A Critique of Jean Watson s Theory of Human Caring. Nicole Price. The George Washington University

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1 Running head: A CRITIQUE OF JEAN WATSON S THEORY OF HUMAN CARING 1 A Critique of Jean Watson s Theory of Human Caring Nicole Price The George Washington University

2 A CRITIQUE OF JEAN WATSON S THEORY OF HUMAN CARING 2 Abstract Jean Watson s grand theory of human caring details the use of caritas processes when caring for one s self and others. A human connection is made and can significantly affect health and wellness (Watson, 2008). This paper details the key factors, including the caritas processes, of the human caring theory. This detailed description is followed by a critique of the theory using Fawcett s criteria (Fawcett, 2005). There has been much research detailing the human caring theory utilization in nursing practice. Evidence is provided to support the soundness and significance of Watson s human caring theory.

3 Running head: A CRITIQUE OF JEAN WATSON S THEORY OF HUMAN CARING 3 A Critique of Jean Watson s Theory of Human Caring Caring is a quality and essential value that every nurse shares in their practice. Jean Watson believes that caring is the essence of nursing (Watson, 2008). Watson s grand theory of human caring has been an evolving process since it s inception in Watson s (2008) belief is that the science of caring is even more valuable to patient healing than that of curing. Dr. Jean Watson is an internationally renowned nursing theorist. She earned a bachelor s and master s degrees in nursing and a PhD in educational psychology and counseling. She is a Distinguished Professor of Nursing at the University of Colorado, where she was the Chair of Caring Science for 16 years (Watson, 2008). As the founder and director of the Watson Caring Science Institute, Watson promotes her theory of human caring on an international level through books, articles, videos, and workshops. Key Concepts There are three main elements to Watson s theory. They include the caritas processes, transpersonal caring relationships, and caring moments (Caruso, Cisar, & Pipe, 2008). Caritas Processes Originally Watson developed ten carative factors and over time they evolved into caritas processes. As described by Caruso, Cisar, and Pipe (2008), caritas is a term that characterizes how nurses may choose to approach their patients and colleagues. Caritas is derived from a Greek word meaning to cherish, to appreciate, to give special attention (Watson, 2008). The ten caritas processes are: 1. Embrace altruistic values and practice loving kindness with self and others.

4 Running head: A CRITIQUE OF JEAN WATSON S THEORY OF HUMAN CARING 4 2. Instill faith and hope and honor others. 3. Be sensitive to self and others by nurturing individual beliefs and practices. 4. Develop helping-trusting-caring relationships. 5. Promote and accept positive and negative feelings as you authentically listen to another s story. 6. Use creative scientific problem-solving methods for caring decisionmaking. 7. Share teaching and learning that addresses the individual needs and comprehension styles. 8. Create healing environment for the physical and spiritual self which respects human dignity. 9. Assist with basic physical, emotional, and spiritual human needs. 10. Open to mystery and allow miracles to enter. Transpersonal caring relationships Watson (2008) states, caring begins with being present, open to compassion, mercy, gentleness, loving-kindness, and equanimity toward and with self before one can offer compassionate caring to others. She describes a universal field that surrounds us and how what one does for oneself affects others and vice versa. This human caring theory can be applied to patients, coworkers and most importantly, one s self. As demonstrated by Goldin and Kautz (2010) in their example of a critical care nurses application of Watson s theory to better her life when faced with the death of her spouse,

5 Running head: A CRITIQUE OF JEAN WATSON S THEORY OF HUMAN CARING 5 a move to a different state, and a new job. This account details her successful changes she made to her life through the ten caritas processes Caring Moments Caring moments are those occasions between a nurse and their patient where they connect deeply on a personal and spiritual level. The nurse is fully present and open to the other person during this period of interaction (Watson, 2008). Evaluation of Theory Fawcett (2005) has developed criteria to analyze and evaluate nursing theories. Those criteria include significance, internal consistency, parsimony, testability, empirical adequacy, and pragmatic adequacy. The following is a critique of Jean Watson s grand theory of human caring using Fawcett s criteria. Significance Watson addresses three metaparadigm concepts: human beings, health, and nursing. She defines a human being as a valued person to be cared for, respected, nurtured, understood, and assisted. Health is complete mental, physical and social wellbeing and functioning. And nursing is a human science where patient s health issues are cared for not only by using science, but also through caring moments or occasions (McEwan & Wills, 2012). Watson details the importance of human caring theory to a strong nursing foundation. Her philosophical and spiritual backgrounds are the basis for the framework and are clearly explained throughout the theory. The human caring theory has been applied to nursing education and patient care models throughout the world.

6 Running head: A CRITIQUE OF JEAN WATSON S THEORY OF HUMAN CARING 6 Internal Consistency Although the theory has evolved over time and has been revised by Watson, the key concepts have remained the same. The ten caritas factors, now called processes are congruent with the conceptual model of caring and its affect on nurses and their patients. Through detailed descriptions of the concepts of transpersonal caring relationships and caring moments, nurses connect to their patients in a positive manner that will aid in healing and health (Caruso et al., 2008). This reflects both semantic clarity and consistency. And although caring moments are also termed caring occasions in the theory, the definitions remain consistent. Parsimony The human caring theory is stated clearly and concisely. The major concepts are clearly defined and supported. Watson uses the ten caritas processes to guide nurses in their practice of caring for themselves and others. Testability There are numerous studies applying Watson s theory of human caring to many aspects of nursing, including professional practice models and nursing education. The research methodology is qualitative and inductive in the human caring theory. This methodology is congruent with the philosophical claims and content of the human caring theory as well. The essence of the theory has been evidenced in studies through in-depth descriptions of experiences in human caring. For example, Drenkard (2008) detailed the success of integrating human caring science into a large hospital s professional practice model and Goldin and Kautz (2010) described the personal experience of a critical care nurse applying the theory to change her life for the better.

7 Running head: A CRITIQUE OF JEAN WATSON S THEORY OF HUMAN CARING 7 Empirical Adequacy The findings of the studies are congruent with the concepts and propositions of the human caring theory. Watson s theory connects nursing and caring and the value of caring to the health and wellness of patients (McEwen & Wills, 2012). Pragmatic Adequacy Education is required before application of the theory into nursing practice. In the study by Caruso et al. (2008), they made the educational sessions very accessible to staff, offering two sessions a day in inpatient and outpatient areas. Drenkard (2008) offered training to implement caring activities and taught centering techniques to give nurses time and opportunity to have more caring moments with their patients. Nurses were taught medication and given centering lounges to prepare them to be even more caring and compassionate to their patients. These studies are just a few that are examples of real world human caring theory in action. They show that it is feasible to implement practice derived from human caring. Comparisons can be made in the Drenkard (2008) study of patient satisfaction scores from before the theory was implemented and after. The results showed an improvement in patient satisfaction. Caruso et al. (2008) used a formal questionnaire on caring efficacy pre and post human caring theory integration. Conclusion Watson s human caring theory is a widely used in nursing practice. Through evaluation using Fawcett s (2005) criteria, the soundness and significance of human caring theory to nursing practice is proven. Nurses caring for themselves can provide a healing environment beneficial to patients. Although Watson s theory is the newest of

8 Running head: A CRITIQUE OF JEAN WATSON S THEORY OF HUMAN CARING 8 nursing s grand theories, it contains concepts that significantly affect nursing practice and how caring can make a difference to the health and wellness of every life they touch.

9 Running head: A CRITIQUE OF JEAN WATSON S THEORY OF HUMAN CARING 9 References Caruso, E., Cisar, N., & Pipe, T. (2008). Creating a healing environment: An Innovative approach to Jwan Watson s theory of human caring. Nursing Administration Quarterly, 32(5), doi: /01.NAQ Drenkard. K.N. (2008). Integrating human caring science into a professional nursing Practice model. Critical Care Nursing Clinics of North America, 20(4), Fawcett, J. (2005). Criteria for evaluation of theory. Nursing Science Quarterly, 18(2), doi: / Goldin, M., & Kautz, D. (2010). Applying Watson's caring theory and caritas processes to ease life transitions. International Journal For Human Caring, 14(1), McEwen, M. & Wills, E.M. (2011). Theoretical basis for nursing (3 rd ed.) Philadelphia: Wolters Kluwer/ Lippincott Williams & Wilkins. Watson, J. (2008). Nursing: The philosophy and science of caring (revised ed.). Boulder, CO: University Press of Colorado.

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