Watson\'s Theory of Nursing Florence Nightingale Taught

Watson's Theory Of Nursing

Florence Nightingale taught us that nursing theories describe and explain what is, and what is not, nursing" (Parker, 2001, p 4). In nursing today, the need for such clarity and guidance is perhaps more important than at any time in the past. As nursing continues to strive for acceptance of its right to be regarded as a profession, and seeks to expand and develop the bank of scientific nursing knowledge, the concepts and values that nursing theories provide are becoming increasingly invaluable. In recent decades, one of the most influential nursing theories has been that of Jean Watson, which has been instrumental in the development of nursing research, education, and practice. However, the crucial test of any nursing theory is not in its universal assumptions and generalizations, but in how it influences nursing practice at the level of the individual nurse and patient. In this respect, while acknowledging its valuable contribution to nursing's body of knowledge, it is also important to examine and evaluate the specific value system, philosophy and concepts that Watson's nursing theory passes on to nursing staff, and their effects upon nursing practice.

A theory, defined in traditional terms, is "an organized, coherent set of concepts and their relationships to each other that offers descriptions, explanations, and predictions about phenomena" (Parker, 2001, p 5). In the past, however, nursing practice has, to a greater extent, relied on theories from other, related, disciplines such as medicine, psychology, and sociology, for guidance. Throughout the last century, however, there has been an increasing desire and willingness to develop theories that pertain specifically to nursing, and which are then able to provide a greater focus of guidance to nursing research, education, and practice (Herbert, p 32. One respected definition of nursing theory is, "a conceptualization of some aspect of reality (invented or discovered) that pertains to nursing. The conceptualization is articulated for the purpose of describing, explaining, predicting or prescribing nursing care" (Parker, 2001, p 5). The ultimate purpose of any nursing theory is the creation and provision of information. This is information which can be used to define nursing and nursing practice, provide principles on which to base nursing research and practice, and to guide nursing staff towards performing, and improving, their personal nursing education and practice. The range of nursing theories ranges from directing the individual nurse in their interactions with the nursed, and influencing their personal beliefs on the purpose and goals of nursing, to providing a structure for the development and evaluation of the body of nursing knowledge, especially through research (Riehl-Sisca, 1989).

Nursing possesses a rich history of individuals that have developed philosophies and theories, dating back to Florence Nightingale's implied 'Environmental Theory' of the 1860's (Marriner-Tomey, 1994, p 8). Since then, the evolution of nursing theory has witnessed the development of a wide and varied set of concepts and ideas, which have added to nursing's acceptance as a profession and as a discipline of knowledge. From the theories of Nightingale and Virginia Henderson (which are often considered as nursing philosophies, due to the broad scope of their ideas and values), through the grand theories of Watson, Neuman, and Rogers, to the middle-range theorists, such as Peplau and Orlando, nursing theorists have increasingly adopted analytical and scientific methodology into their study. Yet, this is an ongoing process, and there continues to be a need for strong commitment to nursing research and theory development, in all areas of nursing practice, education, and administration (Herbert, p 34).

This commitment is certainly apparent in the work of Jean Watson. Since beginning her nursing career, in 1964, Watson has held positions in private practice, consulting, research, education, and educational administration. Her theory, Nursing: The Philosophy and Science of Caring, originated when she was requested to write a nursing textbook, in 1979, which she then refined within the 1985 publication, Nursing Science and Human Care: A Theory of Nursing. Other nursing theorists, such as Madeleine Leininger, in addition to the work of psychologist Carl Rogers, and studies that had been carried out in other sciences and humanities influenced Watson's theory (Watson, 1988). Her theory proposes a philosophy of nursing that highlights caring as the most valuable and central attribute of the profession. Developed from research into various caring behaviors, and the observation and discussion of many nurses' and clients' descriptions of care, Watson based her theory on a set of seven caring assumptions and ten carative factors, which she considers to be the constituents of the Science of Caring (Watson, 1999). The theory's assumptions include; that caring can be effectively demonstrated and practiced interpersonally; that effective caring promotes health, and individual and family growth; caring responses accept a person 'as is' and looks beyond to what they may become, and; the practice of caring is central to nursing, as it denotes a nurse's response to a client's problem and needs. These assumptions are underpinned by the ten carative factors, which include; cultivating sensitivity to oneself and others; developing a helping-trust relationship; promoting the expression of positive and negative feelings, and; providing a supportive, protective, or corrective mental, physical, sociocultural, and spiritual environment. Watson's theory maintains that, when adopted in their totality, these factors provide a foundation for the study and practice of nursing, in addition to forming the basis of delivering effective nursing care. The Science of Caring theory suggests that human care requires: knowledge of human behavior and human responses to actual or potential health problems; knowledge and understanding of individual needs; knowledge of how to respond to the needs of others; knowledge of our own strengths and limitations; knowledge of the meaning of each situation to each individual; and knowledge of how to comfort, offer compassion and empathy (Watson, 1999). It is this emphasis upon the interpersonal, and transpersonal, qualities of congruence, empathy and warmth that Watson attributes to the influence of Carl Rogers and, in more recent years, it is this holistic, client-centered approach that has come increasingly to the forefront of her theory. Watson's theory now asserts that nurses, nurse educators, and nursing researchers, should look beyond the basic assumptions and carative factors. In what is termed the theory's evolving phase, Watson believes that the discipline of nursing should constantly aim to, "facilitate clients' development in the area of health promotion through preventive health actions" (Marriner-Tomey, 1994). This, according to Watson, is necessary if nursing is to maintain human caring as its ideal, and to ensure that transpersonal human care and caring transactions are the tools used in pursuit of nursing's goals. Watson defines the ultimate goal of nursing as, "facilitating a higher degree of harmony within the mind, body, and soul which generates self-knowledge, self-reverence, self-healing, and self-care processes"(Marriner & Tomey, 1994, p 150).

Nursing: The Philosophy and Science of Caring, as with all nursing theories, is guided and evaluated by its contribution to the overriding philosophy of nursing, known as the nursing metaparadigm. The metaparadigm is an accepted concept that describes and defines the general values, principles and methods of the nursing profession, while also providing a framework for the development of more specific theories, such as Watson's. In keeping with all other areas of nursing, the metaparadigm is subject to the increasing pressures of modification but, traditionally, it is comprised of four main concepts - nursing, health, environment, and person. Nursing refers to all the actions and attributes of the individual providing the nursing care; person refers to the individual in receipt of nursing care, which incorporates physical, psychological, sociocultural, and spiritual factors, and can equally be applied to groups such as a family or community; health refers to the level of health or illness experienced by the person; and environment refers to all the internal and external factors, conditions, and circumstances that may affect the person. In gaining an understanding of Watson's theory, and in attempting to objectively evaluate its value to nursing, it is important to examine how The Philosophy and Science of Caring relates to the concepts of the nursing metaparadigm. 1) Nursing: Watson's theory uses the caring process to promote and restore health, prevent illness, and care for the sick. It adopts the concepts of interpersonal and transpersonal caring in order to assist the person in achieving a higher degree of self-knowledge, self-healing, and self-care. The theory is also based on a scientific research process, which allows nursing staff to refer to a growing body of knowledge throughout the process of making nursing judgements and decisions. 2) Health: Is viewed as a subjective state of mind within each individual, but is generally regarded as a high level of physical, psychological, and social functioning, and an absence of illness. 3) Environment: The Philosophy and Science of Caring views the environment as society and all of its influences, including personal, social, cultural, and spiritual factors. 4) Person: The concept that lies at the core of Watson's theory. Person is viewed as a unique human being, to be cared for, valued, respected, and understood. The individuality of each person, and the personal importance of every interaction and experience, rely heavily upon human-to-human care, empathy, and respect if health is to be maximized (Riel-Sisca, 1989).

The major strength, and appeal, of Watson's theory is its emphasis upon a universal philosophy of caring, rather than a situational specific theory. This allows the model to be applied in any, indeed in all, areas of nursing practice. In recent years, the desire of the medical and nursing professions to develop an increasingly holistic approach towards health care has led to the growing application of Watson's theory of caring. The present popularity of the 'science of caring' has caused nursing scholars, such as Marriner & Tomey, to observe that, "nursing journals concerned with the delivery of nursing care contain increasing numbers of articles that reference Watson, and incorporate the importance of caring as an essential domain of nursing" (1994, p 156). The theory has been adopted and applied in a wide range of settings, including intensive care units, pediatric care, and the care of the elderly. It is perhaps in elderly care that Watson's theory can be most accurately evaluated, due mainly to the increased general length of time that the nurse spends with the clients. If utilized effectively, this provides an excellent opportunity for the nurse and client to develop a strong helping-trust relationship, and to use the building of caring relationships to improve the self-knowledge and understanding of both parties. The benefits to client include an increased sense of security and trust, which results in a reduction of anxiety and fear. It allows the client to openly express their feelings, both positive and negative, with the assurance that they will be heard, understood, respected, and cared for. Another benefit, to the clients overall health, is in the increased sense of self-care and control over events, and rather than suffering the negative feelings of 'being looked after' they are able to participate in a mutually respectful and trusting relationship, with a resultant increase in their sense of independence and self-worth. Many elderly clients are negatively affected by feelings of helplessness, and by the fear of dying, but so too are many nurses. Watson's belief that everyone involved in the nursing experience, nurses and clients, should aim to understand their own feelings, as well as each others, exerts a positive influence on both parties and on the relationship. By coming to terms with concepts, such as death, the nurse is able to encourage a more honest and empathetic exchange of views with the client, who subsequently feels increasingly supported and cared for. The importance of caring, to the physical, psychological and spiritual health of elderly clients, was the subject of a research experiment, carried out by Joan Riehl-Sisca (1989), who concluded that the findings were, "congruent with Watson's theory of caring"(p 251)