The Theory of Human Caring

Introduction

Nurses play a crucial role in the health care industry and their contribution to health-delivery systems throughout the world is substantial. Nurses must exercise professionalism in order for their contribution in the medical field to be optimal. This professionalism requires nurses to be well versed in clinical judgment and engage in activities that are founded in sound theoretical frameworks. One of the theories used by professional nurses is the Human Caring Theory which was developed by Jean Watson. Watson developed the Theory of Human caring in the 1980s based on her strong belief that caring is the essence of nursing. She hoped to maximize the human exchange occurring daily in nursing practice in order to provide optimal care for patients. Watson’s ideas were heavily influenced by the Eastern Philosophy and the theorist hoped to integrate these concepts of metaphysical, spiritual-existential, and phenomenological orientation into Western health care. Today, Watson’s theory is one of the most influential in the nursing field. This paper will provide an in-depth discussion on the theory of caring with a particular focus on the philosophy of the nursing theorist Jean Watson.

What is the context of development of the theory?

The primary role of the nursing profession is making use of technical skills to provide proper care to patients in order to enable them to recover and regain their well-being. The Human Caring theory proposed by Watson (2008) asserts that nurses must be “committed to a professional model that exceeds the impersonal, task-oriented, and transactional clinical routines” (p.34). The theory emphasizes on the practice of calmness and loving kindness towards the person who needs professional care. The patient under nursing care must feel the “authentic presence” which is a kind of empowering belief in others.

The Theory of Human Caring is entwined with the principle of the Humanistic-Altruistic System of Value, which involves showing loving kindness within the boundaries of caring. The other component is Faith-Hope which emphasizes on the importance of being authentically present and stimulating the belief in the patient that he/she is being cared for appropriately. The element of Sensitivity is also ingrained in the theory and it entails the promotion of a person’s spiritual practices (SJHLEX, 2012). The theory of caring also involves the Helping-Trusting Human Care relationship which involves cultivating and maintaining a true, trusting, and caring relationship with the patient.

The nurse and the patient are influenced by the choices and actions they make within the confines of their relationship. The Theory is highly entwined with the core values which give importance to reverence, integrity, compassion, and excellence. Watson clearly highlights the importance of treating each patient as unique human beings. She declares that “the Healing space and environment created by nurses expands the patient’s awareness and consciousness and promotes mind, body, and spirit healing” (SJHLEX, 2012, p.5). A nurse who applies this theory must therefore treat the patient’s room as a sacred space, soothing and healing sanctum which leads to a higher degree of health and well-being of the patient.

How is nursing conceptualized in the theory?

The theory of Human Caring serves as a fundamental element in the practice of nursing. It assists in increasing nursing effectiveness and therefore nurtures recovery. The application of this theory helps nursing professionals to achieve effectiveness and efficiency in the field. This achievement acts as the basis of a trusting and healing relationship with the patient, regardless of their health issues. The theory presents the following four major concepts:

  1. Human Being- This concept stresses that the nursing professional providing care must treat his/her patient as a valued person who deserves care, understanding, empathy, respect and the highest quality of care. The patients are not to be viewed collectively but rather as unique individuals.
  2. Health- the nursing professional must define health as a high level of overall physical, psychological, and social functioning by the patient. If one of these elements is missing, then there is an imbalance that points to bad shape or a health crisis. The role of the nurse as a restorer of health is greatly aided by this concept.
  3. Environment/Society- in this concept caring is believed to be present in all cultures or societies. The Current Nursing (2012) notes a caring attitude is transmitted in the nursing professional circle through a culture that lays emphasis on providing care.
  4. Nursing- in this concept, the nursing profession is based on health promotion and provision of medical aid to help in the recovery of the patient. The Theory of Human Caring focuses on the treatment of diseases and promotion of health derived from the strong application of holistic health care as the epicenter of nursing. Watson (1985) states that nursing is a form of giving medical care based on professionalism, science, principles of ethics and considerations for the unique needs of individual patients.

Nursing is conceptualized by this theory as the strategic application of art and science of caring integrated with the fusion of humanistic and selfless systems of values. This profession must be well-versed in the development of a helping-trust relationship with the patients and systematic use of the best practice methods to solve problems and make decisions (Watson, 1979). The theory advocates for a culture of interpersonal teaching and learning where the professionals should empower their patients by providing them with information that will help them to make informed decisions concerning their health. This also ensures that the patient’s autonomy is respected by the nurse.

The nursing profession also considers making allowances for existential-phenomenological forces on which the professional nurse must view each patient’s reality through the windows of their souls-the eyes. This implies that the nurse must have an extraordinary form of sensitivity to the needs and feelings of his/her patient. The nurse must possess emotional intelligence and the skills and knowledge to proactively apply them to restore health and give excellent an quality of human caring.

Who are the nursing authorities who speak about & use this theory?

The Human Caring theory is utilized by a wide range of professionals including: researchers, academicians, nurse associations from all over the globe, health experts, and nursing supervisors/managers. The theory enjoys wide application since it is practical, measurable, realistic, and highly applicable to the needs of the patients regardless of their health conditions. For these academic authorities and professionals, the Theory of Human Caring is seen as an indispensable instrument in making the nursing profession effective in giving excellent nursing care to the patients regardless of their health conditions. The theory also helps them maintain a professional identity in the dynamic context of nursing care (Duquette & Cara, 2000).

Watson’s theory promotes the values of caring by the nurse thereby assisting them to act in a professional manner and therefore get more gratification from their work. The theory offers the nursing authorities the means by which to practice the art of caring and deal with patients and their families in a compassionate manner. This not only promotes healing in the patient, but it also leads to an expansion of the nurse’s personal actualization (Cara, 2012, p.2). The nursing profession as envisioned by Watson’s Theory is a vocation wherein one must have an innate passion for taking care of individuals who require medical attention. The attributes of nursing emphasized on by the Theory of Human Caring make empathy one of the pillars of the nursing profession.

How can the overall significance of the theory be described?

Caring in the nursing profession presents a multifaceted approach designed to provide care for the patient. Crowden (1994) asserts that caring is a core element of the profession and can be defined as “the essence of nursing” (p. 1106). What this means is that the services provided to the patients by the nurses is deeply grounded in the principles of caring. Furthermore, caring is not just a series of actions, but rather it is a manner of acting. The concept of care as demonstrated in nursing includes actions such as: compassion, concern, commitment, respect, and healing (Crowden, 1994)

The concept of caring also involves explaining clinical procedures, assisting the patients with the activity of daily living, and instructing them about the importance of self-care. Care is the predominant concept which distinguishes nursing from other health disciplines since it is central to providing nursing services. Quizet (2012) asserts that while caring is a universal phenomenon, its expression and patterns differ from culture to culture. However, the nursing profession presents standards and concepts that synergize with the different cultures around the globe that practise modern healthcare system or western medicine. According to Watson (1999), nurses can expand their professional role and continually make contributions to health care “within the modern model by developing its foundational caring-healing and health strengths that have always been present on the margin” (45). The concept of caring presented by Watson, also presents scientific research process, and problem solving which provide a framework for decision making through assessment, planning, intervention, and evaluation. The theory is logical, simple and generalizable which means that it can be applied in other contexts in nursing.

Develop a nursing situation or use the suggested nursing situation. How is your nursing situation conceptualized in the theory?

The Gomes family

Jill, 32 year- old, biracial, grade schoolteacher, carries family’s health insurance, 30 weeks pg with twins

Jack, 35 year-old, Caucasian, Mechanical Engineer-the patient who is suffering a stroke

Jenna, 7 year-old

Jack, Jr., 5 year-old

Jimmy, 2 year-old

Elian, Jill’s mother, 61 year-old, widowed, lives 2 blocks away

Juan and Edita, Jack’s father and mother, live in a nearby community

They are Seventh Day Adventists

Mr. Jack Gomez is the subject of nursing care, who is suffering from an acute stroke and therefore needs intensive nursing care using Watson’s Theory of Human Caring. This means the application of ten primary curative factors as discussed above. The seven assumptions on which interpersonal caring is based are vital to maximize the chance of recovery, and the appropriate form of nursing care to the subject patient. It involves the application of the theory which is identical to helping nature and the physician cure the patient. Psychological support is also given to the patient and their physical needs are met. This helps them in their effort to attain and retain their health (Lea, Watson, & Dreary, 1998).

To effectively cater to the needs of the patient, the nurse needs to become a “transpersonal nurse who focuses on healing, caring, and wholeness as opposed to focusing on disease and pathology” (University of Colorado, 2012, p.1). Nursing caring competencies are connected to ontological development of the profession’s human competencies and ways of being and becoming a care giver for the sick or those who needs medical/nursing care, in order for them to recover.

How can you as a nurse utilize this theory in practice?

Applying the principles of the Theory of Human Caring of Watson is vital for the success of attaining recovery of the patient, Mr. Gomez. The theory of Human Caring theory is characterized by processes such as:

Assessment

The nurse would observe and identify the patient’s condition, prognosis, and background. In the case of Mr. Gomez who is suffering from acute stroke, the patient is unable to move his left side of the body. The objective assessment reveals that Mr. Gomes is impaired in turning his body from side to side and also lacks the ability to more from a supine to a sitting position. There are observable tremors on the left hand and arm. The patient was not unable to do basic motor skills (gross and fine motor skills), and twisted verbalization of words. The patient is impaired in doing self-help skills or self- hygiene. Improved assessment which involves identification of the patient’s needs and utilization and performing proper neurological assessment processes will be beneficial to the patient (Dugger, 2010). This process incorporates the utilization of conceptual knowledge for the formulation and conceptualization of a framework which involves providing information on how the patient and his loved ones can collaborate with each other to hasten the patient’s recovery. The Stroke Society Phil (2012) confirms that nurses provide “quality care based on the identified patient needs” (p.3).

It would involve the implementation of theory of Human Caring’s primary carative factors like:

  1. The formation of a humanistic-altruistic system of values
  2. The Installation of faith- hope
  3. Building of a helping-trust relationship which involves empathy, warmth, and congruence.
  4. Cultivation of a relationship with the patient by showing high sensitivity to his needs.
  5. Encouraging of the expression and embracing of both the negative and positive feelings by the patient and his family
  6. Assisting the patient to meet their needs though the utilization of Maslow’s hierarchy of needs where the physical needs of food and fluid are catered for first and then the patient’s higher level needs are met.
  7. The systematic use of the scientific problem-solving method for decision making” (Current Nursing, 2012, p.1). It involves a scientific process that allows control and prediction that permits self-correction, wherein objectivity and neutrality must be observed.
  8. Encouraging interpersonal teaching-learning where equal focus is given to the learning and teaching processes leading to a better understanding of the patient’s perception of his condition.
  9. Providing an environment that is: supportive, curative, protective, and therapeutic for the patient.
  10. Providing allowance for existential-phenomenological forces which involves controlling functions of management of the stroke victim by providing support and protection of his mental and physical well-being. The comfort and safety emanating from this will assist the patient to have the strength needed to face life or death (Current Nursing, 2012).

Plan

This phase involves determining how variables would be measured and articulating the curative care strategies and procedures to be used. In this case, current and acceptable neurological assessment tools and specific medications and care that would be applied. One must take note that “stroke is a complex disease that requires the efforts and skills of all members of the multidisciplinary team and the nurse is often responsible for the coordination of care throughout the continuum” (Summers, et al., 2009, p.2911).

Intervention

This would involve implementation of specific responsibilities of the nurse, giving of informed consent, patient safety, monitoring of neurological-vital signs, documentation of the patient’s progress, and planning of comfort measures like linen changes, patient’s hygiene, turning, proper position, and range of motion. It also involves the provision of a therapeutic environment like giving a patient proper ventilation, maintaining of cleanliness in the recovery room or intensive care unit room to prevent infections, proper lighting, and monitoring of the BP. In addition to this, monitoring of input and output, controlling of Inter-cranial Pressure, proper nutrition, and hydration will be undertaken. The patient will also be given spiritual and psycho-social care like alleviating anxiety or stress on the patient and his family. The nurse needs to respect their beliefs, cultures, and application of bio-ethics in the practice of nursing care. Ensuring compliance with the medication program given by the patient’s doctors and collaboration with the patient’s family and significant others in care plan. If the prognosis will be positive, the nurse must also provide discharge care plans in order to complete the process of healing.

Evaluation

This phase would involve analysis of the medical data and observations so as to highlight the impacts of intervention during the patient’s confinement period. It would also involve scientific and objective interpretation of the results so as to surmise the positive outcome and see if the results can be applied in other cases. The evaluation process and its findings will be incorporated on the doctor’s prognosis on the patient.

Conclusion

This paper set out to discuss Jean Watson’s Theory of Human caring and apply it to a case. It began by revealing the context within which the theory developed and proceeded to show that the theory is based on providing nursing services in an environment of love and care. An overview of how the theory can be conceptualized in nursing has been given and a list of the professionals who utilize this theory revealed. The paper has then applied the theory to a case study of a patient suffering from a stroke and it has been shown that the proper application of the Theory of Human Caring will enhance the chances of a quick recovery by the patient and also increase their level of satisfaction on the services provided. The nurse will also be able to protect and promote the interests and wellbeing of the patient by adhering to this theory.

References

Cara, C. (2012). A pragmatic view of Jean Watson’s caring theory. University de Montreal Faculty of Nursing. Web.

Crowden, A. (1994). On the moral nature of nursing practice. Journal of Advanced Nursing, 20(1), 1104-1110.

Current Nursing. (2012). Jean Watson’s philosophy of nursing. Nursing Theories. Web.

Dugger, R. B. (2010). Concept analysis of health related quality of life in nursing home residents with urinary incontinence. Urologic Nursing, 30(2), 112-120.

Duquette, A., & Cara, C. (2000). Le caring et la santé de l’infirmière. L’infirmière Canadienne, 1(2), 10-11. Web.

Lea, A., Watson, R., & Dreary, I.J. (1998). Caring in nursing: Multivariate analysis. Journal of Advanced Nursing, 28 (3), 662–671.

Quizlet. (2012). Caring in nursing practice. Web.

SJHLEX (2012). Jean Watson’s theory of human caring. Web.

Stroke Society Phil. (2012). Guidelines for the nursing management of stroke patients. Web.

Summers, D., Leonar, A., Wentworth, D., Saver, J.L., Simpson, J., Spilker, J.A., Hock, N. Miller, E. & Mitchell, P.H. (2009). Comprehensive overview of nursing and interdisciplinary care of the acute ischemic stroke patient. American Heart Association Scientific Statement, 40 (1), 2911–2944.

University of Colorado. (2012). Theory of human caring. College of Nursing, The Regents of University of Colorado. Web.

Watson, J. (l979). Nursing: The philosophy and science of caring. Boston: Little, Brown and Company. Boulder, CO: University Press of Colorado.

Watson, J. (1985). Nursing: Human science and human care. CT: Appleton-Century-Crofts. 2nd printing 1988; 3rd printing 1999. NY: NLN (Jones and Bartlett). Web.

Watson, J. (1999). Postmodern nursing and beyond. Web.

Watson, J. (2008). Nursing: The philosophy and science of caring (Rev. ed.). Boulder, CO: University Press of Colorado. Web.

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