Iconic nursing leader and theorist Jean Watson established an innovative and much-needed component to the field of nursing which she refers to as a caring theory. This paper uses Watson's theories and examples of what she called "a caring moment" in the context of fully discussing nursing from Watson's point-of-view.
Major components and background of Watson's theory
"Watson (1988) defines caring as the moral ideal of nursing whereby the end is protection, enhancement, and preservation of human dignity… [caring] involves values, a will, and a commitment to care, knowledge, caring actions and consequences" (Cohen, 1991, p. 899).
In her 1999 book, Nursing: Human Science and Human Care: A Theory of Nursing, Watson makes clear that "Nursing science" needs to move away from "homogeneity of thinking" and find breakthrough ideas that are workable and based on the science of nursing. That said, Watson believes there have been "…some conceptual inconsistencies" within some of nursing "dimensions" (Watson, 1999, p. 5). One of those problems she alludes to is that while nursing theories and concepts should be "…open, fluid, changing, and consistent with human behavior," too often nursing theories and practices have been "…trapped by applications of rigid testability" (Watson, 5). After all, Watson emphasizes, she advocates progress, new methods of discovery, and "the hidden meanings in nature and life," and hence she argues against the use of stagnant, tired theories that linger rather than evolve (6).
When approaching the development of an original theory, there are considerations that Watson believes are important. If the perspective being pursued is "…too global and too abstract" (even if it is powerful and rich with fresh thought) it is "sometimes discredited," Watson writes (8). When theories are being developed for nursing (and in science generally), several concepts must be kept in mind: a) one's "particular leanings" should be made clear; b) a diversity of approaches to nursing should be encouraged; and c) one's own personal values and beliefs should be the drivers for any new suggestions vis-a-vis theories of nursing (Watson, 8).
In her 2011 book, Human Caring Science, Watson outlines the "broad themes" she embraces as she considers what the nursing practice should focus on: a) a philosophical view of the person as a whole person (mind-body-spirit-soul) that is linked to Planet Earth and the cosmos; b) the inner and mysterious meanings of life and "…the caring relationship" between the person and his or her environment; c) offering "caring moments" to the patient; d) non-medical healing through caring relationships with the patient; e) human caring means respecting human dignity (Watson, 19-20).
The Caring Moment
In the Watson Caring Science Institute the author offers that a caring occasion occurs "…whenever the nurse and another come together with their unique life histories…in a human-to-human transaction" (p. 2). A caring moment becomes "transcendent" because the process goes "beyond itself" to become part of a more "complex pattern of life" (p. 2). The caring moment involves "an action and choice by both the nurse and the other"; at the moment that the two connect, a decision can be made where the relationship might possibly go. When the caring moment is "transpersonal," each party will connect with the other "at the spirit level," and thus the caring moment transcends time and space, and healing may begin at a "deeper level than [mere] physical interaction" (Watson, p. 2).
Watson's "Caring Theory" is at work in a number of hospitals and healthcare facilities; the list is presented in an article Watson wrote in the peer-reviewed Journal of Health & Human Services Administration (Watson, 2009). Meanwhile, in the peer-reviewed Journal of Nursing Research, the authors (Suliman, et al., 2009) administered a questionnaire survey in Saudi Arabia -- using 393 patients from three hospitals in different geographical locations -- that showed 97.2% of the patients "…rated overall caring behaviors as important." Some 73.7% of the respondents reported that they had indeed received caring behaviors from the nursing staffs on those three locations. This example shows that caring moments are not limited to Western society.
Major theory assumptions related to person, health, nursing and environment in the context of the caring moment: In that peer-reviewed article, Watson asserts that: a) caring for humans cannot be bought or sold; b) caring and economics "are not mutually exclusive" and they do co-exist to achieve "cost-benefits and cost-effectiveness"; c) caring is an ethical covenant between nurse and the; public, and it goes deeper than "a customer model" orientation; d) nurses and patients require relationships that are based on caring and healing environments; and e) there must be a shift in consciousness in order to transform healthcare; the shift must be from the practitioners -- inside out (Watson, 469-70).
On page 467 Watson insists that "radical change from within is essential" in order to turn back the "non-caring trend many experience or witness in hospitals and health care today." The author believes far too much attention has been focuses on "external issues and forces" (economics, technology, environmental hospitality models, access control, compensation, recruitment, bonuses for signing contracts, and management), which Watson calls "superficial and short-term" (Watson, 467). There has not been sufficient emphasis on the deeper and value-based approach to nursing, Watson asserts, and in order to sustain the "integrity and dignity of the profession" a caring attitude and the implementation of caring moments must be put in place and nurses need to be trained or retrained in that humanistic, thoughtful approach to nursing (467).
Carative Factors: In the same scholarly article, Watson describes a number of carative factors that she believes should be implemented in a nurse-patient setting. Several of those factors deserve mention in this paper. For example, nurses should intentionally pause and breathe before entering a patient's room; and after servicing the patient a nurse should "dim the unit lights" and designate quiet time for patients and their families -- this calms the environment, Watson explains (475). Nurses need to cultivate their own "…spiritual, heart-centered practices of loving kindness"; and healing spaces for nurses need to be created in the hospital or healthcare center (these spaces should be appropriate for meditation and simply relaxing away from the stress of the workplace).
Watson suggests that certain healing objects, like stones or "blessing baskets" should be displayed so nurses and patients see and feel the seriousness involved in the caring moments. The author also suggests the following: a) nurses should place magnets on patient's door with "positive affirmations, and reminders of caring practices"; b) nurses should use the ritual of hand-washing for more than sanitation -- in fact, hand-washing can be symbolic of a cleansing, a blessing, or "releasing" of that last stressful encounter with a patient; and c) human resources should be interviewing and hiring staff based on their orientation toward "caring"; candidates should be asked what a "caring moment" really is (Watson, 475-76).
In a guest editorial in the peer-reviewed Journal of Clinical Nursing (Watson, 2005, p. 913), Watson shows her impatience with the state of nursing (at least as it was in 2005). "What is nursing thinking," she asks, "when there is a world view global shift towards an awakening of human consciousness towards a deeper spiritual dimension of one's humanity?" (913) What is the nursing community doing to make "…our moral, covenantal commitment and contribution to society?" she asks. What is nursing doing with respect to "…pressing human concerns in systems that are increasingly deplete of human caring…[and] is it only scientific-technical epistemic evidence that nursing seeks?" she continues.
She lists a litany of ills that humans are subjected to -- "…illness, tragedy, injury, assault, change, transition and violence… despairing and heart-breaking" and "dying experiences" -- and wonders how nurses can bring "…messages and meanings that offer hope for healing the human spirit" (Watson, 913). The author goes on to explain that there are crisis points in any aspect of life, and when there is a crisis point that opens the door to a "…horizon of possibilities for action" that goes well beyond "what is" and looks for "what might be." Well, Watson continues on page 914, the present time is a crisis point and it should be met with "…a call for nursing to come of age, to instill, inspirit, inspire and birth knowledge, language and practices" that have hitherto been ignored.
Personal reflection on a caring moment
As a nursing student I was caring for a 91-year-old female patient with abnormal uterine bleeding; she had been diagnosed with cervical cancer and it had metastasized. During a meeting with the patient, the doctor, the patient's husband, daughter and the daughter's fiance -- along with the RN and me -- the patient's situation was discussed. The daughter and the daughter's fiance spent a good deal of time arguing for what they thought should happen to the patient, but the patient's husband was not vocal in explaining what he believed should be done.
After the meeting I reentered the patient's room to administer medications; while there I saw that the…