Learning Team 3 Poster Presentation

1. Watson’s Theory of Caring
Angela Guerra, Donnice Johnson, Danisile Maphosa, Idavong Phonasa, Christine Pinones, John Salinas
NURSE 5310 Dr. Elizabeth Sefcik, Ph.D., RN, GNP-BC
Texas A&M University Corpus Christi
Introduction
Internal Consistency
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Definitions of concepts are used consistently.
The structural consistency of the theory has no flaws.
Broad concepts need more clear definition.
Intersubjective ideal concept is only briefly mentioned.
Concept of transcendence is not explained all.
Interchanging words such as caring transaction, occasion or moment when
referring to the same concept can lead to some confusion.
• The context and content are congruent.
Watson’s Caring Theory provides
a “philosophical and moral/ethical
foundation for the profession of
nursing” (Watson, 2013). The belief that
nursing is an intersubjective human
process and emphasizes the caring
relationship between the nurse and the
patient is the basis for the theory. Ten
carative factors provide a framework
for the nurse to provide care which may
promote positive outcomes and preserve
human dignity. Both nursing and
medicine embrace the theory because
of its holistic approach to patient care.
Other health and human service
disciplines may also find application for
the theory.
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Philosophical Claims
> Consistent with “humanism” - a human science driven world view based on the
unity and connectedness of all
> Draws heavily on Eastern philosophy
Application
Application of the Propositions of the Theory
•Caritas 5, “Promoting and accepting positive and negative feelings as
you authentically listen to another’s story”
•Caritas 7, Share teaching and learning that addresses the individual
needs and comprehension styles
(Watson, 2007)
The theory has become an interdisciplinary area of study. It has been used as an
academic resource for other scholarly and professional fields.
Testability of Grand Theory
Empirical Adequacy
Propositions
•Concepts of person, health, nursing, and environment are interrelated
•The person is viewed holistically and is influenced by nursing care in the physical
and nonphysical environment.
•The nurse-patient relationship positively affects the healing process and
promotes restoration of health.
•Nursing focuses on helping the patient achieve a higher level of harmony of
mind, body, and spirit
•Harmony of mind, body, and spirit achieved through caring and the transpersonal
caring relationship.
•Positive patient outcomes occur as a result of a helping and caring nurse-patient
relationship
•It is a grand theory which is broad – touching many aspects of nursing.
•Provides many useful concepts for the practice of nursing and education.
•Detailed descriptions of the ten caritas factors can be used to guide and
improve practice, and could be used in research
Significance to the Nursing Profession
> Provides a framework for nursing processes and holistic care that allows nurses to
 Conceptual Model
> No explicit conceptual model from which it was derived
> Developed from a metaphysical, phenomenological, existential and spiritual
orientation
> Dynamic and evolving – a work in progress .
Concepts are organized and presented in an easy to understand format.
Role of both nurse and patient in the caring process is clearly explained.
Many terms are uncomplicated and simple to follow.
Some terms are abstract and difficult for Western nurse to comprehend
without explanation.
• The ten caritas processes are clearly identified.
• Diagrams can easily covey the process of transpersonal caring and the dynamics
of the nurse-patient relationship.
Relationships among the concepts of theory
•Assumes caring and the nurse-patient relationship lead to positive outcomes
•Described by Watson as central to nursing practice, because it addresses caring
relationships between humans and the deep experiences of life.
•Primary goal of nursing is assumed to be helping the patient achieve a higher
degree of harmony within mind, body, and soul.
•Nursing is believed to be responsible for creating an environment that is
conducive to healing by displaying a positive attitude and accepting the patient
unconditionally .
Significance / Four Metapardigms
facilitate positive changes in a patient’s health status.
> Promotes a “transpersonal caring healing model of nursing” built on mutual trust
between nurse and patient
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Watson's theory incorporates a holistic approach to patient care and
focuses on the relationship between the patient and nurse. Caring science is an
evolving field that is dependent upon the nursing profession and science. The
science is relevant to health, education, and human service professions. The unity
created from caring relationships with others, the community, and the universe
is acknowledged by the act of transpersonal caring. The theory is guided by the
ten caritas processes. These provides framework for incorporating caring into
one’s professional or personal life.
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Parsimony
Description of the Theory
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Significance
 Although much research continues to be published, additional
research is needed to fully establish the empirical adequacy of
Watson’s Theory of Human Caring
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 As of yet, there has been no published research that documents
the outcomes of a Transpersonal Caring Relationship or the
effects of the Ten Caritas Processes, as described by Watson
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Description / Ten Caritas Processes
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Mrs. G is a 68-year-old widow with stage IV colon cancer and metastasis to the bone. She is on
hospice services; her daughter, Sara, moved in to care for her. Upon arrival to the home, Sara greets
the RN. Sara avoids eye contact, answers questions abruptly, and appears angry. Mrs. G is pleasant
and responds politely, but her smile is forced. She tells the RN that she is, “doing pretty good.”
However, the RN notices frequent grimaces and avoidance of movement; Mrs. G appears to be in pain.
Built upon elements that are subjective and related to the experiences of the
individuals involved
Testable using phenomenological methods, which considers the description of
the individual’s personal experiences and beliefs
Consistent with grand theories - encompasses all persons as its population of
interest and attempts to explain and describe “caring” as a foundation for all
nursing
Attempts to help nurses to, “translate their unique talents, interests, and
gifts into human service of caring and healing, for self and others, and even
the planet Earth itself”
Core principles focused on healing, building relationships and personal
experiences, can be applied and examined through a humanistic model.
Personal experiences are significant because of the impact they have upon the
caregiver and recipient of care.
Subjective experience and transpersonal relationships are fundamental to the
theory
The RN establishes a caring relationship through open communication with Mrs. G
(Caritas 5)
> The RN asks and encourages Mrs. G to: rate her pain, and openly discuss her thoughts,
fears, and emotions.
> Mrs. G describes pain at, “7-8” and reports, “no fear” related to her medication. She
states that her daughter becomes frustrated when asked to give her pain meds.
Mrs. G believes Sara is uncertain how she is to administer the medications.
> Mrs. G states that she only wants to “protect” her daughter and make her job easier.
> The RN listens to Mrs. G and encourages her to talk openly about her feelings and her
thoughts about Sara’s behavior and feelings.
The RN establishes a caring relationship through open communication with Sara
(Caritas 5)
> When alone with Sara, the RN encouraging her to express her fears and frustrations
Ten Caritas Processes™
1.Embrace altruistic values and Practice loving kindness
with self and others.
2.Instill faith and hope and honor others.
3.Be sensitive to self and others by nurturing individual
beliefs and practices.
4.Develop helping – trusting- caring relationships.
5.Promote and accept positive and negative feelings as
you authentically listen to another’s story.
6.Use creative scientific problem-solving methods for
caring decision making.
7.Share teaching and learning that addresses the
individual needs and comprehension styles.
8.Create a healing environment for the physical and
spiritual self which respects human dignity.
9.Assist with basic physical, emotional, and spiritual
human needs.
10.Open to mystery and Allow miracles to enter.
Caritas Processes refined from Inova Health
Jean Watson 2007
openly.
> At first, Sara is rude and angry; the RN simply listens and allows Sara an opportunity to
vent her frustrations without fear of judgment.
> The nurse avoids statements such as, “You shouldn’t feel that way”. Instead, she validates
Sara’s feelings by restating them back to her.
> Eventually, Sara begins to cry – stating, “I can’t stand to see her like this” and “ I feel like a
failure, because she never seems to be pain free for long”.
> The RN listens and encourages Sara by explaining that hospice staff, including a social
worker and a chaplain, will be available 24/7 to listen and support her.
Pragmatic Adequacy
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Watson provides a framework to nursing practice specific to
professional nurses in the real world.
Several studies have applied Watson’s theory in the real world of
nursing practice with positive outcomes.
It is legal for the practitioner to implement and measure this
theory’s effectiveness.
Theory-based nursing actions are compatible with expectations for
nursing practice and lead to favorable outcomes as evidenced by the
Denver Nursing Project in Human Caring.
Based on this study, comparisons have been made before and after
implementation of Watson’s Theory of Caring.
Not only did patients report that the program was important to
their overall emotional and physical health, but an increase in job
satisfaction was reported by nurses, hospital length of stay was
decreased, and health care costs were lowered
The RN shares teaching that addresses the individual needs and comprehension
styles (Caritas 7)
> Once Sara is calm, the RN provides education about pain medication and Mrs. G’s disease
process.
> The RN provides adequate information, but is careful to limit it to only what Sara can absorb
at this time.
> The RN also assures Sara that she will review information at every visit and that Sara can
call anytime with questions. She verifies that the education has reduced the stress felt by
Sara and that she has answered her questions thoroughly.
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The RN then facilitates a conversation between mother and daughter. Sara tells her mother that
she will feel better if her mother is honest about her symptoms and pain level. Mrs. G reassures Sara
that she feels well cared for and appreciates her efforts. Ultimately, Mrs. G feels comfortable
asking for pain medication, and Sara becomes confident in her ability to administer her mother’s
medications. The RN establishes a caring relationship in which both patient and caregiver trust the
RN enough to communicate their honest thoughts and feelings.