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Watson proposed even assumptions about the science of caring. The basic assumptions are:
The structure for the science of caring is built upon ten carative factors. These are:
Begins developmentally at an early age with values shared with the parents.
Mediated through one’s own life experiences, the learning one gains and exposure to
the humanities.
Is perceived as necessary to the nurse’s own maturation which then promotes altruistic
behavior towards others.
Faith-hope
Explores the need of the nurse to begin to feel an emotion as it presents itself.
Development of one’s own feeling is needed to interact genuinely and sensitively with
others.
Striving to become sensitive, makes the nurse more authentic, which encourages self-
growth and self-actualization, in both the nurse and those with whom the nurse
interacts.
The nurses promote health and higher-level functioning only when they form person-to-
person relationship.
Strongest tool is the mode of communication, which establishes rapport and caring.
She has defined the characteristics needed to in the helping-trust relationship. These
are:
I. Congruence
II. Empathy
III. Warmth
Communication includes verbal, nonverbal and listening in a manner which connotes
empathetic understanding.
According to Watson, “feelings alter thoughts and behavior, and they need to be
considered and allowed for in a caring relationship”.
According to her such expression improves one’s level of awareness.
Awareness of the feelings helps to understand the behavior it engenders.
According to Watson, the scientific problem-solving method is the only method that
allows for control and prediction, and that permits self-correction.
She also values the relative nature of nursing and supports the need to examine and
develop the other methods of knowing to provide a holistic perspective.
The science of caring should not be always neutral and objective.
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.
Provision for a Supportive, Protective and/or Corrective Mental, Physical, Sociocultural and
Spiritual Environment
Watson divides these into eternal and internal variables, which the nurse manipulates in
order to provide support and protection for the person’s mental and physical well-
being.
The external and internal environments are interdependent.
Watson suggests that the nurse also must provide comfort, privacy and safety as a part
of this carative factor.
Example
Bulimia, anorexia and gastrointestinal ulcers are a just few of the disorders that indicate a
complex interaction between the physiological and psychological.
Phenomenology is a way of understanding people from the way 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 viewing the
person holistically while 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.
Human Being
She adopts a view of the human being as: “…... a valued person in and of him or herself
to be cared for, respected, nurtured, understood and assisted; in general, a
philosophical view of person as fully functional integrated self. He, human is viewed as
greater than and different from, the sum of his or her parts”.
Health
Watson believes that there are other factors that are needed to be included in the WHO
definition of health.
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 way of coping with its environment.
Nursing
According to Watson “nursing is concerned with 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”.
Watson points out that nursing process contains the same steps as the scientific
research process. They both try to solve a problem. Both provide a framework for
decision making. Watson elaborates the two processes as:
Assessment
Plan
Intervention
Evaluation
Analysis of the data as well as the examination of the effects of the interventions based
on the data. Includes the interpretation of the results, the degree to which positive
outcome has occurred and whether the result can be generalized.
It may also generate additional hypothesis or may even lead to the generation of a
nursing theory.
Evaluation
Analysis of the data as well as the examination of the effects of interventions based on
the data. Includes the interpretation of the results, the degree to which positive
outcome has occurred and whether the result can be generalized.
It may also generate additional hypothesis or may even lead to the generation of a
nursing theory.
Watson’s work is logical in that the factors are based on broad assumptions which
provide a supportive framework.
With these carative factors she delineates nursing from other professions.
These carative factors are logically derived from the assumptions and related to the
hierarchy of needs.
The theory is relatively simple as it does not use theories from other disciplines that are
familiar to nursing.
The theory is simple relatively but the fact that it deemphasizes the pathophysiological
for the psychosocial diminishes its ability to be generalizable.
She discusses this in the preface of her book when she speaks of the “trim” and the
“core” of nursing.
She defines trim as the clinical focus, the procedure and the techniques.
The core of the nursing is that which is intrinsic to the nurse-client interaction that
produces a therapeutic result. Core mechanisms are the carative factors.
Strengths
Besides assisting in providing the quality of care that client ought to receive, it also
provides the soul satisfying care for which many nurses enter the profession.
As the science of caring ranges from the biophysical through the intrapersonal,
each nurse becomes an active coparticipant in the client’s struggle towards self-
actualization.
The client is placed in the context of the family, the community and the culture.
It places the client as the focus of practice rather than the technology.
Limitations
Given the acuity of illness that leads to hospitalization, the short length stay, and the
increasing complex technology, such quality of care may be deemed impossible to give
in the hospital.
While Watson acknowledges the need for biophysical base to nursing, this area receives
little attention in her writings.
The ten carative factors primarily delineate the psychosocial needs of the person.
While the carative factors have a sound, foundation based on other disciplines, they
need further research in nursing to demonstrate their application to practice.
Saint Joseph Hospital in Orange, California has selected Jean Watson’s theory of human
caring as the framework base for nursing practice.
The effectiveness of Watson’s Caring Model on the quality of life and blood pressure of
patients with hypertension. J Adv Nurs. 2003;41(2):130-9.
This study demonstrated a relationship between care given according to Watson’s
Caring model and increased quality of life of the patients with hypertension. Further, in
those patients for whom the caring model was practiced, there was a relationship
between the caring model and a decrease in patient’s blood pressure. The Watson
caring Model is recommended as guide to nursing patients with hypertension, as one
means of decreasing blood pressure and increase in quality of life.
Martin LS. Using Watson’s theory to explore the dimensions of adult polycystic kidney
disease. ANNA 1991; 18:403-6.
Mullaney JAB. The lived experience of using Watson’s actual caring occasions to treat
depressed women. Holistic Nursing 2000;18(2):129-42.
Conclusion
Bibliography
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