caring for those whose dignity and humanity are threatened • To create an environment that allows healing of the mind, body and soul • The action and task of the nurse which strives to help the patient obtain the right care and achieve wellbeing

26. Nursing • Caring in nursing- Continuous theme for caring model-building and developing relationships. While the caring process may begin with nurses it crosses over to many other disciplines, causing a dramatic impact on the patient • A special way of being, knowing and doing with the goal of keeping the patient safe in addition to maintaining and promoting the dignity of the patient • Caring is the spirit of nursing. Caring is a distinctive characteristic of the nursing profession

27. What is our interpretation & inference and what are some possible implications & consequences?

28. Clarification of Origins: Watson’s theory is specific to the nursing profession. The humanistic aspects of nursing are emphasized, and intimate, personal moments between nurse and patient are focused on.

29. Clarification of Origins (cont): It is very clear that various theorists and philosophers, along with Jean Watson’s own reflective thinking has influenced her work.

30. Content: As shown in previous slides, Watson’s Theory of Transpersonal Caring adequately describes the four global concepts. Human Being - Watson believes that the person is to be valued, cared for, respected and viewed in a holistic way, as body, mind and spirit. Environment - Watson believes that the person’s environment should be conducive to healing and that the person and their environment are connected. The person’s frame of reference is also something that should be considered, and the nurse should strive to stay within the person’s frame of reference. Health - Health is viewed as overall functioning and distress and disharmony can be caused by more than just disease processes. Nursing – Watson argues that caring is central to the profession of nursing and that nursing care should also focus on promoting health and preventing illness. The nurse should focus their care on healing and wholeness as opposed to tasks, illness and disease.

31. Specificity and scope of view: Watson’s theory can be applied in any area of nursing. The theory of caring addressing all aspects of the health and illness continuum, and the concepts are abstract and open to interpretation. In fact, lack of concrete guidelines has been one of the criticisms of the theory, since nurses do not have specific steps they can follow to apply the principles of the theory in their practice.

32. Watson’s influence: In Nursing Theorists and Their Work (2010), Kristen Swanson credits Watson with influencing her exploration of the concept of caring while completing her doctoral dissertation. Dr. Joanne Duffy also states she was influenced by Watson’s theories while developing her Quality Caring Model

33. When could this model be used in practice?

34. Watson’s theory can be applied during any interaction between patient and nurse. It involves the nurse being involved in the moment, being there with his or her own whole body and mind, and focusing on the point in time that is occurring, not thinking about what is going to happen next or tomorrow or when he or she gets out of work.

35. Examples (cont): While helping a patient with their pre-op Hibiclens bath, the patient expresses fear of the upcoming procedure. The nurse repeats what the patient is saying regarding her concerns so she can clarify what the patient is saying and spends time discussing with the patient her fears and reviewing what to expect before and after the surgery. The nurse allows the patient to express herself without rushing through the shower so she can pass meds to the next patient.

36. Examples (cont): The nurse is caring for an Asian immigrant who speaks very little English. The patient has just had a baby via C-section and will have to stay in the hospital for a couple of days. The nurse decides to research cultural considerations for her patient so that she can understand postpartum traditions that the patient may choose to practice. The nurse communicates her findings to the oncoming nurse and makes adjustments to her care and the patient’s environment in order to facilitate the patient’s cultural traditions.

37. What are the 10 Carative Factors?

38. 10 Carative Factors (Alligood & Toomey, 2010, p. 94) • Formation of a Humanistic altruistic System of Values= satisfaction through giving and extension of the sense of self (Watson, 1979). • Instillation of Faith-Hope= the nurses role in promoting wellness and positive health through developing effective nurse-patient interrelationships and helping the patient learn how to develop health-seeking behaviors (Watson, 1979). • Cultivation of Sensitivity to Self and to Others=as realizes and accepts their own sensitivity and feelings they become more genuine, authentic and sensitive to others (Watson, 1979). • Development of a Helping-Trust Relationship=the nurse can promote effective communication by developing a helping-trust relationship, develop empathy, use a moderate speaking volume, open relaxed posture and congruent expression during conversations (Watson, 1979). • Promotion and Acceptance of the Expression of Positive and Negative Feelings=sharing feeling is a risky experience for both nurse and patient. The nurse must be open and prepared for both positive and negative feelings (Watson, 1979). • Systematic Use of the Scientific Problem-Solving Method for Decision Making=using the nursing process problem-solving approach dispels the traditional image of the nurse as the doctor’s handmaiden (Watson, 1979). • Promotion of Interpersonal Teaching-Learning=shifts the responsibility of wellness and health to the patient as the nurse facilitates, teaches and enables the patient (Watson, 1979). • Provision for Supportive, Protective, and Corrective Mental, Physical sociocultural and Spiritual Environment=the nurse must be aware of the internal and external environment of the patient (Watson, 1979). • Assistance with Gratification of Human Needs=the nurse recognizes the biophysical, psychophysical, psychosocial and intrapersonal needs of self and patient all the while remembering patients must satisfy lower-order needs before attempting to attain higher-order needs (Watson, 1979). • Allowance of Existential-Phenomenological Forces=the nurse has the responsibility to go above and beyond the 10 carative factors and help patients promote their own preventive health actions by teaching patients personal changes to promote health, providing support, teaching problem-solving methods and recognizing coping skills and adaptation to loss (Watson, 1979).

39. CASE STUDY

40. Betty, a 59 year old factory worker, arrives at the emergency room in a small, but busy hospital, not far from her place of employment. She is complaining of intense pain in her left shoulder and anxiety. As an ER nurse with 20 years experience, I have seen a lot of drug seekers come in with the same complaints. Utilizing Watson’s Philosophy and Theory of Transpersonal Caring, I know that I must not pre-judge any patient and I must develop a Helping-Trust Relationship with each patient. Using empathy, congruence, non-possessive warmth, and effective communication is important in building a relationship with a patient in a short amount of time, especially in an E.R. setting.

41. Betty cannot raise her left arm above chest level and there is no obvious injury to the site. Her vitals are as follows: B/P 168/85, PR 115, and T 97.9. What aspect of Watson’s Theory is put into action here? Betty is given 50 mg of Demerol and 2 mg of Ativan. She then states that she has been SOB occasionally. Her pulse ox is 92% on room air. At this point another one of Watson’s carative factors comes into play. Which one?

42. Betty is diagnosed with a mass on her adrenal gland and an enlarged lymph node near her heart. She is oriented, but sleepy from the Demerol and Ativan and still complains of pain in her left shoulder. Her husband lost his job when his shop closed after working there for thirty years. She is not covered by any insurance at this time. She has two grown children and her daughter, a nurse, is present with her in the E.R. How can we approach this family using Jean Watson’s Theory? Which two of the original carative factors could be utilized? Realizing that Betty and her daughter were just given some potentially life threatening news, I encouraged them both to express how they were feeling about this diagnosis.

43. Prior to discharge, Betty was encouraged to seek an appointment with an oncologist and given a prescription for pain meds to help keep her comfortable until she can get in to see the doctor. I walked them out of the cubicle and said a silent prayer for the battle they were about to begin.

44. Key Answer 1. As the nurse caring for her, Watson’s Theory directs me that patients must satisfy lower order needs before attempting to attain higher order needs. Betty’s pain and anxiety must be controlled before she can process and accept what is happening physically. Answer 2. One of Watson’s Original 10 Carative Factors is the Systematic Use of the Scientific Problem Solving Method for Decision Making. I realize that this newly conveyed information may be connected to her original complaints and collect this data for the doctor to review. It is important to keep things organized, knowing what and when to relay for further investigation. Answer 3. Watson’s Theory, based on the Original 10 Caratives, includes Cultivation of Sensitivity to Self and to Others. This explains that as nurses acknowledge their sensitivity and feelings, they become more genuine, authentic, and sensitive to others. This leads to self-actualization through self-acceptance for nurses and patients. Another one of Watson’s Caratives is Promotion and Acceptance of the Expression of Positive and Negative Feelings. This is a huge risk taking move on the part of nurses and patients. Be prepared for whatever feeling is shared, good or bad. Everyone acts and reacts differently and uniquely to each situation presented to them, including minor and major health dilemmas.

45. References