Evaluation of the nursing model: Watson’s Human Caring Theory How this theory influences nurses and their practice Annie Cordova Christian Merz Amber Dysktra Tina Cook

Quote “Maybe this one moment, with this one person, is the very reason we’re here on earth at this time.” From “the Caring Moment” by Jean Watson

Nursing theory Nurses deal with increased acuity and complex cases in today’s health care situations. As a result of high stress and common understaffing situations, nurses must find ways to preserve caring in their practice. Jean Watsons theory provides indispensable tools to protect the caring aspect of nursing practice.

About Jean Watson graduated from the Lewis Gale School of nursing in Roanoke, Virginia in 1961 earned her baccalaureate degree from the University of Colorado in 1964 earned her master’s degree in psychiatric mental health nursing in 1966 and continued her education by earning a doctorate degree in educational psychology and counseling in 1973

Motivation Felt nursing education was focused on “curing” rather that caring Developed the word “carative” to rival the medical aspect of curative Watson believes “human caring is an experience which is invisible and often neglected within conventional models and practices of medical science.” the phenomenon and practice of human caring and healing, are the essence of nursing practice and foundational to sustaining life itself.

Values Jean Watson believes in caring for patients through a holistic approach. Treat the patient not the diagnosis Nurses should heal not only the body but also the mind and the spirit

Watson’s Inspirations Western and Eastern Medical Viewpoints Other Nursing Theorists: Nightingale’s Environment Theory Henderson’s Need Theory Leininger’s Transcultural Nursing theory Peplau’s The Theory of Interpersonal Relations Roger’s Science of Unitary Human Beings Theory Newman's Health as Expanding Consciousness Theory

The Theory of Human Caring Transpersonal human caring is scientific, professional, ethical, creative and personalized caring behaviors between nurse and patient. Carative factors are used as a model to understand nursing as the science of caring. These factors are aimed to help a person maintain health or to die a peaceful death.

Watson’s 10 CARATIVE FACTORS The formation of Humanistic-altruistic system of values The installation of faith-hope The cultivation of sensitivity to one’s self and to others The development of a helping-trust relationship The promotion and acceptance of the expression of positive and negative feelings. The systematic use of the scientific problem-solving method for decision making The promotion of interpersonal teaching-learning The provision for a supportive, protective and corrective mental, physical, socio-cultural and spiritual environment. Assistance with the gratification of human needs. The allowance for existential-phenomenological forces.

Strengths of the Theory focus is on the patient rather than technology or condition focused allows for the nurse to practice the art of caring and also has concerns for the caregiver Watson’s theory easy to understand and to place into practice

Weaknesses of the Theory too heavy on the psychosocial and lacking on the pathophysiological aspects of nursing falls short of giving direction on achieving caring-healing relationships With the increasing work load demands of nurses today, it possibly could take too much time to incorporate into practice

global concepts: Human being Human being refers to “….. 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”. Currentnursing (2012). Nursing Theories. Jean Watson's philosophy of nursing. Retrieved July1, 2013 from: http://currentnursing.com/nursing_theory/Watson.html

Ask the patient To: Tell me about yourself? Tell me about your life experiences? Tell me about your bodily sensations? Tell me about your spiritual and cultural beliefs? Tell me about your goals and expectations?

Global concept: Health     Watson adds the following three elements to WHO definition of health: 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 it’s absence) (currentnursing, 2012).

Ask the patient To: Tell me about your health? What is it like to be in your situation? Tell me how you perceive yourself in this situation? What meaning are you giving to this situation? Tell me about your health priorities? Tell me about the harmony you wish to reach?

Global concept: Environment/society According to Watson, caring (and nursing) has existed in every society. A caring attitude is not transmitted from generation to generation (currentnursing, 2012). It is transmitted by the culture of  the profession as a unique way of coping with its environment(currentnursing, 2012).

Global concept: Nursing “Nursing is concerned with promoting health, preventing illness, caring for the sick and restoring health” (currentnursing, 2012). It focuses on health promotion and treatment of disease. She believes that holistic health care is central to the practice of caring in nursing (currentnursing, 2012). 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” (currentnursing, 2012). .

Ask Yourself: What is the meaning of caring for the persons and their families? For myself? How do I express my caring consciousness and commitment to the persons and their families? To working colleagues? To other health care professionals? To my superiors? To the institution? How do I define the person, environment, health/healing, and nursing? How do I make a difference in people’s life and suffering? How can I be informed by the clinical caritas processes in my practice? How can I be inspired by Watson’s caring theory in my practice?

According to Watson, The nurse’s role is to: Treat the patients body, mind, and spirit Establish a caring relationship with patients Display unconditional acceptance Treat patients with a positive regard Promote health through knowledge and intervention Spend uninterrupted time with patients:”caring Moments

Caring moments included: The nurse and patient make contact. “the nurse enters the patient’s room,” a feeling of expectation is created. Watson also believes these moments transform both the patient and nurse and that they are linked together.

Example of nursing practice situations Jean Watsons theory can be used in labor and delivery. The nurse has a huge impact on providing nursing care to a mother and child during the labor and postpartum process by allowing the mother to express her needs regarding to topics that include physical, social, or mental troubles.

Example of nursing practice situations Watsons theory can be used in a hospital setting or in a home setting that includes hospices care. During the healing or dying processes the nurse provides care that creates an environment that is caring and supports the patient and family members needs.

Nurses use of theory Jean Watson’s theory focuses on human to human relationships that provide a holistic healing approach. This theory can be used in more than one area of nursing that includes ob, medical surgical floor, surgery, in home health care, and hospice care.

Integrating the theory of caring to practice Case Study: A 32 year old expecting mother presents to the Obstetrics department after she fell on the ice on the pavement. She presents to the department anxious, tearful with complaints of no fetal movement, and mild abdominal pain. Her history showed she is 37 weeks pregnant, Gravid 2, Para 0, and spontaneous abortion 1. The patients vitals signs are elevated with BP:175/89, HR:120, Respiration 28, Temp:97.8 . You place the mother on the monitor and you obtain a reactive fetal heart tones. You note the patient is contracting every 3-4 minutes and palpates moderate. You obtain the patient’s history, and do a sterile exam and find the patients dilated to 4 and 90% thinned. The patients husband arrives and now is at the bed side. You leave the room to notify the doctor your assessment.

How dose the nurse apply Jean Watson theory to his/her practice? 1. Apply Jean Watson’s theory, what question would help the nurse question the patient about her life situation? a. Tell me about your spiritual and cultural beliefs? b. Do you have any allergies? c. How often have you seen the doctor within the last week? 2. Based on Watson’s caring theory, what would be one a nursing intervention for the patient? a. Place the fetal monitor on the patient and tell her there will be some test taken soon. b. Establish a transpersonal caring relationship with the patient so she can express her feelings towards the situation. c. Tell the patient she will be fine, take her vitals, and leave the room.

Continued….. 3. As the nurse, what interventions would use to make the patient feel comfortable using Watson’s theory? a. Develop and sustain trusting caring relationship b. Creating healing environment on all levels.( mind, body,& sprit) c. Get the patient extra pillows, something to eat/drink, and provide ordered pain medication. d. A & B e. All of the above

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Article #1 All you need is love (and human caring): transforming health care one nurse, one hospital at a time "No one was giving voice to the human experience," says Dr. Watson. "I was longing for intellectual theories or values or a conceptual framework of what was happening with patient care and the human-to-human relationships." Rather than perform their jobs by rote, the human caring philosophy and theory, combined with an expanded model of caring science, gives nurses the space to reflect on the disciplinary-ethical foundation of their practices and experience themselves as healers. "That's their calling," Dr. Watson says. "This work is consistent with the visionary Nightingale model of nursing. You should see some of the e- mails from people who are thinking about leaving the profession. It gives purpose and meaning to their world on a deep level Petrovski, L. (2012). All you need is love (and human caring): transforming health care one nurse, one hospital at a time . Colorado Nurse , 112(2), Retrieved from http://0- go.galegroup.com.libcat.ferris.edu/ps/i.do?id=GALE%7CA293351743&v=2.1 &u=lom_ferrissu&it=r&p=AONE&sw=w ..\All_you_need_is_love__and_human caring.PDF

Articile #2 Developing a Practice Model for Watson’s Theory of Caring The online version of this article can be found at: http://nsq.sagepub.com/content/24/1/27 Watson’s theory focuses on holistic care and caregivers to patients relationships. This article describes Watson’s theory using a practice model. As described in the article Nurses and patients need to be connected in a relationship that enhances healing. Nurses perform tasks that become routine and can be performed without compassion. It is important for bedside nurse to understand caring theory in depth and use the tools in their daily practice to promote the patients healing process. Lukose, A. (2011). Developing a practice model for watson's theory of caring . Nursing Science Quarterly, 24(1), 27-30. doi: 10.1177/0894318410389073

Article #3 Love and caring ethics of face and hand- an invitation to return to the heart and soul of nursing and our deep humanity. This article reminds nurses that although we care for many patients, not one leaves our lives untouched. It is easy to forget that when we are busy with I and O’s and treatments. This article reminds us to put ourselves in our patients shoes. How would we want to be taken care of. As nurses we have to remember the times when we were spiritually broken and remind ourselves that is the place where our patients are. If we do not remind ourselves of this important value of nursing, we will be separating ourselves from the world spiritually. If that occurs we are not giving our patients 100% care. We need to come back to basics in nursing every so often. Watson, J. (2003). Love and caring ethics of face and hand- an invitation to return to the heart and soul of nursing and our deep humanity. Nursing Administration Quarterly, 2(3),197-200. ..\..\Desktop\Love and caring ethics of face and hand- an invitation to return to the heart and soul of nursing and our deep humanity..pdf

Article #4 Applying Watson’s nursing theory to assess patient perceptions of being cared for in a multicultural environment. Jean Watson’s theory of caring can be used in a variety of settings. The article provided demonstrates how caring can be a universal importance in nursing. The study took place in Saudi Arabia where many nurses from around the world travel to. Watson’s theory of caring for the mind, body and spirit is put to action in Saudi Arabia. The study first looked at the meaning of caring and caring behaviors. In an Emergency Room caring meant that nurses explained procedures where on cancer units, nurses were expected to show compassion and sit and talk with the patient. The patients described how they perceived nurses to behave. One patient stated that nurses should confirm to the patient that they are not overwhelming for the nurse. Since the study was in Saudi Arabia, one way of showing the patient a nurse cares is by using an interpreter. This shows the patient that the nurse cares and will earn the patients trust. Overall, the goal is for the nurse to create a safe and comfortable environment that will turn a patients experience of being sick to a positive experience of feeling helped. Suliman, A.W., Welmann, E., Omer, T., and Thomas, L. (2009). Applying Watson’s nursing theory to assess patient perceptions of being cared for in a multicultural environment. Journal of Nursing Research, 17(4), 293-300. ..\Applying Watson’s nursing theory to assess patient perceptions of being cared for in a multicultural environment..pdf

References Alligood, M.R., & Tomey, A.M. (2010). Nursing theorists and their work. Maryland Heights, MO: 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. doi: 10.1097/01.NAQ.0000314541.29241.14 Current Nursing (2012). Nursing Theories. Jean Watson's philosophy of nursing. Retrieved July1, 2013 from: http://currentnursing.com/nursing_theory/Watson.html Fawcett,J., (N.D.). Overview of nurse theorist. DeSales University. Retrieved June 30, 2013 from: http://www4.desales.edu/~sey0/watson.html Lukose, A. (2011). Developing a practice model for Watson's theory of caring . Nursing Science Quarterly, 24(1), 27-30. doi: 10.1177/0894318410389073 Nursing Theory (2013). Biographies of nursing theorists. Nursing Theorist. Retrieved July 1, 2013 from: http://nursing-theory.org/nursing-theorists/ Watson Caring Science Institute. (2009) Retrieved from http://www.watsoncaringscience.org