Concept Analysis on Jean Watson’s Theory of Human Caring

Introduction

Nursing theory is nothing new it had developed over time. There are many theories devoted to different areas of nursing. Walker and Avant developed the method of concept analysis. The method was focused on strategies that were for theory development in nursing. It consists of analysis, synthesis and derivation into three categories of concepts, statements, and theorie. Concepts within nursing are vital in the identity and defining the scope of discipline. They are used as the core of nursing knowledge. They are how nursing views certain topics within practice. Caring is one of the most useful elements within nursing.

Definition/Explanation of Nursing Concept

The theory of human caring was developed by Jean Watson. The theory states that caring is the essence of nursing. Nurses have the professional obligation to provide the best environment for healing to take place. Caring concepts are the foundation of theoretical development. They represent meaning, experience and ideas related to the human caring experience. Over the years there were several concepts that felt caring was a vital part of nusing knowledge. It wasn’t until around the 1970’s that Jean Watson published her Theory of Human Caring. Watson put a unique perspective on caring. Her theory blended beliefs and ideas from all cultures mostly Eastern and Western to create a spiritual philosophy that can be used throughout nursing practice. At that time she developed the 10 carative factors that have evolved into present day as 10 Carita Processes. When nurses actively engage in using the carita’s they show compassion for their patients. The 10 Caritas Processes surround how nurses should present themselves to patients in a way that allows for a proper caring environment. In order to instill these carita’s one must respect the patient and treat them with loving and kindness, listening to the patient one see’s the patient as a human being and not an object. Being responsive to the patients need and feelings shows patients that the nurse’s practice comes from the heart. Another part of the theory is developing a helping-trusting caring relationship with patients, families and the health care team. When this happens the patient and family will feel like they are able to talk to you without being judged. Having a trusting relationship with the health care team is important this makes the team operate smoothly. These are just a few of the processes Watson’s spoke of, she fought to have caring implemented into nursing education. She found it to be one of the most important aspects of being a nurse. Nurses have to look at themselves and see where they stand in order to provide a caring relationship and environment for their patients. Watson advises nurse’s to accept things the way they are whether pleasant or unpleasant (Norman, Rossillo, & Skelton, 2016). Still support the patient and family regardless of all the negativity happening. The more caring that is shown hopefully the nurse will be creating a healing environment in a slow and steady pace.

Literature Review

There are many articles on Watson’s theory of human caring showing how it applies to different areas of nursing. Lisa Adams show how caring has changed over time with the addition of technology. Adams suggest that as nurses’ workloads have increased that the work environment has lost the caring aspect (Adams, 2016). Adams also explains how the nurse practitioner’s role is emerging to incorporate caring into their everyday practice (Adams, 2016). Ozan and Okumus utilize Watson’s theory of caring in their field of infertility. They showed that implementing Watson’s 10 carative factors it provided support to the patients who have had failed IVF treatments. They conducted a study in which results of the treatments were expressed via face to face, and telephone. The results were positive.

Sitzman’s article on Interbeing and Mindfulness compared to Theory of Human Caring is very interesting. Sitzman explains the similarities in both mindfulness and caring. One example of this is that the theory of human caring is forming and acting from humanistic and altruistic values, where as concepts of mindfulness and interbeing are actions come from values associated with nonharming, peace, compassion, and loving-kindness (Sitzman, 2002). It is evident in this article that mindfulness techniques could encourage understanding and implementation of Watson’s theory. Vivian Norman’s article on Creating healing environments is trying to explain how to create a healing environment using the Theory of Human Caring. She implemented Watson’s theory using educational modalities such as in services, programs and videos. They also had caritas coaches come in to talk to nursing leaders in order to get a better understanding of Watson’s theory. The hospital went as far as developing a electronic health record document for staff to use to document what carita process was used and the caring interventions performed. They have found with the education and coaching the healing environment has been reached with success.

In this article Ackerman was looking for appropriate way in which to measure caring among staff in a healthcare environment. She created several tools one was the Caring Factor Survey-Care Provider Version in which it was a 20-item tool that measures caring using the 10 caritas process. It was eventually modified to 10 items and given to employees who interact with patients. The results were positive, and the tool is used to validate the impact of human caring for nursing staff and patients (Ackerman, 2019).

Defining Attributes

Caring attributes that are often encountered in nursing include honesty, connecting with patients, and being resilient to possible uncertainties in each patient's state of health. A caring nurse is the has knowledge along with interest, vulnerability, and wanting to reach out to comfort patients. Caring also includes being an attentive listener, comforting the patient at their most vulnerable times, being honest with them, showing patience, being responsible, providing up to date accurate information so the patient can make a well-balanced informed decision, being respectful, and calling the patient by name in which they prefer (Dalpezzo, 2009). There are four characteristics of caring most often described in the literature one is a human trait; second is a moral importance; third is an interpersonal interaction; and lastly is a therapeutic intervention. In the same article, nurses saw caring as consideration and sympathy, giving of one’s self, a work style, motivation, communication and meeting needs, knowledge and learning, honesty, and sincerity.

Antecedents and Consequences

An antecedent which is an identifiable occurrence that precedes an event. There is moral need and cognitive motivation that makes us want to help others. Caring needs to be thoroughly taught in nursing programs. In order for nurse to care they need to learn what it means to care, and what we think is caring is it really caring or what we are taught. Caring as said before is a moral need and cognitive motivation it is something you need to learn in order to provide proper patient care and practice as a caring nurse. I believe that people who are attracted to the nursing profession it is because they have a compassion nature about them, and they want to help others. Can caring be taught? Maybe it can be taught, but I believe that if we get away from what we know and focus on how to care which is learning to communicate effectively, learning the how to touch caringly amongst other things I think it can be taught to some extent. Caring is one of the most complex but necessary process in nursing.

The consequences are those events or incidents that occur as a result of the occurrence of the concept. Consequences are not necessarily bad. In connection with the definition the consequences of caring in nursing are; healing, satisfaction, and growth (Dalpezzo, 2009). I do believe caring can have positive consequences on the patient and the nurse. I believe the better the caring the better the patient outcomes, better patient satisfaction and the better the nurse will feel about the care given. Everyone wants to feel cared for even nurses.

Empirical Referents

The final step in a concept analysis is determining the empirical referents for the concept. Empirical referents are measurable way to demonstrate the occurrence of the concept. I think caring can be measured in the terms of patient outcomes. In order to measure caring the patient satisfaction surveys are a good start as well as employee surveys. These two are examples of ways that caring can be reflected. Another way is having satisfaction cards on the unit letting patients or families fill them out at their own will. This is good for staff also to show others how other staff work together to show caring among coworkers.

Model Case

During the process of concept analysis, model cases of the chosen concept needs to be demonstrated. A model example is the use of the concept that demonstrates all the defining attributes of the concept (Dalpezzo, 2009). I have 15 years experiences as a nurse. I have seen a lot of caring and try to conduct my profession as a caring and compassionate nurse. Though these cases I hope to demonstrate caring good, bad and ugly.

I watched today as one of my coworkers struggled with what to do with her patient. She felt as if no one was listening to her. The doctors all said the same thing it is part of the stroke he will come out of it. Yet his respirations were 30-40 he had been admitted over 30 days, yet it is part of the stroke. I talked to her she had tears in her eyes I told her to talk to the doctors again. She was frustrated, the patient’s family fighting amongst themselves was not a very good atmosphere for anyone patient, family or nurse. I admire her she stood by her belief that this patient needed to be more comfortable finally after 8 hours palliative was brought in morphine and Ativan was ordered sadly it didn’t work to ease his breathing. Finally, as a last resort Fentanyl was ordered. The patient once it was given relaxed his work of breathing slowed. He was made a DNR yesterday the patient took his last breath as the doctor, nurse and family were at the bedside. What makes this story so remarkable of a model case is the caring and advocacy this nurse showed during this time.

Borderline Case

I worked in a very busy ER. They were so busy that you did not have time to care for patients. Yes, we passed meds, did the assessments, but to listen to them was difficult. I saw my preceptor get very ugly with a patient over pain medicine it was not necessary. I think this case was more over worked and taking frustration out on what was near and sadly it was a patient.

Contrary Case

I walked into work one morning one of my patients had a rapid happening. I immediately intervened to help. The off going nurse left never gave me report and left the patient there struggling to stop bleeding from an NG tube. She never showed back up. I had to give report to ICU on a patient that I hadn’t gotten report on. This shows no caring for coworkers or patient.

Theoretical Applications of the Concept

As discussed in the beginning of this paper Watson’s theory is applied through the carative factors or caritas processes. There are ten carative factors and these are the following: The Theory of Human Caring is demonstrated as the practice of loving-kindness, equanimity, authenticity, enabling, cultivating a spiritual practice; developing a relationship that is helping-trusting; enabling the expression of both positive and negative feelings; having a caring-healing practice; a willingness to learn for the caring experience; being able to engage in a teaching-learning experience that is genuine; enabling and creating environments that are healing; caring for basic needs, both spiritual and physical; and, being open to spirituality (Wagner, 2010). In practicing as a nurse practitioner, they practice using their own emotions in the caring relationship, they use their own spiritual and emotional experiences all the while looking out for the physical health and wellbeing of their patients.

Conclusion

In conclusion Watson’s Theory of Human Caring encourages an emotional and open approach to care for patients. Nurse Practitioners need to be engaged emotionally and spiritually with their patients and their patient’s families. Caring is vital to nursing in every aspect. When one person shows caring it provides a more positive experience for everyone involved. Research has shown that when patients are truly cared for, both the patient and the nurse benefit. The concept analysis has shown me that when I self-reflected on my time as a nurse there are more caring moments than non-caring moments. I experienced more this weekend at work than I had ever thought possible. It proved to me that when you show how you care about your coworkers and patients that everyone leaves in a better mood.

References

1. Ackerman, L. (2019). Caring science education: measuring nurses' caring behaviors. International Journal of Caring Sciences.
2. Adams, L. (2016). The conundrum of caring in nursing. International Journal of Caring Sciences.
3. Brush, B., Kirk, K., Gultekin, & Baiardi, J. (2011). Overcoming: a concept analysis. Nurs Forum.
4. Butts, J., & Rich, K. (2018). Philosophies and Theories for Advanced Nursing Practice. Jones & Bartlett Learning.
5. Dalpezzo, N. (2009). Nursing care: A concept analysis. Nurse Forum.
6. Norman, V., Rossillo, K., & Skelton, K. (2016). Creating healing environments through the theory of caring. AORN Journal.
7. Ozan, Y., Okumus, H., & Lash, A. (2015). Implementation of watson's theory of human caring: a case study. International Journal of Caring Sciences.
8. Sitzman, K. (2002). Interbeing and mindfulness a bridge to understanding jean watsons theory of caring. Nursing Education Perspectives.
9. Wagner, A. (2010). Watson Caring Science Institute. Retrieved from Core Concepts of Jean Watson's Theory of Human Caring/Caring Science: https://www.watsoncaringscience.org/files/PDF/watsons-theory-of-human-caring-core-concepts-and-evolution-to-caritas-processes-handout.pdf