The Philosophy and Science of Caring Jean Watson, PhD, RN, AHN-BC, FAAN

1. The Philosophy and Science of CaringJean Watson, PhD, RN, AHN-BC, FAAN Sarah Barnett Meghan Brown Misty Donley Leslie Rush

2. The Philosophy and Science of CaringJean Watson, PhD, RN, AHN-BC, FAAN Using "caring as a theme", Jean Watson developed the "carative factors" to help develop the ever evolving nursing philosophies and theories. (Chitty, 308-9)

3. Born in West Virginia Diploma nursing from Lewis-Gale School of Nursing in 1961 BSN from University of Colorado in 1964 MS from University of Colorado in 1966 PhD from University of Colorado in 1973 The Philosophy and Science of Caring first published book in 1979 Founder, Center for Human Caring, University of Colorado Health Sciences Center in 1986 (Watson Caring Science Institute, n.d.) (Chitty, 308) Jean Watson: Background and Education

4. Jean Watson: Background and Education • States “my early work emerged from my own values, beliefs, and perceptions about personhood, life, health, and healing”(Tomey & Alligood, 2006, p. 94) • Influenced by the nursing theorist/philosophers that came before her like Nightingale, Henderson, and her own personal beliefs. • Knowledge development is important value as seen by her numerous writings and teaching positions. • Values about nursing are "developing; maintaining and exemplifying relationship-centered care practices" (Watson Caring Science Institute, n.d.)

5. Jean Watson:Concept “Jean Watson's 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. She believes that a holistic approach to health care is central to the practice of caring in nursing” (Nursing Theory, 2011).

6. Global Concepts Human Being (Patient and Nurse) • Is subjective and unique • Has distinct human needs, which are biophysical, psychophysical, psychosocial and interpersonal • Needs to be valued, respected, nurtured, understood and assisted • Is directly influenced by the external environment Environment • Is critical to the holistic healing (mental, physical, social, emotional, spiritual, developmental, protective, supportive environments), which is conducive to a patient’s health and wellbeing Health • Viewed holistically, as the unity between body, mind, and soul, with all parts working together in harmony and functioning to their full capacity • Absence of illness, or the presence of efforts that leads its absence Nursing • Providing caring, professional and thoughtful interactions to restore and promote holistic health and to prevent illness • Based on human values • Dedicated to the wellbeing of others • Concerned with the health promotion, health restoration, and illness prevention (Chitty & Black, 2011, p. 309)

7. GLOBAL CONCEPTS

8. Jean Watson: Theory and Nursing Process Watson’s nursing process parallels the scientific research process. Both provide a framework for decision making. Both involve solving a problem.

9. Jean Watson’s Theory and Nursing Process 1) Assessment • Involves observation and identification of a problem • Includes the formulation of hypothesis 2) Care Plan • It helps to determine how variables will be examined and measured • It helps to determine what data will be collected and how it will be collected 3) Intervention • It is the implementation of the care plan • It includes the collection of the data 4) Evaluation • Analysis of the data • Effects of the interventions based on the data • Includes the interpretation of the results • It may also generate additional hypothesis

10. Interpretation & Inference • Caring can be effectively demonstrated and practiced only interpersonally. • Caring consists of carative factors that result in the satisfaction of certain human needs. • Effective caring promotes health and individual or family growth. • Caring responses accept person not only as he or she is now but as what he or she may become. • A caring environment is one that offers the development of potential while allowing the person to choose the best action for himself or herself at a given point in time. • Caring is more “healthogenic” than is curing. A science of caring is complementary to the science of curing. • The practice of caring is central to nursing. (Nursing Theories: A Companion to Nursing Theories and Models, 2012). • Jean Watson’s theory was founded on the humanistic aspects of nursing in combination with scientific knowledge. Her concept shows a caring, nurturing relationship between the nurse and patient.

11. Implications & Consequences • A more holilstic care approach. • Better nurse patient relationship. • Patient feeling more empowered in the decision making process.

12. Evaluation of The Philosophy and Science of Caring Jean Watson’s The Philosophy of science and caring Provides a model unique to nursing with concepts that can be applied within many facets of our world. Influenced by her desire to return the human to human interaction to nursing, Watson related her philosophy to the four global concepts. This philosophy can be applied within any discipline of nursing by promoting healing not through focus on the curative factors but instead the mind, body and soul of the patient.

13. Evaluation of “The Philosophy and Science of Caring”: Origins Is The Philosophy and Science of Caringunique to Nursing? • My focus has been on nursing in relation to its covenant to offer compassionate human service to sustain and preserve human dignity and humanity; to sustain caring in instances where it is threatened, biologically or otherwise; a concern with deep caring-healing relationships with humans who are experiencing suffering, loss, grief, death, change/ transition with life threats and challenges, and seeking meaning to be in right-relation, harmony with self and other, and that which is greater than human. Thus, my focus on caring, and caring- healing relationships, emerges from within the discipline of nursing and the practice of professional nursing; but paradoxically transcends nursing. (Clarke, 2009). What Influenced The Philosophy and Science of Caring? • Jean Watson, “found herself frustrated by the almost complete lack of conceptual, intellectual or philosophical focus on the human aspect of patient care.” (Petrovski, 2012). • Watson's education in the early 1960s stressed what she refers to as "curing” techniques and procedures related to a specific disease and its treatment within medical science framework. (Petrovski, 2012). • “Called for a return to the earlier values of nursing and emphasized the caring aspects of nursing.” (Chitty, 2010). • "No one was giving voice to the human experience," says Dr. Watson. "I was longing for intellectual theories or values or a conceptual framework of what was happening with patient care and the human-to-human relationships." (Petrovski, 2012).

14. Evaluation of The Philosophy and Science of Caring: Global Concepts The Philosophy and Science of Caring addresses the Person • Both the patient and the Nurse (Chitty, 2010). • “Dr. Watson has labored to transform nursing into a holistic caring-healing professional practice, grounded in the philosophy, ethic and science of caring, that addresses not just the body but the unity of mind-body-spirit.”(Petrovski, 2012). • Watson also focused on this reciprocity of the relationship, which she indicated addresses the importance of the nurse’s own caretaking. (Lachman, 2012). The Philosophy and Science of Caring addresses the Environment • One that supports human caring (Chitty, 2010). • The nurse guided by Watson’s work has responsibility for creating and maintaining an environment supporting human caring. (Chitty, 2010).

15. Evaluation of The Philosophy and Science of Caring: Global Concepts The Philosophy and Science of Caring addresses Health • In terms of health promotion and illness prevention. (Chitty, 2010). • Illness and disease was equated with lack of harmony within the mind, body and soul experienced in internal and external environments. (Chitty, 2010). • Nursing is concerned with health promotion, health restoration, and illness prevention. (Chitty, 2010). • Watson defines the person’s health as a subjective experience. The Philosophy and Science of Caring addresses Nursing • What nurses contributed to the encounter with the patient. (Chitty, 2010). • Watson views nursing as both a science and an art. according to Watson, being an artist is part of our role and certainly part of caring for patients and their families. (Cara, n.d.). • Caritas honors the dignity of self and other and wholeness of being, which empowers nurses-and thereby their patients-through the quality of their caring-healing relationships and interactions. (Petrovski, 2012). • Emphasized how the nurse and the patient change together through transpersonal caring. (Chitty, 2010).

16. Other theories generated from The Philosophy and Science of Caring • Jean Watson has researched and published the utilization of her theory multiple times • Following publication of her 1979 work, Watson’s caring theory evolved from basic thinking to one of greater awareness of divine and holistic interpersonal relationships • In 1985, she proposed eleven assumptions to explain the relationship between nursing, human values, and caring for others • In 1999, Postmodern Nursing and Beyond, Watson describes an ontological shift in human consciousness by suggesting practice paths for practitioners • Jean Watson’s Theory of Caring, among others has been used in research towards an empirical development of a middle range theory of caring. (Swanson, 1991).

17. Evaluation of “The Philosophy and Science of Caring”: Practice Situations • Kaiser Permanente Northern California is systematically integrating caring science and theory-based practices in all of the 21 Northern California Kaiser facilities. Others, such as Baptist Health in Jacksonville and Miami, Fla., Children's Hospital Colorado, the Michael F. DeBakey Veterans Hospital in Houston, and Atlanta Veteran's Hospital, are engaged in new forms of evidence-based caring science knowledge. In these systems, nurses are becoming scholar clinicians, implementing new professional Caring Science models system wide, as well as exploring new empirical connections between human caring and patient outcomes. (Petrovski, 2012). • The frequency and number of Magnet hospital’s use of caring theory as one core Magnet criterion, is evidence and testimony of caring theory and its impact on nursing over time. (Clarke, 2012).

18. Evaluation of “The Philosophy and Science of Caring”: Practice Situations Questions to use in practice that can help assess the person • Tell me about your spiritual and cultural beliefs? • Tell me about your goals and expectations? Questions to help the nurse reflect upon his/her caring practice • How do I express my caring consciousness and commitment to the persons and their families? To working colleagues? To other health care professionals? To my superiors? To the institution? • How do I define the person, environment, health/healing, and nursing? Questions to use in practice that can help assess the patient’s perspective about health • Tell me how you perceive yourself in this situation? • What meaning are you giving to this situation? • Tell me about your health priorities? (Cara, n.d.)

19. Conclusion Jean Watson “emphasized the caring aspects of nursing” (Chitty, 2011, p. 308). Watson’s philosophy focused on the “human-to-human relationship” (Chitty, 2011, p. 308).

20. Embrace altruistic values and Practice loving kindness with self and others. • Instill faith and hope and honor others. • Be sensitive to self and others by nurturing individual beliefs and practices. • Develop helping – trusting- caring relationships. • Promote and accept positive and negative feelings as you authentically listen to another’s story. • Use creative scientific problem-solving methods for caring decision making. • Share teaching and learning that addresses the individual needs and comprehension styles. • Create a healing environment for the physical and spiritual self which respects human dignity. • Assist with basic physical, emotional, and spiritual human needs. • Open to mystery and Allow miracles to enter. Ten Caritas Processes(Watson Caring Science Institute, 2013). By using Watson’s 10 Carative Factors, the nurse is enabled to “share their genuine selves with patients” (Chitty, 2011, p. 309). Beyond the tasks of nursing care, the patient necessitates a holistic model to reach wellness or even a peaceful passing.

21. Conclusion: continued • The caring model encompasses nursing’s metaparadigm: environment, person, health, & nursing. • Allowing the self to be open to giving and receiving care on a level beyond just meeting physical needs opens the nurse: patient relationship to greater healing, understanding and overall care. • RNs that follow this philosophy create and maintain a supportive environment that embraces human caring while continuing to meet the patients’ primary human requirements. (Chitty, 2011, p. 309)

22. Be a part of Jean’s Million Nurse Project: “Nurses around the world bring this loving heart-centered caring energy of Love and Caring to their individual work every day. However, nurses may be silently unaware of their actual energetic linkage and connection they have with others in their environment, and their natural capability of unlimited expansive potential to affect the universal consciousness field of humanity” (Watson Caring Science Institute, 2013). For more info, visit http://watsoncaringscience.org/education-programs/million-nurse-project/. Jean’s Million Nurse Project

23. For a greater understanding of Jean Watson and her philosophy, visit Watson Caring Science Institute & International Caritas Consortium at http://watsoncaringscience.org/. Does Jean Watson and her philosophy influence your nursing practice?

24. Case Study Dean Smith is a 48 year old male with ALS (Amyotrophic lateral sclerosis) which has left him unable to care for himself. Dean was a teacher prior to leaving for medical disability. He is a widower with two adult children who do not live in the area and are not close with their Dad. His support network is a former student, John, who assists him with household chores and a neighbor, Beth, who manages his medications and takes him to appointments. He presented to the Emergency Department with increased respiratory effort, fever, and new onset inability to maintain oral secretions. Beth states that he is also having a hard time responding to her and she and her husband are concerned to leave him alone. Admission is arranged for probable pneumonia and likely placement in a skilled nursing facility. Report is given from the ED to the Medical Surgical team and Dean is admitted. During admission, Sally, the RN doing his intake notices that Dean is trying to answer her questions but cannot. He is tearful, making fists and groaning. Sally asks the CNA assisting them to please give them a minute and closes the computer. She pulls a chair next to his bed, sits and holds his hand. She asks if he would like her to tell him a little about herself. He squeezes her hand and attempts to nod. Sally proceeds to tell Dean about her family, her dog, her career path and their church. Dean eventually relaxes and falls asleep.

25. Case Study: continued • Do Sally’s actions follow the Watson’s Carative Factors? • Looking at Factor 5: “the promotion and acceptance of the expression of positive and negative feelings”, does Sally sharing with Dean allow him to do this? • What are two ways that Sally followed Watson’s philosophy? • Would you have done this differently? How so?

26. References Cara, C. (n.d.). A Pragmatic View of Jean Watson’s Caring Theory. Université de Montréal Faculty of Nursing. Retrieved from http://www.humancaring.org/conted/Pragmatic%20View.pdf Clarke, P.N., Watson, J., Brewer, B.B. (2009). From theory to practice : caring science according to Watson and Brewer. Nursing Science Quarterly. 22(4). 339-345. doi: 10.1177/0894318409344769 Chitty, K. K., & Black, B. P. (2011). Professional nursing: Concepts and challenges (6th ed.) Maryland Heights, MO: Saunders Elsevier Jean Watson’s Theory of Caring. (n.d.). Metaparadigm. Retrieved from http://upoun207grouph.blogspot.ca/p/metaparadigm-of-concepts.html Lachman, V.D. 2012Applying the Ethics of Care to Your Nursing Practice. MedSurg Nursing. 21(2). 112-116 Retrieved from http://nursingworld.org/MainMenuCategories/EthicsStandards/ Resources/Applying-the-Ethics-of-Care-to-Your-Nursing-Practice.pdf Nursing Theories: A Companion to Nursing Theories and Models. (2012). Jean Watson’s philosophy of nursing. Retrieved from http://www.currentnursing.com/nursing_theory/Watson.html Nursing Theory. (2011). Jean Watson's contribution to nursing theory: Philosophy and science of caring. Retrieved from http://nursing-theory.org/nursing-theorists/Jean-Watson.php

27. References Petrovski, L. (2012). All you need is love (and human caring): transforming health care on nurse, hospital at a time. Colorado Nurse. May/June/July, 15. Retrieved from CINHL database. Swanson, K.M. (1991). Empirical development of a middle range theory of caring. Nursing Research, 40(3), 161-166. Retrieved from CINHL database. Tomey, A. M., & Alligood, M. R. (2006). Nursing theorists and their work (6th ed.). St. Louis, MO: Mosby Elsevier.   Watson Caring Science Institute. (n.d.). Retrieved from http://watsoncaringscience.org/ Watson Caring Science Institute. (2013). Million Nurse Project. Retrieved from http://watsoncaringscience.org/education-programs/million-nurse-project/. Watson Caring Science Institute. (2013). Ten Caritas Processes. Retrieved from http://watsoncaringscience.org/about-us/caring-science-definitions-processes-theory/.