Introduction
Watson proposes even assumptions about the science of caring. The basic assumptions are:
The structure for the science of caring is built upon ten carative factors. These are:
The first three carative factors form the “philosophical foundation” for the science of caring.
The remaining seven carative factors spring from the foundation laid by these first three.
• Begins developmentally at an early age with values shared with the parents.
• Mediated through ones own life experiences, the learning one gains and exposure to
the humanities.
• Is perceived as necessary to the nurse’s own maturation which then promotes
altruistic behavior towards others.
2. Faith-hope
• Explores the need of the nurse to begin to feel an emotion as it presents itself.
• Development of one’s own feeling is needed to interact genuinely and sensitively with
others.
• Striving to become sensitive, makes the nurse more authentic, which encourages self-
growth and self-actualization, in both the nurse and those with whom the nurse
interacts.
• The nurses promote health and higher level functioning only when they form person
to person relationship.
• Strongest tool is the mode of communication, which establishes rapport and caring.
• She has defined the characteristics needed to in the helping-trust relationship. These
are:
o Congruence
o Empathy
o Warmth
• According to Watson, “feelings alter thoughts and behavior, and they need to be
considered and allowed for in a caring relationship”.
• According to her such expression improves one’s level of awareness.
• Awareness of the feelings helps to understand the behavior it engenders.
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.
• 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-
cultural and spiritual environment
• Watson divides these into eternal and internal variables, which the nurse manipulates
in order to provide support and protection for the person’s mental and physical well-
being.
• The external and internal environments are interdependent.
• Watson suggests that the nurse also must provide comfort, privacy and safety as a part
of this carative factor.
Example:
Bulemia, anorexia and gastro-intestinal ulcers are a just few of the disorders that indicate a
complex interaction between the physiological and psychological.
Instillation of faith-hope, becomes: "Being authentically present, and enabling and sustaining
the deep belief system and subjective life world of self and one-being-cared- for";
Cultivation of sensitivity to one's self and to others, becomes: "Cultivation of one's own
spiritual practices and transpersonal self, going beyond ego self";
Promotion and acceptance of the expression of positive and negative feelings, becomes:
"Being present to, and supportive of the expression of positive and negative feelings as a
connection with deeper spirit of self and the one-being-cared-for";
Systematic use of a creative problem-solving caring process, becomes: "creative use of self
and all ways of knowing as part of the caring process; to engage in artistry of caring-healing
practices";
Provision for a supportive, protective, and/or corrective mental, physical, societal, and
spiritual environment, becomes: "Creating healing environment at all levels, (physical as well
as non-physical, subtle environment of energy and consciousness, whereby wholeness,
beauty, comfort, dignity, and peace are potentiated";
Assistance with gratification of human needs, becomes: "assisting with basic needs, with an
intentional caring consciousness, administering ‘human care essentials', which potentiate
alignment of mindbodyspirit, wholeness, and unity of being in all aspects of care"; tending to
both embodied spirit and evolving spiritual emergence; Allowance for existential-
phenomenological-spiritual forces, becomes: "opening and attending to spiritual-mysterious,
and existential dimensions of one's own life-death; soul care for self and the one-being-care-
for.
1. Human being
• She adopts a view of the human being as: “….. a valued person in and of him or
herself to be cared for, respected, nurtured, understood and assisted; in general a
philosophical view of 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”.
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 elements:
• 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. 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.
4. Nursing
• 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
2. Plan
3. Intervention
• Analysis of the data as well as the examination of the effects of interventions based on
the data. Includes the interpretation of the results, the degree to which positive
outcome has occurred and whether the result can be generalized.
• It may also generate additional hypothesis or may even lead to the generation of a
nursing theory.
• Watson’s work is logical in that the factors are based on broad assumptions which
provide a supportive framework.
• With these carative factors she delineates nursing from other professions
• These carative factors are logically derived from the assumptions and related to he
hierarchy of needs.
• The theory is relatively simple as it does not use theories from other disciplines that
are familiar to nursing.
• The theory is simple relatively but the fact that it de-emphasizes the
pathophysiological for the psychosocial diminishes its ability to be generalizable.
• She discusses this in the preface of her book when she speaks of the “trim” and the
“core” of nursing.
• She defines trim as the clinical focus, the procedure and the techniques.
• The core of the nursing is that which is intrinsic to the nurse-client interaction that
produces a therapeutic result. Core mechanisms are the carative factors.
Theories can be the basis for hypotheses that can be tested
Strengths
• Besides assisting in providing the quality of care that client ought to receive, it also
provides the soul satisfying care for which many nurses enter the profession.
As the science of caring ranges from the biophysical through the intrapersonal, each
nurse becomes an active coparticipant in the client’s struggle towards self-
actualization.
• The client is placed in the context of the family, the community and the culture.
• It places the client as the focus of practice rather than the technology.
Limitations
• Given the acuity of illness that leads to hospitalization, the short length stay , and the
increasing complex technology, such quality of care may be deemed impossible to
give in the hospital.
• While Watson acknowledges the need for biophysical base to nursing, this area
receives little attention in her writings.
• The ten caratiive factors primarily delineate the psychosocial needs of the person.
• While the carative factors have a sound foundation based on other disciplines, they
need further research in nursing to demonstrate their application to practice.
Summary
• Watson’s theory
• Its seven assumptions
• The ten carative factors
• Watson’s theory and the four major concepts
• Watson’s theory and the nursing process
• Watson’s work and the characteristic’s of the theory
• Strengths
• Limitations
• Saint Joseph Hospital in Orange, California has selected Jean Watson’s theory of
human caring as the framework base for nursing practice.
• The effectiveness of Watson's Caring Model on the quality of life and blood pressure
of patients with hypertension. J Adv Nurs. 2003 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.
• Martin, L. S. (1991). Using Watson’s theory to explore the dimensions of adult
polycystic kidney disease . ANNA Journal, 18, 403-406 .
• 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
Conclusion