Watson and Pauley: biographical study and influence

Nursing and Care Theories

Two of the major theories of nursing have been published by Jean Watson and by John Paley, who each have taken markedly distinct approaches to conceptualizing nursing care in a theoretical construct. Paley looks at some of the darker elements of nursing, using frames of "slave morality" and applying Nietzschean ideologies to the manifestation of contemporary nursing theory. Jean Watson has approached the theoretical foundation of nursing from a very different perspective over a long career focusing on the compassionate element of nursing care as it applies to human and humane experiences in care and loss.

Jean Watson, who hails from West Virginia, was educated at the University of Colorado and was appointed Distinguished Professor of Nursing and endowed Chair in Caring Science at the same university. Dr. Watson's degrees are in nursing and psychiatric-mental health nursing and PhD in educational psychology and counseling. Dr. Watson has received the prestigious Kellogg Fellowship in Australia as well as a Fulbright Award and half a dozen honorary degrees. The fundamental paper for Dr. Watson's nursing theory was published in 1979 in Nursing and is titled "The Philosophy and Science of Caring." This publication was followed up with 1988's "Nursing: Human Science and Human Care."

Watson divides her view on nursing into seven assumptions and ten primary carative factors pertaining to the role of nursing. The seven assumptions focus upon the key elements manifest in the role of care in nursing. They include acknowledgements such as that caring can only happen in an interpersonal, physical environment and that caring is central to nursing. She stresses the importance of patient agency while in the caring environment and projects that adequate caring contributes to the ability for health promotion and family and individual health (Meleis 1997).

The ten primary carative factors of Watson's work include the development of values situated in a humanistic tradition that arcs toward altruism. Faith, hope, and sensitivity are also crucial elements to the development of a self oriented toward the ability for adequate nursing care. In what might seem like a departure from the more esoteric elements of Watson's philosophy of care, the factors Watson crafts include an explicit reliance upon scientific methodology in decision making. The environment of care is defined by Watson across several variables, including the domain of mental, spiritual, physical, sociocultural, and emotional. The importance of attending to human physical needs is also underscored, highlighting the pragmatic elements of nursing care. Trust and a safely didactic environment are also cited as elements of Watson's philosophy of care (Taylor and Lillis 2001).

John Paley is a Senior Lecturer, Department of Nursing and Midwifery, University of Stirling in the United Kingdom. He takes what could be described as a skeptical perspective on the theories of care that Watson and similar theorists have put forth over the last several decades. Paley's areas of research interest include "Nursing's appropriation of phenomenology, the philosophy of qualitative research, professional ethics, nursing applications of the philosophy of mind, clinical cognition, and dynamic systems in health care. (University of Stirling 2011).

Paley suggests that there is no moral imperative, as Watson states, that privileges the benefit of altruism over any other moral or value system of belief. Even more controversially, Paley looks at the problematic elements of human and human care and suggests that caring is not necessarily and unquestioningly a virtue as Watson suggests and could be reframed as a vice as it "promotes favoritism, injustice, and self-deception. (Paley 2002)." Paley also suggests in his paper examining nursing as advocating a slave mentality that it is not politically realistic to care in a nursing context and that those who support a care-based nursing system are not realistic to the sociopolitical structures that create institutional harm which counters the best interests and intentions of the nursing industry. Paley investigates the way in which the care paradigm is constructed from caring philosophies, such as Watson's, phenomenology, and holism while defining a radical skepticism oriented toward the paradigm (Paley 2002).

It does not seem that Paley and Watson differ tremendously over their particular definitions of humanity, although the role of the human soul and the spiritual element of caring which Watson folds into her philosophy, even in its most nondenominational iterations has no place in Paley's position. On a social level, Paley takes exception to the concept that humanity is bound together out of a particular connective moral obligation and suggest that any conceptualization of such is actually predicated upon a system which elicits favoritism (Paley 2002).

The problems with this system, from Paley's perspective, are demonstrated in Nietzsche's Genealogy of Morality to be both philosophical and pragmatic; that the values of care are "values associated with caring are the expression of a profound resentment, harbored by the slaves (weak, powerless, timorous) against the nobles (strong, powerful, self-confident) (Paley 2002: 1). Watson's theory of caring does not suggest that care is culturally or even biologically embedded, as Paley seems to indicate Watson promulgates. She indicates that the true root of a philosophy of care which is established firmly enough to be transmitted over time are actually environmental and persist over time because the precedent has been firmly established in a particular environment.