Presentation on theme: "Jean Watson’s Theory of Human Caring using Evidenced Based Practice across the Clinical Spectrum of Nursing Presented by Patricia Bell, Carol Gibbs, Jennifer."— Presentation transcript:
1Jean Watson’s Theory of Human Caring using Evidenced Based Practice across the Clinical Spectrum of NursingPresented by Patricia Bell, Carol Gibbs, Jennifer Gilbert, Jennifer Hales and Sarah Rooks
2Key Components of Jean Watson’s Theory Focuses on the ten caritas processes, these are processes Watson believes the nurse must consider and exemplify in order to be an effectively caring nurse (Alligood & Tomey, 2010)The word ‘caritas’ “comes from the Greek word meaning to cherish, to appreciate, to give special attention; it connotes something very fine, that indeed is precious” (Medscape Nurses, 2005).Watson’s theory calls upon nurses to go beyond procedures and tasks, but instead focuses on the nurse-patient relationship resulting in a therapeutic outcome and transpersonal caring process (Alligood et al., 2010)
3Watson’s Theory Continued… Focuses on care of self and care of othersFocuses on spiritual dimension of human relations and caringIntentional presence and authentic presence are keyRegard for the whole-person and being in their world (mind, body, spirit)Caring momentsPhysical and spiritual needs are tended to in a healing environmentPatient is at the center of care, rather than the task or technologyCaring as a method of healing(Alligood et al., 2010)
4Rationale for use of Nursing Theory Nurses who use theory to structure their practice are able to sort patient data quickly, make decisive nursing actions, and deliver outcome-based care, while also improving quality of care (Alligood et al., 2010)Using theory applied to nursing practice helps develop critical thinking while clarifying values and assumptions, and provides a basis for future practice, education, and research (Alligood et al., 2010)Alligood et al. also states “models and theories guide theory-based research for evidence-based practice” (2010, p. 14).Nursing theory is the bridge betweenlearning new information andapplying it to clinical practice!
5Reason for Selecting Watson’s Theory of Human Caring Caring is unique to nursing, whereas medicine focuses on curing disease (Alligood et al., 2010)Watson’s theory is the basis for Relationship Based Care (RBC), which is being implemented in countless hospitals and facilities nationwide. This makes this theory relevant and applicable for many of us!
6Watson’s Theory Used in Research We will explore how Jean Watson’s theory has been used inresearch in a variety of clinical settings.Evidence Based Research Includes These Topics:1.) Creating a Profile of a Nurse Effective in Caring2.) Applying Watson’s Theory for Caring Among Elders3.) Patient Perceptions of Care in a Multicultural Environment4.) Minimizing Preoperative Anxiety with Alternative Caring-Healing Therapies5.) The Attending Nurse Caring ModelT. The
7Creating a Profile of a Nurse Effective in Caring
8Profile of a Caring Nurse The intent of this study was to create a profile of nurses effective in caring within Jean Watson’s Caritas frameworkCaritas nursing is described as acknowledging caring and love as integral aspects of a mutual, humanistic, caring interactionIdentifying unique characteristics between patients and nurses in a context that portrays caring and love has implications for understanding the power of human healing, and also helps gain knowledge of the type of environment in which this type of Caritas nursing can occur(Persky, Nelson, & Watson, 2008)
9BackgroundA formal study of the profile of nurses effective in caring occurred at New York Presbyterian Hospital/Columbia University Center.Study was done prior to implementation of the Relationship Based Care (RBC) delivery model at this establishment.Both qualitative and quantitative data identified demographics and environmental perceptions of caregivers who received the highest score of caring identified by the patients they served.(Persky et al., 2008)
10Study Details 85 nurses responded to a Health Environment Survey (HES) Nurses were selected based on amount of time caring for a patient during their inpatient stay85 patients responded to the Caring Factors Survey (CFS)Patients were selected on basis of admission to six medical/surgical units and one mental health unitAverage length of stay for the patient was 7 daysNurses who were paired with these patients were considered the primary caregiver during that patient’s hospital stayCorrelations of these 85 pairs were examined to identify two factors:-the nurse’s report of the environment-the patient’s report of caringParticipation for both groups was voluntary and consent was given(Persky et al., 2008)
11Research Process Research process of surveys HES and CFS measured: -unit-based employee job satisfaction-patient’s perception of caringStudy then linked nurse factors in relation to patient satisfaction scores to identify specific traits of the nurse who received caring effectiveness scores by the patient.(Persky et al., 2008)
12Research Findings: Nurses reported to be caring by their patients were found to: Report the greatest frustration with every work environment variable measured, especially workloadHave the most hospital and professional experienceWork their scheduled hours of work, not more than scheduled hoursBe of any ageBe most affected by stress in the relationship with the patient, especially “difficult” patientsBe those who most enjoyed coworker relationshipsBe those who most often provided continuity of patient care from admission to discharge(Persky et al., 2008)
13ImplicationsSpeculation of the study considers that nurses who receive the highest scores of caring and love may be frustrated by the incongruence between healthcare environments and values of caringFurther frustration among these nurses may also be rooted in the fact that Caritas nursing takes more time and resources than the nurse has availableUnderstanding this profile of Caritas nurses (those who receive high caring scores) is essential to refining work environment systems in order to improve caring/healing processes(Persky et al., 2008)
14Critique and Reflection Limitations of this studyA single study using limited pairs (85 total) of nurses and patientsTook place at only one institutionArticle states this is the first study the authors are aware of which examines attributes of caring nursesTheory about caring attributes is in early stages and needs further exploration and researchPossibilitiesFuture studies on effective caring and related patient outcomes can be used to demonstrate the interdependence of this relationship. This can help restore caring back into healthcare, while reducing costs and improving outcomes.
15Applying Watson’s Theory for Caring Among Elders
16Caring Among EldersA nurse’s “c0nscious intentionality,” or conscious effort to “be with” the patient and not just “do for” him or her fosters “transpersonal encounters” in which both the nurse and patient fully participate. Such human exchanges promote healing in not only the patient, but in the nurse as well (Watson, 1985).
17Jean Watson’s “Carative Factors” 1.) Humanistic-altruistic system of values2.) Faith-hope3.) Sensitivity to self and others4.) Helping-trusting, human care relationship5.) Expressing positive and negative feelings6.) Creative problem-solving caring process7.) Transpersonal teaching-learning8.) Supportive, protective, and/or corrective mental, physical, societal, and spiritual environment9.) Human needs assistance10.) Existential-phenomenological-spiritual forcesWatson (1995)
18Introducing Laughing Spirit Listening Circles True healing comes from a place deep within us (Strickland, 1996).This place is “the laughing spirit,’’ where “universal perspective and selfawareness” dwell (Glickstein, 1995).Laughing Spirit Listening Circles are group sessions with no leaders allowingmembers to tell their stories in a place that lets them safely and fully expressthemselves in true dialogue (Glickstein, 1995).This research was conducted to validate Glickstein’s Circles naturallyembodied Watson’s theory and these two approaches could be successfullycombined in a project with the elderly (Strickland, 1996).
19Study DetailsSix residents of a retirement community, women ages 83 – 95, were invitedto participate in this pilot project by the center’s activities director.All of them agreed without hesitation to the 5 – hour commitment. Therewere 4 sessions at 1.25 hours each for one week.These residents had lived in the nursing care center from 2 months – 10years, half of them were college educated, one was visually impaired, onewas hearing impaired, and the remainder suffered no major disabilities.Two thirty-seven year old, female volunteers, a nurse and a graduatesociology student, would act as facilitators for the Listening Circle basedon Watson’s Science of Human Caring (1994).Strickland (1996)
20Research Process1.)The volunteers provided initial guidelines for the participants that theirstories could consist of past events, fantasies, ideas, dreams, thoughts,feelings, or anything else they wished to share.2.) Each Laughing Spirit Listening Circle begins with a warm-up round, duringwhich each participant shares a one-minute story and then receives positivefeedback from the group. Then, each member of the Circle shares a longerstory approximately 3 minutes long and again receives positive feedback.3.) The feedback is to be related to one’s own experience of the storyteller andone’s own experience of self while listening.4.) The flow of the conversation should come naturally, without direction fromany one member of the circle.5.) The stories shared did not need to be connected in any way, they were toarise spontaneously from each participant.Strickland (1996)
21Research FindingsEvery member of the Circle told at least one story during each session, whichlasted 5 – 7 minutes.Most of the women appeared uncomfortable receiving positive feedback fromothers. The subject would be changed, attention diverted away from self and toanother woman in the group.When the women were asked about the observation they stated this “totalattention” was not something they were used to, and even though it felt good, theyweren’t sure what to do with the feedback.One of the participants, a retired librarian, called this positive feedback“reciprocal altruism”The participants described their experience in the sessions as a “peaceful, restful,quiet place to come and be listened to,” and “ very neighborly and civilized.”There was much laughter, comforting silence, eye contact, physical reachingout to one another by patting each other’s hand or leg.Strickland (1996)
22Implications for Nursing Practice Simple presence, listening, and witnessing another’s personal experiencecreates a healing-caring environmentThe caring-centered involvement produced a connectedness known as“spiritual transcendence”“Conscious intentionality” to be truly present and authenticThere was eye contact, comforting touch, and silence displayed throughthe sessions between all membersReciprocal altruismStrength and hopeRestful/PeacefulMaking a conscious effort “to be with” the patient and not just “do for”fosters transpersonal encounters
23Critique and Reflection Limitations of the StudyThis study was conducted one timeThis study was conducted only with female residentsThis study was conducted in a retirement communityThe female residents were familiar with one another, so they feltmore comfortable in sharing their personal storiesPossibilitiesThe elderly make it clear that personalized, sincere interactions mean the most to them. It is possible for nurses to provide personal care developing a stronger bond with the elderly simply by “presencing” ourselves during the interventions provided.
24Patient Perceptions of Care in a Multicultural Environment
25Caring in a Multicultural Setting Jean Watson’s caring theory addresses caring relationships among people and the deep experiences of life itselfIn the Kingdom of Saudi Arabia, little is known about the view of the patient in terms of feeling cared for in the clinical settingThe purpose of this study is to explore the patient’s perception of being cared for in the Kingdom of Saudi Arabia
26Research FindingsThe study was designed to explore if caring behaviors displayed by the nurse were considered important to the patient. Most of the nurses in this area came from cultural backgrounds that were different from their patients, making a caring relationship and communication difficult.A questionnaire survey was used to explore the discrepancies existing between the perceived importance of caring behaviors and how frequently these behaviors were experienced.A probability sample of 393 patients was drawn from three different hospitals in three regions in Saudi Arabia. Patients rated caring behaviors as important (97.2%) and these behaviors were frequently experienced (73.7%).
27Research FindingsOverall, the Saudi patients valued the caring behaviors based upon Jean Watson's theory despite the cultural difference between the nurse and patient.The frequency of caring behaviors attended to by the nurse in teaching/learning and helping/trust behavior subcategories were rated lower. This mostly occurred because of the culture differences and language barriers between patients and their nurses.The results indicated the carative factors in Jean Watson's theory were applicable to patients in Saudi Arabia and should be implemented by nurses to meet patient needs.
28CritiqueThe article is missing which caring behaviors the patients ranked as important. This information is important to know when providing care in a different culture. It is important to know the behaviors the patient ranked as important in order to incorporate them into nursing practice.The article is credible since the probability sample was a large number of patients from three different hospitals in various regions of the area. This is important because there are more nurses used in the study instead of just one hospital and one unit.
29Implications for Practice There are many cultures a patient may come from that may differ from the nurse providing care. It is important to be able to display caring behaviors to these patients even though language and culture may present barriers.One of Jean Watson’s carative factors is to be sensitive to self and others by nurturing individual beliefs and practices. The nurse can practice this by utilizing an interpreter to enhance communication between patient and nurse. The nurse can ask the patient using the interpreter, if there is any cultural or religious practice the healthcare team should be aware of regarding care.If the patient knows the nurse cares from the very beginning, this assists in developing a helping, trusting and caring relationship which is also a carative factor.
30ReflectionsIt is important to integrate theory and research into nursing practice, but theory requires evidence through research in order to be applicable in the clinical setting.In this article, patients evaluated how important Jean Watson’s caring behaviors were and according to the results, they were very important to the patient. This helps the nurse to provide better care to the patient, by understanding the patient values.
31Minimizing Preoperative Anxiety with Alternative Caring-Healing Therapies
32Recognizing that preoperative anxiety is a common and distressing problem for most surgical patients, incorporating skilled holistic nursing interventions can be humane acts of caring for the surgical patient” (Norred, 2000, p. 842).
33Minimizing Preoperative Anxiety Dr. Watson believes that through intentional, compassionate, caring, therapeutic use of self, the holistic perioperative nurse can assist the patient in healing.Examples of benefits of holistic caring-healing therapies are:1. Decreased Anxiety2. Less pre-op sedation3. Less post-op pain medication4. Reduced stress
34Research A controlled study of 60 patients undergoing plastic surgery Use of local anesthesia with sedationHypnosis , nurse’s calming words, and comforting techniques used to reduce patients discomfort and anxiety.ResultsPatients under hypnosis used less anti-anxiety medication and narcotics; they were less painful and anxious compared to the patients who received no therapy (Norred, 2000).
35How Watson’s Theory framed this research Watson states that there is “a new paradigm emerging in health care that blends the compassion and caring of nursing in harmony with the curative therapies of medicine” (Norred, 2000, p. 838).In a qualitative analysis of the preoperative concerns of surgical patients, the need for caring was second to the fear of dying (Norred, 2000).It is believed with the integration of alternative therapies in the OR, they can assist the surgical patient to balance their anxiety, stress, and pain (Norred, 2000).
36Implication for Nursing Practice Develop a therapeutic, trusting relationship with every patientUse more relaxation techniques with patientsSpend more time with patients to demonstrate Watson’s caring, holistic therapies
37Critique and Reflection LimitationsThis study did not observe a larger patient population.More research and case studies are needed in order toprove the decrease in pain and anxiety is directly relatedto Watson’s caring theory.PossibilitiesTo explore new ways to improve patient care and satisfaction.To improve the safety of our patients by using less medication before, during, and after surgery.
39The Attending Nurse Caring Model Integrates theory, evidence and advanced caring-healing therapeutics for transforming professional practice.Provides examples for advancing and transforming nursing practice within a reflective, theoretical and evidence-based context. (Watson & Foster 2003)
40BackgroundDue to the fast paced healthcare delivery system, “nurses are torn between the human caring model of nursing”. (Watson & Foster 2003, p. 360) For many nurses, this is what attracted them to the profession. (Watson & Foster 2003)Nurses who are not able to practice within this caring context are reported to be: hardened, oblivious, robot-like, frightened and worn down. (Swanson, 1999).Nursing will need to be reconnected with the foundations of nursing, requiring a renewal of the profession in order for a resolution to the conflict.
41Research A pilot project has been developed where nurses will: Volunteer to apply and participate in applying the Attending Nurse Caring Model as described previously.Be introduced to a series of educational sessions of caring theory. This includes the ten Carative Factors (Watson, 1979) to understand the structure of the caring process.Initiate the search for evidence by defining clinical problems regarding pain management. (Watson & Foster 2003)
42This pilot project is:Underway at The Children’s Hospital in Denver, Colorado.Being held on one post-surgical unit consisting of thirty-seven beds.Constructed and will be applied as a Nursing-Caring Science, theory-guided, evidence-based, collaborative practice model. (Watson & Foster 2003)
43Findings:Nurses participating in the project are learning the Attending Nurse Caring Model:Can increase their caring consciousness.Intentionally use knowledge and evidenceHelp increase autonomyEnhance interdisciplinary teamworkReduce suffering in children (Watson & Foster 2003)
44Implications The Attending Nurse Caring Model evaluates: Contemporary nursing caring valuesRelationshipsTherapeuticsResponsibilities to a higher/deeper order of caring science and professionalism (Watson & Foster 2003)
45Application to Practice Nurses are using caring-healing modalities and nursing therapeutics for:Comfort measuresPain controlCreating a sense of well-beingRelaxationThese modalities are used to work in correlation with physician’s orders for analgesics. (Watson & Foster 2003)
46Critical Reflection The Attending Nurse Caring Model Offers: New options to address disagreements between nursing theory and practice; between nursing caring philosophy, between knowledge, values and system constraints.Hope for both nurses and systems in place to make transformations, while continuing to work within contemporary crises, current systems, today’s society, and current healthcare. (Watson & Foster 2003)
47ReferencesAlligood, M.A., & Tomey, A. M. (2010). Nursing theorists and their work. (7th ed.). Maryland Heights, MO.: Mosby Elsevier. Glickstein, L. (1995). Unpublished raw data. Berkeley, CA: Center for Transformational Speaking. Medscape Nurses. (2005, September 30). Caring science and the caritas field: Lighting our path. Retrieved from Norred, C. L. (2000). Minimizing preoperative anxiety with alternative caring-healing therapies. AORN Journal, 72(5), Persky, G. J., Nelson, J. W., & Watson, J. (2008). Creating a profile of a nurse effective in caring. Nursing Administration Quarterly, 32(1), doi: /01
48ReferencesStrickland, D. (1996). Applying Watson’s theory for caring among elders. Journal of Gerontological Nursing 22(7), Suliman, W.A., Welmann, E., Omer, T., & Thomas, L. (2009). Applying Watson’s nursing theory to assess patient perceptions of being cared for in a multicultural environment. The journal of nursing research: JNR., 17(4), Swanson, K. (1999). What is known about caring in nursing science. In Handbook of Clinical Research (Hinshaw A.S., Feetham S.L., & Shaver J.L.F., eds). Sage, Thousand Oak, CA, USA,
49ReferencesWatson, J. (1985). Nursing: Human science and human care. A theory of nursing. Norwalk, CT: Appleton-Century-Crofts. Watson, J. (1994). Applying the art and science of human caring. New York, NY: National League for Nursing.