Jean Watson's Human Caring Theory in Nursing Practice

Introduction to Watson's Human Caring Theory

Jean Watson's Human Caring Theory has become entrenched in all aspects of nursing practice, inseparable from the art and science of nursing. Watson's philosophy of caring evolved into the science of caring, as evidence-based practice can support the efficacy of carative factors. However, Watson also understood that caring was a moral imperative of nursing care that extends beyond the traditional medical model toward a new transpersonal paradigm.

To promote this paradigm in a concrete manner, Watson proposed what she termed Carative Factors, or the Processes of Caritas, which inform the science of caring. These ten factors are as follows. First, practicing loving-kindness means developing a "caring consciousness" (Watson Caring Science Institute, 2010, p. 2). Second, the nurse is authentically present in the moment with the patient. Third, caring requires one to cultivate a spiritual practice with the goal of transcending the ego. Fourth, it is necessary to develop authentic relationships built on trust and genuine caring. Fifth, the nurse accepts both positive and negative emotions and supports emotional expression. Sixth, art and creativity are processes of caritas, and the nurse uses creativity constructively. Seventh, teaching and learning are ongoing, bi-directional processes. Eighth, caring requires a healing environment that promotes peace and beauty. Ninth, basic needs are attended to within the context of the whole person. Tenth, the nurse is open to miracles, the divine, and to the mysteries that await the soul after its passage from this life.

These ten factors collectively constitute Watson's vision of caring science — a framework that integrates spiritual, humanistic, and scientific dimensions of nursing into a coherent professional philosophy.

Nursing is recognized as both an art and a science, requiring a multidisciplinary background. The first program theme in many nursing mission statements is caring, defined as "the therapeutic use of self which utilizes humanistic and scientific knowledge to enable individuals, families, groups, and communities to promote, maintain, and restore health." This recognition affirms the worth of Watson's caring theory in nursing instruction and toward evidence-based practice.

Integrating Caring Theory with Evidence-Based Practice

The key distinction between institutional definitions of caring and Watson's ten Carative Factors lies in the explicit integration of humanistic with scientific knowledge. Researchers, including Jean Watson herself, have endeavored to fuse caring with science in creative and pragmatic ways. One approach is to measure the efficacy of caring on patient outcomes and staff outcomes. A second method is to allow the two to exist side by side — that is, the nurse becomes adept in both the scientific and caring aspects of the profession simultaneously.

To accomplish the goal of measuring caring, Watson and her colleagues developed the Caring Factor Survey, which has evolved into the Caring Factor Survey-Care Provider Version (Johnson, 2011). The survey centers on the manifestation of caring in relationship with self, patients, families, and colleagues. As nursing mission statements recognize, nursing is fundamentally "a therapeutic helping relationship." The patient does not exist in isolation, separate from the health care team, family members, or spiritual guides. Relationship building and strengthening are therefore cornerstones of nursing, which is why Watson's theories are often described as "holistic" (Lukose, 2011, p. 27).

Measuring Caring: The Caring Factor Survey

The Watson Caring Science Institute continues to develop tools and frameworks that make the measurement and teaching of caring science accessible to practicing nurses and nursing educators alike.