For Nurses Only!!!

1. Jean Watson (http://nursingtheories.weebly.com/jean-watson.html)
Caring Science as Sacred Science
In today’s w orld, nursing seems to be responding to the various demands of the machinery w ith less consideration of the
needs of the person attached to the machine. In Watson’s view , the disease might be cured, but illness w ould remain
because w ithout caring, health is not attained. Caring is the essence of nursing and connotes responsiveness betw een the
nurse and the person; the nurse co-participates w ith the person. Watson contends that caring can assist the person to gain
control, become know ledgeable, and promote health changes.
Major Concepts
Society provides the values that determine howone
should behave and what goals one should strive toward.
Watson (1979) states:
“Caring (and nursing) has existed in every society.
Every society has had some people who have cared for
others. A caring attitude is not transmittedfrom
generation to generation by genes. It is transmittedby
the culture of the profession as a unique way of coping
with its environment.”
Human being is a valued person to be cared for,
respected, nurtured, understood, and assisted.
Health is the unity andharmony within the mind, body,
and soul; health is associated with the degree of
congruence between the self as perceived and the self as
experienced.
Nursing is a human science of persons and human
health – illness experiences that are mediated by
professional, personal, scientific, esthetic, and ethical
human care transactions.
Actual caring occasion involves actions andchoices by
the nurse and the individual. The moment of coming
together in a caring occasion presents the two persons
with the opportunity todecide how to be in the
relationship – what to do with the moment.
The transpersonal concept is an intersubjective human-
to-human relationship in which the nurse affects and is
affectedby the person of the other. Both are fully
present in the moment andfeel a union with the other;
they share a phenomenal field that becomes part of the
life story of both. (Watson, 1999)
Subconcepts
Phenomenal field
The totality of human experience of one’s being in the
world. This refers to the individual’s frame of reference
that can only be known to that person.
Self
The organized conceptual gestalt composed of
perceptions of the characteristics of the “I” or “ME” and
the perceptions of the relationship of the “I” and“ME”
to others andto various aspects of life.
Time
The present is more subjectively real and the past is
more objectively real. The past is prior to, or in a
different mode of being than the present, but it is not
clearly distinguishable. Past, present, andfuture
incidents merge and fuse. (Watson, 1999)
Nursing interventions relatedto human care originally
referred to as carative factors have now been translated
into clinical caritas processes(Watson, 2006):
1. The formation of a humanistic-altruistic system of
values, becomes: “practice of loving-kindness and
equanimity within context of caringconsciousness.”
2. The instillation of faith-hope becomes: “being
authentically present, andenabling 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 to
others becomes: “cultivation of one’s own spiritual
practices and transpersonal self, going beyond ego self.”
4. The development of a helping-trusting relationship
becomes: “developingand sustaining a helping-trusting
authentic caring relationship.”
5. The promotion andacceptance of the expression of
positive and negative feelings becomes: “being present
to, and supportive of the expression of positive and
negative feelings as a connection with deeper spirit of
self and the one-being-cared-for.”
6. The systematic use of the scientific problem-solving
methodfor decision makingbecomes: “creative use of
self and all ways of knowing as part of the caring
process; to engage in artistry of caring-healing
practices.”
7. The promotion of interpersonal teaching-learning
becomes: “engaging in genuine teaching-learning

2. experience that attends to unity of being and meaning
attemptingto stay within other’s frame of reference.”
8. The provision for a supportive, protective, and(or)
corrective mental, physical, sociocultural, and spiritual
environment becomes: “creatinghealingenvironment at
all levels (physical as well as non-physical), subtle
environment of energy andconsciousness, whereby
wholeness, beauty, comfort, dignity, andpeace are
potentiated.”
9. Assistance with the gratification of human needs
becomes: assisting with basic needs, with an intentional
caring consciousness, administering ‘human care
essentials,’ which potentiate alignment of
mindbodyspirit, wholeness, and unity of being in all
aspects of care,” tending to both embodied spirit and
evolving spiritual emergence.
Watson’s (1979)orderingof needs:
a. Lower Order Needs (Biophysical Needs)
Survival Needs
The need for foodand fluid
The need for elimination
The need for ventilation
b. Lower Order Needs (Psychophysical Needs)
Functional Needs
The need for activity-inactivity
The need for sexuality
c. Higher Order Needs (Psychosocial Needs)
Integrative Needs
The need for achievement
The need for affiliation
d. Higher Order Need (Intrapersonal-Interpersonal
Need)
Growth-seekingNeed
The need for self-actualization.
10. The allowance for existential-phenomenological
forces becomes: “openingand attendingto spiritual-
mysterious and existential dimensions of one’s own
life-death; soul care for self and the one-being-cared-
for.”
Assumptions
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 grow th.

3. Caring responses accept a person not only as he or she is now but as w hat he or she may become.
A caring environment is one that offers the development of potential w hile allow ing the person to choose the best action for
himself or herself at a given point in time.
Caring is more “healthogenic” than is curing. The practice of caring integrates biophysical know ledge w ith know ledge of
human behavior to generate or promote health and to provide ministrations to those w ho are ill. A science of caring is
therefore complementary to the science of curing.
The practice of caring is central to nursing. (Watson, 1979).
Relationships
Transpersonal caring field resides w ithin a unitary field of consciousness and energy that transcend time, space and
physicality.
A transpersonal caring relationship connotes a spirit-to-spirit unitary connection w ithin a caring moment, honoring the
embodied spirit of both practitioner and patient, w ithin a unitary field of consciousness.
A transpersonal caring relationship transcends the ego level of both practitioner and patient, creating a caring field w ith new
possibilities for how to be in the moment.
The practitioner’s authentic intentionality and consciousness of caring has a higher frequency of energy than nonc aring
consciousness, opening up connections to the universal field of consciousness and greater access to one’s inner healer.
Transpersonal caring is communicated via the practitioner’s energetic patterns of consciousness, intentionality, and
authentic presence in a caring relationship.
Caring-healing modalities are often noninvasive, nonintrusive, natural-human, energetic environmental field modalities.
Transpersonal caring promotes self-know ledge, self-control, and self-healing patterns and possibilities.
Advanced transpersonal caring modalities draw upon multiple w ays of know ing and being; they encompass ethical and
relational caring, along w ith those intentional consciousness modalities that are energetic in nature that honors w holeness,
healing, comfort, balance, harmony, and w ell-being. (Watson, 2005)
Strengths/Weaknesses
Strengths:
Watson’s w orkcan be used to guide and improve practice. It can provide the nurse w ith the most satisfying aspects of
practice and can provide the client w ith holistic care.
The theory is relatively simple.
Watson’s w orkis logical in that the carative factors are based on broad assumptions that provide a supportive framew ork.
The carative factors are logically derived from the assumptions and related to the hierarchy of needs.
The carative factors delineate nursing from medicine.
Weakness:
Watson’s theory becomes more complex w hen entering the area of existential-phenomenology, for many nurses may not
have the liberal arts background to provide the proper foundation for this area.
Analysis
It is undeniable that technology has already been part of nursing’s w hole paradigm w ith the evolving era of development.
Watson’s suggestion of purely “caring” w ithout giving much attention to technological machineries cannot be solely applied
but then her statement is praisew orthy because she dealt w ith the importance of the nurse patient interaction rather than a
practice confined w ith technology.
Watson stated the term “soul-satisying” w hen giving out care for the clients. Her concepts guide the nurse to an ideal quality
nursing care provided for the patient. This w ould further increase the involvement of both the patient and the nurse w hen the
experience is satisfying.
In providing the enumerated clinical caritas processes, the nurse becomes an active co-participant w ith the patient. Thus,
quality of care offered by the nurse is enhanced.

4. Jean Watson's Philosophy of Nursing
(http://currentnursing.com/nursing_theory/Watson.html)
This page w as last updated on January 26, 2012
I n t r o d u c t i o n
 Theorist - Jean Watson w as born in West Virginia, US
 Educated: BSN, University of Colorado, 1964, MS, University of
Colorado, 1966, PhD, University of Colorado, 1973
 Distinguished Professor of Nursing and Chair in Caring Science at the
University of Colorado Health Sciences Center.
 Fellow of the American Academy of Nursing.
 Dean of Nursing at the University Health Sciences Center and
President of the National League for Nursing
 Undergraduate and graduate degrees in nursing and psychiatric-
mental health nursing and PhD in educational psychology and
counseling.
 Six (6) Honorary Doctoral Degrees.
 Research has been in the area of human caring and loss.
 In 1988, her theory w as published in “nursing: human science and
human care”.
T h e s e v e n a s s u m p t i o n s
1. Caring can be effectively demonstrated and practiced only
interpersonally.
2. Caring consists of carative factors that result in the satisfaction of
certain human needs.
3. Effective caring promotes health and individual or family grow th.
4. Caring responses accept person not only as he or she is now but as
w hat he or she may become.
5. A caring environment is one that offers the development of potential
w hile allow ing the person to choose the best action for himself or
herself at a given point in time.
6. Caring is more “ healthogenic” than is curing. A science of caring is
complementary to the science of curing.
7. The practice of caring is central to nursing.
T h e t e n p r i m a r y c a r a t i v e f a c t o r s
1. The formation of a humanistic- altruistic system of values.
2. The installation of faith-hope.
3. The cultivation of sensitivity to one’s self and to others.
4. The development of a helping-trust relationship

5. 5. The promotion and acceptance of the expression of positive and
negative feelings.
6. The systematic use of the scientific problem-solving method for
decision making
7. The promotion of interpersonal teaching-learning.
8. The provision for a supportive, protective and /or corrective mental,
physical, socio-cultural and spiritual environment.
9. Assistance w ith the gratification of human needs.
10. The allow ance for existential-phenomenological forces.
The first three carative factors form the “philosophical foundation” for the
science of caring. The remaining seven carative factors spring from the
foundation laid by these first three.
1. The formation of a humanistic- altruistic system of values
 Begins developmentally at an early age w ith values shared w ith the
parents.
 Mediated through ones ow n life experiences, the learning one gains
and exposure to the humanities.
 Is perceived as necessary to the nurse’s ow n maturation w hich then
promotes altruistic behavior tow ards others.
2. Faith-hope
 Is essential to both the carative and the curative processes.
 When modern science has nothing further to offer the person, the
nurse can continue to use faith-hope to provide a sense of w ell-being
through beliefs w hich are meaningful to the individual.
3. Cultivation of sensitivity to one’s self and to others
 Explores the need of the nurse to begin to feel an emotion as it
presents itself.
 Development of one’s ow n feeling is needed to interact genuinely and
sensitively w ith others.
 Striving to become sensitive, makes the nurse more authentic, w hich
encourages self-grow th and self-actualization, in both the nurse and
those w ith w hom the nurse interacts.
 The nurses promote health and higher level functioning only w hen
they form person to person relationship.

6. 4. Establishing a helping-trust relationship
 Strongest tool is the mode of communication, w hich establishes
rapport and caring.
 Characteristics needed to in the helping-trust relationship are:
o Congruence
o Empathy
o Warmth
 Communication includes verbal, nonverbal and listening in a manner
w hich connotes empathetic understanding.
5. The expression of feelings, both positive and negative
 “Feelings alter thoughts and behavior, and they need to be
considered and allow ed for in a caring relationship”.
 Aw areness of the feelings helps to understand the behavior it
engenders.
6. The systematic use of the scientific problem-solving method for decision
making
 The scientific problem- solving method is the only method that allow s
for control and prediction, and that permits self-correction.
 The science of caring should not be alw ays neutral and objective.
7. Promotion of interpersonal teaching-learning
 The caring nurse must focus on the learning process as much as the
teaching process.
 Understanding the person’s perception of the situation assist the
nurse to prepare a cognitive plan.
8. Provision for a supportive, protective and /or corrective mental, physical,
socio-cultural and spiritual environment
 Watson divides these into eternal and internal variables, w hich the
nurse manipulates in order to provide support and protection for the
person’s mental and physical w ell-being.
 The external and internal environments are interdependent.
 Nurse must provide comfort, privacy and safety as a part of this
carative factor.

7. 9. Assistance w ith the gratification of human needs
 It is based on a hierarchy of need similar to that of the Maslow ’s.
 Each need is equally important for quality nursing care and the
promotion of optimal health.
 All the needs deserve to be attended to and valued.
Watson’s ordering of needs
 Low er order needs (biophysical needs)
o The need for food and fluid
o The need for elimination
o The need for ventilation
 Low er order needs (psychophysical needs)
o The need for activity-inactivity
o The need for sexuality
 Higher order needs (psychosocial needs)
o The need for achievement
o The need for affiliation
o Higher order need (intrapersonal-interpersonal need)
o The need for self-actualization
10. Allow ance for existential-phenomenological forces
 Phenomenology is a w ay of understanding people from the w ay
things appear to them, from their frame of reference.
 Existential psychology is the study of human existence using
phenomenological analysis.
 This factor helps the nurse to reconcile and mediate the incongruity of
view ing the person holistically w hile at the same time attending to the
hierarchical ordering of needs.
 Thus the nurse assists the person to find the strength or courage to
confront life or death.
W a t s o n ’ s t h e o r y a n d t h e f o u r m a j o r c o n c e p t s
1. Human being
 Human being refers to “….. a valued person in and of him or herself to
be cared for, respected, nurtured, understood and assisted; in general
a philosophical view of a person as a fully functional integrated self.
He, human is view ed as greater than and different from, the sum of

8. his or her parts”.
2. Health
 Watson adds the follow ing three elements to WHO definition of
health:
o A high level of overall physical, mental and social
functioning
o A general adaptive-maintenance level of daily functioning
o The absence of illness (or the presence of efforts that leads
its absence)
3. Environment/society
 According to Watson, caring (and nursing) has existed in every
society.
 A caring attitude is not transmitted from generation to generation.
 It is transmitted by the culture of the profession as a unique w ay of
coping w ith its environment.
4. Nursing
 “Nursing is concerned w ith promoting health, preventing illness,
caring for the sick and restoring health”.
 It focuses on health promotion and treatment of disease. She believes
that holistic health care is central to the practice of caring in nursing.
 She defines nursing as…..
“a human science of persons and human health-illness experiences
that are mediated by professional, personal, scientific, esthetic and
ethical human transactions”.
W a t s o n ’ s t h e o r y a n d n u r s i n g p r o c e s s
 Nursing process contains the same steps as the scientific research
process. They both try to solve a problem. Both provide a framew ork
for decision making.
1. Assessment
 Involves observation, identification and review of the problem; use of
applicable know ledge in literature.
 Also includes conceptual know ledge for the formulation and
conceptualization of framew ork.

9.  Includes the formulation of hypothesis; defining variables that w ill be
examined in solving the problem.
2. Plan
 It helps to determine how variables w ould be examined or measured;
includes a conceptual approach or design for problem solving. It
determines w hat data w ould be collected and how on w hom.
3. Intervention
 It is the direct action and implementation of the plan.
 It includes the collection of the data.
4. Evaluation
 Analysis of the data as w ell as the examination of the effects of
interventions based on the data.
 Includes the interpretation of the results, the degree to w hich positive
outcome has occurred and w hether the result can be generalized.
 It may also generate additional hypothesis or may even lead to the
generation of a nursing theory.
W a t s o n ’ s t h e o r y a n d t h e c h a r a c t e r i s t i c o f a
t h e o r y
1. Logical in nature.
2. Relatively simple
3. Generelizable
4. Based on phenomenological studies that generally ask questions
rather than state hypotheses.
5. Can be used to guide and improve practice.
6. Supported by the theoretical w orkof numerous humanists,
philosophers, developmentalists and psychologists.
S t r e n g t h s
 This theory places client in the context of the family, the community
and the culture.
 It places the client as the focus of practice rather than the technology.
L i m i t a t i o n s

10.  Biophysical needs of the individual are given less important.
 The ten caratiive factors primarily delineate the psychosocial needs of
the person.
 Needs further research to apply in practice.
R e s e a r c h r e l a t e d t o W a t s o n ’ s t h e o r y
The effectiveness of Watson's Caring Model on the quality of life and blood
pressure of patients w ith hypertension. J Adv Nurs. 2003 Jan;41(2):130-9.
 This study demonstrated a relationship betw een care given according
to Watson's Caring model and increased quality of life of the patients
w ith hypertension. Further, in those patients for w hom the caring
model w as practised, there w as a relationship betw een the Caring
model and a decrease in patient's blood pressure. The Watson Caring
Model is recommended as a guide to nursing patients w ith
hypertension, as one means of decreasing blood pressure and
increase in quality of life.
Martin, L. S. (1991). Using Watson’s theory to explore the dimensions of adult
polycystic kidney disease . ANNA Journal, 18, 403-406 .
Mullaney, J. A. B. (2000). The lived experience of using Watson’s actual caring
occasions to treat depressed w omen . Journal of Holistic Nursing, 18(2), 129-
142
Martin, L. S. (1991). Using Watson’s theory to explore the dimensions of adult
polycystic kidney disease . ANNA Journal, 18, 403-406
C o n c l u s i o n
 Watson provides many useful concepts for the practice of nursing.
 She ties together many theories commonly used in nursing education.
 The detailed descriptions of the carative factors can give guidance to
those w ho w ish to employ them in practice or research.
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