Introduction

Nursing theories were developed as a guide for practice and to expand nurses’ critical thinking skills while increasing the better judgment of care for patients (Masters, 2012, p. 14). Theory allows nurses to better analyze patient data, make decisions related to nursing interventions, plan patient care, predict and evaluate outcomes (Masters, 2012, p. 14). While theory is intended to be the framework for practice, theory is woven throughout all nurses’ practice rather it is subconsciously or consciously known. For instance, maintaining sanitary conditions in the work space and for patients is using Florence Nightingale’s theory and it is safe to say every nurse is taught this early on in their career while still being an inspiring nurse. In this instance, nurses are using theory in their practice without being mindful of it.  

Jean Watson, a modern theorist whose theory is based on human caring, has captivated the minds of many nurses for decades. Jean Watson’s theory allows those who utilize it to emphasize on obtaining a higher degree of harmony within the mind, body and spirit. By achieving such harmony one can gain self-knowledge, self-healing, and self-care which in turn can promote healing and ultimately improved health (Masters, 2012, p. 56). Upon Watson forming her theory, she felt the best results could be derived from caring if both the patient and the nurse achieved harmony within. According to Masters, “The goal of the theory is pursued through transpersonal caring guided by 10 carative factors and corresponding caritas processes” (2012, p. 56-57).  “The meaning of caritas is to cherish, appreciate and give special attention; it conveys the concept of love” (Masters, 2012, p. 57). Even though the carative factors and caritas processes are the core that drives the theory, Watson balances out the theory by incorporating what she refers to as the “trim”. The “trim” is vital because it is the procedures, tasks, disease focus, technology and techniques used to improve physical health of patients, however this should not be the focus for practice because it lacks compassion (Masters, 2012, p. 57). Watson utilizes a metaparadigm which allows the theory to positively influence the people involved, their health, nursing practice and the environment.     

Person

            What is unique about Watson’s theory is that it does not have a traditional view to only care for the person as the patient but also the nurse involved. Watson’s theory ensures people are being cared for in a holistic form, meaning the mind, body, spirit and nature of a person has to be considered so healing can occur. Masters mentions how Watson believes humans are “embodied spirits” (2012, p. 59). Meaning people are not only composed of a tangible, physical element but that intangible elements occupy the physical body and all components of an embodied spirit have to be addressed (Sitzman, 2002, p. 2). Watson believes, “a person is able to transcend the physical world by controlling it, changing it, or living in harmony with it” (Masters, 2012, p.59). The holistic approach for nursing care cannot exist if one of the four aspects is being focused on more than the others, they all have to be acknowledged simultaneously (Masters, 2012, p. 59). Watson’s theory suggest a mutual connection in the nurse-patient relationship can be restorative for the patient if the nurse is also able to gain something therapeutic out of the established relationship (Sitzman, 2002, p. 4). It takes two people to build a relationship and in this case it is the nurse and patient, neither one can grow without the interaction of the other (Masters, 2012, p. 60). One of the embedded carative factors mentions developing and sustaining a helping-trusting, authentic and caring relationship; this is intended to maintain a trusting relationship that is built off of authenticity.  For example, if the nurse appears as caring and meeting the needs of the patient it can create trust within the patient and allow the opportunity for an authentic relationship to be established. When nurses and patients establish authentic relationships the patient is more willing to be in harmony with the nurse and the nurse’s awareness and knowledge of compassion for patients can be better understood. This allows for self-reflection and growth within all parties involved (Costello, 2017, pg. 2). 

Health

Masters defines health as unity and harmony within the body, mind and soul (2012, p. 60). Watson’s focus on achieving harmony within one’s self is essentially to promote health for that individual. For a person to manage harmony within themselves it involves acknowledging harmony between self and others as well as self and nature and being open to possibilities (Masters, 2012, p. 60). An example of harmony that can be achieved by self and others is when the nurse has a deep connection with their own spirit but also with the patient’s spirit. If nurses look for the uniqueness in patients, a relationship is built, nurses feel compassion towards patients and are willing to go too far extents so the patients’ health can be improved (Sitzman, 2002, p. 3). Through this process, nurses involve themselves in a moral commitment to improve the patient’s health and while doing so they create harmony within. On the opposite end of the spectrum disharmony can be imposed by disease or a person believing all illnesses are a disease. This creates subjective disharmony within the spheres of the person (Masters, 2012, p. 60).  How disease can cause subjective disharmony within a person is by creating conflict with the physical being of the person and the mind’s thought process. If disharmony is created then it is difficult for a person to regain optimal health.

In order, for caring to be a curative measure on the patient the nurse must promote self-knowledge, self-healing, and self-care and practice it as well. Watson does not interpret caring as a nice thing nurse’s to do for their patients but rather as a serious ontological, ethical and pragmatic concern for nursing (Masters, 2012, p. 60). In Costello’s teaching compassion study, the students who involved self-care in their personal lives noticed a decrease in stress, an increase in awareness and a need for compassion in their practice. Noticing the need for compassion also made the students realize the need for transpersonal relationships that were necessary in the quality of health for those at the end of life (2017, p. 2). Self-healing is great for restoring the energy to be compassionate towards patients because when compassion fatigue sets in there is not much left in the nurse to recognize the patient other than their physical presence. Lack of compassion and lack of acknowledging the spiritual aspects will hinder the healing process for the patient (Costello, 2017, p. 2). If the nurse integrates self- healing in their life they will more likely know how to guide their patients to practice the same. A patient maintaining self-care is vital for one’s health.   

Nursing Practice

            Ever since institutions have begun implementing Watson’s caring theory into patient care, the community now associates the nursing field as caring and it is important for nurses to uphold the image envisioned by many citizens. Nursing should have a reciprocal relationship during caring moments that are guided by carative factors. According to Watson, she feels nursing is a human science and art (Masters, 2012, p. 60). Tasks and procedures are seen as the science component and they vary for nurses in different setting, however, the core of Watson’s caring theory can be used by all nurses in any setting to form transpersonal relationships with their patients (Sitzman, 2002, p. 2). Watson’s theory of caring provides nursing practice a framework for addressing the mind-body-spirit of the nurse and client through the relationship and interactions between the two, this can be viewed as the art aspect to Watson’s belief (Sitzman, 2002, p. 2). The goal for nursing in Watson’s theory, “is to promote growth and find meaning in one’s existence and experience” (Masters, 2012, p. 60). A nurse can grow by using the effective learning tool of reflecting on the life experiences of patients undergoing care for serious illnesses (Costello, 2017, pg. 2). Another one of Watson’s carative factors focuses on the promotion of transpersonal teaching-learning and for the nurse that can promote growth and utilizing that growth when caring for future patients. The nurse should seek a connection with the inner spirit of the patient and have a genuine approach while being centered during the caring moment (Costello, 2017, pg. 2).  

            The caring theory can aid practice by using compassion to improve patient outcomes and getting patients back to optimal health within a short time span. For example, if a patient expressed needing pain medication more frequently than the times the pain medication was due at, this patient can be judged as drug seeking. The caring theory requires a nurse to assess any negative feelings or judgmental thoughts towards a patient so it does not conflict with care management. If the nurse is not judgmental and is sympathetic towards the patient’s needs the nurse can then speak with the physician to request pain medication that is due more frequently or a medication that is more therapeutic for the pain level. By not being judgmental and establishing a genuine relationship with the patient the nurse would be able to properly care for the patient and improve the patient’s health.

Environment

             Caring is the essence of nursing but most importantly it is necessary for a healing environment. “The environment is a nonphysical energetic environment, a vibrational field integral with the person where the nurse is not simply in the environment but “the nurse IS the environment”” (Masters, 2012, p. 59).  One of the carative factors suggest “being present, supportive and expressing positive and negative feelings in order to connect with a deeper spirit with one’s self and the one being cared for” (Masters, 2012, p. 59). It is a crucial factor for the nurse to do self-healing because if corrupt energy is brought into the environment of the patient then the patient will have difficulty healing because it disrupts harmony. The nurse must be aware of any judgmental feelings towards the patient’s situation so it does not foster any negative emotions and postpone being attentive to the patient’s needs (Sitzman, 2002, p. 4). It is also important that a nurse does not carry the negative emotions brought on from an interaction with one patient and carry that energy into the environment of the next patient. The environment is not just the enclosed space the patient occupies but is also a nonphysical energetic space which can be effected by the nurse leaving negative energy in the environment from the nursing-patient interaction (Sitzman, 2002, p. 4). If the nurse leaves joy and comfort then this exposes the patient to a healing environment where wholeness and self-satisfaction can be achieved. 

Other Theories

            Watson’s theory of caring is a derivative from a Zen tradition which many Western theorist do not follow. Incorporating Zen tradition into a theory has allowed it to have a different approach than any other theory since its origin are of a different cultural background (Sitzman, 2002, p. 1). Watson’s theory has evolved since first coming about in 1979 but has never drifted from its originality of one being connected with their interbeing and having a holistic approach for care (Sitzman, 2002, p. 1). Another extremely unique component to the care theory is if a person chooses to use the caring theory they must practice it in their own life (Sitzman, 2002, p. 1). In comparison to Watson’s theory, Betty Neuman uses Western tradition to drive her theory and undoubtedly there is a distinct difference between the two theories of care. Both theories focus on patient care but one is based off a reciprocal transpersonal caring relationship between the nurse and the patient while the other theory bases its focus of care on the patient’s systems. According to Masters, Neuman’s system theory is centered on a perception that approaches a wide range of nursing concerns with its main focus on the wellness of the patient’s system in relation to the environmental stressors and the patient’s systems reacting to the stress (2012, p.151). Neuman’s theory heavily incorporates the client’s systems and being exposed to environmental stressors, whereas Watson does believe the environment has an effect on the person and their physical system but focuses more on the person in a spiritualistic aspect.

Conclusion

             Overall, nursing theories are used to drive practice and increase the better judgement of care for patients. Nursing practice and patient care has evolved since Jean Watson introduced her theory in 1979. The theory ensures its authenticity by having nurses practice the theory in their personal lives as well as in their practice involving patients. The quality of care for humans is optimal, essentially because the holistic approach acknowledges people’s mind, body and soul.