Jean Watson: Theory of Human Caring

You can cure the disease and still leave the patient unwell. That gap is Watson's whole argument: without caring, health is not attained. Her Philosophy and Theory of Transpersonal Caring (Caring Science) puts the human relationship between nurse and patient at the center of practice, alongside the science, not behind it.

Biography of Jean Watson

Jean Watson (June 10, 1940 to present) is an American nurse theorist and nursing professor known for her Philosophy and Theory of Transpersonal Caring and as founder of the Watson Caring Science Institute. Her work on caring is integrated into nursing education and patient care worldwide.

Early Life

Born Margaret Jean Harmon, Watson grew up in Welch, West Virginia, in the Appalachian Mountains, the youngest of eight children in an extended family and community environment. She attended high school in West Virginia, then the Lewis Gale School of Nursing in Roanoke, Virginia, graduating in 1961.

Personal Life

After graduating in 1961, Watson married Douglas and moved west to his native Colorado. In 1997 an accidental injury cost her the loss of her left eye, and in 1998 her husband, whom she considered her physical and spiritual partner and best friend, died, leaving Watson, their two grown daughters Jennifer and Julie, and five grandchildren. Watson described "attempting to integrate these wounds into my life and work. One of the gifts through the suffering was the privilege of experiencing and receiving my own theory through the care from my husband and loving nurse friends and colleagues." Both events shaped her third book, Postmodern Nursing and Beyond.

Education

Watson moved quickly through her education, earning a bachelor's degree in nursing in 1964, a master of science in psychiatric and mental health nursing in 1966, and a Ph.D. in educational psychology and counseling in 1973, all from the University of Colorado at Boulder.

Career and Appointments

After her doctorate, Watson held faculty and administrative posts at the School of Nursing, University of Colorado Health Sciences Center in Denver. In 1981 and 1982 she pursued international sabbatical studies in New Zealand, Australia, India, Thailand, and Taiwan. In the 1980s she and colleagues established the Center for Human Caring at the University of Colorado, the nation's first interdisciplinary center committed to using human caring knowledge for clinical practice, scholarship, administration, and leadership, with international connections to colleagues in Australia, Brazil, Canada, Korea, Japan, New Zealand, the United Kingdom, Scandinavia, Thailand, and Venezuela. That work continues through the University of Colorado's International Certificate Program in Caring Healing.

Watson served as chairperson and assistant dean of the undergraduate program at the University of Colorado School of Nursing, helped plan and implement the nursing Ph.D. program, and was its coordinator and director from 1978 to 1981. From 1983 to 1990 she was Dean of the University of Colorado School of Nursing and Associate Director of Nursing Practice at University Hospital. During her deanship she developed a post-baccalaureate curriculum in human caring, health, and healing that led to a Nursing Doctorate (ND), a professional clinical doctoral degree that in 2005 became the Doctor of Nursing Practice (DNP) degree. From 1993 to 1996 she served on the Executive Committee and Governing Board and as an officer for the NLN, elected president from 1995 to 1996. In 2005 she took a sabbatical for a walking pilgrimage on the Spanish El Camino, and in 2008 she created the nonprofit Watson Caring Science Institute to advance Caring Science.

Works

Watson has authored 11 books, co-authored six, and written many journal articles. Her first, Nursing: The Philosophy and Science of Caring (1979), grew from her notes for an undergraduate course at the University of Colorado; it embraced the 10 carative factors and later "caritas," connecting caring and love, and was reprinted in 1985 and translated into Korean and French. Human Science and Human Care: A Theory of Nursing (1985), reprinted in 1988 and 1999, addressed conceptual and philosophical problems in nursing and was translated into Chinese, German, Japanese, Korean, Swedish, Norwegian, and Danish. Postmodern Nursing and Beyond (1999), her model for bringing nursing into the twenty-first century and shaped by her 1997 eye injury and her husband's 1998 death, was translated into Portuguese and Japanese. Instruments for Assessing and Measuring Caring in Nursing and Health Sciences (2002), a collection of 21 instruments to assess and measure caring, won the American Journal of Nursing Book of the Year Award. Caring Science as Sacred Science (2005) traced her personal journey through caring science, spiritual practice, and caring-healing work and received the American Journal of Nursing 2005 Book of the Year Award. Recent titles include Measuring Caring: International Research on Caritas as Healing (Nelson & Watson, 2011), Creating a Caring Science Curriculum (Hills & Watson, 2011), and Human Caring Science: A Theory of Nursing (Watson, 2012).

Awards and Honors

Watson founded and served on the board of Boulder County Hospice and has held many research and education grants. In 1992 the University of Colorado School of Nursing named her a distinguished professor of nursing. She holds six honorary doctoral degrees from U.S. universities and three from international universities, including Göteborg University in Sweden, Luton University in London, and the University of Montreal in Quebec, Canada. She received the National League for Nursing (NLN) Martha E. Rogers Award in 1993, an NLN honorary lifetime certificate as a holistic nurse in 1997, and in 1999 assumed the nation's first Murchison-Scoville Endowed Chair of Caring Science. New York University recognized her as a Distinguished Nurse Scholar in 1998, and in 1999 she received the Fetzer Institute's National Norman Cousins Award for relationship-centered care. She is an endowed lecturer at universities including Boston College, Catholic University, Adelphi University, Columbia University-Teachers College, and the State University of New York. Her international honors include an International Kellogg Fellowship in Australia in 1982, a Fulbright Research and Lecture Award to Sweden and Scandinavia in 1991, and a United Kingdom lecture tour in 1993, with invitations to New Zealand, India, Thailand, Taiwan, Israel, Japan, Venezuela, and Korea. She is featured in at least 20 nationally distributed audiotapes, videotapes, and CDs on nursing theory. In 2010 she received an Honorary Doctor of Sciences in Nursing from the University of Victoria in British Columbia, Canada.

Philosophy and Theory of Transpersonal Caring

Watson's Philosophy and Science of Caring is about how nurses express care. Nursing "is concerned with promoting health, preventing illness, caring for the sick, and restoring health." Caring is central to practice and, in Watson's view, promotes health better than a simple medical cure; a holistic approach is central to caring. Caring can be demonstrated and practiced by nurses, it promotes the patient's growth, and a caring environment accepts a person as they are while looking to what they may become. Caring connotes responsiveness between nurse and person, with the nurse co-participating to help the person gain control, become knowledgeable, and make healthy changes.

Assumptions

Watson's model makes seven assumptions: (1) caring can be effectively demonstrated and practiced only interpersonally; (2) caring consists of carative factors that satisfy certain human needs; (3) effective caring promotes health and individual or family growth; (4) caring responses accept the patient as they are now and as they may become; (5) a caring environment develops potential while letting the patient choose the best action for themselves at a given time; (6) the science of caring complements the science of curing; (7) the practice of caring is central to nursing.

Major Concepts

The Philosophy and Science of Caring holds four major concepts: human being, health, environment or society, and nursing.

Society provides the values that shape behavior and goals. Watson: "Caring (and nursing) has existed in every society. Every society has had some people who have cared for others. A caring attitude is not transmitted from generation to generation by genes. The culture of the profession transmits it as a unique way of coping with its environment."

Human being is a valued person to be cared for, respected, nurtured, understood, and assisted, a fully functional integrated self, viewed as greater than and different from the sum of the parts.

Health is unity and harmony within mind, body, and soul, tied to the congruence between the self and the self as experienced: a high level of overall physical, mental, and social functioning, a general adaptive-maintenance level of daily functioning, and the absence of illness or efforts leading to it.

Nursing is a human science of persons and human health-illness experiences mediated by professional, personal, scientific, esthetic, and ethical human care transactions.

The actual caring occasion involves actions and choices by nurse and individual, the moment of coming together where the two decide how to be in the relationship. The transpersonal concept is an intersubjective human-to-human relationship in which the nurse affects and is affected by the other, both fully present and sharing a phenomenal field that becomes part of both life stories.

Subconcepts: the phenomenal field is the totality of one's human experience in the world, the individual's frame of reference known only to that person. The self is the organized conceptual gestalt of perceptions of the "I" or "ME" and its relationship to others and to life. Time: the present is more subjectively real, the past more objectively real, and past, present, and future incidents merge and fuse.

Ten Carative Factors

Watson devised 10 carative factors critical to the caring human experience that nurses address with patients, later translating them into clinical caritas processes that connected caring and love. The first three form the philosophical foundation for the science of caring; the remaining seven derive from it: (1) forming humanistic-altruistic value systems; (2) instilling faith-hope; (3) cultivating sensitivity to self and others; (4) developing a helping-trust relationship; (5) promoting expression of feelings; (6) using problem-solving for decision-making; (7) promoting teaching-learning; (8) promoting a supportive environment; (9) assisting with the gratification of human needs; (10) allowing for existential-phenomenological forces.

Carative Factors	Caritas Process
1. “The formation of a humanistic-altruistic system of values.”	“Practice of loving-kindness and equanimity within the context of caring consciousness.”
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.”
3. “The cultivation of sensitivity to one’s self and others.”	“Cultivation of one’s own spiritual practices and transpersonal self going beyond the ego-self.”
4. “Development of a helping-trust relationship” became “development of a helping-trusting, human caring relation” (in 2004 Watson website)	“Developing and sustaining a helping trusting, authentic caring relationship.”
5. “The 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 and self and the one-being-cared for.”
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)	“Creative use of self and all ways of knowing as part of the caring process; to engage in the artistry of caring-healing practices.”
7. “The promotion of transpersonal teaching- learning .”	“Engaging in genuine teaching- learning experience that attends to the unity of being and meaning, attempting to stay within others’ frame of reference.”
8. “The provision of the supportive, protective, and (or) corrective mental, physical, societal, and spiritual environment.”	“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)”
9. “The assistance with the gratification of human needs.”	“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.”
10. “The allowance for existential-phenomenological forces” became “allowance for existential-phenomenological spiritual forces” (in 2004 Watson website)	“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”

Watson's Hierarchy of Needs

Within the ninth factor, assisting with the gratification of human needs, Watson's hierarchy runs from lower-order biophysical or survival needs (food and fluid, elimination, ventilation), to lower-order psychophysical or functional needs (activity, inactivity, sexuality), to higher-order psychosocial or integrative needs (achievement and affiliation), to the higher-order intrapersonal-interpersonal or growth-seeking need (self-actualization).

Watson's Theory and the Nursing Process

Watson's nursing process mirrors the scientific research process: assessment, plan, intervention, and evaluation. Assessment includes observation, identification, and review of the problem and the formation of a hypothesis. The care plan determines how variables are examined or measured and what data is collected. Intervention implements the plan and collects data. Evaluation analyzes the data, interprets results, and may generate a further hypothesis.

Analysis

Technology is now part of nursing's paradigm, so Watson's purely caring emphasis cannot stand entirely alone. Still, her focus on nurse-patient interaction over technology is the strength of the work. She framed care as "soul-satisfying," and her clinical caritas processes make the nurse an active co-participant with the patient, which raises the quality of care.

Strengths

Many find the theory easy to understand and a useful guide to practice that gives providers the most satisfying aspects of the work and patients holistic care. Watson's nontechnical, fluid language describes concepts like caring-love, carative factors, and Caritas; these are abstract and hard to practice, but practicing them deepens understanding. The theory is logical, with carative factors derived from broad assumptions and tied to the hierarchy of needs. Best understood as a moral and philosophical basis for nursing, it spans health promotion, illness prevention, and peaceful death, and gives concrete guidelines for nurse-patient interaction.

Weakness

The theory gives no explicit direction on how to achieve authentic caring-healing relationships, so nurses who want concrete steps may not feel secure using it alone. Some find the Caritas too time-consuming to incorporate, and the personal-growth emphasis appeals to some more than others.

Conclusion

Watson developed the theory while assistant dean of the undergraduate program at the University of Colorado, and it grew through her work planning the nursing Ph.D. program. It centers on how nurses express care, holding that caring promotes health better than medical cure alone, and it produced the 10 carative factors. Watson calls the theory descriptive and evolving and welcomes input. It does not fit traditional scientific methods easily, but qualitative approaches suit it, and it remains a useful orientation for delivering nursing care, helping nurses and patients find meaning and harmony amid growing complexity.