Watsons Theory of

Caring Science
Presenter
Instructor

: Ayyu Sandhi
: Hsiu-Ju Chang

Graduate Institute of Nursing

Taipei Medical University

Outline
Biography
Description of the theory
Critique of the theory
Implementation of the theory
Application in Indonesia
Reference
2

Jean Watson was born

in West Virginia and
raised in an extended
family-community
environment as the
youngest of eight
children.

In 1966: She earned her

master degree in
psychiatric-mental
health nursing

In 1973: She completed

doctorate in educational
psychology and
counseling

In 1964 : She achieved

her bachelor degree
in nursing from
University of Colorado

In the 1980s, Watson

and colleagues
founded the Center
for Human Caring at
the University of

Being awarded National

League for Nursing (NLN)
Martha E. Rogers Award,
which appraises nurse scientists'
significant contributions for
advancing nursing knowledge
and knowledge in other health
Being awarded Fetzer
sciences
Institute's national Norman
Cousins Award in recognition of
her commitment for developing,
maintaining, and exemplifying
relationship-centered care
practices
American Journal of Nursing
Book of the Year Award for her
book
Caring Science as Sacred Science

Description of the theory

Origin
Purpose
Concepts
Definitions
Relationships
Structure
5

Assumptions

Description of the theory :

Origin
Watsons theory is based on her commitment

in honoring the lived experience of self and

other; in preserving humanity; attending to
and helping to sustain human dignity and
wholeness in the midst of threats and crises
of life and death (Watson, 2007).
Watson developed her theory from feminist

theory, metaphysics, phenomenology,

quantum physics, wisdom traditions,
perennial philosophy, and Buddhism. Her
work was influenced by some nursing
theorists, such as Nightingale, Henderson,

 From Nightingale, she connected the sense of

deep commitment and calling (which

answers the question, 'what calls us to care?') to
an ethic of human service.
She agreed on Carl Rogers' phenomenological

approach that nurses are not there to

manipulate and control but rather to
understand, as mostly influential thought at
the time when therapeutic control and
manipulation of the patient are considered as
norm (Alligood, 2014).
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In her first book "Nursing: The Philosophy and

Science of Caring", Watson developed

carative factors which according to her the
core of nursing (Sourial, 1996).
In her fifth book "Caring Science as Sacred

Science", Watson emphasizes nurses to have

deep inner reflection and personal growth,
communication skills, and use of selftranspersonal growth. She also invites nurses
to sustain and deepen own and others'
humanity as moral and ethical starting point
for professional caring (Watson, 2012).
Therefore, any technical skills commonly
aimed at cure are reframed as sacred

Description of the theory :

Purpose
The purpose of the theory is to address

some of the philosophical, conceptual and

empirical problems that confront nursing,
to clarify the human care process in
nursing, and to maintain the concept of
person in nursing (Cohen, 1991).

Description of the theory :

Concepts

10

Description of the theory :

Definitions
Transpersonal caring relationship, as

described by Watson, is a "special kind of

human care relationship, a spiritual union
between two people, which highly respects
for the whole person and their being-in-theworld" (Alligood, 2014).

11

The caring moment is an

existential turning
point for the nurse for
choosing to "see" the
patient. It is an informed
action guided by an
intentionality and
consciousness of how to
"really present" in the
moment. In a caring
moment, the nurse "read"
the field, beyond the
outer appearance of the
patient and the patient's
12 behavior.

13

 Humanistic values
include kindness,
empathy, concern,
and love for self and
others. They derive
from childhood
experiences and are
enhanced by beliefs,
cultures and art.

14

Altruistic values arise

from commitments
to and satisfaction
from receiving
through giving.

The nurse should

preserve faith and hope
and the deep belief
system of the patient,
regardless the medical
intervention, or even
when there is nothing
left to do medically.

15

 The way to develop

sensitivity to self is by
looking into oneself
and willing to explore
one's own feelings
self-acceptance
and acceptance of
others.

16

As consequences,
nurses who are
sensitive to others

 A trusting
relationship
promotes and
accepts the
expression of both
positive and
negative feelings.

17

It involves effective
communication,
empathy,
nonpossessive
warmth (which is
performed by a
moderate speaking
volume, a relaxed

 It can be achieved
through listening to
another person's
story and honoring
another person's
feeling. It may be the
nurse who is the only
one who listens to
and honors anothers
story and all the
feelings that come up
with it.

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Indeed, sharing of
feelings is a risktaking experience for

Being creative means

involving all knowledge,
instincts, intuition,
aesthetics, technology,
skills, empirics, ethics,
personal, and even
spiritual knowing.

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 The responsibility to
achieve and maintain
health and wellness is on
the patient.

20

The nurse has a role to

facilitate with teachinglearning techniques that
are designed to enable
patients to provide selfcare, determine personal
needs, and provide
opportunities for their
personal growth. Things
to keep in mind are that
"teaching" is not merely
conveying information,

 Internal and external

environments have
influence on health
and illness. Internal
environment includes
mental, spiritual wellbeing and sociocultural
beliefs. External
environment includes
comfort, privacy,
safety, cleanliness,
aesthetic
surroundings.

21

By repatterning the
environment

 The nurse needs to

recognize the
biological,
psychological, social,
spiritual, and cultural
needs of self and
patient.

22

All needs are unified

and interdependent;
they are equally
important and must
be valued and
responded during
caring process.

 This carative factor

allows mystery and
philosophical,
metaphysical aspects
of human experiences
and phenomena
which are not in
accordance with
rational thinking and
science. Nevertheless
these unknowns are
real to those affected.

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This factor allows

nurse, patient, and
families being open to
and believe in infinite

Person is viewed holistically

wherein the
body, mind, and soul are
Health is
interrelated
defined as the
Nursing's goal
unity and
Person
is using caring
harmony within
moment to
the body, mind,
help person to
and soul;
Nursing
Health
gain a higher
harmony
degree of
between self
harmony within
and others;
Environment
the body,
harmony
mind, and soul
between self
and nature;
which
Environment is defined as a healing space,
a is a
sacred space in which there is conscious process of
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promotion of the wholeness between the adapting,
body,
and
mind, and soul; instead of simply a place coping,
for

Description of the theory :

Relationships
The caring moment becomes transpersonal

when "nurse and patient together with their

unique life histories and perceptions able to
see and connect with the spirit of others,
becomes part of the life history of both
persons, involves learning of how to be
human by identifying from each other,
open to expanding possibilities of what can
occur" (Watson, 2012).
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If transpersonal caring relationship can be

established, "the patient is better able to have a

release of some of the disharmony of the body,
mind, and soul and be able to release pent-up
energy for his or her own healing process"
(Sourial, 1996). The goal of nursing is achieved
through transpersonal caring relationship
(McCance et al., 1999).
Transpersonal caring relationship is the full

actualisation of the carative factors in a humanto-human transaction.

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Description of the theory :

Structure

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Description of the theory :

Assumptions
1. Care and love are the most universal and

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intense cosmic forces.

2. Often we do not behave well toward each
other. If our humanity is to survive,we need
to be more caring and loving to nourish our
humanity.
3. Since nursing is a caring profession, its
ability to maintain caring ideal and ideology
in practice will affect the human
development and determine nursing's
contribution to society.
4. As a beginning we have to enforce our own
will to care and love toward ourselves and

5. Nursing always hold caring as foundation in

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connection to people with health-illness

concerns.
6. Caring is the essence of nursing.
7. Caring at the individual and group level, has
received less and less emphasis in the
health care delivery system.
8. Caring values of nursing have been
submerged nursing and society in
sustaining human care ideals and a caring
ideology in practice.
9. Preservation and progress of caring as both
an epistemic and clinical initiative is a
significant issue for nursing.
10. Caring can be effectively demonstrated and
practiced only interpersonally.

Critique of the theory

Clarity

Simplicity

Generality

Accessibility

Importance
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Critique of the theory :

Clarity
Watson's concepts are well-defined and her

definitions for concepts are used

consistently.
Watson's conversational style does make

her work rather undisciplined (Sourial,

1996). The use of metaphors, personal
reflections, artwork, and poetry make her
concepts more tangible and more
aesthetic, but in the other hand it makes
the concepts are difficult to understand at
once (Alligood, 2014).
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There are no flaws in the structural

Critique of the theory :

Simplicity
Some scholars find that Watson's theory is easy

to understand and to apply in practice, because

Watson draws on a number of disciplines, which
she feels are familiar to nurses, to formulate
her theory (Alligood, 2014).
But some others consider her theory complex. It

is not unusual because nurses may not have all

of the liberal arts background to provide the
foundation for understanding some of Watson's
principles (McCance et al., 1999).
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Critique of the theory :

Generality
Watson's theory is classified into grand nursing

theory since the scope of the framework

encompassess broad aspects of health-illness
phenomena.
The theory is global and abstract and therefore it

is not unusual to find unclear linkages between

concepts.
Watson's theory allows to develop from it more

middle-range theories, especially with respect to

the 10 carative factors.
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Critique of the theory :

Accessibility
An understanding of Eastern philosophy

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and/or phenomenology is almost required

before the model could be utilized.
This theory has broad applicability. It
addressess the core of nursing (therapeutic
nurse-patient relationship), not the trim of
nursing (procedure, tasks, technique), and
applies to all aspects of health and illness
(Cohen, 1991).
The theory was found to be applicable to
nurses and patients in all settings including
both ambulatory and acute care, at all
phases of development (Caruso et al., 2008),
and in community (Rafael, 2000).

Critique of the theory :

Importance
Watsons 10 carative factors provide a framework

by which nursing can redeem itself from a

curative role and highlight its distinctive caring
role.
This theory incorporates important aspects of

patient safety, as well as gives attention to nurses

to care for themselves (Caruso et al., 2008).
With respect to education, this theory stresses the

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importance of the role of humanities, spirituality,

and art as the vital part in nursing education
curricula (Cohen, 1991).

Implementation of the
theory

The nurses participating in the ANCM project

were learning how the model can increase their

caring consciousness and intentionality to
use knowledge and evidence, as well as to help
increase autonomy, enhance interdisciplinary
teamwork and reduce suffering in patients and
families (Watson & Foster, 2003).
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"The Watson Caritas Patient Score (WCPS)" is an

instrument used to assess perspectives of caring

practices of hospital staffs. Caring practices in
this instrument include providing care with
loving kindness, having helping and trusting
relationships, creating caring environments,
meeting basic needs, and valuing the patients
personal beliefs and faith (WCSI, 2014).
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Magnet hospitals must demonstrate criteria that

recognize quality patient care, nursing excellence,

and innovations in professional practice. Through
Magnet criteria, Watson's caring science theory
helps nurses to consciously shifted from taskoriented biomedical practices to deeper levels of
caring (Watson, 2009).
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Applying Watson's nursing theory to assess patient perceptions of

being cared for in a multicultural environment (Suliman et al., 2009).

The effectiveness of Watson Caring Model on the quality of life and
blood pressure of patients with hypertension (Erci et al., 2003).
Evaluation research within the human caring framework (McCance et
al., 1999).
The multidimensionality of caring: a confirmatory factor analysis of
the Caring Nurse-Patient Interaction Short Scale (Cossette et al.,
2007).
Comfort: exploration of the concept in nursing (Malinowski & Stamler,
2002).
Caring theory as an ethical guide to administrative and clinical
practices (Watson, 2006).
Watson's philosophy, science, and theory of human caring as a
conceptual framework for guiding community health nursing (Rafael,
2000).
Creating a healing environment : an innovative educational approach
for adopting Jean Watson's theory of human caring (Caruso et al.,
2008).
Advancing nursing theory through theory-guided practice: the
emergence of a critical caring perpective (Rafael, 2005).
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Application in Indonesia
In practice: Application of Watson's theory

will help nurses to establish caring relationship

and to create healing environment to all kind
of patients, at all moments, to increase quality
of care and patients' satisfaction.
http://www.pantirapih.or.id/index.php/layanan/ra
wat-inap
In education: Integrating Watson's theory in

the bachelor nursing curriculum, especially in

the first semester, and integrating caring
aspects in each guideline of nursing activities.
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In administration : Apart from the fact

that Indonesian hospitals do not apply

Magnet criteria, using instruments
developed from Watson's theory to
evaluate caring behaviors by practitioners
is very important to be done, as efforts to
improve quality of care.
In research : There are many studies

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conducted in cultural field, which is closely

related to Watson's concept, and it can be
considered as a good start to conduct more
studies based on Watson's theory.

References
Alligood, M. R. (2014). Nursing theorists and their work. St. Louis:

Mosby Elsevier.
Caruso, E. M., Cisar, N., & Pipe, T. (2008). Creating a healing
environment: An innovative educational approach for adopting Jean
Watson's Theory of Human Caring. Nursing Administration Quarterly,
32(2), 126-132.
Cohen, J. A. (1991). Two portraits of caring: a comparison of the artists,
Leininger and Watson. Journal of Advanced Nursing, 16(8), 899-909.
Institute, W. C. S. (2014). Watson Caritas Patient Score. Retrieved
December 2, 2014, from http://watsoncaringscience.org/watsoncaritas-patient-score/
McCance, T. V., McKenna, H. P., & Boore, J. R. (1999). Caring: theoretical
perspectives of relevance to nursing. Journal of Advanced Nursing,
30(6), 1388-1395.
McEwen, M., & Wills, E. M. (2007). Theoretical basis for nursing.
Philadelphia: Lippincott Williams & Wilkins.

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Rafael, A. R. F. (2000). Watson's philosophy, science, and theory of human

caring as a conceptual framework for guiding community health nursing

practice. Advances in Nursing Science, 23(2), 34-49.
Sourial, S. (1996). An analysis and evaluation of Watson's theory of human
care. Journal of Advanced Nursing, 24(2), 400-404.
Watson, J. (2007). Watson s theory of human caring and subjective living
experiences: carative factors/caritas processes as a disciplinary guide to the
professional nursing practice. Texto & Contexto-Enfermagem, 16(1), 129-135.
Watson, J. (2009). Caring science and human caring theory: Transforming
personal and professional practices of nursing and health care. Journal of
health and human services administration, 466-482.
Watson, J. (2012). Nursing: The Philosophy and Science of Caring. In M. C.
Smith, M. C. Turkel & Z. R. Wolf (Eds.), Caring in nursing classics: An essential
resource. New York: Springer Publishing Company.
Watson, J., & Foster, R. (2003). The Attending Nurse Caring Model:
integrating theory, evidence and advanced caringhealing therapeutics for
transforming professional practice. Journal of clinical nursing, 12(3), 360-365.

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