THEORY OF HUMAN CARING

Theory of Human Caring

Ashley Bennett, RN, BSN, FNP-S
Clemson University

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Theory of Human Caring

Jean Watson was born and raised in Welch, West Virginia. After graduating high school,
Watson attended the Lewis Gale School of Nursing and earned a nursing degree. She continued
her education at the University of Colorado and received a nursing baccalaureate degree in 1964.
Watson then proceeded to earn a masters degree in psychiatric-mental health nursing in 1966,
followed by a doctorate in educational psychology and counseling in 1973. After the completion
of her doctoral degree, Watson joined the School of Nursing faculty at the University of
Colorado. During her time as a faculty member, Jean Watson developed the Theory of Human
Caring. (Jesse & Alligood, 2014, p. 79-80). This paper will provide an overview and synopsis of
Jean Watsons Theory of Human Caring.
Purpose and Overview
The Theory of Human Caring is a grand theory initially developed by Jean Watson between
1975 and 1979 while she was teaching at the University of Colorado. This theory was Watsons
first attempt to bring attention to nursing as a developing and distinct health discipline with its
own values, knowledge, and practice (Watson, 2006, p. 296). Watson wanted to separate nursing
from the medical model of diagnosis and treatment. She wished to show nursing as a caringhealing and health model (Watson, 2013). Through the past several decades, Watson has adapted
concepts in her theory to better align with the progression of nursing.
To understand the Theory of Human Caring, one must begin with the four main participants
identified in the theory. The first participant is the nurse. Watson described characteristics that
must be exemplified by the nurse in order to apply the theory to nursing practice. She states the
nurse must not treat humans as objects or separate them from their sense of self. The nurse is to
remain focused on the whole person. Watson also specifies the nurse should have a full

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understanding of how to promote and maintain health, as well as, prevent illness. The nurses
primary goal is the progression and welfare of the person being cared for (Pearson, Vaughan, &
Fitzgerald, 1996). Throughout the theory, it is assumed that the nurse portrays each of these
characteristics.
The person is the second participant described in the Theory of Human Caring. This
participant has also been referred to as personhood, life, and human being. This participant
refers to the person receiving the care. Watson states the person should be viewed in their
entirety, which includes mind, body, and soul. Each person has a unique and ever-changing view
of the world that is shaped by their own experiences, memories, and emotions. The nurse must
view the person in their entirety to fully understand how to care for the person (Pearson,
Vaughan, & Fitzgerald, 1996).
Health is the third participant in the Watsons theory. She originally described health using
three key elements:
1. A high level of overall physical, mental, and social functioning.
2. A general adaptive-maintenance level of daily functioning.
3. The absence of illness (or the presence of efforts that lead to its absence).
In 1988, Watson modified her definition of health. She began to define it as unity and harmony
within the mind, body, and soul (Jesse & Alligood, 2014, p. 86). Watson felt health care
workers were overly focused on illness and she wanted to shift the focus to health.
Environment is the final participant described in the Theory of Human Caring. Watson
used this term to describe both internal and external surroundings that affect both the nurse and
person. The theory places a large emphasis on the nurses role in a persons environment.
Watson states the nurse should help create a protective and supportive setting for the person
(Jesse & Alligood, 2014). In Watsons later work, she moves to a broader view of environment

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and states human beings are a part of nature and should respect and care for the entire
ecosystem (Pearson, Vaughan, & Fitzgerald, 1996, p. 210).
Major Concepts
Each of the participants in the Theory of Human Caring are interrelated and used to define
the four major concepts of the theory.
The first major concept in the Theory of Human Caring is the transpersonal caring
relationship. This relationship describes the connection between the nurse and person. It goes
beyond the physical world and into the spiritual realm. The transpersonal caring relationship
occurs when the nurse moves past the ego self and transcends to authentic caring and healing for
the person. This relationship is formed through actions, words, behaviors, cognition, body
language, feelings, intuition, thought, senses, [and] the energy field (Watson, 2006, p. 299).
There are many assumptions with this concept, including the nurses morality and
intentions. The theory assumes the nurse wishes to place the person ahead of themselves and
views the person in their entirety (mind, body, and soul). It is also assumed the nurse wishes to
identify and connect with the person on a spiritual level. Watson recognized that each nurses
own experiences and circumstances may hinder or enhance their ability to form the transpersonal
caring relationship. She states that through maturity and professional practice, nurses can
develop a better understanding of the transpersonal caring relationship. The nurse and person
must both participate in this relationship but more emphasis is placed on the nurse and their
intentions for the transpersonal caring relationship. Watson believes if the nurse shifts their
focus to the whole person, both the nurse and person will become engaged in the relationship
(Watson, 2006, p. 300).

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The caring moment or caring occasion is the second major concept identified in the
Theory of Human Caring. Watson specifies that the caring moment involves an action and
choice by both the nurse and [person] (Watson, 2006, p. 300). The caring moment allows the
two to exist in a moment of time together and feel the spiritual connection. It allows both the
nurse and person to learn from each other and find commonality on a human level. Watson
believes that in the caring moment, the nurse can no longer view the person as an object. The
nurse and person are left with a heightened sense of humanity.
The third major concept of the Theory of Human Caring is found within the caring
moment. It is the caring consciousness or healing. This concept refers to the consciousness of
the nurse and person participating in the caring moment (Watson, 2006). It allows these
individuals to be aware of the connection within the moment. The caring consciousness goes
beyond time and place, and exists in the spiritual realm. Watson states that it is an intersubjective
experience that can create opportunities for growth in the transpersonal caring relationship even
after the caring moment has ended.
The final major concept of the Theory of Human Caring is the carative factors. This concept
provides the core framework of Watsons idea of nursing and serves as a guide to nursing
practice. The word carative goes beyond physical science, skills, and tasks of nursing. It
describes the emotional and spiritual aspect of nursing. The carative factors were defined in
Watsons original work as follows:
1.
2.
3.
4.
5.
6.
7.

Formation of humanistic-altruistic system of values.

Instillation of faith-hope.
Cultivation of sensitivity to ones self and to others.
Development of a helping-trusting, human caring relationship.
Promotion and acceptance of the expression of positive and negative feelings.
Systematic use of a creative problem-solving caring process.
Promotion of transpersonal teaching-learning.

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8. Provision for a supportive, protective, and/or corrective mental, physical, societal, and
spiritual environment.
9. Assistance with gratification of human needs.
10. Allowance for existential-phenomenological-spiritual forces (Watson, 2006).
These are now referred to as the original carative factors. As Watsons theory evolved, she
wanted to transition the carative factors to broader concepts. She redefined them as the clinical
caritas processes. Caritas is a Greek word that means to cherish and appreciate, giving special
attention to, or loving (Watson, 2006, p. 297). Watson felt the clinical caritas processes
expanded her framework to incorporate love and spirituality. The transformed clinical caritas
processes were defined by Jean Watson as:
1. Formation of humanistic-altruistic system of values becomes a practice of loving
kindness and equanimity within the 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.
3. Cultivation of sensitivity to ones self and to others becomes cultivation of ones own
spiritual practices and transpersonal self, going beyond ego self, opening to others with
sensitivity and compassion.
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 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 caringhealing practices.
7. Promotion of transpersonal teaching-learning becomes engaging in genuine teachinglearning experience that attends to unity of being and meaning, attempting to stay within
others frames of reference.
8. Provision for a supportive, protective, and/or corrective mental, physical, societal, and
spiritual environment at all levels (a physical and 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 ones own life-death; soul
care for self and the one being cared for (Watson, 2006).

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Watson views the clinical caritas processes as a translation of her original carative factors. She
notes that with the progression of the clinical caritas processes, a framework for the future in
nursing is created. Watson believes the clinical caritas processes are a basis for nursings mission
to society and development in caring-healing practices (Watson, 2006).
Nature of the Relationships
All four of these major concepts are interconnected. The clinical caritas processes set the
foundation for nursing. They provide guidance for the nurse in regards to human caring. Once
the nurse understands and begins to personify the clinical caritas processes, he or she is able to
transcend into the transpersonal caring relationship. Following the establishment of the
relationship, the nurse and person will have the opportunity for the caring moment. This moment
will solidify the transpersonal caring relationship by connecting the two at a spiritual level.
During the caring moment, the presence of the caring consciousness will allow the nurse and
person to be aware of the spiritual connection. This will promote more potential acts of human
caring between the nurse and person.
Structure of the Theory
Jean Watsons Theory of Human Caring is presented in a descriptive form. It uses broad
ideas to address one central focus, nursing practice (Jesse & Alligood, 2014). Watson clearly
defines four major participants in the theory: the nurse, person, health, and environment. She
then uses these participants to define four major concepts: transpersonal caring relationship,
caring moment, caring consciousness, and the clinical caritas processes. These concepts and their
connections are well-defined which helps to solidify the primary purpose of the theory. Watson
does not give specific instructions on how to apply the theory to nursing practice. She simply
states the nurse must internalize the concepts of the theory and then he or she will be able to

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apply it to practice (Watson, 2006). This leaves individual nurses a great amount of
interpretation for the application of the theory.
Applications and Research
Due to the well-defined concepts and liberal range for application, the Theory of Human
Caring has been used as a guide in various areas of nursing. The theory has been integrated in
nursing practice through programs like the Attending Nurse Caring Model (ANCM). The
ANCM was a pilot project in a Denver childrens hospital whose mission was to have a
continuous caring relationship with children in pain and their families (Jesse & Alligood, 2014,
p. 87). The initial steps for the project were: create a caring-healing environment, optimize pain
management using pharmacological and caring-healing methods, and include both the children
and family in education regarding treatments. The nurses were educated on the clinical caritas
processes and how to use caring-healing methods. The participants of ANCM stated the program
has helped to redefine themselves as caregivers rather than taskmasters (Watson, 2006, p. 304).
The Theory of Human Caring has been incorporated into many hospitals administration
seeking Magnet status. The Magnet status was developed by the American Nurses Credentialing
Center to recognize hospitals with advanced nursing standards and practices. One hospital that
used the Theory of Human Caring to achieve Magnet status was Central Baptist Hospital in
Lexington, Kentucky. Using the theory, the hospital administration developed a
multidisciplinary group called the Healing Community. This group promotes caring-healing
environments throughout the hospital and local community. Another group called the Nursing
Research Interest Group was formed to apply Watsons theory to evidence-based practice. This
group was able to produce a pilot study to examine the relationship between nursing behaviors of
caring observed by patients and patient satisfaction (Birk, 2006). The study found a direct and

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positive correlation between caring practices of the nurse and patient satisfaction. Other research
studies have been influenced by the Theory of Human Caring outside of the Magnet program.
These studies have been conducted in several countries and have shown the same correlation
between caring practices of the nurse and patient satisfaction.
Conclusion and Future Application
Jean Watsons Theory of Human Caring distinguishes the nursing practice from other
healthcare disciplines through the addition of spirituality. Watsons concept of the transpersonal
caring relationship is especially relevant in my own nursing practice. The development of my
relationship with each patient promotes a nurturing and healing environment. I find the
successful development of the relationship gives the patients peace of mind so they can begin to
focus on themselves.
Another concept of the theory I find useful for my own nursing practice is the carative
factors. This concept serves as a guide to provide holistic nursing care. Two of the carative
factors resonate within me and I hope to always include them in my own nursing practice. The
first is instillation of faith-hope. Illness consumes the healthcare field and can bring immense
pain and sadness for everyone involved. Incorporating faith-hope into my patient care will help
alleviate some pain and sadness for patients. The second carative factor I hope to instill in my
nursing practice is the promotion of transpersonal teaching-learning. Through individualization
and enhancement of both teaching and learning, I will be able to help my patients achieve better
health. Nurses and patients have a two way relationship and each can both learn from and teach
the other. I hope to always individualize my patient teaching and continuously keep an open
mind to learn from each patient.

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The Theory of Human Caring is a grand theory that uses descriptive concepts to
distinguish nursing as a developing and distinct health discipline with its own values, knowledge,
and practice. The theory adds a spiritual element to show that nursing is a separate science
focused on caring instead of curing. There are many assumptions throughout the theory, as well
as, an overall lack of direction for application. The Theory of Human Caring accomplishes
Watsons goal of distinguishing nursing as separate science, but leaves its usability up to
individual interpretation.

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REFERENCES

Birk, Linda. (2006, May 24). The selection and integration of Watsons theory at Central Baptist
Hospital, Lexington KY. Retrieved from
http://watsoncaringscience.org/files/PDF/STTI.pdf
Jesse, D.E. & Alligood, M.R. (2014). Watsons Philosophy and Theory of Transpersonal Caring.
In Alligood, M.R. (Ed.), Nursing Theorists and Their Work (pp.79-97). St. Louis, MO:
Elsevier Mosby.
McGraw, Mary-Jean. (2002). Watsons Philosophy in Nursing Practice. In Alligood, M.R. &
Tomey, A.M. (Eds.), Nursing Theory: Utilization & Application (pp. 97-111). St. Louis,
MO: Mosby, Inc.
Pearson, A., Vaughan, B., & Fitzgerald, M. (1996). Nursing Models for Practice. Oxford, ENG:
Butterworth-Heinemann.
Watson, Jean. (2006). Jean Watsons Theory of Human Caring. In Parker, M.E. (Ed.), Nursing
Theories & Nursing Practice (pp. 295-306). Philadelphia, PA: F.A. Davis Co.
Watson, Jean. (2013). The Human Theory of Caring: Retrospective and Prospective. In Smith,
M.C., Turkel, M.C., & Wolf, Z.R. (Eds.), Caring in Nursing Classics: An Essential
Resource. (pp. 273-242). New York, NY: Springer Publishing Company, LLC.