“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?”

JEAN WATSON

CREDENTIALS AND BACKGROUND

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 Campus)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 (University Hospital)

Watson received six honorary doctoral degrees and three Honorary Doctorates.

1993 – She received the National League for Nursing (NLN) Martha E. Rogers Award1993 – 1996 – served as a member of the Executive Committee and the Governing Board and as an officer for the NLN1995 – 1996 – elected president of NLN1998 – recognized as a Distinguished Nurse Scholar by the NY University1999 – 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

French.

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

nursing.

Her third book, Postmodern Nursing and Beyond (1999)

- Presented as a model to bring nursing practice into the twenty-first century

Fourth book, Instruments for Assessing and Measuring Caring in Nursing and Health Sciences (2002)

- Collection of 21 instruments used to assess and measure caring.

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.

WATSON’S SEVEN ASSUMPTIONS

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.(Watson, 1985)

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 the one-being-cared-for.

WATSON’S CARATIVE FACTORS

WATSON’S ORIGINAL TEN CARATIVE FACTORS

1. Formation of a Humanistic-Altruistic System of Values– 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 humanities.

– 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

processes.– 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 relationship.

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

relationship are:• Congruence• Empathy• Warmth

– Communication includes verbal, nonverbal and listening in a manner which connotes empathetic understanding.

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 relationship”.

– 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 and objective.

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 plan.

8. Provision for a Supportive, Protective and /or Corrective Mental, Physical, Socio-cultural and Spiritual Environment– 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 interdependent.

– Nurse must provide comfort, privacy and safety as a part of this carative factor.

9. Assistance with the gratification of human needs– It is based on a hierarchy of need similar to that of

the Maslow’s.– Each need is equally important for quality nursing

care and the promotion of optimal health.– All the needs deserve to be attended to and

valued.

• 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 Forces– Phenomenology is a way of understanding people

from the way things appear to them, from their frame of reference.

– 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.” (Watson, 1998)

CARITAS PROCESSES

1. Formation of humanistic-altruistic system of values, becomes "Practice of loving-kindness and equanimity within context of caring consciousness“

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-cared- for"

FROM CARATIVE FACTORS TO CLINICAL CARITAS PROCESSES

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 relationship“

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 one-being-cared-for“

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 practices"

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 consciousness, whereby wholeness, beauty, comfort, dignity, and peace are potentiated"

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 emergence

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 being-in-the-world”

TRANSPERSONAL CARING RELATIONSHIP

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.

ASSUMPTIONS OF TRANSPERSONAL CARING RELATIONSHIP

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 moment; actions, words, behaviors, cognition, body language, feelings, intuition, thought, senses, the 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, sound, verbal expressions and other scientific, technical, aesthetic, and human means of communication, into nursing human art/acts or intentional caring-healing modalities.

5. The caring-healing modalities within the context of transpersonal caring/caritas consciousness potentiate 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 one’s world.

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, commitment and action, with some degree of passion”.

• “Nursing is concerned with promoting health, preventing illness, caring for the sick and restoring health”.

WATSON’S THEORY AND THE FOUR MAJOR CONCEPTS

NURSING

• It focuses on health promotion and treatment of disease. She believes that holistic health care is central to the practice of caring in nursing.

• 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 self.

• 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..”

Human Being

• 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.”

Health

• “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.

Environment

PRESENTORS: APRIL JOY G. MAGUIGAD

GRACIELLE PAMELA T. CASTILLO