PATIENT WITH CANCER’S EXPERIENCE OF

NURSE CARING BEHAVIOR ACCORDING TO THE

WATSON CARING THEORY IN WAHIDIN
SUDIROHUSODO MAKASSAR HOSPITAL
Indah Gita Cahyani1, Rini Rachmawaty2, Ilkafah3
1researcher,Hasanuddin University, Makassar
Email: indahgitachyni@gmail.com

ABSTRACT
Background: The hospital’s service quality is related and determined by the quality of nursing treatment, which
patients get from the nurse. Caring is the most important thing that nurse should deliver to the patients. But in reality,
the applying of caring never reach the optimum point, therefore it affects to the healing process and make it becomes
longer. It will also give an impact to the hospital service. Aim: To know the experience of cancer patients according
to Watson caring theory at Wahidin Sudirohusodo Makassar Hospital, based on 10 Carative Factors : Humanistic-
Altruistic Values, Enabling Faith and Hope, Cultivation of Sensitivity to one’ self and other, Development of helping-
trusting, Promotion and Acceptance of expression of positive and negative feelings, Systematic use of the scientific
problem solving method of decision making, Promotion of transpersonal teaching-learning, Provision for a supportive,
protective, and / or corrective mental, social, spiritual environment, Assistance with gratification of human needs, dan
Allowance for existential-phenomenological spiritual dimension in Wahidin Sudirohusodo Makassar Hospital.
Method: This research used qualitative method with phenomenological approachment by using semi structural deep
interview technique to eight participants who were treated in internal and cancer room. Result: this research produced
9 themes: patient's experience according to the nurse caring behaviors while give a therapy, patient's experience of
family’s involvement while the nurses give a therapy, patient's experience about nurse's therapeutic strategy, patient's
experience about informed consent that nurse gives, patient's experience of nurse’s supports, patient's experience
according to the environment around the hospital, patient's experience according to nurse as an educator, patient's
experience about nurse’s response while patient in need or want to complain and also cancer patient's hopes.
Conclussion: This research shows that the nurse caring behavior is almost reach the optimum point which is correlate
with Watson’s caring theory. Unfortunatelly, there are a few things that patients still complain about, like a long time
responses from the nurse when patient needs something and other support facilities in the room.

INTRODUCTION Based on the result of the research,

Caring has become a core important
thing to delivering nurse’s treatment (1). In
the results of the research has stated that a
hospital in America had a low level of nurse’s
caring behavior (2). The results of the
research in Klungkung Hospital, Bali,
showed that 48% of nurses still did not
deliver a caring behavior, and it makes 59%
of patients not being satisfied with the
nursing services provided (3).
Semarang District Hospital, that there was a
significant relationship between nursing
care’s behavior and the level of depression in
patients with diabetic ulcers (4). Nurse’s
caring behavior can be used as an effort to
improve the quality of nursing and safety
services (Nursalam, 2014). Explained in the
research, patients with cancer were one of the
patients who neded nurse’s caring behavior
to through their pain (5). Following that, in
another research result, found that giving
nurse’s care intervention according to 10
carative factors by Watson will improve the
quality of life and happiness index of patients
with cancer (6).
The nurse’s caring theory by Watson has
10 carative factors. Each of the carative
factors has 10 caritas processes can be
applied to patients. 10 of these carative
factors are humanistic-altruistic, instillation
of faith, oneself and others, development of
helping-trusting, promotion and acceptance
of the expression of positive and negative
feelings, systematic use of scientific and
problem solving method of decision-making,
promotion of interpersonal teaching,
provision for a supportive and protective
environment, assistance with gratification of
human needs, and allowance for existential-
phenomenological force.
Wahidin Sudirohusodo Hospital is one of
five hospitals that applying palliative care for
patients with cancer (7). However, some
patients still often complain about nurse’s
caring behavior, especially in the 2nd and 3rd
class, which is a room for patients with
internal disease and cancer. Research has
explained that a few nurses do not provide
good communication to patients, which
communication is one of nurse’s caring
behavior, and it makes patients do not
understand what nurses has explained, and
the worst, miss-understanding (8). This study
aims to obtain a phenomenon related to the
experience of patient with cancer about
nurse’s caring behavior according to
Watson's theory at Wahidin Sudirohusodo
Hospital.
METHOD
This study used qualitative methods with a
phenomenological approachment. There are
eight patients with cancer has been chosen
according inclusion criteria in treatment
rooms at Wahidin Sudirohusodo Makassar
Hospital. Researcher collects the data by
using in depth interview according interview
guidelines that have been made by
researchers. This guide contains 11 questions
based on Watson's caring theory, but these
questions will be develop according to the
patients with cancer’s experience of nurse’s
caring behavior in the treatment room.
However, researchers still keep the
bracketing, which mean researchers will
suppress, limit, or save various assumptions,
knowledge, and beliefs that researchers know
about the phenomenon under study, so the
information that has been provided by
participants is truly natural and comes from
the participants’ experience. Data were
analyzed using the creswell method.
RESULTS
The results of this study produced 9
themes that has been compiled from several
sub-themes. The theme consists of: patient's
experience according to the nurse caring
behaviors while give a therapy, patient's
experience of family’s involvement while the
nurses give a therapy, patient's experience
about nurse's therapeutic strategy, patient's
experience about informed consent that nurse
gives, patient's experience of
supports, patient's experience according to
the environment around the hospital, patient's
experience according to nurse as an educator,
patient's experience about nurse’s response
while patients need or want to complain and
also cancer patient's hopes.
DISCUSSION
This section describes
interpretation of nine themes of patient with
cancer’s experience of nurse’s
behavior according to Watson's theory which
is based on 10 carative factors. namely:
Humanistic-Altruistic Values, Enabling Faith
and Hope, Cultivation of Sensitivity to one'
self and other, Development of helping-
trusting, Promotion and Acceptance of
positive and negative feelings, Systematic
use of the scientific problem solving method
of decision making, Promotion of
transpersonal teaching-learning, Provision
for supportive, protective, and / or mental
corrective, social, spiritual environment,
Assistance with gratification of human needs,
and Allowance for existential -
phenomenological spiritual dimension. The
results of this study will be compared with
theories and previous researches.
1. Exploration of cancer patients'
experience of nurse’s caring behavior
nurse’s according to Watson's theory:
Humanistic-Altruistic Values (Forming
an altruistic value system)
In this study, seven of the eight
participants stated that nurses called the
patient's name according to what patients
want to be called. Calling the patient's
name with the pleasure name is one of
the strategies to keep the therapeutic
the
communication. This is parallel with the
research which explains that nurses who
caring
call the name of the patient's pleasure
name politely will make the nurse and
patient's relationship more familiar (9).
The study also showed that five of
eight participants explained that nurses
were so patient in listening the patients'
complaints. Nurses are required to
delivering nurse’s treatment to the
 patients as well as possible, even though
sometimes patients often complain. This
is parallel with study which states that
nurses must be patient in serving patients
who complain even though sometimes
the patient's complaints do not respect
the service of a nurse (10).
Nurse caring behavior according
Watson's theory explains
humanistic-altruistic values are
common knowledge for nurses.
Humanistic values can be described by
giving attention such as calling the
patient's name with his pleasure call.
While altruistic values can be described
by the process of receiving patient
complaints such as listening to patient
complaints patiently (11).
2. Exploring cancer patients' experience of
nurse’s caring behavior according to
Watson's theory: Enabling Faith and
Hope (Creating Trust and Hope)
Explaining information before giving
a treatment or therapy is a form of
informed consent that must be carried
out by nurses. This is supported by the
research which explains that informed
consent must be accepted by all patients
in each nurse’s treatment or therapy (12).
The analysis of researchers that nursing
services have an effect to the level of
patient satisfaction. This is supported by
the results of research that stated the
relationship of nursing services to the
level of satisfaction of inpatients at
Sumbersari health center in Jember
Regency, which showed that 86.4% of
patients considered that nursing services
were low resulting in 77.3% of patients
that feeling dissatisfied (4). Not only
a expectations about nursing and hospital
services, but the results of this study also
showed that two of the participants
wished that nurses and doctors could
cure the patient's illness so that patients
could return to health and go home.
3. Exploring patients with cancer’s
experience of nurse’s caring behavior
according to Watson's theory:
Development of Sensitivity to one's self
and others.
The results of this study indicate that
four of seven participants, who answered
the sensitivity of nurses, stated that
nurses in Wahidin Sudiro Husodo
Hospotal still did not yet have sensitivity
to patients. Based on the results of
interviews with participants, nurses must
be told to be sensitive to the feelings of
patients, so patients feel that nurses are
not sensitive to their feelings.
 Nurses must know and be sensitive
to patients as a form of nurse’s empathy,
especially for patients with palliative
care. This is supported by research which
explained that nurse’s sensitivity to self
and others is needed in patients with
critical conditions (13). This is also
supported by research which result that
patients will feel more comfortable with
the sensitivity of nurses (14). Suggested
the same thing, nurses must be able to
develop their sensitivity to patients (11).
4. Exploring patient with cancer’s
experience of nurse’s caring behavior
according Watson’s theory:
Development of helping-trusting (Build
rescue-confidence, relationships caring
human being)
The results of this study reflected on
the first theme which discussed about the
patient's experience according to the
nurse caring behaviors while give a
therapy. Researcher's analysis shows
that nurses has applied the principles of
justice to each patient. Research
explained that the principle of justice in
nursing needed to provide equal
treatment according to each patient's
needs (15).
In addition, six of eight participants
said that nurses care about cancer
patients. Participants stated that the form
of nurse’s caring behavior was seen from
the attitude of nurses who were friendly
and gentle in giving therapy. The role of
nurses in overcoming malnutrition in
children with cancer’s research,
explained that showing the nurse’s
caring behavior was one of the
atraumatic nursing interventions (16).
The results of this study also showed
that a form of nurse’s caring behavior
can be seen when the nurses protect the
patient privacy while giving therapy.
This is according to the research which
stated that patients have a right to obtain
privacy (17). The results of this study
indicate that six of eight participants
stated that nurses had a friendly, polite
and gentle attitude when giving therapy.
Research explained that mild touch from
nurses can provide pleasure and
convenience for patients (18). Also,
research explained that politeness while
giving therapy is a guarantee for nurses
to describe patient trust (19). The study
shows that patients feel satisfied with
nurses who are friendly, easy to smile,
polite and attentive (20).
5. Exploring patient with cancer’s can offer as the biggest healing process
experiences of nurse’s caring behavior for patients (11).
accoding to Watson's theory: Promotion
6. Exploring patient with cancer’s
and Acceptance of positive and negative
experience nurse caring behavior
feelings (Promoting and expressing
according to Watson's theory: Systematic
positive and negative feelings)
use of the scientific problem solving
The results of this study showed that
method of decision making (Using
one participant was asked to be honest
process caring a creative solving
about his complaint by the nurse, so the
problems)
patient was welcoming to the nurse. This
The results of this study indicate that
is parallel with the research that saying
three of eight participants stated that
nurses must listen to suggestions from
nurses were able to read the patient's
patients and both parties between
situation when entering to the room. This
patients and nurses must be open and
is supported by the research on the
honest to each other in terms of
application of nurse’s caring behavior
communication in order to create a
acording to Watson's theory to In Vitro
relationship of mutual trust and
Fertilization (IVF) patients, stated that
comprehensive service delivery (21).
nurse’s caring behavior by Watson's
Researcher's analysis shows that if
theory can be a useful guide and
nurses and patients are open to each
becomes the main solution in solving
other in terms of communication,
problems faced by IVF patients (23).
therapeutic communication will created
Calling the patient's name and giving
smoothly and it will improve patient
enthusiasm to the cancer patient is one of
satisfaction. The other research
the creative methods used by nurses after
explained that patients' needs will be
reading the situation in the patient's
fulfilled if nurses can maintain good
room. This is also supported by the
relationships with patients through
results of the study which explained that
communication techniques while
by giving interventions according to 10
providing nursing care (22). Listening to
karative factors Watson, it will improve
other people's stories may be what nurses
the quality of life and happiness index of
cancer patients (6). This process will
 improve the ability of nurses through limited workforce and lack of knowledge
ability, knowledge, instinct, intuition, (25). According to Watson’s caring
aesthetics, technology, skills, empirical theory, to improve the intrapersonal
and even spiritual knowledge (11). learning process, nurses are required to
be involved in the patient's learning
7. Exploring patient with cancer’s
process. This can be indicated by nurses
experience nurse’s caring behavior
who was providing education to patients
according to Watson's theory: Promotion
and their families (11).
of transpersonal teaching-learning
8. Exploring patients with cancer
(Promoting transpersonal teaching)
experience nurse’s caring behavior
The results of this study indicate that
according to Watson's theory: Provision
five of eight participants stated that there
for supportive, protective, and / or
was no education related to patient
corrective mental, social, spiritual
independence. This is contrary to the
environment (Providing support,
book which states that one of the nurses'
protection and / or improvement of
roles is as an educator (Bastable, 2006).
mental, physical, social and spiritual
The role of nurses as educators is not
atmosphere)
achieved even though nurses should
Results of this study, seven of the
provide education to their patients. This
eight participant stated that the inpatient
is parallel with the research which states
room was clean. The cleanliness of the
that the role of nurses as educators is
inpatient room is really have an effects
very important for patients and their
on the patient’s health. The study states
families (24).
that environmental health is an optimum
Based observations, researcher found
environmental condition, so it has a
less-implementation of nurses as
positive effect on the realization of
educators and it happened because
optimum patient’s health (26). Seven
nurses having many jobs, quite limited
from eight patients still complained that
nurses and a lot of patient. This parallel
the room is heat. The heat conditions that
with the study which stated that the
patients complain about can have a
barriers of nurses in conducting
negative impact on patients. This is
education are limited time, too much
parallel with the study which states that
work and patients, busyness, laziness,
 if a hot inpatient room is sustainable, it
will give negative output to the patient's
health (27).
The results of this study indicate that
three patients from eight patients stated
that they were disturbed by the family of
other patients who often made noise.
Noise in the inpatient room can have a
negative impact on the patient. This is
parallel with the study which states that
if the inpatient room has a noisy or noisy
environment, it will give negative output
to the patient's health (27). There are
things that can be assessed from these
factors include comfort, cleanliness,
privacy, security, aesthetic environment
(11).
9. Exploring patient with cancer’s
experience nurse’s caring behavior
according to Watson's theory: Assistance
with gratification of human needs.
This study shows that nurses often
observe patients. Frequent of
observations will increase the patient's
sense of satisfaction during treatment.
This is suitable with research which
states that the most support given by
nurses to patients is the form of nurse
support in providing services to patients
(28). It happened because nurses always
remind patients to eat and take
medication, give regular injections that
have been recommended and must know
the patient's problem with the right
solution, and give enthusiasm, so that
patient patients can recover from the
disease.
Although the nurse’s observation has
often to did, six out of eight participants
complained that the response time the
nurse had was still long. The research
explains that long response times can
have a negative impact, namely
complications, disability and even death
(29). The level of responsiveness of
nurses in serving patients is also one
factor that must be maintained by nurses
to provide the best service. As explained
in the on the book that efforts to provide
services in order to provide patient
satisfaction, especially emergency
services, can be assessed from the nurse's
ability in terms of responsiveness
(Muninjaya, 2011) .
The results of this study indicate that
three participants from four participants,
who gave answers about family
involvement in nursing therapy, stated
that form of family involvement in this
hospital only such as taking medicines at
 the pharmacy, disposing of the patient's
fluids, and closing the curtain. However,
in the nursing treatment, the patient's
family can assist nurses in terms of
personal hygiene. The book explained
that nurses or families can do personal
hygiene such as skin care, bathe patients,
care for eyes, nose and ears, and
immobilize patients (Potter & Perry,
2009). Nurses are not only given
physical touch access but physical
recovery must also be included.
However, nurses still have to involve the
family when carrying out certain nursing
actions that need other people (11).
10. Exploring patient with cancer’s
experience of nurse’s caring behavior
according to Watson's theory: Allowance
for existential-phenomenological
spiritual dimension (Allowing for the
power of spiritual phenomena)
This study found that seven patients
from eight patients stated that nurses
often provide motivation to patients and
remain the patient to courageous while
facing their disease. Giving motivation
like this is suitable with the research
which explained that problems often
increse when a patient has tire to pass
intense treatment or do hospitalization in
a hospital and have no motivation to
recover (30). This is where the nurse's
role as a motivator. The sample in this
study claimed that nurses also often
reminded patients to surrender and
courageous to God in dealing with their
illness. This is consistent with the
research which states that giving
guidance on the implementation of
prayer, thoharoh for sick people, daily
dhikr and prayer and maintaining the
purity of monotheism, the guidance of
sakaratul maut will be responded
positively by patients (31).
Although nurses have rational
science, nurses must trust the existence
of support existential-
phenomenological. This factor has the
last hope, certainty, myth and subjective
metaphor of inner life between nurses
and patients or families that enable
miraculous healing (11).
CONCLUSION
The results of this study indicate that
nurse’s caring behaviori n Wahidin
Sudirohusodo Makassar Hospoital is almost
optimal according to the Watson’s caring
theory. It brings a positive experience for
patient with cancer in the cancer and internal
treatment rooms of Wahidin Sudirohusodo
Makassar Hospital. Nurses have done most of
the ten Watson charity processes in carrying
out nursing care in the treatment rooms.
However, there are still some things that
patients often complain about. This can be
seen from the patient's complaints about the
nurse's long response to responds the patient's
complaints and needs. Nurses have a very
important role to provide for the basic needs
of patients. So, if the nurse's response is long,
that will have an impact on the condition of
patient, especially cancer patients. All
patients expect that nursing services in terms
of response to complaints are improved.
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