This article was developed as a part of assignments during my education in 2013. For citation purpose, please use: Gunawan, J. (2013). The Application of Watson’s Caring Theory in Nursing Administration. Retrieved from jokogunawan.com.
Introduction
Jean Watson’s Theory of Human Caring is a grand theory that contributes to the existential side of nursing. It focuses on authentically caring about the whole patient. This means caring about the patient’s mind, body and spirit so that the healing process can continue at an optimal level. Watson described it as a model of caring that includes both art and science; offering a framework that embraces and intersects with art, science, humanities, spirituality, and new dimensions of mind-body-spirit medicine as well as nursing. Watson believes her theory is an evolving one and should be open to the ever-changing practice of nursing as well as to the dynamics of human phenomena. She elaborates by stating “caring science goes beyond an intellectualization of the topic inviting us into a timeless; yet, timely space to revisit the perennial phenomenon of the human condition”. Applying such abstract concepts of love, faith, caring, hope, trust, spirituality to nursing science can help stratify the concept of human caring.
Today’s nursing practice is very much influenced by the theories created by Dr. Watson. Many institutions are introducing Jean Watson’s Theory of Human Caring as a guide to patient care. According to Caruso, Cisar and Pipe (2008); applying Watson’s theory not only allows for nurses to better care for patients as a whole, but is also allows for nurses to better care for themselves as whole beings as well. By following Watson’s Carative factors, nurses are able to look at the patient as a whole living, breathing, thinking, feeling person- not just a bed number or a lab report value. When Watson’s theories are applied in acute and chronic health care settings it provides a “guide to help articulate what nursing is and does, beyond task orientation” (Caruso et al, 2008, p. 127).
On the other side, Watson’s Theory has influenced nurse administrator to apply in their jobs. As a matter of fact that being a nurse administrator is a challenging, tough, exciting, meaningful, frightening, fun, difficult, rewarding, demanding job. There are so many problems and nursing issues have to be accomplished by nurse administrator. It has its ups and downs, but it is never dull. So, this paper will be explained about how Watson’s theory is applied into practice and administration related to nursing problem.
The study outlines in this paper are:
- To describe the concept of Watson’s theory
- To describe the application Watson’s theory in nursing administration related to nursing
issue
A. The concept of Watson’s theory
Dr. Jean Watson was born and raised in West Virginia, USA. She moved to Boulder, Colorado and has resided there since 1962 (Watson, 2007). Watson is well recognized worldwide for her theories on Human Caring and The Art and Science of Caring in Nursing (Watson Caring Science Institute, 2009). She has accomplished much in her extensive career, and has profoundly impacted the way nurses give care. Dr. Watson is currently the Distinguished Professor of Nursing at the University of Colorado and holds an endowed Chair in Caring Science at the University of Colorado Denver and Anschutz Medical Center Campus (Watson, 1997). She devotes her life to spreading her message of care and compassion throughout the world of nursing.
The Theory of Human Caring is comprised of 3 major conceptual elements: clinical caritas processes, transpersonal caring relationships, caring moment/caring occasion.
The clinical caritas processes emerges from Watson’s own caritas factors that involved the promotion of faith, trust, love, hope, caring, selflessness, spirituality, energy, and understanding. She uses the Greek word ‘caritas’ to mean something that is very fine and indeed precious, (invoking) love”. She calls for these clinical caritas processes to be a guide used to practice this theory.
- Practice of loving kindness and equanimity within context of caring consciousness.
- Being authentically present, and enabling and sustaining the deep belief system and subjective life world of self and one being cared for.
- Cultivation of one’s own spiritual practices and transpersonal self, going beyond ego self and opening to others with sensitivity and compassion.
- Developing and sustaining a helping-trusting, authentic caring relationship.
- 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.
- Creative use of self and all ways of knowing as part of the caring process; to engage in the artistry of caring-healing practices.
- Engaging in genuine teaching-learning experience that attends to unity of being and meaning, attempting to stay within others’ frames of reference.
- Creating a healing environment at all levels (physical as well as non-physical), a subtle environment of energy and consciousness, whereby wholeness, beauty, comfort, dignity, and peace are potentiated.
- Assisting with gratification of human 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 the embodied spirit and evolving spiritual emergence.
- Opening and attending to spiritual-mysterious and existential dimensions of one’s own life-death; soul care for self and the one-being-cared-for.
This guide is supposed to help a nurse toward implementing caring behaviors into their own nursing practice. There are some examples of “carative factors”:
- Showing kindness, concern and love of self and others.
- Enabling and sustaining faith and hope.
- Showing sensitivity to others and to you. (Understand and be sensitive to your own
- feelings.)
- Using interpersonal communication skills to create trusting, helping, and caring
- relationships.
- Accepting the emotions and feelings of others, and encouraging others to share those
- emotions and feelings. Promoting teaching and learning based on an assessment of the
- patient’s perception and feelings.
- Creating an environment that is supportive, protective, and advances physical, emotional,
- and spiritual health and well-being.
- Attending to the basic human needs of the patient.
- Attending to the existential and spiritual needs of the patient.
A transpersonal caring relationship is said by Watson to “move beyond ego self and radiate to spiritual, even cosmic, concerns and connections that tap into healing possibilities and potentials”. Nurses must find it within themselves to explore and reflect on who they are in order to provide optimal care. If the nurse is in touch with what it takes to care about their patient, it may take them on an experience that not only benefits the patient, but the nurse. The nurse transcends their duty by anticipating the needs of the patient and seeing to it that those needs are met.
Caring moment/caring occasion. According to Watson (1988b, 1999), a caring occasion is the moment (focal point in space and time) when the nurse and another person come together in such a way that an occasion for human caring is created. Both persons, with their unique phenomenal fields, have the possibility to come together in a human-to-human transaction. For Watson (1988b, 1999), a phenomenal field corresponds to the person’s frame of reference or the totality of human experience consisting of feelings, bodily sensations, thoughts, spiritual beliefs, goals, expectations, environmental considerations, and meanings of one’s perceptions—all of which are based upon one’s past life history, one’s present moment, and one’s imagined future.
Not simply a goal for the cared-for, Watson (1999) insists that the nurse, i.e., the caregiver, also needs to be aware of her own consciousness and authentic presence of being in a caring moment with her patient. Moreover, both the one cared-for and the one caring can be influenced by the caring moment through the choices and actions decided within the relationship, thereby, influencing and becoming part of their own life history. The caring occasion becomes “transpersonal” when “it allows for the presence of the spirit of both—then the event of the moment expands the limits of openness and has the ability to expand human capabilities” (Watson, 1999).
Some examples of “caring moments” or “moments of truth”:
- Entering the patient’s room.
- Shaking the patient’s hand.
- Making eye contact with the patient.
- Explaining a procedure.
- Making the patient’s environment more comfortable.
Watson’s theory and the nursing process
Before applying nursing process, we have to know the role of the nurse in Dr. Jean Watson’s Caring Theory, namely: Establish a caring relationship with patients, Show unconditional acceptance, Use a holistic treatment approach—one that includes treating the mind, soul, and spirit as well as the body, Spend uninterrupted time with patients – something Watson calls “caring moments”, Promote health through knowledge and intervention.
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
- Assessment involves observation, identification, and review of the problem: use of the
- applicable knowledge in literature.
- It includes conceptual knowledge for the formulation and conceptualization of a framework
- in which to view and assess the problem
- It also includes the formulation of hypotheses about relationships and factors that influence
- the problem.
- Assessment also includes defining variables that will be examined in solving the problem.
Plan
- The plan helps to determine how variables will be examined or measured.
- it includes a conceptual approach or design for solving problems that is referred to as the
- nursing care plan.
- It also includes determining what data will be collected and on what person and how the data
- will be collected.
Intervention
- Intervention is direct action and implementation of the plan.
- It includes the collection of data.
Evaluation
- Evaluation is the method of and the process for analyzing data as well as the examination of
- the effects of intervention based on the data.
- It includes interpretation of the results, the degree to which a positive outcome occurred, and
- whether the results can be generalized beyond the situation. Evaluation may also generate additional hypotheses or possibly even lead to the generation of a nursing theory based the problem studied and the solutions.
B. The Application Watson’s Theory in Nursing Administration related to nursing issue
Problem: Nursing staffing
My name is rico, not the real name. I have experience working and internship in several hospitals. I felt the same way when I cared of patients. It seems like I had no feeling. I did not see every nurses enjoy their jobs, even me. I was just busy in my task doing injections, dressing bandage, bathing patients and clean up the bed, and writing nursing care plan every day. When these things got done, then we kept silent and “chit-chat” (talking and playing mobile phone). Actually, we have much time to meet patients to share or hear patient needs. In fact, I did not see a single nurse did these things. I have been thinking what was going on here. Is everyone dead? Or lazy to death. That was funny and ridiculous. In my analysis, in almost the hospitals I work, they applied the traditional care delivery models, such as functional method, team nursing model, and might be I guest there was no model, it means just did the routine care and implemented the doctor orders. We didn’t even apply caring. I never heard from the nurses’ mouth to care, never heard Nightingale, Watson, even from head nurses. How very poor I am when I remember me in that way. However, it is still the same condition now like the condition before. Did you feel the same way? On the other hand, because of this condition. Many patients reported nurse in newspaper, it indicated that nurses were garrulous, never kept smile, never care to patients, always angry, rude and etc.
Another issue that could be an impact from the condition above:
Telenursing is one of these technology-based advances. A Telenurse is a nurse who utilizes the latest in technology to monitor patients, give medical or first-aid advice and even help locate a clinic, hospital or physician that can best serve the patient’s needs. Telenursing has been used with geriatric care, helping to keep track of the effects of medications and treatments, as well as with mothers in labor. Telenursing is a growing opportunity for nursing professionals who enjoy the role of a nurse who can help benefit many people by monitoring their health from a distance. The benefits of Telenursing come down to the ability to act faster than in a standard nursing environment when the medical issues begin at the patient’s home. Nurses who incorporate the latest technologies and who are not afraid to go beyond their general nursing school curriculum may be able to take advantage of the upcoming opportunities in Telenursing, helping to bridge medical care and technology as well as helping patients receive beneficial medical care in the comfort of their own homes. However, one of the risks involved with Telenursing is that the patient may feel they have lost a personal connection with those in charge of their medical care, and the nurse can feel the same disconnect. Transitioning from face-to-face, interpersonal contact into a technology- based care system may be hard for many people to understand or accept. On the other hand, Technology based care system is a very big issue in Japan nowadays. They create Robot to take care of patient, and these robots also expert in doing nurse job. However, Robots don’t have personalities no matter how realistic you can make their facial expressions. It will have great implication to nursing care. As a nurse administrator, We are greatly concern to ask Where is Caring? And let’s solve this problem.
(This paper does not focus on thelenursing and robot, it is just about the assumption)
As the future nurse administrator, I deeply concern in this situation. I though it is the one of reasons why nurse shortage increased. It is not only the workload of nurses jobs, but also the boring conditions. In my way of thinking, the nurse delivery models, although there are many innovations models to solve this problem. I do not see those models focus on caring, but it much more focuses on task and procedures. To deal with the problem, however, it is no matter what model takes a place, but it is about nurse staffs behaviors and how nurse administrators care or apply caring to the nurse staffs.
Caring is not only confined to a patient-nurse relationship. It can be very useful in dealing with staff nurses and others in the context of the organization. Nurse administrators as well as nurse managers or nurse leaders can exemplify caring and thus enrich the patient care environment by insisting on the development of an emphasis on caring behaviors throughout the nursing division.
How to apply caring in this situation?
In nursing administration, the nursing processes are still the same. It consists of assessment, planning, implementation, and evaluation.
Nursing Process:
Set the goals: to improve nursing’s caring value and change the behavior
Assessment
- Nurses are used to implementing task and procedures than applying caring
- Head nurse or nurse administrator do not apply caring in organization culture
- The nurse delivery models do not support caring in nursing practice
Planning
1) Nurse administrators can apply caritas process to nurse staffs. For the nursing administrator, Nyberg (2011) indicated five attributes enable one consistently to exhibit caring behaviors: commitment, self-worth, ability to prioritize, openness, and ability to bring out potential. By understanding and developing these attributes, the nurse administrator can be the role model who exemplifies caring and encourages it to become an institutional norm
- Commitment: three component(interest, knowledge, and commitment)
- Self worth. Promotes caring emphasizes the need for the nursing administrator to achieve feeling of self-worth, self-understanding, and self-confidence. Placing importance on meeting one’s personal and social needs. Attention to personal needs is very important for nursing administrators
- Prioritize. The third attribute that enables one to be caring is the ability prioritize and order life’s activities in a way that allows time and energy for the caring process. The nurse administrator can prioritize his or her job to encourage caring opportunities and reflect a caring approach. He or she can structure time so as to keep in touch with the feelings of staff nurses. This generally involves making rounds, holding open staff meetings, dealing directly with staff nurse committees, and occasionally getting involved in patient situations. As the nursing administrator displays caring behavior in meetings, conversations, and dealing with nurses, patients, families, and physicians, the caring norm begins to coalesce in the institution. As employees see and feel expressions of caring, the attitudes of caring are reproduced in patient situations
- Openness. Being open is much more difficult than it sounds. The behaviors involved in openness include listening, soliciting comments, watching nonverbal communication cues, asking the right questions, and waiting patiently for answer. An important aspect of developing openness relates to the ways in which nurse administrators respond to feedback. If they express anger or alarm at negative or controversial comments, openness will be suppressed. If they express appreciation for the information provided and confidence about solving problems, people will be willing to continue to risk being open. Developing positive approaches to problem solving contributes greatly to enhanced caring behaviors. The attribute of openness is more than just a willingness to hear: it is a willingness to perceive, to empathize, and to respond. For nurse administrators, openness includes the ability to focus quickly and completely on the reality of many individuals and groups with whom they interact each day. Often the tendency is to split one’s attention between the current interaction and the many other items needing attention, decisions, and actions.
- Ability to bring out potential
2) Apply the innovation care model that emphasizes in caring.
Watson and Foster (2003) conducted a model in pilot study and applies caring as a guide for integrating theory, evidence and advanced therapeutics in the area of children’s pain. This model is called “The Attending Nurse Caring Model (ANCM)”. The ANCM is underway as a pilot project on one unit at The Children’s Hospital in Denver, Colorado. It is constructed as a Nursing-Caring Science, theory-guided, evidence-based, collaborative practice model by applying it to the conduct and oversight of pain management on a 37-bed, postsurgical unit. Caring theory and pain theory are congruent in their contemporary focus on the subjective human experience, the inner life processes and meaning of the experience. Pain theory describes the pain experience as a dynamic interaction among biological, physiological, psychosocial, cultural and spiritual influences. The human caring process requires knowledge of human behavior including the unity of mind, body and spirit, one’s strengths and limitations, and responses, and knowledge of how to comfort, offer compassion and empathy within the context of a caring relationship.
The Attending Caring Nurse (ACN) within the ANCM is responsible for:
- Establishing and sustaining a continuous, caring relationship with patients/families; this relationship may begin before hospital admission, or on hospital admission, and
- continue after discharge with follow-up;
- Comprehensive assessment of caring needs and concerns, from patient’s frame of
- reference – using caring theory as a guide for caring needs;
- Assessing meaning of the subjective as well as objective concerns;
- Co-creating with the patient/family a plan for comprehensive caring and healing that
- intersects with and is coordinated with the medical plan of care;
- Overseeing and assuring comprehensive care planning and in some instances directly carrying out the therapeutic regime plan related to the caring–healing modalities of nursing;
- Creating plans for direct communication with other nurses, physicians and team members to assure continuity.
Responsibility of the nurse administrator in this ANCM model:
- Understanding and communicating caring as philosophy and ethic for organizational processes, structures, and relationships
- Developing skills of caring behaviors, caring presence in formal-informal rela- tionships with individuals and groups
- Being alert and responsive to situations for modeling, creating, and articulating theoretical-philosophical ethics of caring with staff, colleagues
- Providing leadership in implementing, evaluating experimental models of caring based on theoretical-philosophical values
- Critiquing and helping to transform conventional practices by offering an inspired, informed, articulate vision for creating caring-healing systems
- Promoting and supporting research on caring and health/healing outcomes
- Pursuing relationships and data that document relationship between and among caring practice models, and nurse retention, patient-nurse satisfaction, healing outcomes, and costs
- Becoming stewards of caring-economics costs, by incorporating caring as a valuable economic resource and caring as a foundational, ethical variable in cost-benefit ratios
- Experimenting with new demonstration projects that showcase models of caring-healing excellence, new professional practice model
Result of this model: The ANCM elevates contemporary nursing’s caring values, relationships, therapeutics and responsibilities to a higher/deeper order of caring science and professionalism, intersecting with other professions, while sustaining the finest of its heritage and traditions of healing.
Evaluation
1) Measure the behavior of staff and administrator.
Many assessment tools have been developed to measure caring nowadays, such as
- Caring Nurse-Patient Interaction (CNPI) Scale by Cossette (2005). It consists of 70 item tool subdivided into 10 carrative factors: F1 humanism, F2 hope, F3 sensitivity, F4 helping relationship, F5 expression of emotions, F6 problem solving, F7 teaching, F8 environment, F9 needs, F10 spirituality. It can be used in research, clinical, administration, and education.
- Caring assessment Report Evaluation Q-Sort (Care-Q) consisting 29 items by Larson
- Nyberg Caring assessment scale, and etc.
- Caring Behaviors Inventory (Wolf)
- Caring Behaviors Assessment Tool (Cronin & Harrison)
- Caring Behaviors of Nurses Scale (Hinds)
- Professional Caring Behaviors (Horner)
- Caring Ability Inventory (Nkongho)
- Caring Behavior Checklist and Client Perception of Caring (McDaniel
- Caring Assessment Tools (new versions) (Duffy)
- Peer Group Caring Interaction Scale and Organizational Climate for Caring Questionnaire (Hughes)
- Caring Efficacy Scale (Coates)
- Holistic Caring Inventory (Latham)
- Caring Dimensions Inventory (Watson & Lea)
- Caring Attributes Professional Self-concept Technological Influence (Arthur et.al. Hong Kong)
- Caring Professional Scale (Swanson)
- Methodist Health Care System Nurse Caring Instrument (Shepherd & Sherwoodet.al.)
2) Evaluate the effectiveness of the ANCM model
Summary
Watson’s Caring Theory is a core in both nursing practice and nursing administration. The application of theory helps to understand how caring works to solve the individual case and even nursing management problems. Implementing 10 carrative factors brings nurses to be the real person that every single patient wants to be cared for. On the other hand, Nurse Managers or leaders could apply caring to nurse staffs, which the attributes of caring administration are commitment, self-worth, ability to prioritize, openness, and ability to bring out potential. Jean Watson has been piloted the Caring Model which hopefully in the future it will answer the big problems related to nursing care delivery models, nursing staffing, and other administrations issues.
References
Alligood, M.R., Tomey, A.M (2010). Nursing Theorists and their Work.
A Pragmatic View of Jean Watson’s Caring Theory – International …. Retrieved at: www.humancaring.org/conted/Pragmatic%20View.pdf
Erci, B., Sayan, A., Tortumluoglu, G., Kilic, D., Sahin, O., & Gungormus, Z. (2003). The effectiveness of watson’s caring model on the quality of life and blood pressure of patient’s with hypertension. Journal of Advanced Nursing, 41(2), 130-139.
Elements of spirituality and Watson’s theory of transpersonal caring: Expansion of focus. P Burns – Anthology on caring, 1991 – books.google.com
George, J. (1995). Nursing Theories: The Base for Professional Nursing Practice. (4th edition). Norwalk, CT: Appleton & Lange
Nyberg, J. (2011). A caring Approach in Nursing Administration. Retrieved at: books.google.co.id/books?isbn=1457109484
WatsonJ, Foster R. The attending nurse caring model. J Clin Nurs. 2003;12:360–365
Watson, J. (2006). Caring Theory as an Ethical Guide to Administrative and Clinical Practices. Nurs Admin. Vol 30, No 1 pp. 48-55
You can download the PDF here: The Application of Watson’s Caring Theory in Nursing Administration
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