Philosophy and Science

The foundation of Jean Watson’s 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 SEVEN ASSUMPTIONS

Watson proposes seven assumptions about the science of caring. The basic

assumptions are:

Caring can be effectively demonstrated and practiced only interpersonally.

Caring consists of carative factors that result in the satisfaction of certain human needs.

Effective caring promotes health and individual or family growth.

Caring responses accept person not only as he or she is now but as what he or she may become.

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.

Caring is more “healthogenic” than is curing. A science of caring is complementary to the science of curing.

The practice of caring is central to nursing.

CARING SCIENCE DEFINED

Caring science encompasses a humanitarian, human science orientation to human caring processes, phenomena and experiences. Caring science includes arts and humanities as well as science. A caring science perspective is grounded in a relational ontology of being-in-relation, and a world view of unity and connectedness of All. Transpersonal Caring acknowledges unity of life and connections that move in concentric circles of caring - from individual, to others, to community, to world, to Planet Earth, to the universe.

Caring science investigations embrace inquiries that are reflective, subjective and interpretative as well as objective-empirical and Caring science inquiry includes ontological, philosophical, ethical, historical inquiry and studies. In addition, caring science includes multiple epistemological approaches to inquiry including clinical and empirical, but is open to moving into new areas of inquiry that explore other ways of knowing, for example, aesthetic, poetic, narrative, personal, intuitive, kinesthetic, evolving consciousness, intentionality, metaphysical - spiritual, as well as moral-ethical knowing.

Caring science is an evolving new field that is grounded in the discipline of nursing and evolving nursing science, but more recently includes other fields and disciplines in the Academy, for example, Women/Feminist studies, Education, Ecology, Peace Studies, Philosophy/ Ethics, Arts and Humanities, Mindbodyspirit Medicine. As such, caring science is rapidly becoming an Interdisciplinary or Transdisciplinary field of study. It has relevance to all the health, education, and human service fields and professions.

THE IMPLICATIONS OF THE CARING THEORY

The caring model or theory can also be considered a philosophical and moral/ethical foundation for professional nursing and part of the central focus for nursing at the disciplinary level. A model of caring includes a call for both art and science; it offers a framework that embraces and intersects with art, science, humanities, spirituality, and new dimensions of mind/body/spirit medicine and nursing evolving openly as central to human phenomena of nursing practice. I emphasize that it is possible to read, study, learn about, even teach and research the caring theory; however, to truly "get it," one has to personally experience it; thus the model is both an invitation and an opportunity to interact with the ideas, experiment with and grow within the philosophy, and living it out in one’s personal/professional life.

The ideas as originally developed, as well as in the current evolving phase (see Watson, 1999), provide others a chance to assess, critique and see where, how, or if, one may locate self within the framework or the emerging ideas in relation to their own "theories and philosophies of professional nursing and/or caring practice."

If one chooses to use the caring perspective as theory, model, philosophy, ethic or ethos for transforming self and practice, or self and system, the following questions may help (Watson, 1996, p. 161): Is there congruence between (a) the values and major concepts and beliefs in the model and the given nurse, group, system, organization, curriculum, population needs, clinical administrative setting, or other entity that is considering interacting with the caring model to transform and/or improve practice? What is one’s view of human? And what it means to be human, caring, healing, becoming, growing, transforming, etc. For example: In words of Teilhard de Chardin: "Are we humans having a spiritual experience, or are we spiritual beings having a human experience?" Such thinking in regard to this philosophical question can guide one’s worldview and help to clarify where one may locate self within the caring framework. Are those interacting and engaging in the model interested in their own personal evolution? Are they committed to seeking authentic connections and caring-healing relationships with self and others? Are those involved "conscious" of their caring-caritas or non-caring consciousness and intentionally in a given moment and at an individual and system level? Are they interested and committed to expanding their caring consciousness and actions to self, other, environment, nature and wider universe? Are those working within the model interested in shifting their focus from a modern medical science-technocure orientation to a true caring-healing-loving model?

This work, in both its original and evolving forms, seeks to develop caring as an ontological and theoretical-philosophical-ethical framework for the profession and discipline of nursing and clarify its mature relationship and distinct intersection with other health sciences. Nursing caring theory based activities as guides to practice, education and research have developed throughout the USA and other parts of the world. Watson’s work is consistently one of the nursing caring theories used as a guide. Nurses’ reflective-critical practice models are increasingly adhering to caring ethic and ethos.

Because the nature of the use of the caring theory is fluid, dynamic, and undergoing constant change in various settings around the world and locally I am not able to offer updated summaries of activities. Earlier publications seek to provide examples of how the work is used, or has been used in specific settings.

THE TEN CARATIVE FACTORS:  A CLOSER LOOK

To have a clear understanding of Watson’s theory, let us take into consideration the ten carative factors. Carative factors are the nursing interventions that are centered to the concept of caring.

1. Formation of a humanistic-altruistic system of values.

Our experiences greatly affect how we act, think, and feel. It is through these experiences that altruistic or humanistic deeds are either learned or disregarded. It is important that a nurse examine his/her own experiences to achieve a certain level of maturation and realize the potential of forming humanistic and altruistic behavior.  

2. Faith-Hope.

This factor demonstrates the spiritual aspect of caring. Although nursing care is deliberately involved in the physical and psychological care of the human being, this factor permits the basis for interventions that promote spiritual care.

3. Cultivation of sensitivity to self and others.

The cliché of ‘know thyself’ is never outdated. Nurses who are aware of their beliefs, values, and feelings are capable, subsequently, of gaining sensitivity towards the feelings of others. Once nurses achieve this level, exploration of how a patient feels and the communication process becomes beneficial to both the patient and the nurse. Verbalization for the patient becomes easy as he/she feels the nurse’s considerate response.

4. Establishing a Helping-Trust Relationship

Verbal and non-verbal communication is essential in performing nursing care. A simple greeting or acknowledgement before entering a patients room is as powerful as providing curative interventions. Establishing rapport by way of, congruence, empathy, warmth, and honesty is performed early in the nurse-patient relationship to establish trust.

5. Expression of Feelings both Positive and Negative

This factor might translate similar to Cultivation of Sensitivity to Self and Other s; however, it is vital to note that Watson did not limit knowing only of the positive beliefs, values, and feelings but the negative one’s as well. Awareness of both positive and negative feelings gives nurses a balanced self-awareness.

6. Research and Systematic Problem Solving

When we provide patient care, decision-making and critical thinking simultaneously takes effect. Nursing care must always be guided by research and evidence-based findings so as to give the patient or client the optimum amount of care there is.

7. Promotion of Interpersonal Teaching-Learning

To care is to empower – and empowerment of a patient involves teaching and making him/her aware of his potential to gain better control of their health situation. An informed consent will never be deemed valid if a patient does not fully understand what comprises the procedure and what alternatives can be done. Interpersonal teaching also involves assessment of the patient’s level of understanding of a certain situation and, in the end, evaluate effectiveness of the teaching-learning process.

8. Provision of a Supportive, Protective, and/or Corrective Mental, Physical, Sociocultural and Spiritual Environment.

This factor relates to the concepts of man being in constant interaction with the environment. Promotion of health, patient safety, and privacy are crucial in the delivery of care. The two divisions of this carative factor are named external and internal variables. External variables involves physical, safety, and environmental elements while the internal variables consists of mental spiritual of cultural elements. Watson also mentioned that having a clean and esthetic environment enhances a person’s feeling of self actualization.

9. Assistance with the Gratification of Human Needs

Man is viewed holistically; thus, needs of a human being must be met holistically as well. Below are the hierarchy human needs as formulated by Watson:

1. Survival needs  

(Biophysical Needs)

a. Need for food/fluid nourishment 

b. Need for elimination 

c. Need for ventilation

2. Functional needs  

(Lower Order Needs – Psychophysical needs)

a. Need for activity-inactivity 

b. Need for sexuality

3. Integrative needs  

(Higher Order Needs – Psychophysical Needs)

a. Need for achievement 

b. Need for affiliation

4. Growth Seeking Needs  

(Higher Order Needs – Intrapersonal-Interpersonal Needs)

a. Need for self-actualization

Watson also defined holistic care based on various studies on emotional distress and illness.

Her definitions of holistic care includes the following concepts:


Etiological components have many factors and these interact to produce chance through complex neurophysiological functions and neurochemical pathways
Each psychological function has a physiological correlate
Each physiological function has a psychological correlate.

10. Allowance for Existential Phenomenological Factors

Phenomenology, as described by Watson, is a way of understanding people’s perception. This factor emphasizes the a nurse’s skills and capability to understand a particular person’s perceptions on the meaning of life. Incorporating this when caring for a patient boosts restoration of well being.

References:

Anonuevo A. Cora,etal (2005). Theoretical Foundations of Nursing. Quezon City. UP Open University Office of Academic Support and Instructional Services

Wills M. Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing.Philadelphia.Lippincott Williams&Wilkins

www.watsoncaringscience.org