Caring and nursing are deeply interwoven. Caring in the nursing profession can be expressed in many forms such as when a nurse performs a careful assessment, provides education to patients and their families, answers their questions or is just simply provides a therapeutic presence. Jean Watson is a well-known nursing scholar who has developed her own theory on caring and its definition and role in the nursing profession. The Human Caring Theory puts the profession of nursing in a different light and views it as a nontraditional science because it includes human compassion. Watson states when human caring becomes involved in the nursing process, it starts to possess its own phenomena; requiring an explanation of its concepts, meaning and relationships (Watson, 2012). In order to understand how the Theory of Human Caring can be applied to everyday nursing practice; one must study the major concepts behind the theory, what can be learned through applying the theory to practice as well as the how the nursing metaparadigm relates to the theory.
Major Concepts of the Theory of Human Caring
Watson defines the ideal outcome of nursing care as protection, development and preservation of human dignity. Nurses are able to achieve this goal when the major concepts behind the Theory of Human Caring are utilized and put into practice by nurses. The major concepts of Watson’s Theory are the caring moment, carative factors and the transpersonal relationship (McCance, McKenna, & Boore, 1999). A caring moment is stated by Watson to be a heart-centered encounter with another person. A heart-centered encounter is defined as two people with their own phenomenal fields coming together for a human-to-human interaction that is meaningful, genuine, deliberate and honoring to one another. This interaction should expand each other’s world view and spirit and lead to a new self-discovery (Wagner, 2013). Carative factors are the essential aspects of caring in the nursing profession. Watson has chosen to use the word carative versus curative in order to differentiate nursing from medicine. The goal of curative medicine is to cure the patient of illness whereas the objective of the carative aspects of the nursing profession is to help a person achieve and/or maintain their health or die a peaceful and dignified death (Watson, 2007).
There are ten carative factors; formation of a humanistic-altruistic value system, instillation of faith-hope, sensitivity to one’s self and to others, development of a helping-trusting, human caring relationship, encouragement and acceptance of the expression of positive and negative feelings, use of a creative problem-solving process, transpersonal teaching-learning, assistance with gratification of human needs, allowance for existential-phenomenological-spiritual forces and protective and/or corrective mental, physical, societal and spiritual involvement (Watson, 2007). Transpersonal Caring is an important component of Watson’s theory. This type of caring occurs when the nurse senses the patient’s personal view of what is happening in their situation and the world around them. This experience allows for the blending of the nurses background and the patient’s experience and frees them both from isolation. Transpersonal Caring is meant to be a spiritual unification of both patient and nurse that allows them to transcend time, self and the life history of one another (Cohen, 1991).
Caring Patient-Nurse Interaction
A significant caring moment in my nursing career happened while I was a student working on my Associate’s Degree. I was assigned to a blind elderly male patient named Mr. B, who had just had hernia surgery. The nurse I was working with was very busy and did not have the best bedside manner in my opinion. I went into Mr. B’s room to introduce myself, and I could tell he was very nervous and in a great deal of pain. I obtained all of his vital signs and asked him if he would like me to see if he was due for his pain medication. He said, “Yes. I also need my nicotine patch too.” I looked in his MAR and found he was able to receive morphine every hour as needed and had his last dose an hour and a half before, and there was not an order for a nicotine patch. I proceeded to get my nurse and ask if I could administer the morphine with her and she said, “I just gave him a dose. Look at the MAR.” I pointed out to her that he was able to receive it every hour, and she said, “That’s ridiculous. I’m not going to be giving him morphine every hour. What was that doctor thinking?” I looked at her in disbelief. I felt as if she was saying that taking care of this man’s pain was putting a cramp in her day. Next I asked her about ordering a nicotine patch.
Her response was, “I don’t feel that I should bother a doctor for a nicotine patch. If I talk to his doctor, I will mention it.” I informed my teacher, who was apparently aware of this nurses reputation, and was able to get my patient his pain medication and call the doctor to order his nicotine patch. Once he was relaxed enough I started to ask him questions as to how I could make his stay more comfortable. He was blind, so I took his hand and traced his fingers around the buttons on the bed and the TV remote control to get him familiar with their position and function. Then I had him operate them on his own in front of me until he felt he was proficient. His call light was clipped to his shirt, and I taught him how to splint his abdomen if he had to move to prevent pain. Everything he needed such as a urinal, icepack and telephone were all put within his reach. When I asked if there was anything else I could do for him, I noticed he was tearing up.
I immediately assumed he was in pain. When I asked what was wrong, he said, “Oh nothing, sweetheart. I’m just grateful for what you’ve done for me. No one has ever taken that much time to help this old broken man out.” What One Can Learn About Themselves Through Caring Interactions The incident described above became a defining caring moment for me because although my patient probably didn’t know it, just as I had helped him, he had helped me. I learned that my actions, no matter how small I thought they were, can transform someone’s experience. I must admit when I left that room; my eyes weren’t dry either. This was a meaningful, genuine human-to-human interaction where we honored one another. I treated him with the dignity and respect any fellow human being deserved, and he let me be a student. He took the time to answer the questions I had about his condition and made me feel like I was a real nurse making a difference.
Enhancing the Caring Moment
During my encounter with Mr. B, I felt that I did everything within my power and limited student skillset directly to make him more comfortable and at ease in the hospital setting. However, I could have talked with the nurse in charge of his care regarding her attitude. I didn’t at the time because I felt like I was just a student that no one would listen to, but that was the wrong attitude to take. After I had left I couldn’t stop thinking about how he was at the mercy of his nurse’s mood swings and callous attitude. This is another lesson that I learned. No one benefits if no one speaks out about insensitive patient care. In the future, I will not hesitate to speak up if I feel that a negative attitude is affecting a patient’s experience.
Nursing Metaparadigm as it Relates to the Patient Interaction
The metaparadigm of nursing establishes nursing as a profession. The major concepts related to the nursing metaparadigm are; person, health, environment and nursing. All four of these concepts are directly related to my encounter with Mr. B. The interaction that we had was person-to-person. One human being trying to understand another human being’s circumstance. We both contributed to a positive, meaningful, learning experience for one another.
Making my patient’s health and environment a priority was important to me as well. My ultimate goal was to get him out of the state of pain he was in so he was able to tell me what he needed to make his environment comfortable for his stay at the hospital. It was important for him to tell me what he needed because his sight was impaired and I didn’t want to assume his needs.
Another learning opportunity occurred at this point. I had never had the opportunity to work with a patient that was blind before. I took this opportunity to learn what a person with sight impairment needs from those involved with their healthcare. My patient was able to enlighten me on the challenges that a person without sight faces every day. Being put in an unfamiliar environment is most often a stressful and scary experience. Nurses need to take the time to help these patients acclimate to an unfamiliar environment. Watson’s ideal nursing outcome, the preservation of human dignity, was met at the end of the experience through maintaining patient self-determination.
Carative Factors Applied to Caring Moment
Four of Watson’s carative factors played a role in the caring moment
I shared with Mr. B. They are the assistance with gratification of human needs, cultivation of sensitivity to one’s self and others, promotion of interpersonal teaching and development of a helping-trusting-caring relationship.
The carative factor of the gratification of human needs is met when the nurse can help meet the patient’s individual needs (Watson, 2008). Mr. B’s needs were very specific due to the loss of his vision. I was able to make him as comfortable as possible level of worry down by making sure that he knew where everything he needed was and showing him how the bed, call light and remote control function. Mr. B was also very worried because the doctor had not ordered his nicotine patch. Assuring him that I was going to do everything possible to make sure he was prescribed one made him less anxious.
The cultivation of sensitivity to one’s self and others occurs through becoming responsive to a patient’s needs and feelings (Watson, 2008). Just as I was genuinely interested in attending to all of Mr. B’s needs, he was genuinely interested in helping me learn as a student. The way we interacted with one another was authentic and fostered a trusting-caring-helping relationship. The genuineness of our encounter also demonstrates the promotion of interpersonal teaching. Our relationship was co-created, and promoted knowledge and growth (Watson, 2008).
Jean Watson’s Theory of Human Caring provides a solid foundation for any nurse to provide excellent care to their patients. By combining the Watson’s carative factors with the science of medicine, a nurse can attain a more well-rounded perspective of what their patient is experiencing. In turn, the nurse is able to learn from their patient as well as learn more about themselves and what they can achieve through compassionate care.
Cohen, J. (1991). Two portraits of caring. A comparison of the artists, Leninger and Watson. Journal Of Advanced Nursing, 16(8), 899-909. McCance, T., McKenna, H., & Boore, J. (1999). Caring: Theoretical perspectives of relevance to nursing. Jornal of Advanced Nursing, 30(6), 1388-1395. Wagner,
A. (2013). Core concepts of Jean Watson’s theory of human caring/ caring science. Retrieved from http://watsoncaringscience.org/files/Cohort%206/watsons-theory-of-human-caring-core-concepts-and-evolution-to-caritas-processes-handout.pdf Watson, Jean. (2007). Watson’s theory of human caring and subjective living experiences: carative factors/caritas processes as a disciplinary guide to the professional nursing practice. Texto & Contexto Enfermagem, Janeiro/março, 129-135. Watson, J. (2008). Nursing: The Philosophy and Science of Caring (rev. ed.), Boulder: University Press of Colorado Watson, J. (2012). Human caring science: A theory of nursing (2nd ed.). Sudbury, MA: Jones & Bartlett, LLC.