As the healthcare system undergoes major transformations and the role of the professional nurse is expanding, having a definition of the goals and responsibilities of a nurse relative to other professionals within the healthcare community is vital. Nursing theories establish the scope and the significance of a nurse’s role as a healthcare provider. They provide a universal description of nursing that can be applied to nurses practicing within a variety of settings. This paper will examine how the theories of Jean Watson and Madeleine Leininger impact the manner in which professional nurses practice, specifically within the school nurse setting.
Jean Watson’s Philosophy and Science of Caring shows how caring is at the core of nursing practice and is more important than curing. Additionally, she believed that a holistic approach to care is central to the practice of nursing. Watson devised a framework for understanding nursing by developing the ten carative factors. The term carative is used instead of curative to emphasize the distinction between nursing and medicine. According to Blais and Hayes (2011): Watson considers her work to be a philosophical and moral/ethical foundation for professional nursing and part of the central focus for nursing at the disciplinary level. It includes a call for both the art and science that embraces and intersects with art, science, humanities, spirituality, and new dimensions of mind-body-spirit medicine and nursing. (p. 109)
Madeline Leininger was the founder of transcultural nursing. Leininger defined human caring within the context of culture. She recognized that there was a lack of knowledge among nurses in regards to how different cultural backgrounds impacted human behaviors. She identified that care and beliefs about health and illness are imbedded in the values, worldviews and life patterns of people (Cohen 1991). Leininger like Watson also viewed caring as the essence of nursing and unique to the profession. However, she emphasized the aspects of care within a cultural context. Blais and Hayes explain that central to Leininger’s theory is the belief that cultures have differences in their ways of perceiving, knowing, and practicing care but that there are also commonalities about care among cultures (p 109).
A core principle of Watson’s (2008) theory is that nurses have a moral commitment to form transpersonal relationships with others. Nurses, “seek to recognize, honor, and accurately detect the spirit of the other through genuine presencing, being centered, available in the now-moment” (p 81). It is important for nurses to be present in the moment when caring for their patients. They need to be mindful of what they are doing and do it with the intention to care. Furthermore, the very presence of a caring nurse may be the difference between hope and despair. This aspect of caring is especially significant when working with children who have chronic medical conditions and their families. School nurses can provide this type of care by being engaged with the family and learning what is unique about their child. In the case of children with developmental disabilities, although there is no cure to their condition, nurses can focus on the progress they are making in their daily lives thus giving families a sense of hope and support.
Leininger believes that the goal of healthcare personnel should be to work toward understanding of care and the values, health beliefs, and lifestyles of different cultures, which will form the basis for providing culture-specific care (Blais and Hayes, 2011). Culturally competent school nurse are aware and respectful of the importance of the values, beliefs, traditions, customs and parenting styles of the children and families they serve. They also need to be aware of the impact of their interactions with others and take all of these factors into account when planning care for children and their families. For example, with an escalating number of Spanish-speaking immigrants in the school system, school nurses should provide educational written materials in Spanish as well as English and utilize translators to communicate pertinent health related information to Spanish-speaking families.
School nurses may encounter families who do not believe in immunizing their children because of religious beliefs. It is the duty of school nurses to provide education about the risks and benefits of immunizations and attempt to correct any misinformation or misperceptions that may exist. If the family makes an informed decision not to immunize their child, their religious beliefs must be respected and the child should be protected from communicable diseases. Furthermore, schools should provide frequent in-service programs on cultural competency. By respecting the values, beliefs and cultures of all individuals, nurses can continue to provide holistic and competent care to their patients in all areas of nursing.
The nursing theories of Jean Watson and Madeleine Leininger identify the act of caring as unique to the nursing profession. Nurses should continue to strive to provide holistic and individualized care that transcends cultural boundaries. By doing so the role of the nurse will remain a constant in the rapidly changing world of healthcare.
Blais, K. K. & Hayes J. S. (2011). Professional Nursing Practice: Concepts and Perspectives (6th ed). Upper Saddle River, NJ: Pearson Health Science Cohen, J. (1991). Two portraits of caring: a comparison of the artists, Lenininger and Watson. Journal of Advanced Nursing, 16, 899-909. Watson, J. (2008). Nursing: The philosophy and science of caring (rev. ed.). Boulder, CO: University Press of Colorado.