JEAN WATSON'S TRANSPERSONAL CARE THEORY

The Theorist

Margaret Jean Watson

She was born in a small, close-knit town in the Appalachian Mountains of West Virginia in the 1940 s! "ean Watson has claime# that her caring theor$ was #e%elope# while she was ha%ing a personal e&perience '(usban# s )eath* in her life! She mol#e# her professional an# personal life in or#er to #e%elop her theor$!

Education + + + + + ,ra#uate# (igh School in West Virginia ,ra#uate# the -ewis ,ale School of .ursing in 19/1! 0accalaureate #egree in .ursing from 1ni%ersit$ of 2olora#o, 0oul#er 2ampus in 19/4! Master s )egree in 3s$chiatric-Mental (ealth .ursing from 1ni%ersit$ of 2olora#o, (ealth Sciences 2ampus in 19//! )octorate in 4#ucational 3s$cholog$ an# 2ounseling from the 1ni%ersit$ of 2olora#o, ,ra#uate School in 1956!

Employment )r! "ean Watson is )istinguishe# 3rofessor of .ursing an# hol#s an en#owe# 2hair in 2aring Science at the 1ni%ersit$ of 2olora#o (ealth Sciences 2enter! She is foun#er of the original 2enter for (uman 2aring in 2olora#o an# is a 7ellow of the American Aca#em$ of .ursing! She pre%iousl$ ser%e# as )ean of .ursing at the 1ni%ersit$ (ealth Sciences 2enter an# is a 3ast 3resi#ent of the .ational -eague for .ursing She is a wi#el$ publishe# author an# recipient of se%eral awar#s an# honors, inclu#ing an international 8ellogg 7ellowship in Australia, a 7ulbright 9esearch Awar# in Swe#en

an# si& '/* (onorar$ )octoral )egrees, inclu#ing 6 :nternational (onorar$ )octorates 'Swe#en, 1nite# 8ing#om, ;uebec, 2ana#a*! 3ublishe# Writer o .ursing< =he 3hilosoph$ an# Science of 2aring '1959, 19>?* o .ursing< (uman Science an# (uman 2are @ A .ursing =heor$ '19>?, 19>>, 1999* o 3ostmo#ern .ursing an# 0e$on# '1999*

Achievements 9ecipient of se%eral awar#s an# honors inclu#ing< an international 8ellogg 7ellowship in Australia, a 7ulbright 9esearch Awar# in Swe#en an# si& (onorar$ )octoral )egrees, inclu#ing 6 :nternational (onorar$ )octorates 'Swe#en, 1nite# 8ing#om, an# ;uebec*! She was the 1996 recipient of the .ational -eague for .ursing Martha 4! 9ogers Awar#, which recogniAes a nurse scholar who has ma#e significant contributions to nursing knowle#ge that a#%ances the science of caring in nursing an# health sciences! .ew Bork 1ni%ersit$ recogniAe# her as a )istinguishe# .urse Scholar! :n 1999, the 7etAer :nstitute honore# her with the national .orman 2ousins Awar# in recognition of her commitment to #e%elopingC maintaining an# e&emplif$ing relationship-centere# care practices!

PHILOSOPHY AND SCIENCE OF CARIN

=he foun#ation of "ean Watson s theor$ of nursing was publishe# in 1959 in nursing< D=he philosoph$ an# science of caringE :n 19>>, her theor$ was publishe# in Dnursing< human science an# human careE! Watson belie%es that the main focus in nursing is on carati%e factors! She belie%es that for nurses to #e%elop humanistic philosophies an# %alue s$stem, a strong liberal arts backgroun# is necessar$! =his philosoph$ an# %alue s$stem pro%i#e a soli# foun#ation for the science of caring! A humanistic %alue s$stem thus un#er gri#s her construction of the science of caring!

She asserts that the caring stance that nursing has alwa$s hel# is being threatene# b$ the tasks an# technolog$ #eman#s of the curati%e factors! !he Seven Assumptions Watson proposes e%en assumptions about the science of caring! =he basic assumptions are< 1! F! 6! 4! 2aring can be effecti%el$ #emonstrate# an# practice# onl$ interpersonall$! 2aring consists of carati%e factors that result in the satisfaction of certain human nee#s! 4ffecti%e caring promotes health an# in#i%i#ual or famil$ growth! 2aring responses accept person not onl$ as he or she is now but as what he or she ma$ become! ?! A caring en%ironment is one that offers the #e%elopment of potential while allowing the person to choose the best action for himself or herself at a gi%en point in time! /! 2aring is more DhealthogenicE than is curing! A science of caring is complementar$ to the science of curing! 5! =he practice of caring is central to nursing! CARI!AS P"ocess + 2aritas comes from the -atin wor# meaning to cherish, to appreciate, to give special attention, if not loving, attention toC it connotes something that is %er$ fine, that in#ee# is precious :n%ites nurse to e&plore the intersection between personal an# professional

!he !en P"ima"y Ca"ative #acto"s =he structure for the science of caring is built upon ten carati%e factors! :t was first #e%elope# in the $ear 1959! =hese are< 1! F! 6! 4! ?! /! 5! >! =he formation of a humanistic- altruistic s$stem of %alues! =he installation of faith-hope! =he culti%ation of sensiti%it$ to one s self an# to others! =he #e%elopment of a helping-trust relationship =he promotion an# acceptance of the e&pression of positi%e an# negati%e feelings! =he s$stematic use of the scientific problem-sol%ing metho# for #ecision making =he promotion of interpersonal teaching-learning! =he pro%ision for a supporti%e, protecti%e an# Gor correcti%e mental, ph$sical, sociocultural an# spiritual en%ironment! 9! Assistance with the gratification of human nee#s! 10! =he allowance for e&istential-phenomenological forces!

As "ean #e%elope# her theor$ o%er time, she begin to change these carati%e factors into clinical caritas processes! =hese inclu#e#< 1! 7ormation of humanistic-altruistic s$stem of %alues, becomes< $P"actice o# lovin%&'indness and e(uanimity )ithin conte*t o# ca"in% consciousness+ 0egins #e%elopmentall$ at an earl$ age with %alues share# with the parents! Me#iate# through ones own life e&periences, the learning one gains an# e&posure to the humanities! :s percei%e# as necessar$ to the nurse s own maturation which then promotes altruistic beha%ior towar#s others! F! :nstillation of faith-hope, becomes< $,ein% authentically p"esent- and ena.lin% and sustainin% the deep .elie# system and su./ective li#e )o"ld o# sel# and one&.ein%&ca"ed& #o"$0 :t is essential to both the carati%e an# the curati%e processes! When mo#ern science has nothing further to offer the person, the nurse can continue to use faith-hope to pro%i#e a sense of well-being through beliefs which are meaningful to the in#i%i#ual! 6! 2ulti%ation of sensiti%it$ to oneHs self an# to others, becomes< $Cultivation o# one1s o)n spi"itual p"actices and t"anspe"sonal sel#- %oin% .eyond e%o sel#$0 4&plores the nee# of the nurse to begin to feel an emotion as it presents itself! )e%elopment of one s own feeling is nee#e# to interact genuinel$ an# sensiti%el$ with others! Stri%ing to become sensiti%e, makes the nurse more authentic, which encourages self-growth an# self-actualiAation, in both the nurse an# those with whom the nurse interacts! =he nurses promote health an# higher le%el functioning onl$ when the$ form person to person relationship!

4! )e%elopment of a helping-trusting, human caring relationship, becomes< $Developin% and sustainin% a helpin%&t"ustin%- authentic ca"in% "elationship$0 Strongest tool is the mo#e of communication, which establishes rapport an# caring! She has #efine# the characteristics nee#e# to in the helping-trust relationship! =hese are< 2ongruence, 4mpath$, Warmth 2ommunication inclu#es %erbal, non%erbal an# listening in a manner which connotes empathetic un#erstan#ing!

?! 3romotion an# acceptance of the e&pression of positi%e an# negati%e feelings, becomes< $,ein% p"esent to- and suppo"tive o# the e*p"ession o# positive and ne%ative #eelin%s as a connection )ith deepe" spi"it o# sel# and the one&.ein%& ca"ed&#o"$0 Accor#ing to Watson, Dfeelings alter thoughts an# beha%ior, an# the$ nee# to be consi#ere# an# allowe# for in a caring relationshipE! Accor#ing to her such e&pression impro%es one s le%el of awareness! Awareness of the feelings helps to un#erstan# the beha%ior it engen#ers!

/! S$stematic use of a creati%e problem-sol%ing caring process, becomes< $c"eative use o# sel# and all )ays o# 'no)in% as pa"t o# the ca"in% p"ocess0 to en%a%e in a"tist"y o# ca"in%&healin% p"actices$0 Accor#ing to Watson, the scientific problem- sol%ing metho# is the onl$ metho# that allows for control an# pre#iction, an# that permits self-correction! She also %alues the relati%e nature of nursing an# supports the nee# to e&amine an# #e%elop the other metho#s of knowing to pro%i#e an holistic perspecti%e! =he science of caring shoul# not be alwa$s neutral an# obIecti%e!

5! 3romotion of transpersonal teaching-learning, becomes< $En%a%in% in %enuine teachin%&lea"nin% e*pe"ience that attends to unity o# .ein% and meanin% attemptin% to stay )ithin othe"1s #"ame o# "e#e"ence$0 =he caring nurse must focus on the learning process as much as the teaching process! 1n#erstan#ing the person s perception of the situation assist the nurse to prepare a cogniti%e plan! >! 3ro%ision for a supporti%e, protecti%e, an#Gor correcti%e mental, ph$sical, societal, an# spiritual en%ironment, becomes< $C"eatin% healin% envi"onment at all levels- 2physical as )ell as non&physical- su.tle envi"onment o# ene"%y and consciousness- )he"e.y )holeness- .eauty- com#o"t- di%nity- and peace a"e potentiated$0 Watson #i%i#es these into eternal an# internal %ariables, which the nurse manipulates in or#er to pro%i#e support an# protection for the person s mental an# ph$sical well-being! =he e&ternal an# internal en%ironments are inter#epen#ent! Watson suggests that the nurse also must pro%i#e comfort, pri%ac$ an# safet$ as a part of this carati%e factor!

9! Assistance with gratification of human nee#s, becomes< $assistin% )ith .asic needs- )ith an intentional ca"in% consciousness- administe"in% 3human ca"e essentials1- )hich potentiate ali%nment o# mind&.ody&spi"it- )holeness- and unity o# .ein% in all aspects o# ca"e$0 ten#ing to both embo#ie# spirit an# e%ol%ing spiritual emergenceC :t is groun#e# in a hierarch$ of nee# similar to that of the Maslow s! She has create# a hierarch$ which she belie%es is rele%ant to the science of caring in nursing! Accor#ing to her each nee# is eJuall$ important for Jualit$ nursing care an# the promotion of optimal health! All the nee#s #eser%e to be atten#e# to an# %alue#! 4atson5s o"de"in% o# needs

-ower or#er nee#s 'bioph$sical nee#s* =he nee# for foo# an# flui# =he nee# for elimination =he nee# for %entilation -ower or#er nee#s 'ps$choph$sical nee#s* =he nee# for acti%it$-inacti%it$ =he nee# for se&ualit$ (igher or#er nee#s 'ps$chosocial nee#s* =he nee# for achie%ement =he nee# for affiliation (igher or#er nee# 'intrapersonal-interpersonal nee#* =he nee# for self-actualiAation

10! Allowance for e&istential-phenomenological-spiritual forces, becomes< $openin% and attendin% to spi"itual&myste"ious- and e*istential dimensions o# one1s o)n li#e&death0 soul ca"e #o" sel# and the one&.ein%&ca"e&#o"6 3henomenolog$ is a wa$ of un#erstan#ing people from the wa$ things appear to them, from their frame of reference! 4&istential ps$cholog$ is the stu#$ of human e&istence using phenomenological anal$sis! =his factor helps the nurse to reconcile an# me#iate the incongruit$ of %iewing the person holisticall$ while at the same time atten#ing to the hierarchical or#ering of nee#s! =hus the nurse assists the person to fin# the strength or courage to confront life or #eath!

!he #i"st th"ee ca"ative #acto"s #o"m the 7philosophical #oundation+ #o" the science o# ca"in%6 !he "emainin% seven ca"ative #acto"s sp"in% #"om the #oundation laid .y these #i"st th"ee6

!he 8etapa"adi%m

96

Human .ein%

She a#opts a %iew of the human being as< DK!! a %alue# person in an# of him or herself to be care# for, respecte#, nurture#, un#erstoo# an# assiste#C in general a philosophical %iew of a person as a full$ functional integrate# self! (e, human is %iewe# as greater than an# #ifferent from, the sum of his or her partsE! :6 Health

Watson belie%es that there are other factors that are nee#e# to be inclu#e# in the W(L #efinition of health! She a##s the following three elements< A high le%el of o%erall ph$sical, mental an# social functioning A general a#apti%e-maintenance le%el of #ail$ functioning =he absence of illness 'or the presence of efforts that lea#s its absence* ;6 Envi"onment<society

Accor#ing to Watson caring 'an# nursing* has e&iste# in e%er$ societ$! A caring attitu#e is not transmitte# from generation to generation! :t is transmitte# b$ the culture of the profession as a uniJue wa$ of coping with its en%ironment! =6 Nu"sin%

Accor#ing to Watson 7Nu"sin% is conce"ned )ith p"omotin% health- p"eventin% illnessca"in% #o" the sic' and "esto"in% health+6 :t focuses on health promotion an# treatment of #isease! She belie%es that holistic health care is central to the practice of caring in nursing! She #efines nursing asK!! 7A human science o# pe"sons and human health&illness e*pe"iences that a"e mediated .y p"o#essional- pe"sonal- scienti#ic- esthetic and ethical human t"ansactions+6

Acceptance in the Nu"sin% Community

96 P"actice Watson is an eternal optimist, an# she writes from a #eep place about the personal as well as the sacre#! =he philosoph$ in%ites to e&plore one s curiosities about the origins of hisGher call to care! (er writing encourages e&plorations of Juestions such as< What calls me to care? What is the root of my caring response? How will I respond? Why do I fail to respond? When is it hard to care? How will I sustain and nurture my caring consciousness? Who will care for me? :6 Education Watson #efines her intent to #escribe the core '.urse-patient interaction resulting to therapeutic communication* of nursing rather than the trim of nursing 'the proce#ure, task an# outcome*! With the focus, the framework is not limite# to an$ nursing specialt$! Although she emphasiAes that the trim are necessar$, she belie%es that the trim cannot be the center of professional mo#el of nursing care! ;6 Resea"ch 3atient outcomes in caring transactions are a potential are for stu#ies! 9esearch an# practice shall focus both on subIecti%e an# obIecti%e patient outcomes to #etermine whether or not caring is in#ee# the truest essence of nursing!

St"en%ths
1! 0esi#es assisting in pro%i#ing the Jualit$ of care that client ought to recei%e, it also pro%i#es the soul satisf$ing care for which man$ nurses enter the profession! F! As the science of caring ranges from the bioph$sical through the intrapersonal, each nurse becomes an acti%e coparticipant in the client s struggle towar#s self-actualiAation! 6! =he client is place# in the conte&t of the famil$, the communit$ an# the culture! 4! :t places the client as the focus of practice rather than the technolog$!

Limitations

1! ,i%en the acuit$ of illness that lea#s to hospitaliAation, the short length sta$, an# the increasing comple& technolog$, such Jualit$ of care ma$ be #eeme# impossible to gi%e in the hospital! F! While Watson acknowle#ges the nee# for bioph$sical base to nursing, this area recei%es little attention in her writings! 6! =he ten caratii%e factors primaril$ #elineate the ps$chosocial nee#s of the person! 4! While the carati%e factors ha%e a soun# foun#ation base# on other #isciplines, the$ nee# further research in nursing to #emonstrate their application to practice!

CASE S!>DY

Rico Sandoval a !"#$ear old tr%c& driver is ad'itted to the hos(ital )ollo*ing an accident *hich ca%sed the )ront o) his tr%c& to catch )ire+ He s%))ered )ro' ,%rns and *as r%shed to the ER diagnosed *ith dee( s(lit# thic&ness and )%ll thic&ness ,%rns o) the anterior chest ar's and hands+ His vital signs are as )ollo*s- T- ".+/012 PR34567'in2 8P3"97.6+ A ra(id in)%sion o) lactated ringers *as started and he *as also receiving 56: h%'idi)ied o;$gen via )acial 'as&+ L%ng so%nds indicate ins(irator$ and e;(irator$ *hee<ing and a (ersistent co%gh reveals soot$ s(%t%' (rod%ction+ A )ole$ catheter is inserted and initiall$ drains a 'oderate a'o%nt o) dar& concentrated %rine+ He is alert and oriented ,%t co'(lains o) severe (ain associated *ith the ,%rn in=%ries+

Analysis? 96 Ho) the client assessment st"uctu"ed@ Watson points out that nursing process contains the same steps as the scientific research process! =he$ both tr$ to sol%e a problem! 0oth pro%i#e a framework for #ecision making! Assessment phase is a opportunit$ for 7ormation of a (umanistic-altruistic s$stem of %alues, :nstillation of faith-hope, 2ulti%ation of sensiti%it$ to oneHs self an# to others an# )e%elopment of a helping-trusting, human caring relationship Watson s theor$ of caring insists that a holistic approach, assessment ma$ inclu#e the social histor$ of the patient, as it allows the inter%iewer to un#erstan# a more complete approach to the patient s care! =he en%ironment in which patient li%es as well as his habits within that en%ironment, help to pro%i#e a more complete an# potentiall$ more successful plan of care! Watson elaborates assessment as for him, it in%ol%es obser%ation, i#entification an# re%iew of the problemC use of applicable knowle#ge in literature! :6 Ho) the client data is analyAed@ Watson s theor$ anal$Ae #ata b$ the formulation of h$pothesisC #efining %ariables that will be e&amine# in sol%ing the problem!

7ormulation of .ursing )iagnosis such as :neffecti%e Airwa$ 2learance rGt brochial secretions, 7lui# Volume )eficit rGt acti%e %olume loss, 9isk 7or :nfection rGt :na#eJuate 3rimar$ #efense an# 3ain rGt tissue inIur$!

;6 Ho) the client needs a"e la.eled@ Watson in#icates that nee#s are interrelate#! =he science of caring suggests that the nurse recogniAe an# assist with each of the interrelate# nee#s in or#er to reach the highest or#er nee# of self-actualiAation! Watson s or#ering of nee#s Higher order needs (psychosocial needs) @ @ The need for achievement The need for affiliation

Higher order need (intrapersonal-interpersonal need) @ The need for self-actualization

-ower or#er nee#s 'ps$choph$sical nee#s* @ @ The need for activity The need for sexuality

-ower or#er nee#s 'bioph$sical nee#s* The need for food and fluid @ @ The need for elimination The need for ventilation

=6 Ho) is ca"e planned and delive"ed@ Watson elaborate# that planning inclu#es a conceptual approach or #esign for problem sol%ing! :t #etermines what #ata woul# be collecte# an# how on whom! 3ro%ision for a supporti%e, protecti%e, an#Gor correcti%e mental, ph$sical, societal, an# spiritual en%ironment

3romoting interpersonal teaching-learning Assistance with gratification of human nee#s

B6 Ho) is client "esponse<ca"e evaluated@ Accor#ing to Watson, e%aluation inclu#es anal$sis of the #ata as well as the e&amination of the effects of inter%entions base# on the #ata! :nclu#es the interpretation of the results, the #egree to which positi%e outcome has occurre# an# whether the result can be generaliAe#! Watson belie%es that harmon$ of D0o#$ , min#, an# spiritE of the caregi%er an# the patient is one of the greatest outcome of care!

REFERENCES =imber 08! 7un#amental skills an# concepts in 3atient 2are, 5th e#ition, -WW, . =heoretical 7oun#ations of .ursing b$ 2arl 0alita, et al! ,eorge 0! "ulia , .ursing =heories- =he base for professional .ursing 3ractice , 6r# e#! .orwalk, Appleton M -ange! Wills M!4%el$n, Mc4wen Melanie 'F00F*! =heoretical 0asis for .ursing 3hila#elphia! -ippincott WilliamsM wilkins! Meleis :brahim Afaf '1995* , =heoretical .ursing < )e%elopment M 3rogress 6r# e#! 3hila#elphia, -ippincott! Inte"net Resou"ces http?<<)))6)atsonca"in%science6o"%< http?<<)))6nu"sin%6ucdenve"6edu<#aculty<ca"in%6htm %hs6o"%Guploa#e#7ilesG666G.ursingG4atsonsN!heo"yNofNCa"in%0>0/O1P!p#f www!humanca"in%6o"%Gconte#G3ragmatic View!p#f Vi#eo clips http?<<)))6youtu.e6com<)atch@vCE&%/&D'9EF' http?<<)))6youtu.e6com<)atch@vChLRDpG;*HIG http?<<)))6youtu.e6com<)atch@vC:J#dDO("aGs