2010 IYNURSE

Above: Logo used with permission Caravan Express Right: Jean Watson Nurse-theorist, speaker and author

and the Next Decade of Holistic Healing:

Transforming Self and System from the Inside Out
by JEAN WATSON PhD, RN, AHN-BC, FAAN aring Science is transforming health care from the evolution of the practitioners themselves, rather than externally oriented systemsfrom the inside out. Practitioners of holistic nursing serve as major exemplars of practitioners of Caring Science and Caring Theory. Philosophies, ethics, values and theories of human caring in nursing have continued to evolve over the past three decades. This has largely occurred silently and behind the scenes in enlightened, progressive academic nursing programs worldwide, and through the enduring commitments, professional activities, scholarship and practices of holistic nursing practitioners, under the leadership of the American Holistic Nurses Association (AHNA) and other like-minded professional associations. More recently, in the past decade or so, there has been increasing attention to theory-guided practice models and

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caringhealing relationships as the core of professional nursing. Moreover, practitioners, especially those in the field of holistic nursing, seek authentic spirit-filled healing practices, which give meaning and purpose to their personal/professional spiritual lives and work, and to those whom they serve. A framework of Caring Science has evolved during this same past decade, along with attention to theory-guided practice. Together, they offer a bigger vision and deeper foundation for holistic nursing, embracing, yet transcending, current practices and offering an expanded vision for nursings future. This evolved integration and synthesis of Caring Science and Theory gives birth to authentic, spirit-filled, loving caring-healing practices that embrace all of humanity, offering a hopeful paradigm for this era (Watson & Foster, 2003; Watson, 2006, 2008). In recent years, many nursing leaders and administrators
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In the past decade or so, there has been increasing attention to theory-guided practice models and caring-healing relationships as the core of professional nursing.
have been committed to going beyond magnet hospital criteria for nursing to acknowledging that changes in nursing practice help to transform the entire staff and system. Some of the new awakenings pertaining to caring and healing include the following (Watson, 2009): Human caring is not a commodity to be bought and sold; Caring and economics can co-exist to achieve cost-benefits and cost effectiveness including quality care outcomes and improved safety measures; Caring is a professional, ethical covenant that nursing has with its pubic to sustain human caring; Caring science provides a disciplinary foundation to guide professional development and practices; Practitioners and patients alike require caring relationships, healing environments, and a culture of caring, healing and love, if authentic practices are to be sustained within any healthcare setting (Watson, 2003, 2005, 2008); True transformation of health care ultimately has to come from a shift in consciousness and intentional, informed actions of the practitioners themselves; True reform toward authentic caring-science institutions requires change from the inside out, drawing upon the human spirit and visions of what might be refusing to succumb to what is and no longer works. participants of the International Caritas Consortium (ICC, www.caritasconsortium.org). Indicators of Caring Theory in action are identified from my personal experiences witnessing and influencing cultural-system change within a variety of hospitals throughout the United States (Watson, 2009; Watson & Foster, 2003). Hospitals are: Making Caring Science integral to the organizational culture, through articulating the human-caring vision, philosophy, values, ethical and scientific foundation for staff and patients alike; Introducing and naming the professional caring-practice models, leading to new patterns of delivery of caring; Using the language of the theory to express and communicate the phenomenon of human caringacknowledging that in this postmodern era, if a profession does not have language to communicate its focus, it becomes invisible; Using conscious, intentional healing-arts rituals. For example, using hand washing not just for infection control, but to energetically cleanse oneself in order to bless and release the previous situation, and opening to receive the next; or pausing to set intention before entering a patients room (Watson, 1999); Seeking to see and connect with the spirit-filled person, behind the disease, diagnosis, treatment, behavior, etc.; Practicing caring-healing modalitiesfor self and patients (e.g. massage, therapeutic touch, healing touch, reflexology, aromatherapy, calmative oil of essences, sound, music, arts and a variety of energetic modalities); Incorporating systematic centering exercises and mindfulness practice, individually and collectively; Placing magnets on patients doors, with positive affirmations, reminders, quotes from the theory and other positive message reminders; Exploring documentation of caring language and integration of Caring Theory into computerized documentation systems (Rosenberg, 2006); Participating in multi-site research, assessing caring among staff and patients (Quinn, Smith, Ritenbaugh, Swanson, & Watson, 2003; Watson, 2010); Creating healing environments, sanctuary for nurses own space and healing environment for patients paying attention to the subtle environment or Caritas field (Watson, 2005); Displaying healing objects, art, blessings baskets, healing stones, etc., for staff and patients use; Creating Caritas circles to share caring moments (Watson, 2008);
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AHNA and its members are paving the way toward authentic transformation from the inside out. As such there is an increasing trend toward a spiritualizing of health, away from the outdated medicalizing of human health and illness. There is an opening to the spirituality of practitioners as well as patients, honoring the sacred life force, the mystery and miracles of our humanity, and vicissitudes of human experiences. Hospital and nursing administrators as well as managers have a significant role to play in transforming the dominant medical techno-cure system of today, which has been identified in some classic research as biocidic (unhealthy, toxic, no life-giving force), in contrast to biogenic (life giving and life receiving for patient and practitioner alike) (Halldorsdottir, 1991). Thus, Caring Science/ theory-guided clinical care, combined with holistic healing practices, is restoring the human spirit and inner healing processes. authentic Change is Underway New projects and practice models using Caring Science/Caring Theory are underway (Watson, 2009). When systems begin to authentically embrace Caring Theory and its role in healing, and thus creating biogenic practices, the foundation for professional nursing shifts. Many of the changes are occurring among
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Engaging in caring rounds at bedside with patients; Interviewing and selecting staff on the basis of caring orientation (for example asking candidates to describe a caring moment); Developing caring competencies Caritas literacy as guide to assess and promote staff development and assure and sustain caring healing relationships and practices (Watson, 2008).

These and other practices are occurring in a variety of hospitals across the United States, often in magnet hospitals or those seeking magnet recognition. Caring Science/Caring Theory combined with caring-healing modalities, represented by holistic nursing, are contributing to this major system shift to create authentic Caring Science Systems for now and the emerging future.
References Quinn, J. F Smith, M., Ritenbaugh, C., Swanson, K., & Watson, M. J. ., (2003). Research guidelines for assessing the impact of the healing relationship in clinical nursing. Alternative therapies in health and medicine, 9(3), A65-A79. Rosenberg, S. (2006). Utilizing the language of Jean Watsons CaringTheory within a Computerized Clinical Documentation system. CIN: Computers, Informatics, Nursing, 24(1), 53-56. Watson, J. (1999; reprinted 2005). Postmodern nursing and beyond. UK: New York: Churchill-Livingston/Elsevier. Watson, J. (2003). Love and caring: Ethics of face and hand. Nursing Administration Quarterly, 27(3), 197-202. Watson, J. & Foster, R. (2003). The Attending Nurse Caring Model: Integrating theory, evidence and advanced caring-healing

therapeutics for transforming professional practice. Journal of Clinical Nursing, 12(3), 360-365. Watson, J. (2005). Caring science as sacred science. Philadelphia: F A. . Davis. Watson, J. (2006). Caring Theory as ethical guide to administrative and clinical practices. Nursing Administrative Quarterly, 30(1), 48-55. Watson, J. (2008). Nursing. The philosophy and science of caring (Rev. ed.). Boulder: University Press of Colorado. Watson, J. (2009). Caring Science and Human Caring Theory: Transforming personal/professional practices in nursing and healthcare. Journal of Health and Human Services Administration, 31(4), 466-482.

Jean Watson PhD, RN, AHN-BC, FAAN is distinguished professor of nursing and holds an endowed chair in Caring Science at the University of Colorado Denver and Anschutz Medical Center Campus. She is founder of the original Center for Human Caring in Colorado and is a fellow of the American Academy of Nursing, and author /co-author of more than 14 books. She is a recipient of several awards and honors, including an international Kellogg and a Fulbright Research Award. She holds eight Honorary Doctoral Degrees, including five International Honorary Doctorates. She is founder and director of a new non-profit foundation, the Watson Caring Science Institute, www.watsoncaringscience.org. Editors Note: Jean Watson will be a keynote speaker at AHNAs 30th Annual Conference, Re-Visioning Environment: Creating a Habitat for Healing, this June in Colorado Springs.

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