Dr. Jean Watson developed the Theory of Human Caring during 1975-1979. At the time, she was a faculty member at the University of Colorado. The theory emerged from Watson’s own views regarding nursing as well as her doctoral studies in social, clinical, and educational psychology. The development of the theory was Watson’s initial effort aimed at bringing focus and meaning to nursing discipline as an emerging field and also as a unique health profession having its own distinctive practices, mission to society, knowledge, values, and ethics. In developing the theory, Watson also drew influence from her participation in an integrated nursing curriculum and efforts aimed at discovering a common order and meaning in nursing that surpassed subspecialty and specialty areas, populations, and settings.
Based on Watson’s emerging perspective, she explicitly stated that nursing practices, knowledge, philosophy and ethics associated with human caring need clear and structured worldview and concepts that underlie nursing as a unique profession and discipline. The Theory of Human Caring transcends the physical worldview to include inner, inter-subjective, and subjective meanings, the core process of healing, and the life experiences of an individual. The original Theory of Human Caring developed by Watson advocated the need of distinctive caring-healing arts. Watson labelled the processes involving human caring as the 10 carative factors, which are complementary to the traditional medicine but are contrasted with the “curative factors.”
Since the original development of the theory in 1979, it has been revised several times in 1981, 1985, and the 1990s, which led to the creation of a more updated and detailed view of the 10 caritas processes in 2011, towards understanding caring as a sacred science, and the development of a global consciousness for leaders. The original theory developed in 1979 was based on the ten carative factors as the underlying framework to guide nursing. While the ten carative factors are still essential in nursing, Watson considered the term factor as being too stagnant; thus, she extended the carative factors to caritas processes in order to reflect the contemporary and dynamic nature of these ideas. Over time, the theory has evolved from the ten carative factors to clinical caritas processes.
The present form of the theory of caring provides links among healing, human caring, and peace in the world since nurses act as caritas peacemakers when exercising caring for others and for themselves. This shift is characterized by moving towards a more spiritual/metaphysical emphasis on transpersonal caring. It also marks a transition from the ontological caring science towards the metaphysical paradigm caring science.
The purpose of Watson’s theory of caring is to balance the cure aspect of medicine and give nursing its distinctive professional, scientific, and disciplinary standards. Essentially, Watson’s theory of caring was developed with the aim of bringing meaning to nursing as a distinct health discipline which is focused on caring rather than curing.
The original Watson’s Theory of Human Caring comprised seven assumptions. The first assumption is that, for caring to be practiced and demonstrated effectively, it should be interpersonal. The second assumption of this theory is that caring encompasses carative factors that lead to the satisfaction of certain human’s needs. The third assumption is that effective caring plays a crucial role in promoting the health of an individual or a family. Fourth, the Theory of Human Caring is based on the presumption that caring responses embrace the individual as he/she currently is, as well as what he/she might become in the future. The fifth assumption is that a caring environment is characterized by developing the potential while enabling the person to elect the best course of action at a specified point in time. The sixth assumption is that caring tends to be more healthogenic when compared to curing; however, caring science complements the curing science. The final assumption suggests that caring is an essential aspect of nursing.
The key concepts in the Watson’s Theory of Human Caring (original and emergent) are the 10 carative factors later transposed to carative processes; the transpersonal caring moment; caring intentionality/consciousness and energetic presence; and caring healing-modalities. The original carative factors included forming a humanistic-altruistic value system; instilling hope and faith; cultivating sensitivity to others and oneself; developing a trusting-helping and human caring relationship; promoting and accepting the expression of both negative and positive feelings; using the process of creative problem-solving caring in a systematic manner; promoting transpersonal teaching and learning; providing protective, corrective, and supportive spiritual, societal, physical, and mental environment; assisting with gratifying human needs; and allowing for the existence of spiritual forces.
These caritas have been transposed into caritas processes. Forming a humanistic-altruistic value system is transposed into practicing kindness, love and equanimity in caring consciousness. Instilling hope and faith now entails authentic presence and facilitating and maintaining a deep system of beliefs. Cultivating sensitivity to others and oneself has now been transposed to cultivating one’s transpersonal self and spiritual practices, transcending the ego of oneself and opening oneself to others in a compassionate and sensitive manner. Developing a trusting-helping and human caring relationship has now been transposed to the development and maintenance of an authentic helping-trusting relationship. Promoting and accepting the expression of both negative and positive feelings now entail being supportive of as well as present to the articulation of both negative and positive feelings as a means of connecting with oneself and the person who is being cared for – listening to the story of another person in an authentic manner. Using the process of creative problem-solving caring in a systematic manner has now been transposed to using the self creatively and engaging in the art of caring. Promoting transpersonal teaching and learning now involves engagement in a genuine teaching and learning experience along with striving to stay in the frames of reference of the person being cared for. Providing protective, corrective, and supportive spiritual, societal, physical, and mental environment has now been transposed to the creation of a healing environment at various levels including non-physical and physical environment. Assisting with gratifying human needs now includes providing help with basic needs during the caring process. Lastly, allowing for the existence of spiritual forces which means attending to and embracing spiritual-mysterious dimensions – accepting the possibility of miracles.
The transpersonal caring moment takes place at any time when the nurse and another person interact with each other in a human-to-human transaction. This interaction is characterized as transcendent. It also involves both a choice and an action by nurse and the other person. This moment provides an opportunity for both the nurse and the patient to make a decision regarding how to behave as far as the relationship is concerned. In case of transpersonal caring, both the nurse and the patient feel connected to each other at the spiritual level; as a result, this moment goes beyond the limits of space and time to open novel possibilities for human connection and healing at levels beyond the physical interaction.
Regarding the concept of caring consciousness, Watson states that consciousness is required for transpersonal caring to manifest itself. The transpersonal aspect associated with a caring moment depends significantly on the consciousness/intentionality of the nurse during the caring moment. Consciousness plays an important role in ensuring an interrelation between the caring individual and the individual being cared for. In addition, it also guarantees that the healing/caring process is connected to the higher cosmic energy as well as other humans. Watson posits that the nurse’s consciousness is projected into the person being cared for, and that consciousness surpasses the space-time and physical boundaries. the existence of nurse’s caritas consciousness, intentionality, and moral commitment aid in potentiating, promoting, enhancing, and protecting human healing, wholeness, and dignity, in which individuals generates their own understanding for dying and living, wholeness, healing, and existence. Also, the consciousness and will of a health practitioner encourage the significance of individual’s subjective-spiritual condition when pursuing to withstand caring during despair and threat. The intentional caring during transpersonal loving or caring unity of being, wholeness, and consciousness results in harmony through avoiding disharmony, and removing blocked energy that affects the process of natural healing. Therefore, individuals are helped by nurses to access the healer within, in the sense of Nightingale’s thoughts on nursing through natural healing process.
Regarding caring modalities, Watson proposed that the level of transpersonal spirit-to-spirit connection between an individual and a practitioner is interpreted through various human, esthetic, technical, and scientific communication means inside nursing healing modalities or acts as well as verbal expressions, sound, touch, information, procedures, facial expressions, gestures, and movements.
The Theory of Human Caring places a lot of focus on the humanistic aspects associated with nursing and their interrelationships with nursing practice and nursing knowledge. The science of caring also incorporates spiritual dimensions in the nursing practice. The theory covers the nurse-patient interaction and the ways in which this interaction can surpass the objective evaluation to be characterized by the development an important caring relationship that involves understanding the perspective of the other person and creating a mutual bond. The theory is congruent with nursing because Watson provided a definition of all the four metaparadigm concepts in nursing, which are the person (human being), health, nursing, and the environment.
In the Theory of Human Caring, nursing has been defined as the study of persons and human health such as disorder understanding that are mediated by ethical, esthetic, scientific, personal, and professional human care transactions. The environment is perceived as providing values that governs the behavior and objectives of an individual. Watson states that caring has existed in every society, at least a person who cared for others. A caring attitude is conveyed through the profession culture indicating an outstanding way of coping with its environment, but it is not transmitted from one generation to another by genes. Concerning health, it is defined as a high level of general social, mental, and physical functioning. Additionally, it is the level of overall adaptive-maintenance of everyday effectiveness, illness absence, and the availability of efforts causing the absence of illness. It is accompanied by the rate of congruence between the self as experienced and the self as perceived; it is harmony and unity surrounding the soul, body, and mind. The human being is viewed as much greater and diverse creation. Human being is a person that needs care, assistance, understanding, nurturing and respect.
Numerous research studies have employed the Theory of Human Caring as a basis for improving patient care. An example of such a study is one by Arslan‐Özkan, Okumuş, & Buldukoğlu, who embarked on exploring the impacts of a nursing care intervention designed using the Theory of Human Caring on distress stemming from perceived self-efficacy, being infertile, and the levels of adjustment. The authors designed a randomized controlled trial study involving 105 infertile Turkish women, with 52 in the intervention group and 53 in the control group. Data for the research was gathered by the Infertility Distress Scale, Fertility Adjustment Scale, and the Infertility Self-Efficacy Scale. The treatment group received an intervention designed using the Theory of Human Caring. The findings of the research indicated that the intervention group had higher self-efficacy and adjustment scores, in comparison to significantly lower infertility distress scores. The authors concluded that the nursing care that hinges upon the Theory of Human Caring can help to lower the negative impacts associated with infertility among women significantly, and can also increase their adjustment and self-efficacy. Another study by Vandenhouten, Kubsch, Peterson, Murdock, & Lehrer, who sought to identify the fact that affect the perceived professional caring among nurses. The study was performed with 242 nurses who completed a questionnaire based on the Theory of Human Caring. The findings of their research indicated that nurses who were more familiar with this theory showed higher scores for caring.
An appropriate clinical case that the Theory of Human Caring can be applied to involves caring for a patient who has been hospitalized with a heart disease. The patient is a devout Christian who believes in prayers. The patient explains that he wishes to have fully recovered before Christmas because his grandson is visiting him. However, he is worried that the treatment might take longer than expected, and he is not even sure that it will be effective. The patient also expresses worries with his heart condition which may fail at any time.
In such a case, the nurse must strive to create a caring moment by engaging in conversations with the patient focusing on their life experiences and their expectations among others. This theory requires nurses to view the patient as a holistic being irrespective of their illness in order to create a caring experience. It is important to establish a connection during the first interaction. Welcoming the patient is equally important. The next step that the nurse should undertake would involve making arrangements to ensure that the patient’s environment is comfortable for him. It is also imperative for the patient and the nurse to share common experiences for the healing to be enhanced. In such a case, besides the conventional medical treatment, the nurse should continually instill hope and faith and provide support to the patient. The patient might request for prayers to be conducted within the hospital facilities. In the event of such a request, the nurse should not deny his request. Instead, the nurse should agree to the prayers, which is an indication of the belief that miracles do happen. The nurse should also accept the patient unconditionally and spend considerable time with the patient to show genuine concern for the patient’s condition. Since the patient had expressed negative feelings, the nurse should encourage the patient and inform that he needs to do his best to ensure that the treatment goes as planned – this involves prioritizing the needs of the patient.