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What IS the Jean Watson Theory of Nursing?

This blog gets a lot of hits as a search result for Jean Watson's Caritas theory of nursing. A recent comment asked for a real-life, non-academic definition of the theory.

If I had to put it in a brief nutshell, I'd say that theory states that nurses need to recognize the patient not only as a physical being, but as a spiritual being as well. Not only do we concern ourselves with measurable parameters (vital signs, lab results, radiology scan results, etc.) but also with the non-physical needs of the patient as well.

Many of the twelve Caritas (Caring Theories) described in Jean Watson's theory can also be understood in terms of the seven Chakras- the seven energy centers of the body.

• Survival issues such as financial independence, money, and food
• Sense of abundance, well-being, pleasure, sexuality.
• Self-worth, self-confidence, self-esteem.
• Love, joy, inner peace.
• Communication, self-expression of feelings, the truth.
• Intuition, imagination, wisdom, ability to think and make decisions.
• Inner and outer beauty, our connection to spirituality, pure bliss.

In Jean Watson's theory, the well-being of the caregiver is also enhanced. As nurses, we can become more spiritually actualized by creating a unique "time-space relationship" with the patient. By living "in the moment" with the patient, the nurse and patient can become more than the sum of the parts.

To be honest, I don't have much of an idea exactly how that last part happens, and I think this is where the theory becomes a challenge. But I think that an important place to start is to ask the patient questions, truly listen to their answers, and try to be as supportive as a nurse can be:

• Tell me about yourself?
• Tell me about your life experiences?
• Tell me about your bodily sensations?
• Tell me about your spiritual and cultural beliefs?
• Tell me about your goals and expectations?
• Tell me about your health?
• What is it like to be in your situation?
• Tell me how you perceive yourself in this situation?
• What meaning are you giving to this situation?
• Tell me about your health priorities?
• Tell me about the harmony you wish to reach?

(from A Pragmatic View of Jean Watson's Caring Theory, Chantal Cara, Ph.D., RN)

From Jean Watson's A Caring Moment (a meditative recording):

Why are we in this field, when it often seems like we are only there to fix the body, to give physical diagnosis and treatment?

Healing is much more than that... it's about honoring your presence, your connectedness with another person. It is that caring moment that can be a critical turning point in your life and in another person's life, as we touch another person's humanity... This is what healing is all about.

What if we began to pause, and to realize that, maybe, this one moment, with this one person, is the very reason we are here on Earth at this time?

When we hold them in their whole-ness, we hold their healing for them, and we help to sustain them when they are most vulnerable... and as we sustain another person, we are sustaining ourselves...

You can listen to Jean Watson's recordings here.

Employee self scheduling; Jean-Watson Theory; Stocks; Ladykitty and other reasons I don't sleep right...

I've been really busy of late. Several weeks ago, I posted about how our hospital had started to institute layoffs, which has been a bit of an eye opener considering a few months before that, we were all talking about the nursing shortage. So even though I am pretty far up the food chain now, I started to apply my philosphy of "making myself indispensable." Which basically means I have totally over-extended myself.

• I recently found out that our scheduling program (called AtStaff) already has the capability for employees to enter their own schedule requests. For years, we have been told that this was something that would be available "later" but come to find out we've had it for years. Which means I could be just a few weeks away from being able to do the schedule totally on the computer, with employees entering their requests online and balancing themselves (somewhat) online. I'll still have to make the always-unpopular decisions of who to move from the overstaffed shifts to the understaffed ones, but it can all apparently happen on our intranet without the reams of paper I presently use to produce a schedule.
• However, because no one in the hospital knows how to implement this aspect of the program, I am having to learn it on my own with some webinars from our vendor. It has been a lot of time, and I'm at the hospital late or on my days off a lot more than I like.
• After I figure out how to do the program, I have to figure out how to orient my fellow charge nurses and then our 80+ employees on the process.
• I'm still working on the implementation of the Jean Watson Caring Theory of Nursing, but I am at a total standstill. Most of this is because our initial meeting with Jean Watson simply didn't impress very much of us, especially those that are as firmly rooted in the Scientific Method as I am. I've read her material and so I saw this conflict on the horizon, but now our Clinical Directors, Vice Presidents and CEO's are wondering how to get the Jean Watson model up and running when we are also supposedly into Evidenced Based Practice. I'm sure there's a way for both to co-exist, and no one would deny that many of our patients can benefit, but I have not come up with a way to either model the behavior or teach it to others, much less design a way to document that we use the theory.
• The stock market has been in a rally for the past couple of months, which basically gives me another part-time and sometimes full-time job. I run stock screens after each day's close, which I have to spend one or two hours doing research. So when I'm working, I have to get up early to do some printing and research, then when I get back at 7am I finish that, settle on the 3-5 stocks I'll stalk at the opening bell, and then I'm watching the screen on and off until the close. If I'm working, I have to set Stops and hit the sack by 10a or I'm doomed. It's been busy but at least it's also been profitable.
• LadyKitty, our 13-year old tabby, is still getting 150-200cc subcutaneous fluids pretty much every day. That's been going on now for the past 16 months. She has her good days, and her bad days. On her bad days, I put her in the closet in my room so the other cats can't bother her, and sometimes that means I am up two or three hours after I go to sleep to let her out.

Luckily, roomie has pretty much taken over running the apartment, taking care of all the cleaning and cooking.

A meeting with Jean Watson... 2 stars out of 4...

Jean Watson spoke at our hospital the other day.

I had worked the night before, and my shift ended at about 0630am, but the meeting wasn't scheduled until 8a. So I spent more than an hour sitting in my car, parked in the employee parking deck, watching Rachel Maddow shows on my iPod.

The meeting was packed, with about 50 nurses attending. All of us were either charge nurses or clinical directors with a few clinical educators mixed in.

I think Jean Watson thought all of us were well-versed in her theory, and that everyone in the room was accustomed to the spiritual, metaphysical and existential nature of her work. I don't think she realized that very few of the nurses attending were very familiar with her book. Thus it surprised me when, with very little by way of introduction or preparation, she proceeded with a meditation exercise. She brought out a "singing bowl" very similar to the one pictured here, and she rubbed the rim with the stick which caused the bowl to resonate.

I've never been very good with meditation. I've tried several times to meditate and I just can't do it. So while everone else in the room bowed their heads and closed their eyes, I started to get a serious case of... the giggles.

To stop myself, I started calculating the Fibonacci sequence of numbers in my head.

Not a great beginning.

It's not that I don't believe in the theory. I do think it is important to appreciate our patients as a total, unique, spiritual, significant human being, and not simply a machine. That's something I can get behind.

But I was sort of hoping the meeting would be more of a "hands on" session, with all of us charge nurses discussing how to actually use the theory.

• What specific behaviors would be seen when observing a nurse that is well versed in the theory?
• What sort of verbalizations should be used? In other words, what needs to be said?
• How do you document use of this theory?
• How do you use the theory if your background and comfort zone is more scientific / numerical / logical / empirical?
• As a charge nurse, with scientific background/personality, how can I teach or model this theory for my nurses?

We didn't really go into that at the meeting. In fact, at one point, one of the nurses finally simply asked Jean Watson to go over the 10 Caritas Processes, to which she surprisingly replied, "Wow I'm not sure I can do that, I'm not sure _I_ even know them."

One of the nurses handed her a copy of her book, after which she did give a pretty good review of the basic concepts, but I was still taken aback that she didn't know her own material well enough to cite them from memory (although she did admit that she planned to do a more thorough discussion of the theory in a more general-audience meeting later in the day).

I guess if I had to rate the meeting, I'd have to give it 2 stars out of 4.

Jean Watson: Caring Theory of Nursing... Caritas Processes...

Updated 3/14/2009

   Our hospital network is adopting Jean Watson's Caring Theory of Nursing.

Most nursing theories are based on Nursing as a humane and compassionate application of a scientific method. Jean Watson encourages us to "return to our core values", and recall the "original reason we all went into nursing", things we as nurses tend to forget when carrying out the "clipboard nurse" type of nursing, where we exhaustively collect data in the form of measurements and numbers. Watson asks all of us as nurses to be more "in tune to the moment" when interacting with our patients (she doesn't like the "customer" model of the modern hospital), and realize that our interactions can be more humane, significant, and caring.

Nursing, as the underling of the medical profession, often works to turn the human being into the human body, further breaking him/her down into just a "body", and eventually just a "machine."

Nursing work too often focuses on "doing" rather than "being", and has become too easy to "do something" to a machine, things we would never consider doing to a human being.

Watson describes ten "Caritas Processes". Originally "Carative Factors," she redefines these essential "core values":

Formation of humanistic-altruistic system of values, becomes: "Practice of loving-kindness and equanimity within context of caring consciousness

Instillation of faith-hope, becomes: "Being authentically present, and enabling and sustaining the deep belief system and subjective life world of self and one-being-cared- for";

Cultivation of sensitivity to one's self and to others, becomes: "Cultivation of one's own spiritual practices and transpersonal self, going beyond ego self";

Development of a helping-trusting, human caring relationship, becomes: "Developing and sustaining a helping-trusting, authentic caring relationship";

Promotion and acceptance of the expression of positive and negative feelings, becomes: "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";

Systematic use of a creative problem-solving caring process, becomes: "creative use of self and all ways of knowing as part of the caring process; to engage in artistry of caring-healing practices";

Promotion of transpersonal teaching-learning, becomes: "Engaging in genuine teaching-learning experience that attends to unity of being and meaning attempting to stay within other's frame of reference";

Provision for a supportive, protective, and/or corrective mental, physical, societal, and spiritual environment, becomes: "Creating healing environment at all levels, (physical as well as non-physical, subtle environment of energy and consciousness, whereby wholeness, beauty, comfort, dignity, and peace are potentiated";

Assistance with gratification of human needs, becomes: "assisting with basic needs, with an intentional caring consciousness, administering ‘human care essentials', which potentiate alignment of mindbodyspirit, wholeness, and unity of being in all aspects of care"; tending to both embodied spirit and evolving spiritual emergence; Allowance for existential-phenomenological-spiritual forces, becomes: "opening and attending to spiritual-mysterious, and existential dimensions of one's own life-death; soul care for self and the one-being-care-for.

 

Our new Clinical Director gave all of us Charge Nurses a copy of Watson's book, which I dutifully read and attempted to absorb over a weekend.

It's going to be a challenge for me. I've never been that "spiritual" or "metaphysical", instead relying on my scientific background thoroughly grounded in skepticism and empiricism. A lot of these carative factors / Caritas Processes are difficult for me to understand on anything more than an intellectual basis. In other words, I have been unable to bridge the gap between vocabulary and meaning.

Jean Watson is scheduled to come to our hospital tomorrow, and I'll be meeting with her along with other charge nurses throughout the hospital in a 90-minute presentation.

Links:

Jean Watson's information page from the University of Colorado Denver.

The Watson Caring Science Institute's page.

From RNJournal.com, a good overview.

Search Query Results from PubMed.

A Pragmatic View of Jean Watson's Caring Theory.   A Word document giving a general review of Watson's Theory and a case study of its implementation.  (Viewer).