When most people are asked 'what do nurses do," there is a strong likelihood that the word 'caring' will arise in the conversation. Many nurses, particularly new nurses, identify caring as one of the personal qualities that attracted them to the profession. However, caring can be a very nebulous concept, as even non-nurses give 'care' to others and non-nurses can be 'caring' people. Nursing, in an effort to create an empirical and academic basis for itself as a discipline has fought against the idea that nursing is just about caring. However, it cannot 'ignore' the idea of caring, given that one of the concepts that distinguishes nursing from other forms of medical care is its patient-centric and individualistic perspective.
I have chosen caring as the concept I will focus on in this paper, with a specific focus on Jean Watson's Theory of Caring, given that it is one of the major theories of nursing that 'dares' to place the concept of caring at the center of its mission. Watson's theory will be compared and contrasted with Madeleine Leininger's Culture Care Theory in a literature review. It should be noted that while Watson's theory aims to be scientific, it also attempts to embrace some concepts of caring that nurses might shy away from. Watson's view of what she calls caring science encompasses "multiple epistemological approaches to inquiry including clinical and empirical, but is open to moving into new areas of inquiry that explore other ways of knowing, for example, aesthetic, poetic, narrative, personal, intuitive, kinesthetic, evolving consciousness, intentionality, metaphysical-spiritual, as well as moral-ethical knowing" (Vance 2011).
Watson has been praised by nurses for being willing to retain caring as a core nursing value and for inspiring nurses. Today, nurses are increasingly viewed as just practicing an ordinary job (and perhaps choosing their profession for economic and practical reasons rather than as a true vocation). "Upholding Watson's caring theory not only allows the nurse to practice the art of caring, to provide compassion to ease patients' and families' suffering, and to promote their healing and dignity but it can also contribute to expand the nurse's own actualization" (Cara 2011).
Review of literature
According to Jean Watson, caring is not merely an emotion, but a science. The concept of caring is humanitarian but involves caring in terms of a human science orientation, including observation of human phenomenon and experiences. Watson's theory of caring science "includes arts and humanities as well as science...and a world view of unity and connectedness of all. Transpersonal Caring acknowledges unity of life and connections that move in concentric circles of caring-from individual, to others, to community, to world, to Planet Earth, to the universe" (Vance 2011). Watson calls the cornerstone of her theory the caritas factors, which she lists as follows:
...a humanistic-altruistic system of value; faith-hope; sensitivity to self and others; helping-trusting, human care relationship; expressing positive and negative feelings; creative problem-solving caring process; transpersonal teaching-learning; supportive, protective, and/or corrective mental, physical, societal, and spiritual environment; human needs assistance" and "existential-phenomenological-spiritual forces" (Cara 2011).
Nurses provide hope, but not unrealistic hope -- they treat the individual needs of the patient with sensitivity and support patients as caregivers, but corrective aid is not the same for all patients, depending on the stage of life, culture, and environment of the patient. There is also a spiritual dynamic to nursing connected with the nurses' status as a healer.
Critics of Watson have called her views excessively idealistic, given that a nurse coping with the day-to-day challenges of working on a ward will likely not be able to focus on 'the universe' when trying to shoulder an overburdened schedule, patient load, and high levels of physical and mental stress. However, Chantal Cara of the Universite de Montreal nursing faculty states: "Being informed by Watson's caring theory allows us to return to our deep professional roots and values; it represents the archetype of an ideal nurse. Caring endorses our professional identity within a context where humanistic values are constantly questioned and challenged" (Cara 2011). Cara states that Watson's concerns are more rather than less relevant than ever before because of the over-burdened nature of the healthcare system.
Watson defines caring in a very practical, behavior oriented fashion: caring behaviors, are "attentive listening, comforting, honesty, patience, responsibility, providing information so the patient can make an informed decision, touch, sensitivity, respect, [and] calling the patient by name" (Vance 2011). This is part of the transpersonal caring relationship that is at the heart of nursing, which involves reaching deeper into spiritual connections between the nurse and the patient.
It should be noted that Watson is not the only nursing theorist to make care a cornerstone of his or her theory. For example, Madeleine Leininger's Culture Care Theory likewise stresses care and the need for establishing a mutual understanding between patient and nurse. Leininger's theory, however, stresses to a greater degree the cultural component of caring. Watson tends to focus more on the individual, while Leininger stresses contextualizing the cultural care needs of the patient within the cultural environment. According to Leininger, care is not transnational or transtheoretical, but is culturally specific. Giving culturally appropriate care means addressing "the subjectively and objectively learned and transmitted values, beliefs and patterned lifeways that assist, support, facilitate, or enable another individual or group to maintain their well-being, health, to improve their human condition and lifeway, or to deal with illness, handicaps, or death" (Metaparadigm in Leininger's Theory, 2011, Madeline Leininger cultural care).
Some patients may wish to make important life decisions autonomously; some families may wish to have a more collective and collaborative decision-making process when determining what care is appropriate, and the nurse must not assume that care is the same for every patient or what she or he would prefer, if in the same situation. Understanding difference as well as similarity is important in Leininger's theory. "According to Watson (1988b, 1999), a caring occasion is the moment (focal point in space and time) when the nurse and another person come together in such a way that an occasion for human caring is created" (Cara 2011). Leininger views what Watson would call the caring moment as always part of a wider cultural dynamic.
Watson stresses that the nurse must be aware of herself and her needs as well as for the patient, much like Leininger stresses cultural self-awareness, but Leininger's theory suggests that such transpersonal caring may not be welcome for patients from different backgrounds. However, within both theories, antecedents for care require self-knowledge on the part of the nurse, as well as an awareness of the patient's particular situation. Both theories of caring also stress the need for dialogue between nurse and patient. The consequences of a failure of communication or a failure to acknowledge the patient's worldview can be compromised care -- Leininger stresses the need to tailor care to culture and respecting different cultural concepts of health, but also to engage in cultural repatterning and restructuring to optimalize care, for example. Watson's emphasis is on the patient's 'being in the world' and inquires about the patient's environment (including the patient's cultural environment) and personal view of health rather than imposes a singular concept of health upon the patient.
The concept of care in nursing reflects the idea that the nurse must understand the patient's environmental context. For example, when dealing with a child who is ill, the nurse must phrase his or her inquires in age-appropriate ways and also includes the parent in discussions about the child's health in a manner that is respectful of the difficulties the parent is going through. The parents' education and life situation must be considered when explaining what care is appropriate, as must the cultural view of the correct relationship of child to adult. For example, parents from a traditional Muslim culture might assume they have a greater decision-making authority over their older adolescent's health, particularly decisions regarding sexuality, which the nurse may need to keep in mind when advising them that their daughter should be vaccinated against HPV, which is a sexually transmitted disease linked to cancer. Caring does not mean foregoing the vaccine, but it does mean understanding that the parents must understand that the vaccine is a preventative step for the child's entire life and can protect against certain kinds of cancer -- it is not birth control or reflect the girl's sexual status.
The concept of care also reflects a notion of treating the patient in mind, body, and spirit. For example, when dealing with a patient who is deciding to undergo another round of chemotherapy, the patient's willingness to suffer through the treatment and its consequences must be evaluated as well as the statistical likelihood of its success. A good example of this was recently reported in the media -- a chef was diagnosed with tongue cancer, and originally, it was recommended that he have most of his tongue removed. However, because of the importance of his sense of taste…