“The nursing profession, and each nurse
within it, is invited to consider/reconsider:
How do we walk through life? How do we get
our footing to bring the artistry of caring
and global caritas consciousness into our
lives, our work, and our world?”
Margaret Jean Harman Watson, PhD, RN, AHN-
BC was born in Southern West Virginia and grew
up in the small town of Welch, West Virginia.
1964 – Baccalaureate degree in Nursing (Boulder
1966 – Master’s Degree in Psychiatric-Mental
Health Nursing (Health Sciences Campus)
1973 – Doctorate in Educational Psychology and
Counseling (Graduate School, Boulder Campus)
1978 – 1981 – Coordinator and Director of
the nursing PhD program (University of
Colorado School of Nursing)
1983 – 1990 – Dean (UC School of Nursing and
Associate Director of Nursing Practice
Watson received six honorary doctoral
degrees and three Honorary Doctorates.
1993 – She received the National League for
Nursing (NLN) Martha E. Rogers Award
1993 – 1996 – served as a member of the
Executive Committee and the Governing Board
and as an officer for the NLN
1995 – 1996 – elected president of NLN
1998 – recognized as a Distinguished Nurse
Scholar by the NY University
1999 – assumed the nation’s first Murchison-
Scoville Endowed Chair of Caring Science
Her first book, Nursing: The Philosophy and
Science of Caring (1979)
- Developed from her notes for an undergraduate course
taught in the University of Colorado.
- Watson’s 10 carative factors
- Reprinted in 1985 and was translated into Korean and
Her second book, Nursing: Human Science
and Human Care – A Theory of Nursing
- Published in 1985 and reprinted in 1988 and 1999
- Addressed some conceptual and philosophical problems in
Her third book, Postmodern Nursing and
- Presented as a model to bring nursing practice into the
Fourth book, Instruments for Assessing and
Measuring Caring in Nursing and Health
- Collection of 21 instruments used to assess and measure
Her fifth and latest book, Caring Science as
Sacred Science (2005)
- Describes her personal journey to enhance understanding
about caring science, spiritual practice , the concept and
practice of care, and caring-healing work.
1. Caring can be effectively demonstrated and
practiced only interpersonally.
2. Caring consists of carative factors that result
in the satisfaction of certain human needs.
3. Effective caring promotes health and
individual or family growth.
4. Caring responses accept person to choose
the best action for himself or herself at a
given point in time.
5. A caring environment is one that offers the
development of potential while allowing the
person to choose the best action for himself
or herself at a given point in time.
6. Caring is more “healthogenic” than is curing.
A science of caring is complementary to the
science of curing.
7. The practice of caring is central to nursing.
The original carative factors served as a guide to
what was referred to as the "core of
nursing", in contrast to nursing’s "trim". Core
pointed to those aspects of nursing that
potentiate therapeutic healing processes and
relationships; they affect the one caring and
1. Formation of a Humanistic-Altruistic System
– Begins developmentally at an early age with
values shared with the parents.
– Mediated through ones own life experiences, the
learning one gains and exposure to the
– Is perceived as necessary to the nurse’s own
maturation which then promotes altruistic
behavior towards others.
2. Instillation of Faith-Hope
– Is essential to both the carative and the curative
– When modern science has nothing further to offer
the person, the nurse can continue to use faith-
hope to provide a sense of well-being through
beliefs which are meaningful to the individual.
3. Cultivation of sensitivity to Self and to Others
– Explores the need of the nurse to begin to feel an
emotion as it presents itself.
– Development of one’s own feeling is needed to
interact genuinely and sensitively with others.
– Striving to become sensitive, makes the nurse
more authentic, which encourages self-growth
and self-actualization, in both the nurse and those
with whom the nurse interacts.
– The nurses promote health and higher level
functioning only when they form person to person
4. Development of a Helping-Trust Relationship
– Strongest tool is the mode of communication,
which establishes rapport and caring.
– Characteristics needed to in the helping-trust
– Communication includes verbal, nonverbal and
listening in a manner which connotes empathetic
5. The Promotion and Acceptance of the
Expression and Negative Feelings
– “Feelings alter thoughts and behavior, and they
need to be considered and allowed for in a caring
– Awareness of the feelings helps to understand the
behavior it engenders.
6. The Systematic Use of the Scientific Problem-
Solving Method for Decision Making
– The scientific problem- solving method is the only
method that allows for control and prediction, and
that permits self-correction.
– The science of caring should not be always neutral
7. Promotion of Interpersonal Teaching-Learning
– The caring nurse must focus on the learning
process as much as the teaching process.
– Understanding the person’s perception of the
situation assist the nurse to prepare a cognitive
8. Provision for a Supportive, Protective and /or
Corrective Mental, Physical, Socio-cultural and
– Watson divides these into eternal and internal
variables, which the nurse manipulates in order to
provide support and protection for the person’s
mental and physical well-being.
– The external and internal environments are
– Nurse must provide comfort, privacy and safety as a
part of this carative factor.
9. Assistance with the gratification of human
– It is based on a hierarchy of need similar to that of
– Each need is equally important for quality nursing
care and the promotion of optimal health.
– All the needs deserve to be attended to and
• Watson’s ordering of needs
– Lower order needs (biophysical needs)
• The need for food and fluid
• The need for elimination
• The need for ventilation
– Lower order needs (psychophysical needs)
• The need for activity-inactivity
• The need for sexuality
– Higher order needs (psychosocial needs)
• The need for achievement
• The need for affiliation
• Higher order need (intrapersonal-interpersonal need)
• The need for self-actualization
10. Allowance for Existential-Phenomenological
– Phenomenology is a way of understanding people
from the way things appear to them, from their frame
– Existential psychology is the study of human existence
using phenomenological analysis.
– This factor helps the nurse to reconcile and mediate
the incongruity of viewing the person holistically while
at the same time attending to the hierarchical
ordering of needs.
– Thus the nurse assists the person to find the strength
or courage to confront life or death.
"Caritas" comes from the Greek word meaning to
cherish, to appreciate, to give special attention, if
not loving, attention to; it connotes something
that is very fine, that indeed is precious.
“At this time I now make new connections between
carative, caritas and without hesitation invoke the
"L" word, which caritas conveys, that is love,
allowing love and caring coming together for a
new form of deep transpersonal caring.”
1. Formation of humanistic-altruistic system of
values, becomes "Practice of loving-kindness
and equanimity within context of caring
2. Instillation of faith-hope, becomes "Being
authentically present, and enabling and
sustaining the deep belief system and
subjective life-world of self and one-being-
3. Cultivation of sensitivity to one’s self and to
others, becomes "Cultivation of one’s own
spiritual practices and transpersonal
self, going beyond ego self“
4. Development of a helping-trusting, human
caring relationship becomes "Developing and
sustaining a helping-trusting, authentic caring
5. Promotion and acceptance of the expression
of positive and negative feelings, becomes
"Being present to, and supportive of the
expression of positive and negative feelings as
a connection with deeper spirit of self and the
6. Systematic use of a creative problem-solving
caring process becomes "creative use of self
and all ways of knowing as part of the caring
process; to engage in artistry of caring-healing
7. Promotion of transpersonal teaching-
learning, becomes "Engaging in genuine teaching-
learning experience that attends to unity of being
and meaning attempting to stay within other’s
frame of reference“
8. Provision for a supportive, protective, and/or
corrective mental, physical, societal, and spiritual
environment, becomes "Creating healing
environment at all levels, (physical as well as non-
physical, subtle environment of energy and
wholeness, beauty, comfort, dignity, and peace
9. Assistance with gratification of human
needs, becomes "assisting with basic
needs, with an intentional caring
consciousness, administering ‘human care
essentials’, which potentiate alignment of
mind-body-spirit, wholeness, and unity of
being in all aspects of care”; tending to both
embodied spirit and evolving spiritual
10. Allowance for existential-phenomenological-
spiritual forces, becomes "opening and
attending to spiritual-mysterious, and
existential dimensions of one’s own life-death;
soul care for self and the one-being-care-for."
Watson (1999) describes a “Transpersonal
Caring Relationship” as foundational to her
theory; it is a “special kind of human care
relationship—a union with another person—
high regard for the whole person and their
1. Moral commitment, intentionality and caritas
consciousness by the nurse protects,
enhances and potentiates human dignity,
wholeness and healing whereby allowing a
person to create or co-create his/her own
meaning for existence.
2. The conscious will of the nurse affirms the
subjective and spiritual significance of the
patient while seeking to sustain caring in the
midst of threat and
despair, biological, institutional or otherwise.
The result is an honoring of an I-Thou
Relationship rather than an I-It Relationship.
3. The nurse seeks to recognize, accurately
detect, and connect with the inner condition
of spirit of another through genuine
presencing and being centered in the caring
actions, words, behaviors, cognition, body
language, feelings, intuition, thought, senses, t
he energy field, and so on, all contribute to
transpersonal caring connection.
4. The nurse’s ability to connect with another at
this transpersonal spirit- to- spirit level is
translated via movements, gestures, facial
expressions, procedures, information, touch, s
ound, verbal expressions and other
scientific, technical, aesthetic, and human
means of communication, into nursing human
art/acts or intentional caring-healing
5. The caring-healing modalities within the
context of transpersonal caring/caritas
harmony, wholeness, unity of being by
releasing some of the disharmony, the blocked
energy that interferes with the natural healing
processes; thus the nurse helps another
through this process to access the healer
within, in the fullest sense of Nightingale’s
view of nursing.
6. On-going personal and professional
development and spiritual growth, and
personal spiritual practice assist the nurse in
entering into this deeper level of professional
healing practice, allowing for awakening to a
transpersonal condition of world and more
fully actualizing the "ontological
competencies" necessary for this level of
advanced practice of nursing.
7. The nurse’s own life history, previous
experiences, opportunities for focused studies,
having lived through or experienced various
human conditions, or of having imagined others’
feelings in various circumstances, are valuable
teachers for this work; to some degree the
necessary knowledge and consciousness can be
gained through work with other cultures, study of
the humanities (art, drama, literature, personal
story, narratives of illness journeys, etc.) along
with an exploration of one’s own values, deep
beliefs, and relationship with self, others, and
8. Other facilitators are personal growth
experiences such as psychotherapy, transpersonal
psychology, meditation, bio-energetics work, and
other models for spiritual awakening.
9. Continuous growth is on-going for developing
and maturing within a transpersonal caring
model. The notion of health professionals as
wounded healers is acknowledged as part of the
necessary growth and compassion called forth
within this theory/philosophy.
• Nursing is consists of
“knowledge, thought, values, philosophy, com
mitment and action, with some degree of
• “Nursing is concerned with promoting
health, preventing illness, caring for the sick
and restoring health”.
• It focuses on health promotion and treatment
of disease. She believes that holistic health
care is central to the practice of caring in
• She defines nursing as…..
“a human science of persons and human
health-illness experiences that are mediated
by professional, personal, scientific, esthetic
and ethical human transactions”.
• Watson uses interchangeably the terms
human being, person, life personhood and
• She views the person as “a unity of
mind/body/spirit/nature” and describes that
“personhood is tied to notions that one’s soul
possess a body that is not confined by
objective time and space..”
• She defined health as “unity and harmony
within the mind, body and soul”.
• It is associated with the “degree of
congruence between the self as perceived and
the self as experienced”.
• “Illness is not necessarily disease; instead it is
a subjective turmoil of disharmony within a
person’s inner self or soul.”
• “Healing spaces can be used to help others
transcend illness, pain and suffering”.
• According to Watson, caring (and nursing) has
existed in every society.
• A caring attitude is not transmitted from
generation to generation; It is transmitted by
the culture of the profession as a unique way
of coping with its environment.