In the realms of the present times, improvements in health care system have
intensified nurse’s workload and responsibilities sad but true, nurses in the present
times often forget their caring attitudes when they are faced with stressful and
Despite of this, we nurses must learn how to deal with the complexities arising in
every patient situation and must find ways of preserving their caring practice. One
nursing theory has seemed indispensable for this goal-Jean Watson’s theory of
3. Jean Watson view of caring is the most valuable attribute nursing has to offer to
humanity, yet caring has received less emphasis than other aspects of the practice of
nursing over time.
In Watson’s view disease might be cured but illness would still remain because
without caring, health is not fully attained.
5. Born: West Virginia in 1940 July 21 st.
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
She was also the Dean of Nursing at the
University Health Sciences Center and
President of the National League for
6. Widely published author and recipient of several awards and
honors, six Honorary Doctoral Degrees, including 3
International Honorary Doctorates (Sweden, United Kingdom,
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
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”
7. 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 Chair in Caring Science
University of Colorado Health Sciences Center
8. 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
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 Fetzer Institute Norman Cousins Award (watsoncaringscience.org,2015)
• International Fellowship in Australia (watsoncaringscience.org,2015)
• Fulbright Research Award in Sweden (watsoncaringscience.org,2015)
• Holds 10 honorary Doctoral Degrees including 8 International honorary
Doctorates 10 Holistic Nurse of the Year (ahna.org, 2010)
10. CREATING THE THEORY
(WHY)• Plan was to bring new meaning and dignity to nursing
• Used concepts from personal and professional experience
• Inducted, grounded, and combined with philosophy, ethical, intellectual, and
• The goal was to enhance the public view of humanity and life in correlation
• Watson’s commitment: professional role and mission of nursing; ethical
covenant with society as sustaining human caring and preserving human
dignity; attending to and helping to sustain human dignity, humanity, and
wholeness in the midst of threats and crises of life and death
11. CREATING THE THEORY (HOW)
• “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
Dr. Watson states that though her life’s work 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 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 –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 is Love. We are all energy of LOVE.” (Watson, 2015).
13. BASIC ASSUMPTIONS OF THE
Watson proposes even assumption of about the science of caring these are:
Caring can be effectively demonstrated and practiced only
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 person not only as he or she is now but as what
he or she may become.
14. A caring environment is one that offers the development of potential
while allowing the person to chose the best action for himself at a given
point in time.
Caring is more “health ogenic” than is curing. A science of caring is
complementary to the science if curing.
The practice of caring is central to nursing.
15. MAJOR CONCEPTUAL ELEMENTS
• The ten carative factors (Greek word “caritas” means to cherish &
appreciate, giving special attention to, loving factors)
• Transpersonal caring relationship
• Caring occasion
• Caring and healing model of theory
16. 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).
17. 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
• Transitioned from Carative Factors to Caritas Processes as Watson’s ideas and
• 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)
18. ORIGINAL 10 CARATIVE
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 caring
5.Promotion and acceptance of the expression of positive and
19. 6. Systematic use of a creative problem solving caring process
7. Promotion of transpersonal 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,
20. 1. THE FORMATION OF A HUMANISTIC-ALTRUISTIC SYSTEM OF
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 behaviour towards others.
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.
21. 3. CULTIVATION OF SENSITIVITY TO ONE’S SELF AND TO
Explores the need of the nurse to begin to feel an emotion as it presents
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.
22. 4. ESTABLISHING A HELPING-TRUST RELATIONSHIP
Strongest tool is the mode of communication, which establishes rapport and
She has defined the characteristics needed to in the helping-trust relationship.
Communication includes verbal, nonverbal and listening in a manner which
connotes(imply) empathetic understanding.
23. 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 and objective.
24. 7. PROMOTION OF INTERPERSONAL TEACHING-LEARNING
The caring nurse must focus on the learning process as much as the teaching
Understanding the person’s perception of the situation assist the nurse to prepare a
8. PROVISION FOR A SUPPORTIVE, PROTECTIVE AND /OR
CORRECTIVE MENTAL, PHYSICAL, SOCIO-CULTURAL AND
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
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.
25. 9. ASSISTANCE WITH THE GRATIFICATION OF HUMAN
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.
26. 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-
The need for self-actualization
The need for activity-
The need for food and fluid,
27. 10. ALLOWANCE FOR EXISTENTIAL-PHENOMENOLOGICAL
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
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.
28. “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
29. THE TRANSPERSONAL CARING
• 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-
• 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)
30. • The nurse and the patient are transformed together in this relationship.
•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,
31. THE CARING OCCASION/CARING
• This can occur during various nursing interventions and interactions with each patient.
•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).
32. CARING & HEALING MODEL OF
• The nurse is able to help the patient with overall well-being by assisting
them with the release of “disharmony and blocked energy” (Watson &
• 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).
33. WATSON’S THEORY AND THE
FOUR MAJOR CONCEPTS
• 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 a person as a fully functional
integrated self. He, human is viewed as greater than and different from,
the sum of his or her parts”.
34. 2. HEALTH
• Watson believes that there are other factors that are needed to be
included in the WHO definition of health. She adds the following three
• 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)
35. 3. ENVIRONMENT/SOCIETY
• According to Watson caring (and nursing) has existed in every society. A
caring attitude is not transmitted from generation to generation. It is
transmitted by the culture of the profession as a unique way of coping
with its environment
36. 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
37. “May be this one moment, with
this one person, is the very
reason we’re here on Earth at
39. NURSING CONCEPTUAL MODEL OF
• 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
41. WATSON’S WORK AND THE
CHARACTERISTIC OF A THEORY
• According to Watson, “a theory is an imaginative grouping of
knowledge, ideas and experiences that are represented symbolically and
seek to illuminate a given phenomenon”
• She views nursing as,
“….both a human science and an art and as such it cannot be considered
qualitatively continuous with traditional, reductionist, scientific
• She suggests that nursing might want to develop its own science that
would not be related to the traditional sciences but rather would develop
its own concepts, relationships and methodology.
42. • Theories can interrelate concepts in such a way as to create a different
way of looking at a particular phenomenon
• 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
• She describes caring in both philosophical and scientific terms.
• Watson also indicates that needs are interrelated.
• The science of caring suggests that the nurse recognize and assist with
each of the interrelated needs in order to reach the highest order need of
43. CARATIVE FACTORS & NURSING
“Watson’s theory offers a
conceptual approach to care
that is focused on the
human caring relationships
that are viewed as the core of
nursing practice.” (Marckx,
1995, p. 46)
44. USING THE CARATIVE
• Illness as disharmony
• Carative factor #9: provide assistance with basic human
needs while also designing specific interventions to instill
hope. (Marckx, 1995)
• Humanistic and altruistic values
• Carative factor #1: respecting the patient’s autonomy and
freedom of choice in determination of care. (Marckx, 1995)
45. RESEARCH RELATED TO WATSON’S
• 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
• 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.
46. • Mullaney, J. A. B. (2000). The lived experience of using Watson’s actual
caring occasions to treat depressed women Journal of Holistic Nursing,
• Martin, L. S. (1991). Using Watson’s theory to explore the dimensions of
adult polycystic kidney disease. ANNA Journal, 18, 403-406 .
47. WATSON’S THEORY AND
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
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; defining variables that will be
examined in solving the problem.
48. 2. PLAN
It helps to determine how variables would be examined or measured;
includes a conceptual approach or design for problem solving. It
determines what data would be collected and how on whom.
It is the direct action and implementation of the plan.
It includes the collection of the data.
49. 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.
50. HOW NURSES RELATE TO
Embrace altruistic values and Practice loving kindness with self and others.
Instill faith and hope and honor others.
Be sensitive to self and others by nurturing individual beliefs and practices.
Develop helping – trusting- caring relationships.
Promote and accept positive and negative feelings as you authentically
listen to another’s story
Use creative scientific problem-solving methods for caring decision making.
Share teaching and learning that addresses the individual needs and
Create a healing environment for the physical and spiritual self which
respects human dignity.
Assist with basic physical, emotional, and spiritual human needs.
Open to mystery and Allow miracles to enter.
51. 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.
52. 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
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
• 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.
• The client is placed in the context of the family, the community and the
• It places the client as the focus of practice rather than the technology.
• 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 10 carative factors primarily delineate the psychosocial needs of the
• While the carative factors have a sound foundation based on other
disciplines , they need further research in nursing to demonstrate their
application to practice.
55. • 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.
56. • 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.
Betty’s pain and anxiety must be controlled before she can process and accept what
is happening physically.
57. • 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.
58. • 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 Lori 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
• 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.
59. • 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, Betty 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
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edition, Philadelphia, Lippincott.
• Potter A 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.
61. 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.