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Jean Watson’s Theory
Theory of Human Caring
PRESENTER: Ms. Ritika soni
OUTLINE
• Biography
• Creating the theory (why) (how)
• Basic assumptions of theory
• Major elements
• Metaparadigms
• Application in nursing & other areas
• Strengths
• Limitation
• Example
• Conclusion
• References
Biography of Jean Watson
• Dr. Jean Watson is a nurse theorist
who developed “Philosophy and
Theory of Transpersonal Caring” or
“Caring Science” and founder of
Watson Caring Science Institute.
• She wanted to be a nurse at the
age of 10, when she saw a friend
of her older sister having a
seizure.
Born: West Virginia in a small town Welch,
10 June 1940, youngest of eight children.
Educated: BSN (1964), MS (1966), PhD
(1973) from University of Colorado.
Dr. Watson has earned undergraduate and
graduate degrees in nursing and psychiatric-
mental health nursing and PhD in educational
psychology and counseling.
Distinguished Professor of Nursing at the
University of Colorado Health Sciences
Center.
She was also the Dean of Nursing at the
University Health Sciences Center and
President of the National League for Nursing
Widely published author and recipient of several awards and
honors, six Honorary Doctoral Degrees, including 3
International Honorary Doctorates (Sweden, United Kingdom,
Canada).
Her research has been in the area of human caring and loss.
The foundation of Jean Watson’s theory of nursing was
published in 1979 in nursing: “The philosophy and science of
caring”
In 1988, her theory was published in “nursing: human science
and human care”.
In 2002 she published the book “Assessing and measuring
caring in nursing and health sciences”
Author and co-author of over 20 books
Past President of the National League of Nursing
Fellow of American Academy of Nursing
Distinguished Professor of Nursing and Chairman in
Caring Science at the University of Colorado
Health Sciences Center
(watsoncaringscience.org, 2015)
Career Milestones
Founding member of International Association in Human Caring and
International Caritas Consortium (watsoncaringscience.org, 2015)
Founder and Director of the Watson Caring and Science Institute
(watsoncaringscience.org, 2015)
In 2010 launched the Million nurse Global Caring Field Project (2015)
October 2013 was inducted as a Living Legend by the American
Academy of Nursing (Kelly, 2013)
The following publications reflect the evolution of her
theory of caring from her ideas about the philosophy and
science of caring.
• Nursing: The Philosophy and Science of Caring (1979)
• Human Science and Human Care – A Theory of Nursing (1985)
• Reprinted in 1988 & 1999.
• Postmodern Nursing and Beyond (1999)
• Instruments for Assessing and Measuring Caring in Nursing
and Health Sciences (2002)
• Caring Science as Sacred Science (2005)
AWARDS
• The Fetzer Institute Norman Cousins Award (watsoncaringscience.org,2015)
• International Fellowship award in Australia (watsoncaringscience.org,2015)
• Fulbright Research Award in Sweden (watsoncaringscience.org,2015)
• Living legend , inducted in 2013 by the American academy of nursing.
• Holds 10 honorary Doctoral Degrees including 8 International honorary
Doctorates 10 Holistic Nurse of the Year (ahna.org, 2010)
CREATING THE THEORY (WHY)
• Watson’s commitment: enhance the professional role and mission of nursing;
sustaining human caring and preserving human dignity; humanity, and
wholeness in the midst of threats and crises of life and death
• The goal was to enhance the public view of humanity and life in correlation
with nursing
CREATING THE THEORY (HOW)
• Used concepts from personal and professional experience
• “Dr. Watson drew parts of her theory from nursing writers
like Florence Nightingale as well as from works of
psychologists and philosophers.” (Theory Description, n.d.)
• “Her theory is one based on the human interactive process
that recognizes the spiritual and ethical dimensions relevant to
the human care process.” (Theory Description, n.d.)
CREATING THE THEORY
(HOW)
Dr. Watson states that her personal experience had been to live out her theory,
she did not fully understand her purpose until she was involved in a freak
accident where she lost her eye sight. She describes it as:
My soul life journey, purpose and learning transcended my professional world.
“It was only after a traumatic eye injury and uncanny golfing accident with my grandson, (where
I lost my eye, literally, metaphorically and symbolically – losing my left eye/(ego)/ I . I had to
learn to be still, to surrender to all, to let go, to learn to receive, to be open to unknown mystery
and miracles – it was the mystic and metaphysical/spiritual practices and inner experiences that
carried me through.
It was this journey of losing my eye and losing my world as I had known it, including my
beloved and devoted husband, who shortly thereafter, committed suicide & left Watson and their
two grown daughters, Jennifer and Julie, and five grandchildren –that I awakened and grasped
my own writing. I was given the painful but loving, growing blessings of spiritual mystical
experiences, that I have experienced and learned my oneness with all. I learned that all there is
Love. We are all energy of LOVE.” (Watson, 2015).
• Watson states that she is “attempting to integrate these
wounds into my life and work. One of the gifts through the
suffering was the privilege of experiencing and receiving my
own theory through the care from my husband and loving
nurse friends and colleagues.” These two personal life-altering
events contributed to writing her third book, Postmodern
Nursing and Beyond.
Philosophy and Theory of Transpersonal Caring
/Watson’s Theory of Transpersonal Caring?
• According to Watson’s theory, “Nursing is concerned with
promoting health, preventing illness, caring for the sick, and
restoring health.” It focuses on health promotion, as well as the
treatment of diseases. According to Watson, caring is central to
nursing practice, and promotes health better than a simple medical
cure.
• The nursing model also states that caring can be demonstrated and
practiced by nurses. Caring for patients promotes growth; a caring
environment accepts a person as he or she is, and looks to what he
or she may become.
BASIC ASSUMPTIONS OF THE
THEORY
Watson proposes seven assumptions:
Caring can be effectively demonstrated and practiced only
interpersonally.
Caring consists of carative factors that results in the satisfaction of
certain human needs.
Effective caring promotes health and individual or family growth.
Caring responses accept a person not only as he or she is now but as
what he or she may become.
A caring environment is one that offers the development of
potential while allowing the person to choose the best action for
himself at a given point in time.
Caring is more “healthogenic” than is curing. The practice of
caring integrates biophysical knowledge with knowledge of human
behavior to generate or promote health. A science of caring is
complementary to the science of curing.
The practice of caring is central to nursing.
Watson Proposes following 11 assumptions
Watson says that nursing education and health care delivery system must be based
on human values and concern for the welfare of others.
1. Care & Love comprise the primal and universal psychic energy.
2. Care & love , are the cornerstones of our humanness; nourishment of these
needs fulfill our humanity.
3. The ability to sustain the caring in practice will affect the development of
civilization and determine nursing contribution in society.
4. Caring for ourselves is perquisite caring for others.
5. Historically nursing has held a human care and caring stance in regard to people
with health- illness concern.
6. Caring is the central unifying focuses of nursing practice, the essence of
nursing.
7. Caring at the human level has been increasingly in the health care delivery
system.
8. Nursing’s caring foundation has been sublimated by
technological advancement and institutional constraints.
9. A significant issue for nursing today and in the future is the
preservation and advancement of human care.
10.Only through interpersonal relationships can human care be
effectively demonstrated and practiced.
11.Nursing social, moral, and scientific contributions to human
kind and society lie in its commitments to human care ideals in
theory practice and research.
MAJOR CONCEPTUAL ELEMENTS
1. The ten carative factors
2. Transpersonal caring relationship
3. Caring occasion
4. Caring and healing model of theory
When looking at this theory of practice, Black informs us that
the emphasis for nursing practice focuses primarily on “How
can I create an environment of trust, understanding, and
openness so that the patient and I can work together in meeting
his or her needs?” (Black, 2014).
1. Ten CARATIVE FACTORS
• Goal was to provide a framework for the “core of nursing”
Watson referred to the “core” as the philosophy, science and art of caring
• Caritas-comes from the Latin word meaning “to cherish and appreciate,
giving special attention to, or loving.” Builds upon Carative Factors
• Caritas processes openly displays more love and caring and a deeper human
experience (Watson, 2014)
ORIGINAL 10 CARATIVE
FACTORS
1 .Formation of a humanistic–altruistic system of values
2. Instillation of faith–hope
3. Cultivation of sensitivity to one’s self and to others
4.Development of a helping–trusting, human
relationship
caring
5.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.Provision for a supportive, protective, and/or corrective mental, physical,
societal, & spiritual environment
9. Assistance with gratification of human needs
10.Allowance for existential–phenomenological–spiritual forces
(Watson, 2014)
1. THE FORMATION OF A HUMANISTIC-ALTRUISTIC SYSTEMOF
VALUES
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 / experience which
then promotes altruistic behaviour towards 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 well-being through beliefs which
are meaningful to the individual.
3. CULTIVATION OF SENSITIVITY TO ONE’S SELF ANDTO
OTHERS
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.
4. ESTABLISHING A HELPING-TRUSTING HUMAN CARING
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:
• Congruence/ harmony
• Empathy
• Warmth
Communication includes verbal, nonverbal and listening in a manner which
connotes(imply) empathetic understanding.
5. THE EXPRESSION OF FEELINGS, BOTH POSITIVE AND NEGATIVE
“Feelings alter thoughts and behaviour, and they need to be considered and
allowed for in a caring relationship”.
Awareness of the feelings helps to understand the behaviour it engenders.
6. THE SYSTEMATIC USE OF THE SCIENTIFIC PROBLEM-SOLVING
METHOD FOR DECISION MAKING
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 an holistic perspective.
The science of caring should not be always neutral.
7. PROMOTION OF INTERPERSONALTEACHING-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-CULTURALAND
SPIRITUALENVIRONMENT
Watson divides these into external 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.
9. ASSISTANCE WITH THE GRATIFICATION OF HUMAN
NEEDS
It is grounded in a hierarchy of need similar to that of the Maslow’s.
She has created a hierarchy which she believes is relevant to the science
of caring in nursing.
According to her 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
Lower order needs (biophysical needs)
The need for food and fluid
The need for elimination
The need for ventilation
Lower order needs (psychophysical needs)
The need for activity-inactivity
The need for sexuality
Watson’s ordering of needs
Higher order needs (psychosocial needs)
The need for achievement
The need for affiliation
Higher order need (intrapersonal-
interpersonal need)
The need for self-actualization
self-
actualization
(Psychosocial
needs)
Need for
achievement,
affiliation
(Psychophysical needs)
The need for activity-
inactivity, sexuality
(Biophysical needs)
The need for food and fluid,
elimination, ventilation
10. ALLOWANCE FOR EXISTENTIAL-PHENOMENOLOGICAL
FORCES
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 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.
“Too often we underestimate
the power of a touch, a
smile, a kind word, a
listening ear, an honest
compliment, or the smallest
act of caring, all of which
have the potential to turn a
life around.”
2.THE TRANSPERSONAL CARING
RELATIONSHIP
• This portion of the theory focuses on “the one caring and the one cared
for.” (Cara, 2003). The nurse and patient can develop a deep divine
relationship that blends together and promotes overall health and well-
being.
• This process requires the use of “Actions, words, behaviours, cognition,
body language, feelings, intuition, thought, senses, and the energy field”
(Watson & Woodword, 2010).
• The nurse has a professional as well as a personal obligation to not only
see the patient as more than an object but to also protect and assist with
improving the patient’s dignity. (Cara, 2003)
•The nurse should be using her professional experience
to promote healing and bonding with the patient. This
may include the use of various communication
techniques, both verbal and non-verbal to achieve a
healing and gentle relationship. (Watson & Woodward,
2010)
• The nurse and the patient are transformed together in this relationship.
(Black, 2014).
3.THE CARING OCCASION/CARING
MOMENT
•This portion of the theory focuses on an actual tangible
moment in time in which the nurse recognizes the
connection that is developed between him/herself and the
patient. (Cara, 2003). This moment dictates the ability for
the nurse to have an overall impact on the patient.
•According to Cara, The Caring Moment “Consists of
feelings, bodily sensations, thoughts, spiritual beliefs,
goals, expectations, environmental considerations, and
meanings of one’s perceptions—all of which are based
upon one’s past life history, one’s present moment, and
one’s imagined future.” (Cara, 2003).
• This can occur during various nursing interventions and interactions with each patient.
4.CARING & HEALING MODEL OF
THEORY
• The nurse is able to help the patient with overall well-being by assisting
them with the release of “disharmony and blocked energy” (Watson &
Woodward, 2010).
• The use of this portion of the theory helps the patient with overall
healing and renewal. (Black, 2014).
• Nurses can impact the patient through “health promotion, health
restoration, and illness prevention” (Black, 2014).
WATSON’S THEORY AND THE
FOUR MAJOR CONCEPTS
1. PERSON
• She adopts a view of the human being as: “….. a valued person to be
cared for, respected, nurtured, understood and assisted; in general a
philosophical view of a person as a fully functional integrated self. She
believes that humans are best viewed in developmental conflicts and
their family is necessary for health care.
• The nurse must understand human beings when they are sick, well or
under stress.
2. HEALTH
• Watson believes Health is the unity and harmony within the mind, body,
and soul.
• It is defined as a:
• A high level of overall physical, mental and social functioning
• A general adaptive-maintenance level of daily functioning
• 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.
Every society has had some people who cared for others .Watson viewed
environment and which helps the person to meeting their needs
accordingly.
4. 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, aesthetic and ethical human transactions”.
“May be this one moment, with
this one person, is the very
reason we’re here on Earth at
this time”s
WATSON’S THEORY AND NURSING PROCESS
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:
1. ASSESSMENT
Involves observation, identification and review of the problem; use of
applicable knowledge in literature.
Also includes conceptual knowledge for the formulation and
conceptualization of framework.
Includes the formulation of hypothesis; & factors that influence
the problem.
Assessment also includes defining variables that will be
examined in solving the problem.
2. PLAN
It helps to determine how variables would be examined or measured;
includes a conceptual approach or design for problem solving that is
referred to as the nursing care plan. It determines what data would be
collected, how & on whom.
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 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 AND THE
CHARACTERISTIC OF ATHEORY
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 work of numerous humanists,
philosophers, developmentalists and psychologists.
• The basic assumptions for the science of caring in nursing and the ten
carative factors that form the structure for that concept is unique in
Watson’s theory.
• She describes caring in both philosophical and scientific terms.
• Caring is placed in hierarchical contexts, meeting lower order physiological
needs first, then moving towards higher order psychosocial & intrapersonal
needs.
• She also said needs are iterrelated.
RESEARCH RELATED TO WATSON’S
THEORY
• Saint Joseph Hospital in Orange, California has selected Jean Watson’s
theory of human caring as the framework base for nursing practice.
Advanced Practice Nursing Quarterly,4(1), 70-77.
• The effectiveness of Watson's Caring Model on the quality of life and
blood pressure of patients with hypertension. J Adv Nurse. 2003
Jan;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
practised, there was a relationship between the Caring model and a
decrease in patient's blood pressure. The Watson Caring Model is
recommended as a guide to nursing patients with hypertension, as one
means of decreasing blood pressure and increase in quality of life.
• Mullaney, J. A. B. (2000). The lived experience of using Watson’s actual
caring occasions to treat depressed women 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 .
HOW TO INTEGRATE THEORY IN TO
NURSING PRACTICE
• Establishing a caring relationship with patient.
• Treat patients a holistic being
• Display unconditional acceptance
• Treat patients with positive regards.
• Promote health through knowledge and intervention
• Spend uninterrupted time with patient .
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.
• 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.
LIMITATIONS
1. Biophysical needs of the individual are given less important.
2. The ten carative factors primarily delineate the psychosocial needs of
the person.
3. Needs further research to apply in practice.
• Vidhya, a 59 year old factory worker, arrives at the emergency room in a
small, but busy hospital, not far from her place of employment. She is
complaining of intense pain in her left shoulder and anxiety. As an
causality nurse with 20 years experience, I have seen a lot of drug
seekers come in with the same complaints.
• Utilizing Watson’s Philosophy and Theory of Transpersonal Caring, I
know that I must not pre-judge any patient and I must develop a
Helping-Trust Relationship with each patient. Using empathy,
congruence, non-possessive warmth, and effective communication is
important in building a relationship with a patient in a short amount of
time, especially in an Emergency setting.
CASE SITUATION
• Vidhya cannot raise her left arm above chest level and there is no obvious injury to
the site. Her vitals are as follows: B/P 160/80, PR 115, and T 98.6. What aspect of
Watson’s Theory is put into action here?
• Answer 1. As the nurse caring for her, Watson’s Theory directs me that patients must
Satisfy lower order needs before attempting to attain higher order needs. Vidya’s
pain and anxiety must be controlled before she can process and accept what is
happening physically.
• Vidhya is given 50 mg of Tramadol and 2 mg of Lorazepam. She then
states that she has been SOB occasionally. Her pulse ox is 92% on room
air. At this point another one of Watson’s carative factors comes into
play. Which one?
• Answer 2. One of Watson’s Original 10 Carative Factors is the
Systematic Use of the Scientific Problem Solving Method for
Decision Making. I realize that this newly conveyed information may
be connected to her original complaints and collect this data for the
doctor to review. It is important to keep things organized, knowing what
and when to relay for further investigation.
• Vidhya is diagnosed with a mass on her adrenal gland and an enlarged lymph node
near her heart. She is oriented, but sleepy due to drug and still complains of pain in
her left shoulder. Her husband lost his job when his shop closed after working there
for thirty years. She is not covered by any insurance at this time. She has two grown
children and her daughter, is present with her . How can we approach this family
using Jean Watson’s Theory? Which two of the original carative factors could be
utilized?
• Answer 3. Watson’s Theory, based on the Original 10 Caratives, includes
Cultivation of Sensitivity to Self and to Others. This explains that as nurses
acknowledge their sensitivity and feelings, they become more genuine, authentic,
and sensitive to others. This leads to self-actualization through self-acceptance for
nurses and patients. Another one of Watson’s Caratives is Promotion and
Acceptance of the Expression of Positive and Negative Feelings. This is a huge
risk taking move on the part of nurses and patients. Be prepared for whatever feeling
is shared, good or bad. Everyone acts and reacts differently and uniquely to each
situation presented to them, including minor and major health dilemmas.
• Realizing that Vidhya and her daughter were just given some potentially
life threatening news, I encouraged them both to express how they were
feeling about this diagnosis.
• Prior to discharge, she was encouraged to seek an appointment with an
oncologist and given a prescription for pain meds to help keep her
comfortable until she can get in to see the doctor. I helped them out of
the cubicle and said a silent prayer for the battle they were about to
begin.
NURSING CONCEPTUAL MODEL OF
CARE
• The patient is at the centre of everything we do! Our view of nursing, person,
environment, and health affects how we interact with patients.
• Our model of caring is based on Sister Callista Roy's Theory of Adaptation and
Jean Watson's Theory of Human Caring.
• The conceptual framework guides us through the nursing process. We help the
patient and family adapt to their state of health and we do so with the unique
human-to-human interaction consistent with nursing.
• The conceptual framework provides the structure to achieve the Geisinger
Nursing vision of securing the legacy, quality, innovation and market growth.
This will ensure success in achieving the organization's mission of Heal, Teach,
Discover, and Serve
CARATIVE FACTORS & NURSING
“Watson’s theory offers a
conceptual approach to care
that is focused on the
nonmedical, human-to-
human caring relationships
that are viewed as the core of
nursing practice.” (Marckx,
1995, p. 46)
NURSING IMPLICATIONS:
• Nurses model of caring is based on Sister Callista Roy's Theory of
Adaptation and Jean Watson's Theory of Human Caring.
• Its conceptual framework guides us through the nursing process. We help
the patient and family adapt to their state of health and we do so with the
unique human-to-human interaction consistent with nursing.
Nursing is based on the concept of care. Many nurses have adopted Jean Watson’s
Caring Theory in their practice.
Nurses should establish a caring relationship with patients.
Mutuality should be obtained between the nurse and patient concerning the patient’s
healthcare situation and needs.
Nurses should treat patients as holistic beings (body, mind and spirit) with a positive
regard.
Nurses should promote health through knowledge and intervention, and display
acceptance towards patients that is unconditional.
Caring occasions/moments should transform both the patient and nurse, as they are
linked together.
REFERENCES
• GeorgeB Julia, nursingtheories- The base for
professional nursing practise, 3rd Edition, Norwalk,
Appleton &Lange.
• Taylor Carol, Lillis Carol (2001) The art & science of nursing
care, 4 th
• edition, Philadelphia, Lippincott.
• PotterA Patricia, Perry G Anne (1992), Fundamentals of
nursing concepts process & practise 3RD edition, Mosby year
book,London.
• Marilyn E.Parker, Nursing theories & nursing practise, Second
edition, F.A.Davis company, Jaypee brothers, New Delhi, P.P-295-
305.
Nurses seem to just have
compassion in their blood.
Compassion is not a trait that
can be taught. Watson’s Ten
Caritas Processes relate to
nursing in a way that many
other theories may not.
Watson focused on not only
the physical aspect of nursing
but providing spiritual and
emotional needs as well. It is
our duty as nurses to provide
not only physical care to help
heal a patient but also to
provide emotional and
spiritual support and to
respect a patient’s religion.
Jean watson theory- Ritika Soni

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Jean watson theory- Ritika Soni

  • 1. Jean Watson’s Theory Theory of Human Caring PRESENTER: Ms. Ritika soni
  • 2. OUTLINE • Biography • Creating the theory (why) (how) • Basic assumptions of theory • Major elements • Metaparadigms • Application in nursing & other areas • Strengths • Limitation • Example • Conclusion • References
  • 3. Biography of Jean Watson • Dr. Jean Watson is a nurse theorist who developed “Philosophy and Theory of Transpersonal Caring” or “Caring Science” and founder of Watson Caring Science Institute. • She wanted to be a nurse at the age of 10, when she saw a friend of her older sister having a seizure.
  • 4. Born: West Virginia in a small town Welch, 10 June 1940, youngest of eight children. Educated: BSN (1964), MS (1966), PhD (1973) from University of Colorado. Dr. Watson has earned undergraduate and graduate degrees in nursing and psychiatric- mental health nursing and PhD in educational psychology and counseling. Distinguished Professor of Nursing at the University of Colorado Health Sciences Center. She was also the Dean of Nursing at the University Health Sciences Center and President of the National League for Nursing
  • 5. Widely published author and recipient of several awards and honors, six Honorary Doctoral Degrees, including 3 International Honorary Doctorates (Sweden, United Kingdom, Canada). Her research has been in the area of human caring and loss. The foundation of Jean Watson’s theory of nursing was published in 1979 in nursing: “The philosophy and science of caring” In 1988, her theory was published in “nursing: human science and human care”. In 2002 she published the book “Assessing and measuring caring in nursing and health sciences”
  • 6. Author and co-author of over 20 books Past President of the National League of Nursing Fellow of American Academy of Nursing Distinguished Professor of Nursing and Chairman in Caring Science at the University of Colorado Health Sciences Center (watsoncaringscience.org, 2015) Career Milestones
  • 7. Founding member of International Association in Human Caring and International Caritas Consortium (watsoncaringscience.org, 2015) Founder and Director of the Watson Caring and Science Institute (watsoncaringscience.org, 2015) In 2010 launched the Million nurse Global Caring Field Project (2015) October 2013 was inducted as a Living Legend by the American Academy of Nursing (Kelly, 2013)
  • 8. The following publications reflect the evolution of her theory of caring from her ideas about the philosophy and science of caring. • Nursing: The Philosophy and Science of Caring (1979) • Human Science and Human Care – A Theory of Nursing (1985) • Reprinted in 1988 & 1999. • Postmodern Nursing and Beyond (1999) • Instruments for Assessing and Measuring Caring in Nursing and Health Sciences (2002) • Caring Science as Sacred Science (2005)
  • 9. AWARDS • The Fetzer Institute Norman Cousins Award (watsoncaringscience.org,2015) • International Fellowship award in Australia (watsoncaringscience.org,2015) • Fulbright Research Award in Sweden (watsoncaringscience.org,2015) • Living legend , inducted in 2013 by the American academy of nursing. • Holds 10 honorary Doctoral Degrees including 8 International honorary Doctorates 10 Holistic Nurse of the Year (ahna.org, 2010)
  • 10. CREATING THE THEORY (WHY) • Watson’s commitment: enhance the professional role and mission of nursing; sustaining human caring and preserving human dignity; humanity, and wholeness in the midst of threats and crises of life and death • The goal was to enhance the public view of humanity and life in correlation with nursing
  • 11. CREATING THE THEORY (HOW) • Used concepts from personal and professional experience • “Dr. Watson drew parts of her theory from nursing writers like Florence Nightingale as well as from works of psychologists and philosophers.” (Theory Description, n.d.) • “Her theory is one based on the human interactive process that recognizes the spiritual and ethical dimensions relevant to the human care process.” (Theory Description, n.d.)
  • 12. CREATING THE THEORY (HOW) Dr. Watson states that her personal experience had been to live out her theory, she did not fully understand her purpose until she was involved in a freak accident where she lost her eye sight. She describes it as: My soul life journey, purpose and learning transcended my professional world. “It was only after a traumatic eye injury and uncanny golfing accident with my grandson, (where I lost my eye, literally, metaphorically and symbolically – losing my left eye/(ego)/ I . I had to learn to be still, to surrender to all, to let go, to learn to receive, to be open to unknown mystery and miracles – it was the mystic and metaphysical/spiritual practices and inner experiences that carried me through. It was this journey of losing my eye and losing my world as I had known it, including my beloved and devoted husband, who shortly thereafter, committed suicide & left Watson and their two grown daughters, Jennifer and Julie, and five grandchildren –that I awakened and grasped my own writing. I was given the painful but loving, growing blessings of spiritual mystical experiences, that I have experienced and learned my oneness with all. I learned that all there is Love. We are all energy of LOVE.” (Watson, 2015).
  • 13. • Watson states that she is “attempting to integrate these wounds into my life and work. One of the gifts through the suffering was the privilege of experiencing and receiving my own theory through the care from my husband and loving nurse friends and colleagues.” These two personal life-altering events contributed to writing her third book, Postmodern Nursing and Beyond.
  • 14. Philosophy and Theory of Transpersonal Caring /Watson’s Theory of Transpersonal Caring? • According to Watson’s theory, “Nursing is concerned with promoting health, preventing illness, caring for the sick, and restoring health.” It focuses on health promotion, as well as the treatment of diseases. According to Watson, caring is central to nursing practice, and promotes health better than a simple medical cure. • The nursing model also states that caring can be demonstrated and practiced by nurses. Caring for patients promotes growth; a caring environment accepts a person as he or she is, and looks to what he or she may become.
  • 15. BASIC ASSUMPTIONS OF THE THEORY Watson proposes seven assumptions: Caring can be effectively demonstrated and practiced only interpersonally. Caring consists of carative factors that results in the satisfaction of certain human needs. Effective caring promotes health and individual or family growth. Caring responses accept a person not only as he or she is now but as what he or she may become.
  • 16. A caring environment is one that offers the development of potential while allowing the person to choose the best action for himself at a given point in time. Caring is more “healthogenic” than is curing. The practice of caring integrates biophysical knowledge with knowledge of human behavior to generate or promote health. A science of caring is complementary to the science of curing. The practice of caring is central to nursing.
  • 17. Watson Proposes following 11 assumptions Watson says that nursing education and health care delivery system must be based on human values and concern for the welfare of others. 1. Care & Love comprise the primal and universal psychic energy. 2. Care & love , are the cornerstones of our humanness; nourishment of these needs fulfill our humanity. 3. The ability to sustain the caring in practice will affect the development of civilization and determine nursing contribution in society. 4. Caring for ourselves is perquisite caring for others. 5. Historically nursing has held a human care and caring stance in regard to people with health- illness concern. 6. Caring is the central unifying focuses of nursing practice, the essence of nursing. 7. Caring at the human level has been increasingly in the health care delivery system.
  • 18. 8. Nursing’s caring foundation has been sublimated by technological advancement and institutional constraints. 9. A significant issue for nursing today and in the future is the preservation and advancement of human care. 10.Only through interpersonal relationships can human care be effectively demonstrated and practiced. 11.Nursing social, moral, and scientific contributions to human kind and society lie in its commitments to human care ideals in theory practice and research.
  • 19. MAJOR CONCEPTUAL ELEMENTS 1. The ten carative factors 2. Transpersonal caring relationship 3. Caring occasion 4. Caring and healing model of theory
  • 20.
  • 21. When looking at this theory of practice, Black informs us that the emphasis for nursing practice focuses primarily on “How can I create an environment of trust, understanding, and openness so that the patient and I can work together in meeting his or her needs?” (Black, 2014).
  • 22. 1. Ten CARATIVE FACTORS • Goal was to provide a framework for the “core of nursing” Watson referred to the “core” as the philosophy, science and art of caring • Caritas-comes from the Latin word meaning “to cherish and appreciate, giving special attention to, or loving.” Builds upon Carative Factors • Caritas processes openly displays more love and caring and a deeper human experience (Watson, 2014)
  • 23. ORIGINAL 10 CARATIVE FACTORS 1 .Formation of a humanistic–altruistic system of values 2. Instillation of faith–hope 3. Cultivation of sensitivity to one’s self and to others 4.Development of a helping–trusting, human relationship caring 5.Promotion and acceptance of the expression of positive and negative feelings
  • 24. 6. The systematic use of the scientific problem-solving method for decision making 7. The promotion of interpersonal teaching-learning. 8.Provision for a supportive, protective, and/or corrective mental, physical, societal, & spiritual environment 9. Assistance with gratification of human needs 10.Allowance for existential–phenomenological–spiritual forces (Watson, 2014)
  • 25. 1. THE FORMATION OF A HUMANISTIC-ALTRUISTIC SYSTEMOF VALUES 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 / experience which then promotes altruistic behaviour towards 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 well-being through beliefs which are meaningful to the individual.
  • 26. 3. CULTIVATION OF SENSITIVITY TO ONE’S SELF ANDTO OTHERS 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.
  • 27. 4. ESTABLISHING A HELPING-TRUSTING HUMAN CARING 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: • Congruence/ harmony • Empathy • Warmth Communication includes verbal, nonverbal and listening in a manner which connotes(imply) empathetic understanding.
  • 28. 5. THE EXPRESSION OF FEELINGS, BOTH POSITIVE AND NEGATIVE “Feelings alter thoughts and behaviour, and they need to be considered and allowed for in a caring relationship”. Awareness of the feelings helps to understand the behaviour it engenders. 6. THE SYSTEMATIC USE OF THE SCIENTIFIC PROBLEM-SOLVING METHOD FOR DECISION MAKING 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 an holistic perspective. The science of caring should not be always neutral.
  • 29. 7. PROMOTION OF INTERPERSONALTEACHING-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-CULTURALAND SPIRITUALENVIRONMENT Watson divides these into external 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.
  • 30. 9. ASSISTANCE WITH THE GRATIFICATION OF HUMAN NEEDS It is grounded in a hierarchy of need similar to that of the Maslow’s. She has created a hierarchy which she believes is relevant to the science of caring in nursing. According to her 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.
  • 31. WATSON’S ORDERING OF NEEDS Lower order needs (biophysical needs) The need for food and fluid The need for elimination The need for ventilation Lower order needs (psychophysical needs) The need for activity-inactivity The need for sexuality Watson’s ordering of needs Higher order needs (psychosocial needs) The need for achievement The need for affiliation Higher order need (intrapersonal- interpersonal need) The need for self-actualization self- actualization (Psychosocial needs) Need for achievement, affiliation (Psychophysical needs) The need for activity- inactivity, sexuality (Biophysical needs) The need for food and fluid, elimination, ventilation
  • 32. 10. ALLOWANCE FOR EXISTENTIAL-PHENOMENOLOGICAL FORCES 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 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.
  • 33.
  • 34. “Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around.”
  • 35. 2.THE TRANSPERSONAL CARING RELATIONSHIP • This portion of the theory focuses on “the one caring and the one cared for.” (Cara, 2003). The nurse and patient can develop a deep divine relationship that blends together and promotes overall health and well- being. • This process requires the use of “Actions, words, behaviours, cognition, body language, feelings, intuition, thought, senses, and the energy field” (Watson & Woodword, 2010). • The nurse has a professional as well as a personal obligation to not only see the patient as more than an object but to also protect and assist with improving the patient’s dignity. (Cara, 2003)
  • 36. •The nurse should be using her professional experience to promote healing and bonding with the patient. This may include the use of various communication techniques, both verbal and non-verbal to achieve a healing and gentle relationship. (Watson & Woodward, 2010) • The nurse and the patient are transformed together in this relationship. (Black, 2014).
  • 37. 3.THE CARING OCCASION/CARING MOMENT •This portion of the theory focuses on an actual tangible moment in time in which the nurse recognizes the connection that is developed between him/herself and the patient. (Cara, 2003). This moment dictates the ability for the nurse to have an overall impact on the patient. •According to Cara, The Caring Moment “Consists of feelings, bodily sensations, thoughts, spiritual beliefs, goals, expectations, environmental considerations, and meanings of one’s perceptions—all of which are based upon one’s past life history, one’s present moment, and one’s imagined future.” (Cara, 2003). • This can occur during various nursing interventions and interactions with each patient.
  • 38. 4.CARING & HEALING MODEL OF THEORY • The nurse is able to help the patient with overall well-being by assisting them with the release of “disharmony and blocked energy” (Watson & Woodward, 2010). • The use of this portion of the theory helps the patient with overall healing and renewal. (Black, 2014). • Nurses can impact the patient through “health promotion, health restoration, and illness prevention” (Black, 2014).
  • 39. WATSON’S THEORY AND THE FOUR MAJOR CONCEPTS 1. PERSON • She adopts a view of the human being as: “….. a valued person to be cared for, respected, nurtured, understood and assisted; in general a philosophical view of a person as a fully functional integrated self. She believes that humans are best viewed in developmental conflicts and their family is necessary for health care. • The nurse must understand human beings when they are sick, well or under stress.
  • 40. 2. HEALTH • Watson believes Health is the unity and harmony within the mind, body, and soul. • It is defined as a: • A high level of overall physical, mental and social functioning • A general adaptive-maintenance level of daily functioning • The absence of illness (or the presence of efforts that leads its absence)
  • 41. 3. ENVIRONMENT/SOCIETY • According to Watson, caring (and nursing) has existed in every society. Every society has had some people who cared for others .Watson viewed environment and which helps the person to meeting their needs accordingly.
  • 42. 4. 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, aesthetic and ethical human transactions”.
  • 43. “May be this one moment, with this one person, is the very reason we’re here on Earth at this time”s
  • 44.
  • 45. WATSON’S THEORY AND NURSING PROCESS 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: 1. ASSESSMENT Involves observation, identification and review of the problem; use of applicable knowledge in literature. Also includes conceptual knowledge for the formulation and conceptualization of framework. Includes the formulation of hypothesis; & factors that influence the problem. Assessment also includes defining variables that will be examined in solving the problem.
  • 46. 2. PLAN It helps to determine how variables would be examined or measured; includes a conceptual approach or design for problem solving that is referred to as the nursing care plan. It determines what data would be collected, how & on whom. 3. INTERVENTION It is the direct action and implementation of the plan. It includes the collection of the data.
  • 47. 4. 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.
  • 48. WATSON’S WORK AND THE CHARACTERISTIC OF ATHEORY 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 work of numerous humanists, philosophers, developmentalists and psychologists.
  • 49. • The basic assumptions for the science of caring in nursing and the ten carative factors that form the structure for that concept is unique in Watson’s theory. • She describes caring in both philosophical and scientific terms. • Caring is placed in hierarchical contexts, meeting lower order physiological needs first, then moving towards higher order psychosocial & intrapersonal needs. • She also said needs are iterrelated.
  • 50. RESEARCH RELATED TO WATSON’S THEORY • Saint Joseph Hospital in Orange, California has selected Jean Watson’s theory of human caring as the framework base for nursing practice. Advanced Practice Nursing Quarterly,4(1), 70-77. • The effectiveness of Watson's Caring Model on the quality of life and blood pressure of patients with hypertension. J Adv Nurse. 2003 Jan;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 practised, there was a relationship between the Caring model and a decrease in patient's blood pressure. The Watson Caring Model is recommended as a guide to nursing patients with hypertension, as one means of decreasing blood pressure and increase in quality of life.
  • 51. • Mullaney, J. A. B. (2000). The lived experience of using Watson’s actual caring occasions to treat depressed women 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 .
  • 52. HOW TO INTEGRATE THEORY IN TO NURSING PRACTICE • Establishing a caring relationship with patient. • Treat patients a holistic being • Display unconditional acceptance • Treat patients with positive regards. • Promote health through knowledge and intervention • Spend uninterrupted time with patient .
  • 53. 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. • 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.
  • 54. LIMITATIONS 1. Biophysical needs of the individual are given less important. 2. The ten carative factors primarily delineate the psychosocial needs of the person. 3. Needs further research to apply in practice.
  • 55.
  • 56.
  • 57. • Vidhya, a 59 year old factory worker, arrives at the emergency room in a small, but busy hospital, not far from her place of employment. She is complaining of intense pain in her left shoulder and anxiety. As an causality nurse with 20 years experience, I have seen a lot of drug seekers come in with the same complaints. • Utilizing Watson’s Philosophy and Theory of Transpersonal Caring, I know that I must not pre-judge any patient and I must develop a Helping-Trust Relationship with each patient. Using empathy, congruence, non-possessive warmth, and effective communication is important in building a relationship with a patient in a short amount of time, especially in an Emergency setting. CASE SITUATION
  • 58. • Vidhya cannot raise her left arm above chest level and there is no obvious injury to the site. Her vitals are as follows: B/P 160/80, PR 115, and T 98.6. What aspect of Watson’s Theory is put into action here? • Answer 1. As the nurse caring for her, Watson’s Theory directs me that patients must Satisfy lower order needs before attempting to attain higher order needs. Vidya’s pain and anxiety must be controlled before she can process and accept what is happening physically.
  • 59. • Vidhya is given 50 mg of Tramadol and 2 mg of Lorazepam. She then states that she has been SOB occasionally. Her pulse ox is 92% on room air. At this point another one of Watson’s carative factors comes into play. Which one? • Answer 2. One of Watson’s Original 10 Carative Factors is the Systematic Use of the Scientific Problem Solving Method for Decision Making. I realize that this newly conveyed information may be connected to her original complaints and collect this data for the doctor to review. It is important to keep things organized, knowing what and when to relay for further investigation.
  • 60. • Vidhya is diagnosed with a mass on her adrenal gland and an enlarged lymph node near her heart. She is oriented, but sleepy due to drug and still complains of pain in her left shoulder. Her husband lost his job when his shop closed after working there for thirty years. She is not covered by any insurance at this time. She has two grown children and her daughter, is present with her . How can we approach this family using Jean Watson’s Theory? Which two of the original carative factors could be utilized? • Answer 3. Watson’s Theory, based on the Original 10 Caratives, includes Cultivation of Sensitivity to Self and to Others. This explains that as nurses acknowledge their sensitivity and feelings, they become more genuine, authentic, and sensitive to others. This leads to self-actualization through self-acceptance for nurses and patients. Another one of Watson’s Caratives is Promotion and Acceptance of the Expression of Positive and Negative Feelings. This is a huge risk taking move on the part of nurses and patients. Be prepared for whatever feeling is shared, good or bad. Everyone acts and reacts differently and uniquely to each situation presented to them, including minor and major health dilemmas.
  • 61. • Realizing that Vidhya and her daughter were just given some potentially life threatening news, I encouraged them both to express how they were feeling about this diagnosis. • Prior to discharge, she was encouraged to seek an appointment with an oncologist and given a prescription for pain meds to help keep her comfortable until she can get in to see the doctor. I helped them out of the cubicle and said a silent prayer for the battle they were about to begin.
  • 62. NURSING CONCEPTUAL MODEL OF CARE • The patient is at the centre of everything we do! Our view of nursing, person, environment, and health affects how we interact with patients. • Our model of caring is based on Sister Callista Roy's Theory of Adaptation and Jean Watson's Theory of Human Caring. • The conceptual framework guides us through the nursing process. We help the patient and family adapt to their state of health and we do so with the unique human-to-human interaction consistent with nursing. • The conceptual framework provides the structure to achieve the Geisinger Nursing vision of securing the legacy, quality, innovation and market growth. This will ensure success in achieving the organization's mission of Heal, Teach, Discover, and Serve
  • 63.
  • 64. CARATIVE FACTORS & NURSING “Watson’s theory offers a conceptual approach to care that is focused on the nonmedical, human-to- human caring relationships that are viewed as the core of nursing practice.” (Marckx, 1995, p. 46)
  • 65. NURSING IMPLICATIONS: • Nurses model of caring is based on Sister Callista Roy's Theory of Adaptation and Jean Watson's Theory of Human Caring. • Its conceptual framework guides us through the nursing process. We help the patient and family adapt to their state of health and we do so with the unique human-to-human interaction consistent with nursing.
  • 66. Nursing is based on the concept of care. Many nurses have adopted Jean Watson’s Caring Theory in their practice. Nurses should establish a caring relationship with patients. Mutuality should be obtained between the nurse and patient concerning the patient’s healthcare situation and needs. Nurses should treat patients as holistic beings (body, mind and spirit) with a positive regard. Nurses should promote health through knowledge and intervention, and display acceptance towards patients that is unconditional. Caring occasions/moments should transform both the patient and nurse, as they are linked together.
  • 67. REFERENCES • GeorgeB Julia, nursingtheories- The base for professional nursing practise, 3rd Edition, Norwalk, Appleton &Lange. • Taylor Carol, Lillis Carol (2001) The art & science of nursing care, 4 th • edition, Philadelphia, Lippincott. • PotterA Patricia, Perry G Anne (1992), Fundamentals of nursing concepts process & practise 3RD edition, Mosby year book,London. • Marilyn E.Parker, Nursing theories & nursing practise, Second edition, F.A.Davis company, Jaypee brothers, New Delhi, P.P-295- 305.
  • 68. Nurses seem to just have compassion in their blood. Compassion is not a trait that can be taught. Watson’s Ten Caritas Processes relate to nursing in a way that many other theories may not. Watson focused on not only the physical aspect of nursing but providing spiritual and emotional needs as well. It is our duty as nurses to provide not only physical care to help heal a patient but also to provide emotional and spiritual support and to respect a patient’s religion.