Jean Watson's transpersonal caring nursing principles and behaviors

Watson Job Aid

Watson job-aid: Jean Watson's caring science

Transpersonal Caring Nursing

Principles for nurses, even principles on a subject as important as caring, can seem overly vague and theoretical unless they are put into practical terms. Nursing theorist Jean Watson has attempted to define her idealistic concept of Transpersonal Caring Nursing in a behavioral as well as a theoretical sense. Watson's list of 'behaviors' make her theory relatable to nurses in the field, as well as those who teach nursing theory. Transpersonal nursing views nursing as "concentric circles of caring-from individual, to others, to community, to world, to Planet Earth, to the universe. Caring science investigations embrace inquiry that are reflective, subjective and interpretative as well as objective-empirical" (Vance 2010: 1). Caring science is empirical in the sense that it is based upon nursing science. However, it is also willing to incorporate the philosophical, artistic, spiritual, and kinesthetic into its overview. Science is merely one way of knowing, not the only way.

The new professional model of caring-healing practices that informs Watson's work views the patient as an equal partner in the healing and treatment process. Treatment is not administered 'to' a patient, rather the journey is a mutual one, and requires a shared sense of empathy on the part of the nurse with the patient, rather than solely seeing the patient in terms of his or her degree of health or illness. Watson identified her model as postmodern, or rejecting the notion of a singular paradigm or culture. It views all beings as integrated into cyclical processes of life and death and calls upon nurses to strive to "lift their focus from a modern medical science-technocure orientation to a true caring-healing-loving model" (Theory, 2011, Caring Science Institute). The following job aid distills Watson's principles into her guidelines for nursing behavior to make these transpersonal concepts useful in the day-to-day life of a working nurse.

Job aid: Remember Watson's Top ten caring behaviors

Comforting

Nurses are often dealing with patients in high-stress, serious situations. Patients may have received an unwelcome diagnosis for themselves or for a loved one. A nurse must demonstrate empathy, even if he or she is also striving to provide a scientific remedy. Watson says of patient and nurse: "together they join in a mutual search for meaning and wholeness of being and becoming to potentiate comfort measures, pain control, a sense of well-being, wholeness, or even spiritual transcendence of suffering" (Theory, 2011, Caring Science Institute).

Honesty

Comforting the patient does not mean 'sugar-coating' the truth. Nurses must be honest with patients, using appropriate language for the patient's level of cognition and age. While hope and optimism are important parts of providing care, the hopefulness must be realistic. For some patients, hopefulness might mean an end of suffering rather than an end of an illness.

Patience

This is perhaps the most difficult value to embrace as part of Watson's model. Today, expediency and financial value rather than patience are often celebrated in healthcare. Getting an accurate diagnosis and understanding the patient's priorities and state of mental or physical wellness, however, cannot be rushed. Patience can often save a great deal of grief later on, as patience ensures for a complete understanding of the patient's situation.

Responsibility

The nurse takes responsibility for the patient as a human being. Responsibility is not simply filling in a chart: it means seeking to understand the patient. "The one caring and the one being cared for are interconnected" (Vance 2011: 2).

Providing information so the patient can make an informed decision

Giving information to patients is essential to ensure that patients are able to participate in their treatment to the maximum extent of their capabilities.

Touch

In our tactile-phobic world, nurses may feel uncomfortable touching patients even when medically necessary. Touching the patient in a respectful manner during invasive procedures should be done with the patient's verbal consent and acknowledgement of the discomfort the patient might feel.

Sensitivity

The nurse must often deal with a patient who has experienced loss -- loss of vital physical functions, the loss of a loved one, or simply the loss of a particular self-image (like a woman who must confront infertility). The nurse must strive to see the world with the patient's own eyes, rather than grow hardened to the cycles of illness and death that he or she witnesses over the course of his or her workday. "The goal of nursing with Watson's theory is centered around helping the patient gain a higher degree of harmony within the mind, body, and soul" and without acknowledging the uniqueness of the patient's worldview, this goal cannot be realized (Vance 2010:2).

Respect

As treatment is a mutual partnership, it must be founded upon the principle of respect for the patient. "The patient is viewed as whole and complete, regardless of illness or disease" (Vance 2010:2)

Calling the patient by name

Transactions between nurse and patient must mirror those of authentic relationships outside of the healthcare environment. The nurse must call the patient by name and convey in his or her small and large gestures the nurse's sense of connection to the patient's worldview and physical, mental, social, and spiritual condition.

Conclusion: Enhancing scholarship

The breadth of philosophy and empathetic understanding called upon by the Watson model underlines the need for nursing to become a truly cross-disciplinary field, encompassing the humanities as well as the social sciences. Modern medicine has become a technologically-driven endeavor, and even the field of mental health has increasingly tended to focus on biology rather than upon the psychology of healing. Nursing educators must seek to create discussions between themselves and other fields, and nursing students must strive to seek out an understanding of other disciplines as much as possible over the course of their education. They must continue to build upon their base of knowledge of other cultures, ways of viewing health and sickness in literature, and medical ethics. Nursing demands a soul of breadth and depth, and these qualities will enhance the resiliency of the nurse as well as the nurse's ability to provide care. "The future already reveals that all health care practitioners will need to work within a shared framework of caring relationships; mindbodyspirit medicine; embracing healing arts, caring practices, and processes; and the spiritual dimensions of care much more completely" (Theory, 2011, Caring Science Institute).