¶ … Professional Practice Model: Jean Watson's Caring Model The objective of this study is to examine the philosophy of Jean Watson's Caring Model and to provide the organizational definition and state the organization's mission and vision statement. Several definitions of the concept will be identified in the nursing literature. Finally, this work will state how this concept supports the professional model chosen.

The work of Jean Watson and Roxie Foster (2003) reports a proposed model entitled 'The Attending Nursing Caring Model' (ANCM) held to be an "exemplar for advancing and transforming nursing practice within a reflective, theoretical, and evidence-based context." (p.360) It is reported that nurses who are unable to "practice within a caring context are reported to be hardened, oblivious, robot-like, frightened and worn down." (Swanson, 1999, cited in Watson and Foster, 2003, p. 361) Watson and Foster (2003) additionally note that nurses are "torn between the human caring model of nursing that attracted them to the profession and the task-oriented biomedical model and institutional demands that consumes their practice time." (p. 360)

I. Watson's Nursing Model of Caring

Gessner (n.d.) reports that Watson's model of caring was originally developed in the 1970s and modified several times to what is now the "postmodern transpersonal caring-healing paradigm (1999) which is applicable to the practice of nursing and other disciplines." (p.2) Gessner goes on to report that the various concepts that Florence Nightingale and other nursing leaders are valid presently to modern clinicians. The themes included in Watson's caring model include: (1) the idea of the human being valued as an individual who is to be "cared for, respected, nurtured, understood, and assisted" and (2) an emphasis placed on "human-to-human care transaction" between the nurse and the individual. (Gessner, 2003, p.2) Gessner reports that the work of Fitzpatrick and Whall noted the belief of Watson that both the patient and nurse are active participants in the process of caring and healing through experiencing "the quantum energy fields conducive to healing from a spiritual, mystical, environment." (2005, p.297 cited in Gessner, n.d., p.2)

II. Watson's Concepts

Watson's concepts are reported as having a "spiritual element that affects both the nurse and the client, allowing them to connect deeply and transcend the moment." (Gessner, n.d., p.2) Watson's model can be described best according to Gessner "in terms of the nursing metaparadisgm" as Watson states that caring is "the moral ideal" (1988, p.54 cited in Gessner, n.d., p.2) According to Watson, since nursing is "a human science, there are important moral, spiritual and metaphysical components and we can use our spirits to relate to others." (p.3) Watson holds that the individual has three elements stated as: (1) the mind; (2) the body; and (3) the soul and all of these are affected by the self. Watson holds that the individual is a spiritual as well as physical being and that they have their own personal existence and experience. (Gessner, n.d., paraphrased)

III. The Nursing Role

Watson's caring model of nursing holds that the role of the nurse is to: (1) establish a caring relationship with the patient; (2) treat patients as holistic beings meaning that they are comprised by body, mind and spirit; (3) display unconditional acceptance of the patient; (4) treat patient with positive regard; (4) display unconditional acceptance; (5) promote health through use of knowledge and intervention; (6) spend time with the patient that is not interrupted known as 'caring moments'. (Vanguard Health Systems, n.d.)

IV. Characteristics of the Caring Moment

The caring moment is characterized by the following according to Watson: (1) The nurse makes contact with the patient and enters the room which creates a sense of expectation in the patient; (2) the nurse's attitude and level of competence creates the patient's idea of the world becoming: (a) larger or smaller; (b) brighter or drab; (c) rich or dull; (d) threatening or secure; and (3) these moments transform the patient and the nurse in that the two are linked together. (Vanguard Health Systems, n.d.)

V. Nursing Theory Applied -- Case Studies

Piedmont Hospital

Nursing theory is reported in the work of the Piedmont Hospital 'Professional Nursing Practice Model: Philosophy of Care' as being based on four major concepts including: (1) person; (2) health; (3) environment; and (4) nursing. (1997, p.2) A theory indicates a direction from which facts and events may be viewed. Concepts are reported as the "elements used to generate theories." (Piedmont Hospital, 1997, p.2)

Winter Haven Hospital

Winter Haven Hospital reports that its organization adopted Jean Watson's Theory of Caring as the...

The hospital is reported to have applied Jean Watson's caring behaviors to the hospital-wide implementation of a computerized job description. Specifically the process involved a small group being "convened by Human Resources and tasked with revising job descriptions." (p.1) It is reported that the following statement was incorporated into all job descriptions:
"All Winter Haven Hospital employees practice the Art and Science of Caring as described by Jean Watson's Caring Behaviors, including but not limited to: treating everyone with loving kindness, honoring faith and hope, developing caring trusting relationships, promoting teaching and learning, and creating healing environments." (Winter Haven Hospital, 2013, p.1)

Also reported is an incorporation of the Professional Model of Care behaviors into the electronic documentation system. Caring behaviors is reported to have identified in the hospital's Model of Care and are included in the nursing job descriptions. As well, the behaviors were included as 'measures of performance' in appraisals of annual performance stated to have merit increases tied to the performance.

Created as well were "RN Clinical REWARDS" or "Recognizing Excellence, Worth, Ambition, Resourcefulness, and Dedicated Service. The application process is reported to make a requirement of the nurse writing about how the five Caritas processes were utilized in caring for their patients. The Nursing Shared Governance membership is reported to conduct evaluation of the documentation of each applicant on how Jean Watson's Caring Theory has been effectively used in the provision of care for his or her patients. The approach utilized in adapting the Model of Care for Winter Haven Hospital has been that of enculturation which are reported to have numerous and diverse activities.

The hospital staff is reported to have made a commitment to staff members to participate in the Caring Coach program since its inception stated to support the growth and development of their caring philosophy in addition to the hospital's Model of Care. It is reported that the nursing staff received the assistance of coaches on caring behaviors that worked with the nurses in the creation of a common language that "consistently describes the behaviors in the electronic documentation tool." (Winter Haven Hospital, 2013, p.1)

In addition, a caritas coach is reported to have worked in the creation of a healing environment for oncology patients. This involved getting each of the rooms painted a different color and working with local artists who are reported to have made a donation of artwork for each room that created a feeling of home rather than what is described as the "typical, stark hospital room." (Winter Haven Hospital, 2013, p.1) The coach additionally painted the staff's break room to create a space that was more serene where staff could get away from the demands of work.

VI. Application of the Caring Behaviors in the Present Organization

Following the review of nursing literature on the application of Jean Watson's Theory of Caring Behaviors, and the subsequent review of case studies of organizations that have applied the tenants and principles contained in Jean Watson's Theory of Caring Behaviors the knowledge has been gained that there are several requirements in adoption of and adaptation to the this model by the organization. The first step in adopting this model of nursing care is the development of a language that is understood by all nursing staff that is effective in discussing and describing the specific caring behaviors contained in this model.

The second step is the institution of the caring behaviors in the daily routine and tasks of nursing staff so that the caring behaviors become firmly ingrained in the nursing model or otherwise stated that the caring behaviors become second-nature to the nursing staff in their provision of care to their patients. The third step is the institution of a system of measuring performance of nursing staff in their provision of nursing care using the caring behaviors as espoused by Jean Watson in her Theory of Caring. This will be accomplished in the same manner described by Winter Haven Hospital. This process of measuring performance will be such that will provide rewards to nursing staff that effectively utilize the five caritas in their provision of nursing care to their patients. Coaches will be available to effectively inspire, motivate, instruct, and direct the nursing staff in their provision of patient care using the caring behaviors as described in the nursing model of Jean Watson. Coaches will also instruct and direct nursing staff in the structural changes in the organization that will assist their labor in providing nursing care using the caring behaviors as described in the work of Jean Watson.

Summary and Conclusion

This study has…