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By: Tosin Ola-Weissmann
"We are the light in
institutional darkness,
and in this model we
get to return to the
light of our humanity"

Dr. Jean Watson, PhD, RN,
AHN- BC, FAAN
Watson Caring Science
Institute
Introduction
 Jean Watson’s Theory of
  Human Caring (TOC)
 Theoretical framework
  and critical components
 Application in the peri-
  operative clinical setting
 Sacred Space
  implementation
Nursing Metaparadigms in
          Watson’s Theory of Caring
 Patient: Holistic individual with interrelated parts
 Health: Unity of mind, body, and soul
 Nursing: Develop a caring, transcendental relationship
 Environment: All factors that affect balance
 Nurses’ role: Attending to and balancing the
  environment



(Watson, 2005, p. 10-12)
Theoretical Framework
Theoretical model of the
Theory of Caring reflects
on nurse’s responsibility
to:
 Value
 Respect
 Nurture
 Understand
 Assist with becoming
  fully functional and
  integrated self
Theoretical Framework
 Based on nurse-patient
  relationship versus task
  orientation
 Framework demands
  nurses ask several
  questions:
   What is one’s view of
   human?
   What does it mean to
   be
   human, caring, healing,
   etc.
Conceptual Components of the
       Theory of Caring
Carative Elements/Caritas
        Processes

Development and use of
 transpersonal caring
     relationships

Caring Event or Moment
The 10 Caritas
 Practice loving-kindness    Creativity and artistry
 Be authentically present    Create healing
 Be supportive and            environment
  helping                     Engage in teaching-
 Cultivate spirituality       learning
 Develop trust               Assist with basic needs
                              Be open



                                      (Parker, 2001, p. 347)
Critical Components of TOC
 Human Science
 Human Caring
 Experiences
 Phenomena
Watson’s Theory in Clinical Practice
 The nurse must;
    Establish relationship
     with patient
    Approach patient in a
     holistic way
    Provide unconditional
     acceptance
    Treat patient with
     positive regard
    Encourage learning


     (Wainwright, n.d. p. 1)
Application in Peri-operative
            Clinical Setting
 Assessment                    Outcomes/Planning
    Anxiety and fear             Education
    Chaos                        Demonstration
    Loud
    Technology
 Diagnosis
    Less postoperative pain
    Faster discharges
    High patient
     satisfaction scores
                                 (Schmock, Breckenridge &
                                 Benedict, 2009).
Application in Peri-operative
              Clinical Setting
 Implementation of Sacred
 Space
   Lights off
   Non-necessary machines
      off
     Quiet time instituted
     Music (if preferred)
     Warm blankets and towels
      provided for patient
     No interruption by staff
      while sacred space is in
      session
     Post sign on doorway of
      patient’s room
Conclusion
 Theory of Caring
 Nursing practice is
  enhanced by the Theory
  of Caring
 Sacred Space
  Implementation
   Poster
References
Alligood, M. R., & Tomey, A. M. (2006). Nursing theory: Utilization and application (3rd ed.). St Louis, MO: Mosby

    Elsevier.

Cara, C. (2005). A Pragmatic view of Jean Watson’s caring theory [Lecture notes]. Retrieved from University of

    Montreal website: http://humancaring.org/conted/Pragmatic%20View.pdf

Eddins, E. A., & Riley-Eddins, E. E. (1997). Watson’s theory of human caring: the twentieth century and beyond.

    Journal of Multicultural Nursing & Health, 3(3), 30-35.

George, J. (2011). Nursing Theories: The base for professional nursing practice (6th ed.). Retrieved from University of

    Phoenix library.

Getty Images (2012). Keywords, “Nursing,” “Caring,” “Touch”. Retrieved October 28, 2012 from http://gettyimages.com

Parker, M. E. (2001). Nursing theories and nursing practice. Philadelphia: Davis.

RNpedia (2012). Nursing Theorist. Retrieved October 27, 2012, from

    http://www.rnpedia.com/home/notes/fundamentals-of-nursing-notes/nursing-theorist
References continued
Schmock, B., Breckenridge, D., & Benedict, K. (2009). Effect of sacred space environment on surgical patient

    outcomes: a pilot study. International Journal For Human Caring, 13(1), 49-59.

University of Colorado, Denver College of Nursing (2006). Jean Watson and the Theory of Caring. Retrieved October

    27, 2012, from http://www.nursing.ucdenver.edu/faculty/j_watson_about.htm

Wainwright, N. (n.d.). How to apply Jean Watson’s Theory of Caring into nursing. Retrieved October 27, 2012 from

    http://www.ehow.com/how_7350428_apply-watsons-nursing-theory-nursing.html#ixzz2AWmbVdlV

Watson Caring Science Institute International Caritas Consortium (2012). Caring Science ten Caritas processes.

    Retrieved October 28, 2012, from http://www.watsoncaringscience.org/index.cfm/category/80/theory.cfm

Watson, J. (1985). Nursing: The philosophy and science of caring (2nd ed.). Boulder: Colorado Associated Press.

Watson, J. (1997). The theory of human caring: Retrospective and prospective. Nurse Science Quarterly, 10(1), 49-52.

Watson, J. (2005). Caring science as sacred science. Philadelphia: F. A. Davis.

Wendler, M. C., & Brilowskig, G. A. (2005). An evolutionary concept analysis of caring. Journal of Advanced Nursing,

    50(6), 641-650. http://dx.doi.org/:10.1111/j.1365-2648.2005.03449.x

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Nursing conceptual model presentation

  • 2. "We are the light in institutional darkness, and in this model we get to return to the light of our humanity" Dr. Jean Watson, PhD, RN, AHN- BC, FAAN Watson Caring Science Institute
  • 3. Introduction  Jean Watson’s Theory of Human Caring (TOC)  Theoretical framework and critical components  Application in the peri- operative clinical setting  Sacred Space implementation
  • 4. Nursing Metaparadigms in Watson’s Theory of Caring  Patient: Holistic individual with interrelated parts  Health: Unity of mind, body, and soul  Nursing: Develop a caring, transcendental relationship  Environment: All factors that affect balance  Nurses’ role: Attending to and balancing the environment (Watson, 2005, p. 10-12)
  • 5. Theoretical Framework Theoretical model of the Theory of Caring reflects on nurse’s responsibility to:  Value  Respect  Nurture  Understand  Assist with becoming fully functional and integrated self
  • 6. Theoretical Framework  Based on nurse-patient relationship versus task orientation  Framework demands nurses ask several questions:  What is one’s view of human?  What does it mean to be human, caring, healing, etc.
  • 7. Conceptual Components of the Theory of Caring Carative Elements/Caritas Processes Development and use of transpersonal caring relationships Caring Event or Moment
  • 8. The 10 Caritas  Practice loving-kindness  Creativity and artistry  Be authentically present  Create healing  Be supportive and environment helping  Engage in teaching-  Cultivate spirituality learning  Develop trust  Assist with basic needs  Be open (Parker, 2001, p. 347)
  • 9. Critical Components of TOC  Human Science  Human Caring  Experiences  Phenomena
  • 10. Watson’s Theory in Clinical Practice  The nurse must;  Establish relationship with patient  Approach patient in a holistic way  Provide unconditional acceptance  Treat patient with positive regard  Encourage learning (Wainwright, n.d. p. 1)
  • 11. Application in Peri-operative Clinical Setting  Assessment  Outcomes/Planning  Anxiety and fear  Education  Chaos  Demonstration  Loud  Technology  Diagnosis  Less postoperative pain  Faster discharges  High patient satisfaction scores (Schmock, Breckenridge & Benedict, 2009).
  • 12. Application in Peri-operative Clinical Setting  Implementation of Sacred Space  Lights off  Non-necessary machines off  Quiet time instituted  Music (if preferred)  Warm blankets and towels provided for patient  No interruption by staff while sacred space is in session  Post sign on doorway of patient’s room
  • 13. Conclusion  Theory of Caring  Nursing practice is enhanced by the Theory of Caring  Sacred Space Implementation  Poster
  • 14. References Alligood, M. R., & Tomey, A. M. (2006). Nursing theory: Utilization and application (3rd ed.). St Louis, MO: Mosby Elsevier. Cara, C. (2005). A Pragmatic view of Jean Watson’s caring theory [Lecture notes]. Retrieved from University of Montreal website: http://humancaring.org/conted/Pragmatic%20View.pdf Eddins, E. A., & Riley-Eddins, E. E. (1997). Watson’s theory of human caring: the twentieth century and beyond. Journal of Multicultural Nursing & Health, 3(3), 30-35. George, J. (2011). Nursing Theories: The base for professional nursing practice (6th ed.). Retrieved from University of Phoenix library. Getty Images (2012). Keywords, “Nursing,” “Caring,” “Touch”. Retrieved October 28, 2012 from http://gettyimages.com Parker, M. E. (2001). Nursing theories and nursing practice. Philadelphia: Davis. RNpedia (2012). Nursing Theorist. Retrieved October 27, 2012, from http://www.rnpedia.com/home/notes/fundamentals-of-nursing-notes/nursing-theorist
  • 15. References continued Schmock, B., Breckenridge, D., & Benedict, K. (2009). Effect of sacred space environment on surgical patient outcomes: a pilot study. International Journal For Human Caring, 13(1), 49-59. University of Colorado, Denver College of Nursing (2006). Jean Watson and the Theory of Caring. Retrieved October 27, 2012, from http://www.nursing.ucdenver.edu/faculty/j_watson_about.htm Wainwright, N. (n.d.). How to apply Jean Watson’s Theory of Caring into nursing. Retrieved October 27, 2012 from http://www.ehow.com/how_7350428_apply-watsons-nursing-theory-nursing.html#ixzz2AWmbVdlV Watson Caring Science Institute International Caritas Consortium (2012). Caring Science ten Caritas processes. Retrieved October 28, 2012, from http://www.watsoncaringscience.org/index.cfm/category/80/theory.cfm Watson, J. (1985). Nursing: The philosophy and science of caring (2nd ed.). Boulder: Colorado Associated Press. Watson, J. (1997). The theory of human caring: Retrospective and prospective. Nurse Science Quarterly, 10(1), 49-52. Watson, J. (2005). Caring science as sacred science. Philadelphia: F. A. Davis. Wendler, M. C., & Brilowskig, G. A. (2005). An evolutionary concept analysis of caring. Journal of Advanced Nursing, 50(6), 641-650. http://dx.doi.org/:10.1111/j.1365-2648.2005.03449.x

Editor's Notes

  1. Today’s presentation focuses on Jean Watson's Theory of Human Caring. During this presentation we will analyze the theoretical framework, review the critical components of the Theory of Caring, and discuss how the theory is utilized in nursing practice. This presentation will also detail application of Watson’s Theory of Caring into the peri-operative environment by instituting a “sacred space” and explain the process of implementing the sacred space. Enjoy!
  2. According to Watson, “the patient is viewed holistically wherein the body, mind, and soul are interrelated; each part a reflection of the whole, yet the whole is greater than and different from the sum of parts”(Watson, 1985, p. 10). She defines the person as a being-in-the-world who holds three spheres of being—mind, body, and spirit—that are influenced by the concept of self and who is unique and free to make choices (Watson, 2005, p. 15). “We need to honor deep, subjective meanings and feelings about life, living, the natural inner processes, personal autonomy, and freedom to make choices shaped by subjective intent” (Alligood & Tomey, 2006, p. 107).Health is defined in Watson’s theory as the unity and harmony within the body, mind, and soul (Eddins & Riley-Eddins, 1997, p. 31). Health is a process of adapting, coping, and growing throughout life and is associated with the degree of congruence between self as perceived and self as experienced (Alligood & Tomey, 2006, p. 109). Illness is a subjective turmoil or disharmony within a person’s inner self or soul at some level or disharmony within the spheres of mind, body, and soul (UCDCN, 2006, p. 2). The agent for change in terms of healing is the person’s internal, mental-spiritual consciousness, which allows the self to be healed (Alligood & Tomey, p. 109). Thus nursing must focus on the “individual’s own view of his or her health or illness” (Eddins & Riley-Eddins, 1997, p. 31). Nursing’s goal is “to help persons gain a higher degree of harmony within the mindbodyspirit, which generates self-knowledge, self-reverence, self-healing, and self-care processes while allowing for diversity and possibility” (Alligood & Tomey, 2006, p. 108). The nurse uses the caritas to develop a caring, transcendental relationship with the patient in the caring moment (Watson, 2005, ¶ 11). Dr. Watson also adds that caring can be viewed as the nurse’s moral ideal of preserving human dignity by assisting a person to find meaning in illness and suffering in order to restore or promote the person’s harmony (Cara, 2005).The environment, according to Watson, comprises of all the factors that play a part in the holistic mindbodyspirit balance (2005). The nurses’ role also involves “attending to supportive, protective, and or corrective mental, physical, societal, and spiritual environments” (Watson, 1985, p. 10). This includes both the immediate environment and the energetic field within the patient (Watson, 2005). The nurse becomes the environment in which “sacred space” is created (Alligood & Tomey, 2006, p. 114).
  3. Watson’s theoretical model reflects on nurse’s responsibility to value, respect, nurture, understand and assist the client to becoming fully functional and integrated self. Through this metaparadigm both the nurse and the client or family experiences a transpersonal caring relationship.
  4. Theoretical framework is formulated to transform both self and practice. Watson’s theory emphasizes a framework for professional practice based on nurse-patient relationships rather than on task orientation. Self-learning is dependent on nurses developing personal growth, communication skills, therapeutic use of self, holistic assessment skills, and caring towards health and healing. The foundation of the framework demands that nurses ask several questions to determine if Watson’s theory is congruent with the values and beliefs of the clinical practice arena to transform or improve practice. What is one’s view of human? What does it mean to be human, caring, healing, etc.? According to Teilhard de Chardin, who influenced Watson’s philosophy of human caring, “Are we humans having a spiritual experience, or are we spiritual beings having a human experience?”
  5. Three conceptual elements form the foundation of theory include; carative processes/elements, development and use of transpersonal caring relationships, and caring event/moment.
  6. There are 10 carative factors that are at the core of nursing and influence nursing (Watson, 1997). The carative factors attempt “to honor the human dimensions of nursing’s work and the inner life world and subjective experiences of the people we serve” (Watson, p. 50). All the carative factors and “caritas” come together in a transpersonal caring moment, which is the dynamic human-to-human connection (Alligood & Tomey, 2006, p. 109). The original carative factors evolved over the decades into the 10 caritas that are listed below. These will be applied to an actual caring moment. Practice of loving kindness and equanimity within context of caring consciousness.Being authentically present, and enabling and sustaining the deep belief system and subjective life world of self and the one-being-cared-for.Cultivation of one’s own spiritual practices and transpersonal self, going beyond ego self, opening to others with sensitivity and compassion.Developing and sustaining a helping-trusting, authentic caring relationship.Being present to, and supportive of, the expression of positive and negative feelings as a connection with deeper spirit of self and the one-being-cared-for.Creative use of self and all ways of knowing as part of the caring process; to engage in artistry of caring-healing practices.Engaging in genuine teaching-learning experience that attends to unity of being and meaning, attempting to stay within others’ frames of reference.Creating healing environment at all levels (physical as well as non-physical), subtle environment of energy and consciousness, whereby wholeness, beauty, comfort, dignity, and peace are potentiated.Assisting with basic needs, with an intentional caring consciousness, administering “human care essentials,” which potentiate alignment of mindbodyspirit, wholeness, and unity of being in all aspects of care; tending to both the embodied spirit and evolving spiritual emergence.Opening and attending to spiritual-mysterious and existential dimensions of one’s own life-death; soul care for self and the one-being-cared-for (Parker, 2001, p. 347).
  7. Theory of caring and science studies the connectivity of all components in relation to human healing; human science, human caring, experiences, and phenomena. Watson’s philosophy of transpersonal relationships blends the sciences and humanities merging the caring-healing arts into nursing theory and practice creating its own unique values, knowledge, and practices along with a moral code and duty to society. According to Watson, “I emphasize that it is possible to read, study, learn about, even teach and research the caring theory; however, to truly “get it,” one has to personally experience it; thus the model is both and invitation and an opportunity to interact with the idea, experiment with and grow within the philosophy, and living it out in one’s personal/professional life (Watson Caring Science Institute, 2012)”. These essential elements focus on the alignment of the theory with nursing’s metapardigm; patient, health, environment, and nursing. This conceptual model supports the caring theory and its application to nursing practice based on scientific evidence and research supporting the philosophy of holism and efficacy of the theory.
  8. According to Wainright (n.d., p. 1), when used in nursing there are six crucial elements of Watson’s theory. Establish a relationship with your patient. This is important for developing trust, establishes the nurses’ identity and is central to the patient.Approach the patient in a holistic way. There must be consideration for the physical, mental an emotional state the patient may be in. It is always important to let the patient know that you are interested in them as a human being. Take the time to find out the patient’s likes, habits, and proclivities. Going the extra mile to get coffee sweetened just the way they like it exhibits the caring relationship. Providing unconditional acceptance: The nurse must not judge the patients’ decisions, habits, culture, beliefs, and values. Do not forget that conversation, body language, and non-verbal communication can show one’s real feelings. Treating a patient with positive regard. The nurse should always be encouraging and supportive.Education is essential to health promotion. According to Watson these are “transforming moments”. The nurse should facilitate learning-teaching moments.The nurse is the key player in who spends the most time with the patient. Taking the extra five minutes when providing care can make a huge difference. Don’t rush through care. Make sure to answer questions as best you can or offer to find answers. Maintain eye contact, and touch the patient. Allow the patients to feel they have their very own caregiver.
  9. The Sacred Space can be instituted in any clinical arena. For the purposes of this project, the sacred space will be initiated in the peri-operative setting using the nursing process. Please see the attached poster for a summary of the Sacred Space.Assessment: In 2009, Schmock, Breckenridge, & Benedict conducted a qualitative study on the effects of implementing Watson’s theory of caring by instituting a “sacred space” for patients pre and post operatively to improve patient outcomes and healing. Peri-operatively, patients often experience a level of anxiety and stress before surgery (Wendler & Brilowskig, 2005) due to the convictions of anesthesia, general fears, previous experiences, and spiritual beliefs. This stress and anxiety is further exacerbated by the chaos in the pre-operative setting, loud noises, high use of technology and constant traffic of staff in and out of the patients’ room. Diagnosis: The results of the study showed that a statistically significant difference existedwhen perception of sacred space and perception of nurse caring were compared bygroup (sacred space versus traditional OR environments). In the study, patients who took a time out pre-operatively and made use of a quiet, ‘sacred space’ denoted by nursing staff, seemed to have less pain postoperatively, higher patient satisfaction scores, and were discharged faster (Schmock, Breckenridge & Benedict, 2009). Outcomes/Planning:Nursing staff is given a short in-service using this presentation that explains the benefits of the ‘sacred space’. Nurses are encouraged to verbalize additional strategies that will benefit the sacred space.
  10. Implementation:The sacred space is implemented after all the pre-operative paperwork and assessments are completed. The consents have been signed, the patient has changed into the hospital gown, and the IV has been started. All pre-operative medications have been given and the patient is all ready for surgery. The nurse serves as a guardian of the environment to ensure that the sacred space is maintained. The nurse does all the steps above and places the poster on the room door. Family members can be present (based on patient’s preference). Due to scheduling, the sacred space is in session for only 5-15 minutes. Once the time is up, the patient is wheeled into surgery. The sacred space can also be used post-operatively once the patient is stable pending discharge. The sacred space can be augmented with pain therapies to reduce postoperative pain.
  11. Jean Watson’s Theory of Caring is applicable in almost every nursing setting. The elements of TOC ensure that the nurse can effectively create and maintain a caring relationship with her patients. Implementing the sacred space in the peri-operative setting has been shown to provide better patient outcomes, higher satisfaction, and less post-operative pain. The sacred space can be instituted with ease into almost every peri-operative nursing environment. By using the presentation and the poster given to the group, the Sacred Space can be an effective tool to reduce the stress and anxiety associated with surgery.