The Transpersonal Theory/ Theory of Human Care Margaret Jean Watson She was born in a small, close-knit town

in the Appalachian Mountains of West Virginiain the 1940s. Jean Watson has claimed that her caring theory was developed while shewas having a personal experience (Husbands Death) in her life. She molded herprofessional and personal life in order to develop her theory. PHILOSOPHY AND SCIENCE OF CARING  The foundation of Jean Watsons theory of nursing was published in 1979 in nursing: The philosophy and science of caring. In 1988, her theory was published in nursing: human science and human care.  Watson believes that the main focus in nursing is on carative factors. She believes that for nurses to develop humanistic philosophies and value system, a strong liberal arts background is necessary. This philosophy and value system provide a solid foundation for the science of caring. A humanistic value system thus under grids her construction of the science of caring.  She asserts that the caring stance that nursing has always held is being threatened by the tasks and technology demands of the curative factors.

 The essence of Watsons theory is authentic caring for the purpose of preserving the dignity and wholeness of humanity.  Watson sees nursings "collective caring -healing role and its mission in society as attending to, and helping to sustain, humanity and wholeness."  Watson envisions nursing as a human science discipline as well as an academic clinical profession with a societal mission, that is, "caring and healing work with others during their most vulnerable moments of lifes journey."  According to Watson, knowledge and practice for a caring healing discipline are primary derived from the arts and humanities and an emerging human science that acknowledges a convergence of art and science.  Watson was a leader in advocating for a strong liberal arts background with an emphasis on philosophy and values as the necessary educational basis for the science of caring.

The Seven Assumptions Watson proposes even assumptions about the science of caring. The basic assumptions are: 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 not only as he or she is now but as what he or she may become. 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.

CARITAS Process  Caritas comes from the Latin 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

Invites nurse to explore the intersection between personal and professional

The Ten Primary Carative factors The structure for the science of caring is built upon ten carative factors. It was first developed in the year 1979. These are: 1.The formation of a humanistic- altruistic system of values. 2.The installation of faith-hope. 3.The cultivation of sensitivity to ones self and to others. 4.The development of a helping-trust relationship 5.The promotion and acceptance of the expression of positive and negative feelings. 6.The systematic use of the scientific problem-solving method for decision making 7.The promotion of interpersonal teaching-learning. 8.The provision for a supportive, protective and /or corrective mental, physical, socio-cultural and spiritual environment. 9.Assistance with the gratification of human needs. 10. The allowance for existential-phenomenological forces. As Jean developed her theory over time, she begins to change these carative factors into clinical caritas processes. These included: 1. Formation of humanistic-altruistic system of values, becomes: "Practice of loving-kindness and equanimity within context of caring consciousness 1. Begins developmentally at an early age with values shared with the parents. 2. Mediated through ones own life experiences, the learning one gains and exposure to the humanities. 3. Is perceived as necessary to the nurses own maturation which then promotes altruistic behavior towards others.

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"; 1. It is essential to both the carative and the curative processes. 2. 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 one's self and to others, becomes: "Cultivation of one's own spiritual practices and transpersonal self, going beyond ego self";

1. Explores the need of the nurse to begin to feel an emotion as it presents itself. 2. Development of ones own feeling is needed to interact genuinely and sensitively with others. 3. Striving to become sensitive, makes the nurse more authentic, which encourages self-growth and selfactualization, in both the nurse and those with whom the nurse interacts. 4. The nurses promote health and higher level functioning only when they form person to person relationship.

4. Development of a helping-trusting, human caring relationship becomes: "Developing and sustaining a helpingtrusting, authentic caring relationship"; 1. Strongest tool is the mode of communication, which establishes rapport and caring. 2. She has defined the characteristics needed to in the helping-trust relationship. 3. These are: Congruence, Empathy, Warmth Communication includes verbal, nonverbal and listening in a manner which connotes empathetic understanding.

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"; According to Watson, feelings alter thoughts and behavior, and they need to be considered and allowed or in a caring relationship. According to her such expression improves ones level of awareness. Awareness of the feelings helps to understand the behavior it engenders.

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"; 1. According to Watson, the scientific problem- solving method is the only method that allows for control and prediction, and that permits self-correction. 2. She also values the relative nature of nursing and supports the need to examine and develop the other methods of knowing to provide an holistic perspective. 3. The science of caring should not be always neutral and objective. 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"; 1. 2. The caring nurse must focus on the learning process as much as the teaching process. Understanding the persons perception of the situation assist the nurse to prepare a cognitive plan.

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 andconsciousness, whereby wholeness, beauty, comfort, dignity, and peace are potentiated"; 1. 2. Watson divides these into eternal and internal variables, which the nurse manipulates in order to provide support and protection for the persons mental and physical well-being. The external and internal environments are interdependent.

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Watson suggests that the nurse also must provide comfort, privacy and safety as a part of this carative factor.

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-bodyspirit, wholeness, and unity of being in all aspects of care"; tending to both embodied spirit and evolving spiritual emergence; 1. 2. 3. It is grounded in a hierarchy of need similar to that of the Maslows. She has created a hierarchy which she believes is relevant to the science of caring in nursing. According to her 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. Watsons 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-spiritual forces, becomes:"opening and attending to spiritualmysterious, and existential dimensions of one's own life-death; soul care for self and the one-being-care-for. 1. 2. 3. 4. 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.

The first three carative factors form the philosophical foundation for the science of caring. The remaining seven carative factors spring from the foundation laid by these first three.

The Metaparadigm 1. Human being

She adopts a view of the human being as:.. a valued person in and of him or herself to be cared for, respected, nurtured, understood and assisted; in general a philosophical view of a person as a fully functional integrated self. He, human is viewed as greater than and different from, the sum of his or her parts. 2. Health Watson believes that there are other factors that are needed to be included in the WHO definition of health. She adds the following three elements: A high level of overall physical, mental and social functioning A general adaptive-maintenance level of daily functioning The absence of illness (or the presence of efforts that leads its absence) 3.Environment/society 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. 4.Nursing According to Watson 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 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.

CASE STUDY Rico Sandoval, a 39-year old truck driver is admitted to the hospitalfollowing an accident which caused the front of his truck to catchfire. He suffered from burns and was rushed to the ER, diagnosedwith deep split- thickness and full thickness burns of the anteriorchest, arms and hands. His vital signs are as follows: T: 96.2F;PR=140/min; BP=98/60. A rapid infusion of lactated ringers wasstarted and he was also receiving 40% humidified oxygen via facialmask. Lung sounds indicate inspiratory and expiratory wheezingand a persistent cough reveals sooty sputum production. A foleycatheter is inserted and initially drains a moderate amount of darkconcentrated urine. He is alert and oriented but complains of severepain associated with the burn injuries. Analysis: 1.How the client assessment structured? Watson points out that nursing process contains the same steps as the scientific research process. They both try to solve a problem. Both provide a framework for decision making. Assessment phase is a opportunity for Formation of a Humanistic-altruistic system of values, Instillation of faith-hope, Cultivation of sensitivity to one's self and to others and Development of a helping-trusting, human caring relationship Watsons theory of caring insists that a holistic approach, assessment may include the social history of the patient, as it allows the interviewer to understand a more complete approach to the patients care.The environment in which patient lives as well as his habits within that environment, help to provide a more complete and potentially more successful plan of care. Watson elaborates assessment as for him, it involves observation, identification and review of the problem; use of applicable knowledge in literature. 2.How the client data is analyzed?

 Watsons theory analyze data by the formulation of hypothesis; defining variables that will be examined in solving the problem. Formulation of Nursing Diagnosis such as Ineffective Airway Clearance r/t brochial secretions, Fluid Volume Deficit r/t active volume loss, Risk For Infection r/t Inadequate Primary defense and Pain r/ttissue injury. 3.How the client needs are labeled? Watson indicates that needs are interrelated. The science of caring suggests that the nurserecognize and assist with each of the interrelated needs in order to reach the highest orderneed of self-actualization

Watsons ordering of needs Watsons ordering of needs Higher order needs (psychosocial needs) The need for achievement The need for affiliation Higher order need (intrapersonal-interpersonal need) The need for self-actualization Lower order needs (psychophysical needs) The need for activity The need for sexuality Lower order needs (biophysical needs) The need for food and fluid The need for elimination The need for ventilation

4.How is care planned and delivered? Watson elaborated that planning includes a conceptual approach or design for problem solving. It determines what data would be collected and how on whom.

 Provision for a supportive, protective, and/or corrective mental, physical, societal, and spiritual environment Promoting interpersonal teaching-learning Assistance with gratification of human needs 5.How is client response/care evaluated? According to Watson, evaluation includes analysis of the data as well as the examination of the effects of interventions based on the data. Includes the interpretation of the results, the degree to which positive outcome has occurred and whether the result can be generalized. Watson believes that harmony of Body , mind, and spirit of the caregiver and the patient is one of the greatest outcome of care.

REFERENCES Timber BK. Fundamental skills and concepts in Patient Care, 7th edition, LWW, N Theoretical Foundations of Nursing by Carl Balita, et al. George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton & Lange. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia, Lippincott. Internet Resources http://www.watsoncaringscience.org/ http://www.nursing.ucdenver.edu/faculty/caring.htm ghs.org/uploadedFiles/.../Nursing/Watsons_Theory_of_Caring0806[1].pdf www.humancaring.org /conted/Pragmatic View.pdf

Video clips http://www.youtube.com/watch?v=E-gj-Vk1JZk http://www.youtube.com/watch?v=hLRDpQ3x7KQ http://www.youtube.com/watch?v=29fdVOqraQ