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Running head: WATSONS THEORY OF CARING SCIENCE

Watsons Theory of Caring Science : Description, Critique and Implementation


Ayyu Sandhi
Graduate Institute of Nursing, Taipei Medical University

Running head: WATSONS THEORY OF CARING SCIENCE


Abstract

Jean Watsons theory of caring science, with the concepts of transpersonal caring relationship,
caring moment, and the 10 carative factors, is strongly based on sincerity, genuineness, love,
and humanistic values as her efforts to bring the world of nursing to its roots. This theory is
widely integrated in nursing curriculum, being applied in clinical settings to monitor caring
behaviors of staffs as well as to improve the quality of care, and being developed through
studies. This paper aims to provide historical biography of the theorist, description and
critique of the theory, as well as to determine its implication in nursing community. The
opportunity for this theory to be applied in Indonesia is also provided.
Keywords: Jean Watsons theory, caring science

Running head: WATSONS THEORY OF CARING SCIENCE


Watsons Theory of Caring Science : Description, Critique and Implementation

WATSONS THEORY OF CARINGHistorical


SCIENCEBiography

Margaret Jean Harman Watson, PhD, RN, AHN-BC, FAAN is Distinguished


Professor and Dean Emerita of the University of Colorado Denver, College of Nursing
Anschutz Medical Center (WCSI, 2014). She was born in West Virginia and raised in an
extended family-community environment as the youngest of eight children. She achieved her
bachelor degree in nursing from University of Colorado in 1964. From the same university,
she earned her master degree in psychiatric-mental health nursing in 1966 and doctorate in
educational psychology and counseling in 1973. In the 1980s, Watson and colleagues
founded the Center for Human Caring at the University of Colorado, which became the
nation's first interdisciplinary center committed to use knowledge of human caring for
practice, education, administration and leadership. She is a widely published author and
recipient of many awards and honors, such as National League for Nursing (NLN) Martha E.
Rogers Award, which appraises nurse scientists' significant contributions for advancing
nursing knowledge and knowledge in other health sciences; Fetzer Institute's national
Norman Cousins Award in recognition of her commitment for developing, maintaining, and
exemplifying relationship-centered care practices; and American Journal of Nursing Book of
the Year Award for her book Caring Science as Sacred Science (Alligood, 2014).
Description of the Theory
Origin
The origin of Watson's theory was emerged from her quest to bring new meaning and
dignity to the world of nursing and patient care. She identified her framework based on the
commitment in honoring the lived experience of self and other; in seeking to preserve
humanity, even when threatened; attending to and helping to sustain human dignity and
wholeness in the midst of threats and crises of life and death (Watson, 2007).

Running head: WATSONS THEORY OF CARING SCIENCE


Watson developed her theory from feminist theory, metaphysics, phenomenology,

quantum physics, wisdom traditions, perennial philosophy, and Buddhism. Her work was
influenced by some nursing theorists, such as Nightingale, Henderson, Leininger, Peplau,
Rogers, Newman, and also by the work of Gadow, a nursing philosopher and health care
ethicist.
From Nightingale, Watson connected the sense of deep commitment and calling
(which answers the question, 'what calls us to care?') to an ethic of human service. She agreed
on Carl Rogers' phenomenological approach that nurses are not there to manipulate and
control but rather to understand, as mostly influential thought at the time when therapeutic
control and manipulation of the patient are considered as norm (Alligood, 2014).
In her first book entitled "Nursing: The Philosophy and Science of Caring", Watson
originally intended to formulate an integrated bachelor nursing curriculum, but instead she
developed carative factors which according to her the core of nursing (Sourial, 1996). In her
fifth book "Caring Science as Sacred Science", Watson emphasizes for nurses to have deep
inner reflection and personal growth, communication skills, and use of self-transpersonal
growth. She also invites nurses to sustain and deepen own and others' humanity as moral and
ethical starting point for professional caring (Watson, 2012). Therefore, any technical skills
commonly aimed at cure are reframed as sacred acts conducted with a caring consciousness
and completed in a way that respects the person as embodied spirit (McEwen & Wills, 2007).
Purpose
The purpose of the theory is to address some of the philosophical, conceptual and
empirical problems that confront nursing, to clarify the human care process in nursing, and to
maintain the concept of person in nursing (Cohen, 1991).
Concepts and Definitions
WATSONS THEORY OF CARING SCIENCE

Running head: WATSONS THEORY OF CARING SCIENCE


Watson (as cited in McEwen & Wills, 2007) described caring as ethical and moral

WATSONS
THEORY
OF
CARING SCIENCE
ideal of nursing
that has
interpersonal
and humanities qualities without setting aside the

importance of empirical factors in knowledge and skills. She defined caring science as an
evolving philosophical-ethical-epistemic field of study, grounded in the discipline of nursing,
which reintroduces spirit and sacred dimensions back into nurses' work, and allows for
unification between metaphysics and the material-physical world of modern science (Watson,
2012).
Watson's main concepts of caring science include transpersonal caring relationship,
caring occasion/caring moment and the 10 carative factors. Transpersonal caring relationship,
as described by Watson, is a "special kind of human care relationship, a spiritual union
between two people, which highly respects for the whole person and their being-in-theworld" (Alligood, 2014). In the transpersonal caring relationship, the nurse enters into
another person's experiences, and another can enter into the nurse's experiences.
The caring occasion/caring moment can be an existential turning point for the nurse
for choosing to "see" the patient. It is an informed action guided by an intentionality and
consciousness of how to "really present" in the moment. In a caring occasion/caring moment,
the nurse "read" the field, beyond the outer appearance of the patient and the patient's
behavior.
The 10 carative factors are considered as the essential aspects of caring in nursing,
which guide nurses to practice professionally instead of functioning as technicians or
medical-skilled workers. Carative means caring with love, which is a deeper and expanded
dimension of nursing (McEwen & Wills, 2007). Watson then broadened the carative factors
to a closely related concept, caritas (a word derived from Latin that means "to cherish, to
appreciate, to give special attention"). She provided a translation, more fluid language of the
original carative factors into clinical caritas processes which allow nurse practitioners to use

Running head: WATSONS THEORY OF CARING SCIENCE


them in more open ways. Caritas processes included an explicit spiritual dimension and

WATSONS THEORY
OFof
CARING
straightforward
elicitation
love andSCIENCE
caring. The original 10 carative factors are as stated

below (Watson, 2007).


Humanistic altruistic system of values. Humanistic values include kindness,
empathy, concern, and love for self and others. They derive from childhood experiences and
are enhanced by beliefs, cultures and art. Altruistic values arise from commitments to and
satisfaction from receiving through giving. Humanistic-altruistic values are fundamental
things for human caring and promote the best professional care.
Enabling and sustaining faith and hope. In dealing with one's illness, person's
beliefs in faith and hope are important that they are need to be encouraged, honored and
respected as significant influences in promoting and maintaining health. The nurse should
preserve faith and hope and the deep belief system of the patient, regardless the medical
intervention, or even when there is nothing left to do medically.
Sensitivity to self and other. Sensitivity to self is the recognition and
acknowledgement of feelings, both happiness and sadness. The way to develop sensitivity to
self is by looking into oneself and willing to explore one's own feelings. Sensitivity to self not
only leads to self-acceptance and psychological growth, but to sensitivity and acceptance of
others. Nurses who recognize and use their sensitivity promote self-development and selfactualization, and are able to encourage the same growth in others. As consequences, nurses
who are sensitive to others have better ability to learn about other's worldview, which
increases their concern for others' comfort, recovery, and wellness.
Development of a helping-trust relationship. A trusting relationship promotes and
accepts the expression of both positive and negative feelings. It involves effective
communication, empathy, nonpossessive warmth (which is performed by a moderate

Running head: WATSONS THEORY OF CARING SCIENCE


speaking volume, a relaxed open posture, and facial expressions that are congruent with

WATSONS
THEORY
OFreal,
CARING
communications),
being
honest,SCIENCE
genuine, and authentic.

Promoting and accepting the expression of positive and negative feelings and
emotions. The caring relationship can go deeper, more honest and authentic if nurses allow
themselves to focus on feelings and emotional aspects of an event during the caring process.
It can be achieved through listening to another person's story and honoring another person's
feeling. It may be the nurse who is the only one who listens to and honors anothers story and
all the feelings that come up with it. Indeed, sharing of feelings is a risk-taking experience for
both nurse and patient. By doing so, the nurse must be prepared for either positive or negative
feelings.
Systematic use of the scientific problem-solving method for decision making.
Nursing process is a systematic, creative problem-solving method in dealing with patients'
response to illness. Being creative means involving all knowledge, instincts, intuition,
aesthetics, technology, skills, empirics, ethics, personal, and even spiritual knowing.
Transpersonal teaching-learning. Nursing is about caring, which is a separate
WATSONS
OFresponsibility
CARING SCIENCE
concept
fromTHEORY
curing. The
to achieve and maintain health and wellness is on the7
patient. The nurse has a role to facilitate with teaching-learning techniques that are designed
to enable patients to provide self-care, determine personal needs, and provide opportunities
for their personal growth. Things to keep in mind are that "teaching" is not merely conveying
information, and "learning" is not merely receiving information and data from the patient, but
it involves caring relationship as a context, that nurse should work from the patients frame of
reference, grasping the meaning and significance of the information for the person, as well as
the readiness of the patient to be the best teacher for themselves.
Provision of supportive, protective, and/or corrective mental, physical, societal,
and spiritual environment. Internal and external environments have influence on health and

Running head: WATSONS THEORY OF CARING SCIENCE


1
illness. Internal environment includes mental, spiritual well-being and sociocultural beliefs.
WATSONS
THEORYincludes
OF CARING
SCIENCE
External
environment
comfort,
privacy, safety, cleanliness, aesthetic surroundings. 8
By repatterning the environment consciously, the nurse promotes healing and enhances
quality of care.
Assisting with gratification of human needs. The nurse needs to recognize the
biological, psychological, social, spiritual, and cultural needs of self and patient. Lower-order
needs must be fulfilled before trying to obtain higher-order needs. Food, elimination, and
ventilation are examples of lower-order needs, while self-actualization is an example of
higher-order needs. All needs are unified and interdependent; they are equally important and
must be valued and responded during caring process.
Allowance for existential-phenomenological forces. This carative factor allows
mystery and philosophical, metaphysical aspects of human experiences and phenomena
which are not in accordance with rational thinking and science. Nevertheless these unknowns
are real to those affected. This factor allows nurse, patient, and families being open to and
believe in infinite possibilities for miracles.
Table 1
Translation from 10 Carative Factors to Caritas Processes
Carative Factors
Humanistic altruistic system of values

Caritas Processes
Practice of loving-kindness and equanimity
within the context of caring consciousness

Enabling and sustaining faith and hope

Being authentically present, enabling and


sustaining the deep belief system and
subjective life-world of self and one-beingcared for

Sensitivity to self and other

Cultivation of ones own spiritual practices


and transpersonal self going beyond the ego
self

Development of a helping-trust relationship

Developing and sustaining a helping-trusting

WATSONS THEORY OF CARING SCIENCE

Running head: WATSONS THEORY OF CARING SCIENCE


authentic caring relationship

Promoting and accepting the expression of


positive and negative feelings and emotions

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

Systematic use of the scientific problemsolving method for decision making

Creative use of self and all ways of knowing


as part of the caring process; to engage in the
artistry of caring-healing practices

Transpersonal teaching-learning

Engaging in genuine teaching-learning


experience that attends to unity of being and
meaning, attempting to stay within
othersframe of reference

Provision of supportive, protective, and/or


corrective mental, physical, societal, and
spiritual environment

Creating healing environment at all levels


(physical as well as nonphysical, subtle
environment of energy and consciousness,
whereby wholeness, beauty, comfort, dignity,
and peace are potentiated

Assisting with 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

Allowance for existential-phenomenological


forces

Opening and attending to spiritualmysterious and existential dimensions of


ones own life-death; soul care for self and
the one-being-cared for

Watson (as cited in McEwen & Wills, 2007) described metaparadigm concepts of
nursing (person, health, environment, and nursing) as stated below.
Person. Person is viewed holistically wherein the body, mind, and soul are
interrelated; each part is a reflection of the whole, yet the whole is greater than and different
from the sum of the parts.

Running head: WATSONS THEORY OF CARING SCIENCE


1
Health. Health is defined as the unity and harmony within the body, mind, and soul;
WATSONS
THEORY
OF CARING
SCIENCE
harmony between
self and
others; harmony
between self and nature, and openness to

10

increased possibility; which is a process of adapting, coping, and growing throughout life.
Disease is associated with disharmony between body, mind, and soul or disharmony between
the person and nature; which makes the person less open to diversity.
Environment. Environment is defined as a healing space, a sacred space in which
there is conscious promotion of the wholeness between the body, mind, and soul; instead of
simply a place for bodies to be treated.
Nursing. Nursing consists of knowledge, thought, values, philosophy, commitment,
and action; with some degree of passion. Nursing's goal is using caring moment to help
person to gain a higher degree of harmony within the body, mind, and soul; which generates
self-knowledge, self-reference, self-healing, and self-care processes while allowing for
diversity and possibility.
Relationships
Watson linked her concepts by the relational proposition that states "transpersonal
caring relationship is the full actualisation of the carative factors in a human-to-human
transaction". She also argued that if transpersonal caring relationship can be established, "the
patient is better able to have a release of some of the disharmony of the body, mind, and soul
and be able to release pent-up energy for his or her own healing process" (Sourial, 1996). The
goal of nursing, as defined in metaparadigm concepts, is achieved through transpersonal
caring relationship (McCance, McKenna, & Boore, 1999).
The caring occasion/caring moment becomes transpersonal when "two persons (nurse
and patient) together with their unique life histories and perceptions able to see and connect
with the spirit of others, becomes part of the life history of both persons, involves learning of

Running head: WATSONS THEORY OF CARING SCIENCE


1
how to be human by identifying from each other, open to expanding possibilities of what can
occur" (Watson,

2012).

Structure

Figure 1. Watsons theory of caring science as adapted from Sourial (1996).


Assumptions
Watson's assumptions related to caring science values (Cohen, 1991): 1) Care and
love are the most universal, mysterious, intense cosmic forces they cover the primal and
universal psychic energy; 2) Often these needs are unnoted, or we know people need each
other in loving and caring ways, but often we do not behave well toward each other. If our
humanity is to survive, however, we need to become more caring and loving to nourish our
humanity and evolve as a civilization and live together; 3) Since nursing is a caring
profession, its ability to maintain caring ideal and ideology in practice will affect the human
development and determine nursing's contribution to society; 4) As a beginning we have to
enforce our own will to care and love toward ourselves and not to others. We have to treat
ourselves with gentleness and dignity before we can respect and care for others with

Running head: WATSONS THEORY OF CARING SCIENCE


1
gentleness and dignity; 5) Nursing has always held a human-care and caring foundation in
WATSONS
THEORY
OF
CARING
WATSONSto
THEORY
OFhealth-illness
CARINGSCIENCE
SCIENCE
10
connection
people with
concerns; 6) Caring is the heart of nursing and the 11
most central and unifying focus for nursing practice; 7) Caring at the individual and group
level, has received less and less emphasis in the health care delivery system; 8) Caring values
of nursing have been submerged nursing and society in sustaining human care ideals and a
caring ideology in practice; 9) Preservation and progress of caring as both an epistemic and
clinical initiative is a significant issue for nursing today and in the future; 10) Caring can be
effectively demonstrated and practiced only lnterpersonally. The intersubjective human
process keeps alive a common sense of humanity; it teaches us how to be human by
identifying ourselves with others, whereby the humanity of one is reflected in the other; and
11) Nursing's social, moral, and scientific contributions to humankind and society lie in its
commitment to human care ideals in theory, practice and research.
Critique of The Theory
Analysis of nursing theory; which is the first step in applying nursing theory to
education, research, administration, or practice, is an important process conducted to attain
knowledge about theoretical adequacy so nurse scientists are able to test, expand, or extend
the theory within their research interests (Alligood, 2014). To determine theoretical adequacy,
analysis criteria are provided (Chinn & Kramer, 2008).
Clarity
Watson's concepts are well-defined and her definitions for concepts are used
consistently. Watson's conversational style does make her work rather undisciplined (Sourial,
1996). The use of metaphors, personal reflections, artwork, and poetry make her concepts
more tangible and more aesthetically appealing, but in the other hand it makes the concepts
are difficult to understand at once (Alligood, 2014). There are no flaws in the structural

Running head: WATSONS THEORY OF CARING SCIENCE


1
consistency of her propositions, but additional diagrams will help to make her theory more
WATSONS
THEORY
concise (Sourial,
1996).OF CARING SCIENCE

12

Simplicity
Some scholars find that Watson's theory is easy to understand and to apply in practice,
because Watson draws on a number of disciplines, which she feels are familiar to nurses, to
formulate her theory (Alligood, 2014). But some others consider her theory complex. It is not
unusual because nurses may not have all of the liberal arts background to provide the
foundation for understanding some of Watson's principles (McCance et al., 1999).
Generality
Watson's theory is classified into grand nursing theory since the scope of the
framework encompassess broad aspects of health-illness phenomena. The theory is global
and abstract and therefore it is not unusual to find unclear linkages between concepts.
Watson's theory allows to develop from it more middle-range theories, especially with respect
to the 10 carative factors (Cohen, 1991).
Accessibility
Since Watson's theory is derived from many disciplines and it utilizes terms or
concepts that are not immediately familiar to many nurses, an understanding of Eastern
philosophy and/or phenomenology is almost required before the model could be utilized. In
spite of this, this theory has broad applicability. It addressess the core of nursing (therapeutic
nurse-patient relationship), not the trim of nursing (procedure, tasks, technique), and applies
to all aspects of health and illness (Cohen, 1991). The theory was found to be applicable to
nurses and patients in all settings including both ambulatory and acute care, at all phases of
development (Caruso, Cisar, & Pipe, 2008). Despite being developed for individuals,
Watson's theory is proposed as a nursing framework that is philosophically congruent with
contemporary global approaches to community health and health promotion (Rafael, 2000).

Running head: WATSONS THEORY OF CARING SCIENCE


Qualitative, naturalistic, and phenomenological methods are relevant to test this theory,

WATSONS
THEORY
OF that
CARING
SCIENCE
13
although Watson
suggests
a combination
of qualitative-quantitative study may be useful
(Alligood, 2014).
Importance
Watson's theory is derived from many disciplines, therefore it provides a very useful
metaphysical, philosophical and spiritual dimension to nursing. Her 10 carative factors
provide a framework by which nursing can redeem itself from a curative role and highlight its
distinctive caring role. This theory incorporates important aspects of patient safety, as well as
gives attention to nurses to care for themselves (Caruso et al., 2008). With respect to
education, this theory stresses the importance of the role of humanities, spirituality, and art as
the vital part in nursing education curricula (Cohen, 1991).
Implementation of the Theory
WATSONS
Practice THEORY OF CARING SCIENCE

14

Watson's theory can help nurse practitioner to look back on his or her lived experience
that accumulates and gathers interpretive significance as it is remembered; and help to
establish and maintain future caring relations by answering these kind of questions (McEwen
& Wills, 2007): 1) What health event brings this person to health facility?; 2) What
information do I need to know in taking care of this person?; 3) Can I find new ways of
caring?; 4) Can I encourage to find hope?; 5) How can I enter this person's private space?; 6)
What specific forms of caring will best acknowledge, affirm, and sustain?; 7) How can I
enable this person to express his or her concern?; 8) How must this person be feeling?; 9)
What is the uniqueness of this person?; 10) How has this event affected his or her life pattern
and role?
Watsons theory has been validated in outpatient, inpatient, and community health
clinical settings with various populations. A model called "Attending Nurse Caring Model

Running head: WATSONS THEORY OF CARING SCIENCE


1
(ANCM)" is constructed as a theory-guided, evidence based practice model (Alligood, 2014).
WATSONS
THEORY OFinCARING
SCIENCE
15
The nurses participating
the ANCM
project were learning how the model can increase their
caring consciousness and intentionality to use knowledge and evidence, as well as to help
increase autonomy, enhance interdisciplinary teamwork and reduce suffering in patients and
families. Finally, the ANCM improves nursings caring values, relationships, therapeutics and
responsibilities to a higher/deeper level, sustaining the finest of its heritage and traditions of
healing, while in collaboration with other health professions (Watson & Foster, 2003).
Watson also developed "The Watson Caritas Patient Score (WCPS)", which is a reliable and
valid instrument used in hospitals and systems throughout the United States (and other parts
of the world) to assess perspectives of caring practices of hospital staffs. The instrument
contains five critical caring questions to assess caring practices which are derived from the 10
carative factors. Caring practices in this instrument include providing care with loving
kindness, having helping and trusting relationships, creating caring environments, meeting
basic needs, and valuing the patients personal beliefs and faith (WCSI, 2014).
Administration
In relation to its application in administration and leadership, as an awareness to the
lack of human caring in the system, a number of hospitals in the United States have shifted
toward explicit implementation of Watson's caring science theory as a guide toward
professional nursing practice changes, as well as culture institutional changes. Some of this
momentum is triggered by the American Nurses Credentialing Center, Magnet Hospital
Program. Magnet hospitals must demonstrate criteria that recognize quality patient care,
nursing excellence, and innovations in professional practice. Through Magnet criteria,
Watson's caring science theory helps nurses to consciously shifted from task-oriented
biomedical practices to deeper levels of caring (Watson, 2009).
Research

Running head: WATSONS THEORY OF CARING SCIENCE


1
Applying Watson's nursing theory to assess patient perceptions of being cared
WATSONS
THEORY OF
CARING SCIENCE
16
for in a multicultural
environment.
This study aimed to explore Saudi patient perceptions
of important caring behaviors of nurses where most nurses in the workforce come from
different cultural backgrounds from the patients. Result showed that Saudi patients
recognized overall caring behaviors as derived from 10 carative factors as important. It also
provided evidence that carative factors in Watson's theory were also applicable in Middle
Eastern cultures, aside from the fact that the theory was developed in Western cultural setting
(Suliman et al., 2009).
The effectiveness of Watsons Caring Model on the quality of life and blood
pressure of patients with hypertension. This study aimed to determine the effectiveness of
a nurses caring relationship based on Watsons Caring Model on the blood pressure and the
quality of life of hipertentive patients. The result showed that care given according to
Watsons Caring Model was likely to associated with decreased blood pressure and increased
quality of life of the patients. This study acted as an evidence that nursing care can be given
systematically and nursing science and art can be congruent in nursing practice (Erci et al.,
2003).
Evaluation research within the human caring framework. Neil and Schroeder (as
cited in McCance et al., 1999) provided an example of the practical application of Watson's
theory through a project focused on an outpatient centre for persons living with HIV-AIDS
which used Watson's work as the basis for education, clinical practice and research. The result
indicated that authentic caring reationships helped to strengthen individual healing process,
which contributed to decreased length of hospital stay and hospital admission, which lead to
significant potential cost saving.
The multidimensionality of caring: a confirmatory factor analysis of the Caring
NursePatient Interaction Short Scale. The Caring NursePatient Interaction Short Scale

Running head: WATSONS THEORY OF CARING SCIENCE


1
(CNPI-Short Scale) was originally named Caring NursePatient Interactions Scale (CNPIWATSONS
OFa CARING
SCIENCE to assess attitudes and behaviours associated
17
Long Scale),THEORY
which was
70-item questionnaire
with Watsons 10 carative factors. It then was refined due to its length to be a 23-item
questionnaire reflecting four caring domains (humanistic care, relational care, clinical care
and comforting care) (Cossette et al., 2006). This paper added empirical support of the
construct validity of CNPI-Short Scale. During the construct validity process, this model
emerged as a middle-range theory and offered a structure that is testable in clinical research,
while still reflected Watson's theory of caring (Cossette et al., 2008).
Comfort: exploration of the concept in nursing. Kolcaba (as cited in Malinowski &
Stamler, 2002) described comfort as the state of having met basic human needs in physical,
social, psychospiritual, and environmental contexts. In order to gain a profound
understanding of comfort, transpersonal caring relationship should be established.
Additionally, Watson provided a direct reference to comfort in her eight carative factor. She
stated that comfort is an external variable that the nurse can control, therefore comfort
activities can be supportive, protective, or even corrective for a person's internal and external
environments (Malinowski & Stamler, 2002).
Caring theory as an ethical guide to administrative and clinical practices. In
dealing with nursing shortage and improving quality of care, addressing the system's problem
on the surface (for example, increasing enrollments, giving more incentives, etc.) will only
create a hostile environment that places money over human life and quality of caring-healing
experiences for patients and practitioners. Caring and economics, however, are not mutually
exclusive. Caring in Nursing Administration model is developed to transform medical system
to shift from economics towards professional practice that is based on morality-ethics-values,
to make it cost-benefit and cost-efficient (Watson, 2006).

Running head: WATSONS THEORY OF CARING SCIENCE


1
Watson's philosophy, science, and theory of human caring as a conceptual
WATSONS
OFcommunity
CARING SCIENCE
18
framework THEORY
for guiding
health nursing practice. Hesitance to using Watson's
theory to guide community health nursing practice is usually related to the centrality of the
transpersonal relationship concept, and the question of how it can be translated into nursing
practice in which communities are the focus of attention. In fact, the philosophy underpinning
a person-to-person relationship can be extended to person-to-community relationship, which
is congruent with the concept of mutuality that is central to transpersonal caring relationship.
The concept of wholeness, as well as nursing metaparadigm concepts in Watson's theory, is
applicable in guiding community health nursing practice. Community assessment guided by
Watson's theory is also provided in this study (Rafael, 2000).
Creating a healing environment : an innovative educational approach for
adopting Jean Watson's theory of human caring. This study described an educational
model which was developed to deliver Watson's theory and its use within 3 areas (practice,
education, and research). The educational model included reflection-session, role-play, and
discussion. This is proved to be valuable in improving nurses' caring efficacy and selfconfident in conveying intentional caring towards the patients (Caruso et al., 2008).
Advancing nursing theory through theory-guided practice: the emergence of a
critical caring perpective. "Critical caring" is proposed as a hybrid, middle-range theory in
public health nursing practice. Critical caring transforms Watson's 10 carative processes into
7 carative health-promoting processes that form a core of public health nursing practice and
will need to be developed further in the future (Rafael, 2005).
Application in Indonesia
Practice
Indonesia is known to have "patient-classification" in a public hospital based on
patients' health insurance and their capability to pay the health service, in term of room

Running head: WATSONS THEORY OF CARING SCIENCE


1
occupied by the patients. Although the practitioners always try their best to provide the same
WATSONS
THEORY
OFespecially
CARINGthe
SCIENCE
18
quality of treatment
and
nurses, who always try their best to establish the same
quality of caring relationship, it is not denied that nurses tend to be more caring toward
patients who occupy higher-class room. Application of Watson's theory will help nurses to
establish caring relationship and to create healing environment to all kind of patients, at all
moments, to increase quality of care and patients' satisfaction.
Education
Integrating Watson's theory in the bachelor nursing curriculum, especially in the first
semester, will help nursing students to realize the identity of being a nurse and to find the
autonomy role of the nurse. Integrating caring aspects in each guideline of nursing activities
will help nursing students to acknowledge that being a nurse is more than doing technicalmedical work, but to establish a human-to-human relationship which the harmony of mindbody-spirit is the outcome.
Administration
Apart from the fact that Indonesian hospitals do not apply Magnet criteria, using
instruments developed from Watson's theory to evaluate caring behaviors by practitioners is
very important to be done, as efforts to improve quality of care.
Research
There are many studies conducted in cultural and local wisdom field, which is
WATSONS
THEORY
OF CARING
SCIENCE
19
closely related
to Watson's
concept, and
it can be considered as a good start to conduct more
studies based on Watson's theory.

Running head: WATSONS THEORY OF CARING SCIENCE

References
WATSONS
CARING
SCIENCE
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