JEAN WATSON'S

TRANSPERSONAL CARE THEORY

The Theorist

Margaret Jean Watson

She was born in a small, close-knit town in the Appalachian Mountains of West Virginia
in the 1940’s. Jean Watson has claimed that her caring theory was developed while she
was having a personal experience (Husband’s Death) in her life. She molded her
professional and personal life in order to develop her theory.

Education

• Graduated High School in West Virginia

• Graduated the Lewis Gale School of Nursing in 1961.
• Baccalaureate degree in Nursing from University of Colorado, Boulder Campus in 1964.
• Master’s Degree in Psychiatric-Mental Health Nursing from University of Colorado,
Health Sciences Campus in 1966.
• Doctorate in Educational Psychology and Counseling from the University of Colorado,
Graduate School in 1973.

Employment

• Dr. Jean Watson is Distinguished Professor of Nursing and holds an endowed Chair in
Caring Science at the University of Colorado Health Sciences Center.

• She is founder of the original Center for Human Caring in Colorado and is a Fellow of
the American Academy of Nursing. She previously served as Dean of Nursing at the
University Health Sciences Center and is a Past President of the National League for
Nursing

• She is a widely published author and recipient of several awards and honors, including an
international Kellogg Fellowship in Australia, a Fulbright Research Award in Sweden
and six (6) Honorary Doctoral Degrees, including 3 International Honorary Doctorates
(Sweden, United Kingdom, Quebec, Canada).
 • Published Writer
o Nursing: The Philosophy and Science of Caring (1979, 1985)
o Nursing: Human Science and Human Care – A Nursing Theory (1985, 1988,
1999)
o Postmodern Nursing and Beyond (1999)

Achievements

• Recipient of several awards and honors including: an international Kellogg Fellowship in

Australia, a Fulbright Research Award in Sweden and six Honorary Doctoral Degrees,
including 3 International Honorary Doctorates (Sweden, United Kingdom, and Quebec).

• She was the 1993 recipient of the National League for Nursing Martha E. Rogers Award,
which recognizes a nurse scholar who has made significant contributions to nursing
knowledge that advances the science of caring in nursing and health sciences.

• New York University recognized her as a Distinguished Nurse Scholar.

• In 1999, the Fetzer Institute honored her with the national Norman Cousins Award in
recognition of her commitment to developing; maintaining and exemplifying
relationship-centered care practices.

PHILOSOPHY AND SCIENCE OF CARING

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 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 one’s 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 begin 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”

Begins developmentally at an early age with values shared with the parents.

Mediated through ones own life experiences, the learning one gains and exposure
to the humanities.

Is perceived as necessary to the nurse’s 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";

It is essential to both the carative and the curative processes.

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";

Explores the need of the nurse to begin to feel an emotion as it presents itself.

Development of one’s own feeling is needed to interact genuinely and sensitively

with others.

Striving to become sensitive, makes the nurse more authentic, which encourages
self-growth and self-actualization, in both the nurse and those with whom the
nurse interacts.

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 helping-trusting, authentic caring
relationship";

Strongest tool is the mode of communication, which establishes rapport and

caring.

She has defined the characteristics needed to in the helping-trust relationship.

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 for in a caring relationship”.

According to her such expression improves one’s 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";

According to Watson, the scientific problem- solving method is the only method
that allows for control and prediction, and that permits self-correction.

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.

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";

The caring nurse must focus on the learning process as much as the teaching
process.

Understanding the person’s 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 and
consciousness, whereby wholeness, beauty, comfort, dignity, and peace are
potentiated";

Watson divides these into eternal and internal variables, which the nurse
manipulates in order to provide support and protection for the person’s mental and
physical well-being.

The external and internal environments are interdependent.

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-body-spirit, wholeness, and
unity of being in all aspects of care"; tending to both embodied spirit and
evolving spiritual emergence;

It is grounded in a hierarchy of need similar to that of the Maslow’s.

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.

Watson’s 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 spiritual-mysterious, and existential dimensions of one's
own life-death; soul care for self and the one-being-care-for.

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”.

Acceptance in the Nursing Community

 1. Practice

Watson is an eternal optimist, and she writes from a deep place about the personal as well as the
sacred. The philosophy invites to explore one’s curiosities about the origins of his/her call to
care. Her writing encourages explorations of questions such as:

What calls me to care?

What is the root of my caring response?
How will I respond?
Why do I fail to respond?
When is it hard to care?
How will I sustain and nurture my caring consciousness?
Who will care for me?

2. Education

Watson defines her intent to describe the core (Nurse-patient interaction resulting to therapeutic
communication) of nursing rather than the trim of nursing (the procedure, task and outcome).
With the focus, the framework is not limited to any nursing specialty. Although she emphasizes
that the trim are necessary, she believes that the trim cannot be the center of professional model
of nursing care.

3. Research

Patient outcomes in caring transactions are a potential are for studies. Research and practice shall
focus both on subjective and objective patient outcomes to determine whether or not caring is
indeed the truest essence of nursing.

Strengths

1. Besides assisting in providing the quality of care that client ought to receive, it also
provides the soul satisfying care for which many nurses enter the profession.
2. As the science of caring ranges from the biophysical through the intrapersonal, each
nurse becomes an active coparticipant in the client’s struggle towards self-actualization.
3. The client is placed in the context of the family, the community and the culture.
4. It places the client as the focus of practice rather than the technology.

Limitations
1. Given the acuity of illness that leads to hospitalization, the short length stay, and the
increasing complex technology, such quality of care may be deemed impossible to give in
the hospital.
2. While Watson acknowledges the need for biophysical base to nursing, this area receives
little attention in her writings.
3. The ten caratiive factors primarily delineate the psychosocial needs of the person.
4. While the carative factors have a sound foundation based on other disciplines, they need
further research in nursing to demonstrate their application to practice.

CASE STUDY
Rico Sandoval, a 39-year old truck driver is admitted to the hospital
following an accident which caused the front of his truck to catch
fire. He suffered from burns and was rushed to the ER, diagnosed
with deep split- thickness and full thickness burns of the anterior
chest, arms and hands. His vital signs are as follows: T: 96.2ºF;
PR=140/min; BP=98/60. A rapid infusion of lactated ringers was
started and he was also receiving 40% humidified oxygen via facial
mask. Lung sounds indicate inspiratory and expiratory wheezing
and a persistent cough reveals sooty sputum production. A foley
catheter is inserted and initially drains a moderate amount of dark
concentrated urine. He is alert and oriented but complains of severe
pain 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

 Watson’s 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 patient’s 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?

• Watson’s 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/t tissue injury.

3. How the client needs are labeled?

• Watson indicates that needs are interrelated. The science of caring suggests that the nurse
recognize and assist with each of the interrelated needs in order to reach the highest order
need of self-actualization.

Watson’s 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=29fdVOqraQs