Watson\'s Theory of Caring Theory/Clinical

¶ … Watson's Theory of Caring

Theory/Clinical Articles

Barker, B. & Reynolds, B. (1994). A critique: Watson's caring ideology. The proper focus of psychiatric nursing? J. Psychosoc Nurs Ment Health Serv. (32)(5):17-22.

In this article Barker and Reynolds critique Watson's theory of caring under two main arguments. First, they state that the conceptualization of care has a limited clinical utility in psychosocial contexts because psychotherapeutic traditions already incorporate concepts of helping. Second, they argue that in Watson's theory of caring, the use of caring language delimits any utility that the "caring" construct might possess, and that Watson's conceptualization of caring is an inappropriate focus for psychiatric nursing. They counter-argue that historical precedents exist for many of the propositions upon which the science of caring is based. Barker and Reynolds conclusion is that forty years of psychiatric nursing practice research and education render Watson's notion of a "science of caring" redundant. The application and reaction to this article is that the theory of caring may not be applicable to psychiatric nursing, but is still useful to other areas of nursing, and additional research in psychiatric studies is needed to support their assumptions.

Chantal, C. (2003). A Pragmatic View of Jean Watson's Caring Theory. Retrieved October 24, 2007, at http://www.humancaring.org.

Chantal provides an overview of Watson's caring theory to the nursing community, with the goal of facilitating the understanding of Watson's work to the field, allowing nurses to readily apply this knowledge within their practice. An overview of the administrative restructuring changes that is currently occurring in the healthcare industry is discussed in relation to the connected risk of dehumanizing patient care. The article concludes with the view that if we are to consider caring as the core of nursing, nurses will have to make a conscious effort to preserve human caring within their clinical, administrative, educational, and research practice. In applying this view to nursing, caring requires an intention and a commitment to care for the individual. The reaction to the article is that nurses have to be conscious and engaged to care in order to connect and establish a relationship with the cared-for to promote health and healing.

Costley, C. & Gibbs, P. (2006). Researching others: care as an ethic for practitioner researchers. www.informaworld.com1):89-98.

Costley & Gibbs explore the concept of whether Watson's theory of caring is a virtuous act as well as an advisable act. This article considers the locus of ethical responsibility for work-based practitioners, and considers ethics for researchers undertaking research in their organizations. The authors argue that, as practitioner researchers, they are insiders who have insider knowledge for the purpose of the research, as subjects, and this creates for them a different ethical position than for researchers able to research and then leave the context of their research space. In application to nursing, the authors argue whether an ethics of care should prevail. The issue and reaction raised are the ethical considerations practitioner researchers have to reflect upon ensure that they sufficiently take account of their position in the research community and how an ethics of care could be implemented to safeguard personal and moral relations to others.

Falk, a. (2000). Watson's Philosophy, Science, and Theory of Human Caring as a Conceptual Framework for Guiding Community Health Nursing Practice. Advances in Nursing Science. (23)(2):34-49.

This article explains how many nursing theories are criticized because of their focus on individuals and have been developed primarily for practice within the context of infirmity and disease, thus making them inadequate to guide community health nursing practice. Falk discusses Watson's theory of caring as an exception and proposes it as a nursing framework that is philosophically congruent with contemporary global approaches to community health and health promotion. This article applies to nursing the concept of a community assessment tool based on Watson's theory and documents recent community health nursing research studies. Falk uses the studies to conclude that the integral connection of the nurse with the community is evidence that effective public health nursing practice cannot dichotomize the community from the individuals within it. The reaction to nursing is to use Watson's to guide community health nurses to be consistent with the philosophy and practices of the founders of public health nursing

Fly, N. (1993). Beyond Professional Caring: Teaching Nursing Students the Art of Christian Caring. Retrieved October 24, 2007, at http://www.aiias.edu/ict/vol_10/10cc_167-185.htm.

This article discusses Watson's caring theory and Christian beliefs. Fly explains that nurses have historically been viewed as caregivers in the sense of emotional contribution and clinical expertise. Fly outlines nursing shortages and national health care changes, stating that nursing has become involved in developing a theory of caring for client interactions and teachable in nursing schools. The article concludes that the caring ministry of Christian professionals has been of interest to various philosophers and theologians, and that their insights enhance the Christian nurses' view of the healing role. It applies this theory to nursing by concluding that the unselfish love of nurses, manifested in acts of disinterested kindness, will make it easier for these suffering ones to believe in the love of Christ. The reaction to this article is that students in Christian nursing programs will build on existing theories of caring to include an involvement with clients which supports faith, meaning, and hope.

Foster, R. (2006). A Perspective on Watson's Theory of Human Caring. Nursing Science Quarterly. (19): 332.

Foster discusses the topic of caring theory, its focus in the future, and the manner in which it will affect magnet hospitals, nurse shortages, and the corporate climate. The article covers theory-guided practice and the manner in which it is currently being implemented in "magnet" hospitals; Foster argues that implementing theory guided practice in hospitals for "magnet" designation begs the question of whether administrators expected the positive outcomes reported for patients, providers and systems. The article concludes that the connection between nursing theory guided practice and desired outcomes brings about changes in caring in which theory will be increasingly implemented and examined. The reaction is a positive one because the strength behind caring theory is that allows for nurses to reconnect with patients, themselves, and other hospital staff. Foster believes that caring theory has longetivity in its application because it allows nurses to make a difference in their patients lives.

Lee, K. (1995). Do not resuscitate: bioethical and nursing perspectives. Retrieved October 23, 2007, at http://library.uws.edu.au/adt-NUWS/public/adt-NUWS20030807.133935/index.html.

Lee authors a thesis that focuses on the use of Watson's theory of human caring for Do Not Resuscitate (DNR) patients in acute medical-surgical wards. Lee discusses the dilemmas faced by DNR patients and explores solutions offered by Watson's theory. The thesis discusses how traditional nursing practice places the nurse in a difficult situation by focusing on physical health. Lee suggests that Watson's theory of caring should be applied to DNR patients because for these patients there is no physical cure. The thesis states that Watson's holistic approach to caring offers the nurses guidelines for their practice and meaning for their actions. This idea directly applies to DNR nurses because decisions are made by medical officers but implemented by nurses. Lee suggests that since no cure is possible, the nurse can feel distressed and incompetent. The reaction is that for DNR the patients, Watson's theory can offer support for patients and nurses.

Medscape. (2005). Caring Science and the Caritas Field: Lighting our path. Retrieved October 23, 2007, at http://www.medscape.com/viewarticle/513614.

This article discusses the many changes nurses are experiencing in current practice, such as new technological developments, regulatory demands, pharmaceutical advances, legislative mandates, patient safety concerns, nursing shortages, and shrinking economic resources. It outlines the three concepts related to Watson's theory of caring; the transpersonal caring-healing relationship is a relationship that is related to a philosophic, moral and spiritual foundation; the clinical caritas process, which consists of ten factors that make connections between love and caring in the spiritual aspect of nursing; and the caritas field which is described as a field of consciousness created when the nurse focuses on love and caring as his or her way of being, and consciously manifests a healing presence with others. The article's conclusion is that caring science provides a scientific-philosophical-moral context from which to explore, describe, and research human healing, and that caring science it is science reconsidered from an ontologic perspective. The application and reaction to nursing is positive.

Norred, C. (2000). Minimizing Preoperative Anxiety With Alternative Caring-Healing Therapies.

AORN Journal. (Nov).

Norred analyzes the integration of alternative therapies to balance the anxiety and stress experienced by surgical patients. The article reviews prior research studies, suggesting that in analysis of the preoperative concerns of surgical patients, the need for caring was the most common theme of concern after the fear of death. The article discusses Watson's theory of caring and describes that to meet the psychological or spiritual needs of patients, nurses traditionally incorporate humanistic, altruistic values by using the power of prayer, spiritual beliefs, or suggestions or through a trusting therapeutic nurse-patient relationship. Norred concludes a nurse's relationship and interpersonal teaching enables the patient to provide self-care, determine personal needs, and provide for personal growth. In applying this article to the nursing field, it appears that combining therapies with surgery can enhance care to surgical patients. The article reaction is preoperative anxiety can be reduced with holistic nursing.

Rosenberg, S. (2006). Utilizing the Language of Jean Watson's Caring Theory Within a Computerized Clinical Documentation System. CIN: Computers, Informatics, Nursing.

This article describes and critiques a healthcare facility that was part of an eight-hospital organization that adopted Watson's theory of caring as part of their nursing philosophy. It provides an overview of the caring theory and its many meanings. Rosenberg critiques the caring theory, stating that during the implementation of the theory within the setting described, it was noted that there was no mechanism in the current documentation system for clinical nursing staff to document the patient experience using any language specific to the theory. As a result, the nurses at the healthcare facility decided to develop a new context in charting that consisted of an extensive clinical documentation system upgrade. The article concluded with a discussion of the steps taken that supported the newly adopted caring philosophy at the facility. The application and reaction is that such a system could be implemented at other facilities as well.

Saewyc, E. (2000). Nursing Theories of caring. Journal of Holistic Nursing. (18)(2):114-128.

This article discusses the manner in which caring has emerged as a central paradigm in nursing over the past four decades. Saewyc suggests that caring as a central focus in nursing care of adolescents is developmentally appropriate and has been documented as the primary mechanism of effective health promotion for working with teens throughout the world. The article concludes that other disciplines in adolescent health are beginning to realize the importance of caring therapeutics in practice, but nursing remains in the forefront of theory development and research in this area and is well positioned to provide leadership in further articulating caring theory within adolescent health care. In applying the theory of caring to nursing, it is suggested that nurses must include advocacy for the legitimacy and the importance of caring modalities in promoting the health of adolescents. The reaction to this article is positive, in that youths are more susceptible to caring than other patients would be.

Stroud, S. (2004). To Touch on Caring.

Whitireia Nursing Journal.

Stroud discusses the aspect of "caring" and its' meaning, involvement, appearance and difference in nursing. Stroud explains that although many nurse theorists agree that caring is the heart of nursing, there are a variety of theories about what actually constitutes caring in the nursing context. Watson's theory of caring is discussed in relation many other caring theories. The article concludes that there is tension between the increasingly technological and medicalized influences on nursing practice, and the reaction against this toward a more humanistic view of nursing. As applied to nursing, practitioners are able to learn about various caring theories, find ways to deal with tension and internal disagreements in their practice, and apply these ideas when dealing with difficult patients. The article's reaction to nursing is that the quality of care, or whether nurses actually give care at all, will depend on the attitude that the nurse brings to their actions.

Research Articles

Baldursdottir, G. & Jonsdottir, H. (2002). The importance of nurse caring behaviors as perceived by patients receiving care at an emergency department. Heart & lung. (31)(1):67-75.

The study researched the affect of heavy nurse workloads on patient care. The purpose of the study was to identify which nurse caring behaviors are perceived by patients in an emergency department as important indicators of caring. The nurse caring behaviors were categorized in terms of relative importance with respect to demographic variables and perceived illness. The study method consisted of a 61-item questionnaire mailed to 300 emergency department patients that reflected the 10 factors of Watson's theory. The study results indicated that subjects scored the items involving clinical competence (such as giving shots, etc.) as the most important nurse caring behaviors. The study concluded that the study mirrored previous research, that subjects considered clinical competence to be the most important nurse caring behavior. The application and reaction of this study is that clinical competence further emphasizes the notion of caring as a moral stance integral to all interactions with patients.

Brown, C., Holcomb, L., Maloney, J., Naranjo, J., Gibson, C. & Russell, P. (2007). Caring in Action: The Patient Care Facilitator Role Caring in Action: The Patient Care Facilitator Role. Retrieved October 23, 2007, at http://www.uscsh.edu.

The research studied plans for a new patient care facilitator (PCF) role, and identified research strategies to evaluate the effectiveness of the caring model. The study method consisted of open-ended questionnaires with demographic questions administered to staff from three nursing units. The respondents included nurses, physicians, and ancillary professional and nonprofessional staff.

The study results indicated that patients perceived that everyone knew their care when they had a PCF than with no PCF. The study results concluded that a PCF increased the continuity of patient care. In applying the study results to nursing, patients who had a PCF for their care felt ready to go home at a significantly higher rate than did those who did not have a PCF. The reaction to this study is that love, caregiving, and emotional connection are strong themes surrounding the role of the PCF, and the PCF assists patients, families, doctors and nurses.

Childs, a. (2006). The Complex Gastrointestinal Patient and Jean Watson's Theory of Caring in Nutrition Support. Gastroenterology Nursing. (29)(4):283-288.

Childs studied a 34-year-old man diagnosed with bowel cancer that underwent surgery for the removal of 90% of the stomach, spleen and left kidney that the tumor was attached to. The patient underwent chemotherapy for three months to shrink the tumor, but suffered side effects that reduced his eating, resulting in weight loss of over 20 kg in two months. Under Watson's theory of care, he was able to gain two to three pounds a week for the next eight weeks and continue chemotherapy. His care was managed and maintained in his home with the support of his family and community nursing. The results of the study indicated that nutrition support did not remove the cancer, but sustained him enough to continue chemotherapy. The nurse was able to care for him holistically by providing the therapy required. The reaction to the study is that the theory of caring was not enough to cure the cancer.

Ciechanowski, P., Walker, E., Katon, W., Russo, J. (2002). Attachment Theory: A Model for Health Care Utilization and Somatization. Psychosomatic Medicine (64):660-667.

This research examined Watson's theory of caring in relation to attachment theory, which proposes that cognitive schemas based on earlier repeated experiences with caregivers influence how individuals perceive and act within interpersonal relationships. The researchers hypothesized that medical patients with preoccupied and fearful attachment would have higher physical symptom reporting and that preoccupied attachment would be associated with higher and fearful attachment with lower primary care utilization and costs. The study method consisted of a large sample of adult female primary care health maintenance organization patients. The study results indicated that patients with preoccupied attachment had the highest primary care costs and utilization, whereas patients with fearful attachment had the lowest. Applied to nursing, this suggests that attachment style is an important factor in assessing symptom perception and health care utilization. The reaction is that despite being on opposite ends of the utilization spectrum, patients with preoccupied and fearful attachment have the highest symptom reporting.

Erci, B., Sayan, a., Tortumluoglu, G., Kilia, D., Sahin, O. & Gungormus, Z. (2003). The effectiveness of Watson's Caring Model on the quality of life and blood pressure of patients with hypertension. J Adv Nurs. (41)(2):130-139.