Professional Documents
Culture Documents
Chapter
18
J E A N W ATSO N
Jean Watson
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SECTION V
CHAPTER 18
focus on transpersonal caring moment, postmodern critiques, to metaphysical from theory to ontological paradigm for caring science.
A broad, evolving unitary caring science
worldview underlies the uid evolution of the
theory and the philosophical-ethical foundation for this work.
system of values.
2. Instillation of faithhope.
3. Cultivation of sensitivity to ones self and
to others.
4. Development of a helpingtrusting,
learning.
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What diers in the caritas process framework is that a decidedly spiritual dimension and
an overt evocation of love and caring are
merged for a new unitary cosmology for this
millennium. Such a perspective ironically places
nursing within its most mature framework and
is consistent with the Nightingale model of
nursingyet to be actualized but awaiting its
evolution. This direction, while embedded
in theory, goes beyond theory and becomes a
converging paradigm for nursings future.
Thus, I consider my work more a philosophical, ethical, intellectual blueprint for
nursings evolving disciplinary/professional
matrix, rather than a specic theory per se.
Nevertheless, others interact with the original
work at levels of concreteness or abstractness.
If the theory is read at the carative factor
level, it can be interpreted as a middle-range
theory. If the theory is read at the transpersonal unitary caring science/transpersonal
caring consciousness level, the theory can be
interpreted as a grand theory located within
the unitarytransformative context.
The caring theory has been and increasingly
is being used nationally and internationally as
a guide for educational curricula, clinical practice models, methods for research and inquiry,
and administrative directions for nursing and
health-care delivery.
Heart-Centered Transpersonal
Caring Moment: Caritas Field
Whether the theory is read at dierent levels,
used as a language system for documentation,
used as a guide for professional nursing practice models, or used as the focus of multisite
or individual clinical caring research studies,
the essence of the lived theory is in the transpersonal caring moment. The caring moment can
be located within any caring occasion, as a
concept within middle-range or even prescriptive or practice-level theory.
However, the caring moment is most evident within the transpersonal caritas energetic
eld model, in that ones consciousness, intentionality, energetic heart-centered presence
is radiating a eld beyond the two people or
the situation, aecting the larger eld. Thus,
nurses can become more aware, more awake,
more conscious of manifesting/radiating a caritas eld of love and healing for self and others,
helping to transform self and system. For more
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This work, in both its original and evolving forms, seeks to develop caring as an
ontologicalepistemological foundation for a
theoreticalphilosophicalethical framework
for the profession and discipline of nursing
and to clarify its mature relationship and distinct intersection with other health sciences.
Nursing caring theorybased activities as
guides to practice, education, and research
have developed throughout the United States
and other parts of the world. The caring/
caritas model is consistently one of the nursing caring theories used as a guide in Magnet
Hospitals in the United States and found to
be culturally consistent with nursing in many
other cultures, nations, and countries. Nurses
reflective-critical practice models are increasingly adhering to a caring ethic and ethos as
the moral and scientific foundation for a profession that is coming of age for a new global
era in human history.
Latest Developments
The Watson Caring Science Institute (WCSI)
was established in 2007 as a nonprot foundation. The following statements dene and
theory to life in academic and clinical practice settings by supporting and learning
from each other
2. To share knowledge and experiences so
that we might help guide self and others in
the journey to live the caring philosophy
and theory in our personal and professional
lives.
The consortium gatherings, sponsored by
systems implementing caring theory in practice:
Provide an intimate forum to renew, restore, and deepen each persons and each
systems commitment and authentic practices of human caring in their personal/
professional life and work.
Learn from each other through shared work
of original scholarship, diverse forms of caring inquiry, and modeling of caringhealing
practices.
Mentor self and others in using and extending the theory of human caring to transform education and clinical practices.
Develop and disseminate caring science
models of clinical scholarship and professional excellence in the various settings in
the world.
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SECTION V
Conclusion
Consistent with the wisdom and vision of Florence Nightingale, nursing is a lifetime journey
of caring and healing, seeking to understand
and preserve the wholeness of human existence
across time and space and national/geographic
boundaries, to oer heart-centered compassionate, informed knowledgeable human caring to society and humankind. This timeless
view of nursing transcends conventional minds
and mindsets of illness, pathology, and disease
that are located in the physical body with curing as end goal, often at all costs. In nursings
timeless model, caring, kindness, love, and
heart-centered compassionate service to humankind are restored. The unifying focus and
process is on connectedness with self, other,
nature, and God/the Life Force/the Absolute.
This vision and wisdom is being reignited
today through a blend of old and new values,
ethics, and theories and practices of human
caring and healing. These caritas consciousness
practices preserve humanity, human dignity,
and wholeness and are the very foundation of
transformed thinking and actions.
Such a values-guided relational ontology
and expanded epistemology and ethic is embodied in caring science as the disciplinary
ground for nursing, now and in the future. The
advancement of nursing theory, which includes both ideals and practical guidance, is
Practice Exemplar
and modeled by Dr. Jean Watson, through experiential interactions with caringhealing
modalities. The end of the retreat opened opOctober 2002 presented the opportunity for portunities for participants to merge caring
17 interdisciplinary health-care professionals
theory and pain theory into an emerging
at the Childrens Hospital in Denver, Colcaring-healing praxis.
orado, to participate in a pilot study designed
Returning from the retreat to the preexistto (1) explore the eect of integrating caring
ing schedules, customs, and habits of hospital
theory into comprehensive pediatric pain
routine was both daunting and exciting. We
management and (2) examine the Attending
had lived caring theory, and not as a remote
Nurse Caring Model (ANCM) as a care deand abstract philosophical ideal; rather, we
livery model for hospitalized children in pain.
had experienced caring as the very core of our
A 3-day retreat launched the pilot study. Partrue selves, and it was that call that had led us
ticipants were invited to explore transpersonal
into the health-care professions. Invigorated
human caring theory (caring theory) as taught
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333
cocreation, we can build on existing foundations to nurture evolution from what is to what
can be.
Our missionto translate caring theory
into praxishad strong foundational support.
Building on this supportive base, we committed our intentions and energies toward creating a caring culture. The following is not
intended as an algorithm to guide one through
varied steps until caring is achieved but is
rather a description of our ongoing processes
and growth toward an ever-evolving caring
praxis. These processes are cocreations that
emerged from collaboration with other ANCM
participants, fellow health professionals, patients and families, our environment, and our
caring intentions.
First Steps
One of our rst challenges was to make the
ANCM visible. Six tangible exhibits were displayed on the unit as evidence of our commitment to caring values. First, a large, colorful
poster titled CARING was positioned at the
entrance to our unit. Depicting pictures of diverse families at the center, the poster states our
three initial goals for theory-guided practice:
(1) create caringhealing environments, (2) optimize pain management through pharmacological and caringhealing measures, and
(3) prepare children and families for procedures
and interventions. Watsons clinical caritas
processes were listed, as well as an abbreviated
version of her guidelines for cultivating caring
healing throughout the day (Watson, 2002).
This poster, written in caring theory language,
expressed our intention to all and reminded us
that caring is the core of our praxis.
Second, a shallow bowl of smooth, rounded
river stones was located in a prominent position at each nursing desk. A sign posted by the
stones identied them as CaringHealing
Touch Stones, inviting one to select a stone
as every human being has the ability to share
their incredible gift of lovinghealing. These
stones serve as a reminder of our capacity to
love and heal. Pick up a stone, feel its smooth
Continued
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SECTION V
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335
Education
Unit educational oerings were also revised to
reect caring theory. Phase classes, a 2-year
curriculum of serial seminars designed to support new hires in their clinical, educational,
and professional growth, now include a unit
on self-care to promote personal healing and
support self-growth. The unit on pain management was expanded to include use of
caringhealing modalities. A new interactive
session on the caritas processes was added that
asks participants to reect on how these
processes are already evident in their praxis
and to explore ways they can deepen caring
praxis both individually and collectively as a
unit. The tracking tool used to assess a new
employees progress through orientation now
includes an area for reection on growing in
caring competencies. In addition to changes in
phase classes, informal clock hours were offered monthly. Clock hours are designed to respond to the immediate needs of the unit and
encompass a diverse range of topics, from conict resolution, debrieng after specic events,
and professional development, to health treatment plans, physiology of medical diagnosis,
and in-services on new technologies and pharmacological interventions. Oered on the unit
at varying hours to accommodate all work
336
SECTION V
their pillows and favorite stued animal or doll the families goals. Transitional conferences
and come dressed in pajamas. Night- and day- provide an opportunity to coordinate contishift sta members have honored one another nuity of care, share insight into the unique
with surprise beginning-of-the-shift meals, personality and preferences of the child, coorstaying late to care for patients and families, dinate team eort, meet families, provide them
and refusing to give o-going report until with tours of our unit, and collaborate with
their on-coming coworkers had eaten. Color- families. Other caringhealing arts oered on
ful caring stickers are awarded when one sta our unit are therapeutic touch, guided imagery,
member catches another in the ACT of car- relaxation, visualization, aromatherapy, and
ing, being present, making anothers day, play- massage. As ACT participants, our challenge
ing, and choosing a positive attitude. These is to express our caring values through every acacts are authentic and not performed as hos- tivity and interaction. Caring theory guides us
pitality acts and within the customer mindset; and manifests in innumerable ways. Our interrather, they are a professional covenant nurs- view process, meeting format, and clinical
ing has with humanity around the world.
nurse specialist (CNS) role have been transgured through caring theory. Our interview
ACT Guidelines
process has transformed from an interrogative
Placing caring theory at the core of our praxis three-step procedure into more of a sharing
supports practicing caringhealing arts to pro- dialogue. We are adopting another meeting
mote wholeness, comfort, harmony, and inner style that expresses caring values.
Our unit director had the foresight to
healing. The intentional conscious presence of
budget
a position for a CNS to support the
our authentic being to provide a caringhealing
cocreation
of caring praxis. The traditional
environment is the most essential of these arts.
CNS
rolesresearcher,
clinical expert, collabPresence as the foundation for cocreating carorator,
educator,
and
change agenthave
ing relationships has led to writing ACT
allowed
the
integration
of
caring theory develguidelines. Written in the doctor order section
opment
into
all
aspects
of
our unit program.
of the chart, ACT guidelines provide a formal
The
CNS
role
advocates
self-care
and faciliway to honor unique families values and betates
sta
members
to
incorporate
caring-healliefs. Preferred ways of having dressing changes
performed, most helpful comfort measures, ing arts into their practice through modeling
home schedules, and special needs or requests and hands-on support. In addition to providare examples of what these guidelines might ing assistance, searching for resources, acting
address. ACT members purposefully use the as liaison with other health-care teams, and
word guideline as opposed to order as more con- promoting sta in their eorts, the very presgruent with cocreative collaborate praxis and to ence of the CNS on the unit reinforces our
encourage critical thinking and exibility. commitment to caring praxis.
Building practice on caring relationships has
led to an increase in both the type and volume Conclusion
of care conferences held on our unit. Previ- We continue to work toward incorporating
ously, care conferences were called as a way to caring ideals in every action. Currently, we are
disseminate information to families when modifying our competency-based guidelines
complicated issues arose or when communica- to emphasize caring competency within tasks
tion between multiple teams faltered and fam- and skills. Building relationships for supportilies were receiving conicting reports, plans, ive collaborative practice is the most exciting
and instructions. Now these conferences are and most challenging endeavor we are now
oered proactively as a way to coordinate team facing as old roles are reevaluated in light
eorts and to ensure we are working toward of cocreating caring-healing relationships.
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337
Summary
Nursings future and nursing in the future
will depend on nursing maturing as the distinct health, healing, and caring profession
that it has always represented across time but
has yet to fully actualize. Nursing thus ironically is now challenged to stand and mature
within its own caring science paradigm,
while simultaneously having to transcend it
and share with others. The future already reveals that all health-care practitioners will
need to work within a shared framework
of caringhealing relationships and human
environmental energetic field modalities.
Practitioners of the future pay attention to
consciousness, intentionality, energetic human
presence, transformed mindbodyspirit medicine, and will need to embrace healing arts
and caring practices and processes and the
References
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de Chardin, P. (1959). The phenomenon of man. New
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Gadow, S. (1995). Narrative and exploration: Toward a
poetics of knowledge in nursing. Nursing Inquiry, 2,
211214.
Hills, M. & Watson, J. (2011). Creating a caring curriculum. Emancipatory pedagogies (a Caring Science
Library Series with Springer/Watson Caring Science
Institute). New York: Springer.
338
Bibliography
Watson, J. (1999). Postmodern nursing and beyond. Edinburgh, Scotland, UK: Churchill Livingstone/WB
Saunders. Translated into Japanese and Portugeuse.
Watson, J. (2002). Instruments for assessing and measuring
caring in nursing and health sciences. New York:
Springer. (American Journal of Nursing Book of the
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Revised 2nd edition. 2008.
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Fawcett, J. (2002). The nurse theorists: 21st century
updatesJean Watson. Nursing Science Quarterly,
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Fawcett, J., Watson, J., Neuman, B., & Hinton-Walker,
P. (2001). On theories and evidence. Journal of
Nursing Scholarship, 33(2), 121128.
Quinn, J., Smith, M., Swanson, K., Ritenbaugh, C., &
Watson, J. (2003). The healing relationship in
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