A Critique of Jean Watson’s Theory of Transpersonal Caring

Different views of nursing gave rise to the formulation of various nursing theories that contribute greatly to the advancement and evolution of the nursing profession as a whole. Some focus on the curative nature of nursing, while others revolve around the social and ethical aspect of the profession that complements conventional medicine. Among the latter is Dr. Jean Watson’s Theory of Transpersonal Caring, which this paper attempts to analyze and evaluate using J. Fawcett’s Framework of Analysis and Evaluation of Conceptual Models of Nursing.

Dr. Watson’s personal views of nursing brought about the conception of the theory in 1979, at the time when she was a professor of nursing at the University of Colorado. Her background in educational-clinical and social psychology influenced these views, along with her involvement in a nursing curriculum that sought to establish a standard to nursing that transcends settings, populations, specialty, subspecialty areas and so forth. It was an attempt to bring meaning and focus to nursing as an emerging discipline and distinct health profession with its own unique values, knowledge and practices, with its own ethic and mission to society (Watson, 2006).

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Originally, Watson’s theory revolved around three major elements, namely the carative factors, the transpersonal caring relationship, and the caring moment. She stated ten carative factors that served as guidelines for the nursing practice and basically centered on the principles of caring.

The transpersonal caring relationship describes how the nurse goes beyond an objective assessment, showing concerns toward the person’s subjective and deeper meaning regarding their own health care situation, while the caring moment is defined as the moment (focal point in space and time) when the nurse and another person come together in such a way that an occasion for human caring is created (Cara, 2003).

In this context, the four essential concepts of nursing – person, environment, health, and nursing – are encompassed in the theory. Being holistic in nature, the theory presents its framework as a congregation of all these concepts, centering on the person.

Watson regards a person as an individual with unique qualities and unique needs. The person is recognized as a being capable of communicating with another beyond physical interaction. The person is viewed as whole and complete, regardless of illness of disease (Watson, 2006).

The environment is regarded as a healing space, where the person’s awareness and consciousness can expand and promote mindbodyspirit wholeness and healing (Watson, 1999). Inevitably, the state of a patient’s environment can influence an individual’s state of health. The physical environment can affect how the person can connect and exist in the spiritual environment created by transpersonal caring relationships, and could affect the effectiveness of the science of caring.

Health is referred to as the unity and harmony within the mind, body and soul. It is a state of complete physical, mental, and social well-being and functioning (Hagopian, 2007). The theory establishes that caring can promote a person’s health better than the curative means of conventional medicine. Through caring, the care giver recognizes the condition of the recipient at a deeper level, enabling him/her to sympathize as needed, and provide the appropriate care needed by the patient. With this means of understanding the patient better, there is greater chance of addressing the patient’s needs, creating the needed balance in his/her physical, mental, and social well-being.

Watson defines nursing “as a human science of persons and human health – illness experiences that are mediated by professional, personal, scientific, esthetic, and ethical human care transactions” (Watson, 1988). The theory also emphasizes caring as central to nursing, and is essentially what the theory wishes to achieve. Nursing is not just about curing an illness or disease – it is beyond that.

It is about the nurse being able to center consciousness on the entire being of the other in order to detect his/her inner condition, and impart genuine concern through caring moments communicated through “movements, gestures, facial expressions, procedures, information, touch, sound, verbal expressions and other scientific, technical, aesthetic, and human means of communication.” The role of consciousness is deemed greatly important, because then the nurse exhibits commitment and sincere intention to connect with the patient at a deeper level, thus becoming an effective aid in nursing the patient back to health, physically, emotionally, and spiritually (Watson, 2006).

As can be derived from what has been discussed, the theory is concerned with establishing nursing as a profession distinct from the curative nature of conventional medicine, to which it has been originally strongly associated with – the original role of the nurse being to primarily care for the patient as dictated and required by disease or illness. The theory places emphasis on the transcendent and healing quality of a caring relationship shared by nurse and patient. It describes how transpersonal caring goes beyond physical reality and ventures into the spiritual, opening greater possibilities of healing and well-being, as opposed to disease-based medication and regard to patient.

Watson’s theory has guided nursing practices in different areas, including rehabilitation centers, hospices, hospitals, and long-term care facilities. Watson’s model proved to be socially significant, as well. It has served as a conceptual framework for guiding community health nursing practice, and has been described as “philosophically congruent with contemporary global approaches to community health and health promotion” (Rafael, 2000). However, this model can both lead to nursing activities that meet social expectations, and create expectations that require societal change.

In this time when people think twice before trusting, nursing professionals may have to exert more conscious effort in making the connection and creating transpersonal caring relationships because beyond the hesitation, society expects the nursing community to be sympathetic, concerned, and genuinely caring of their patient. On the other hand, as transpersonal caring becomes increasingly successful in the improvement of the patient’s well-being, higher expectations of nurses are created. This may lead to society being increasingly dependent on nurses, and less on medical technology.

The effectiveness of Watson’s theory has been validated with its use as a guide in several studies centering on caring science. It has been “recommended as a guide to nursing patients with hypertension, as one means of decreasing blood pressure and increase in quality of life,” in a study made on its effectiveness on the quality of life and blood pressure of patients with hypertension in Turkey (Erci, Sayan, Tortumluoglu, Kilic, Sahin, & Gungormus, 2003). In another study on caring for old adults, it was established that the theory was effective in improving the quality of life and peace of mind, body, and soul of the older people, just by caring and listening attentively to what they have to say (Bernick, 2004).

Through the years since the conception of the theory, Watson’s work continues to evolve. In recent updates, she had offered the concept of clinical caritas processes over the original carative factors. It basically injects more spirituality and love into the framework. Such a perspective ironically places nursing within its most mature framework, consistent with the Nightingale model of nursing, yet to be actualized, but awaiting its evolution within a caring-healing theory. This direction, ironically while embedded in theory, goes beyond theory and becomes a converging paradigm for nursing's future (Watson, 2006).

References
Bernick, L. (2004). Caring for older adults: practice guided by Watson's caring-healing model. Nursing Science Quarterly, 17(2):128-34.

Cara, C. (2003). A pragmatic view of Jean Watson’s caring theory. International Journal of Human Caring, 7(3), 51-61.

Erci, B., Sayan, A.,Tortumluoglu, G., Kilic, D., Sahin, O., & Gungormus Z. (2003). The effectiveness of Watson's Caring Model on the quality of life and blood pressure of patients with hypertension. Journal of Advanced Nursing, 41(2), 130–139.

Hagopian, G. (2007). Nursing theorists. Retrieved February 8, 2007 from www.nipissingu.ca/faculty/arohap/aphome/NURS3006/Resources/theorists.ppt

Rafael, AR. (2000). Watson's philosophy, science, and theory of human caring as a conceptual framework for guiding community health nursing practice. ANS. Advances in Nursing Science, 23(2):34-49.

Watson, J. (1988). Nursing: Human science and human care. A theory of nursing (2nd printing). New York: National League for Nursing.

Watson, J. (1999). Postmodern nursing and beyond. Toronto, Canada: Churchill Livingstone.

Watson, J. (2006). Dr. Jean Watson’s Theory of Human Caring. Retrieved February 8, 2007 from http://www2.uchsc.edu/son/caring/content/evolution.asp