Introduction of theorist:

 Margaret jean Watson born in south west Virginia and grew up during 1940s
and 1950s in small town of Welch.
 She done her graduation in 1961 from lewis gale school of nursing in
Roanoke, Virginia.
 she done her graduation in nursing from university of Colorado.
 She done her bsc in 1964 at boulder campus and Msc in psychiatry nursing
in 1966 at health science campus.
 She done her Ph.D in educational psychology and counseling in 1973 at
graduate school boulder campus
 Dr. jean Watson is distinguished professor of nursing and former dean of the
school of nursing at university of Colorado in 1983-1990.
 She developed post baccalaureate nursing curriculum in human caring,
health ,healing which lead to career professional clinical doctoral degree.
This programme was selected as a national programme in implemented in
1990 .
 She received honorary doctoral degree from assumption college in
Worcester ,Massachusetts, The university of Akron, university of west
Virginia,Goteborg university in swedonand university of London.
 She also received the distinguished professor of nursing at university of
Colorado in 1992.
 In 1993 she received the award of national league of nursing Martha E.
Rogers award.
 She was president of NLN from 1995-1996.
 she is the founder of the cantre of caring in Colorado.she is also a member of
American academy of nursing and has served as president of national league
of nursing.
National and international work of Watson:
 Her national and international work includes lectureships throughout
various states.
 Her international activities include an international Kellogg
fellowship in Australia, Fulbright research and lecture award to
Sweden
  She also involved in international projects and invitation in various
countries.

Publications of Watson:

 In 1979 Nursing: the philosophy of science and technology

 Nursing human science and human caring –A theory of nursing published in
1988.
 Most recently in 1999 she published Postmorden nursing and beyond
 One of her earliest written treaties on caring model was presented at an
American nurses association divison of practice meeting in 1979.
 Caring science as sacred science in 2005
Theoretical sources:
 Traditional nursing knowledge of nightingale,Henderson,krueter and hall.
 She acknowledge the work of leininiger ,gadow, and peplau as background
of her theory.
 She also refer the work of others such as Msalow, Heidegger,Erickson,
selye, lazarus, Whitehead, de Chardin and Serte.
 She also acknowledge feminist theory, quantum physics, wisdom traditions
and perennial philosophy, .
 She puts her emphasis on the carl roger ‘s thought of understanding,
therapist patient relationship,transpersonal psychology and
phenomenological view.
 Yalom ‘s 11 curative factors stimulated watson’s thinking about
psychodynamics and human component that is applied to her 10 carative
factors in nursing.
Major concept of theory:

The major conceptual elements of the original theory are:

 Ten carative factors

 Transpersonal caring relationship
 Caring moments/caring occasion
 Caring healing modalities
Other component include are
 Expanding views of self and person
  Caring healing consciousness and intentionality to care and promote healing
caring consciousness as energy within the human environment field for a
caring environment.
 Unitary consciousness: unbroken wholeness and connectedness of all
 Advanced caring healing modalities /nursing arts as future model for
advanced practice of nursing qua nursing.
Ten carative factors:

Watson describe 10 carative factors as those aspects of nursing that actually

potentiate therapeutic healing processes and relationships; they affect the one
caring and the one being cared for. These 10 carative factors are based on
knowledge base, clinical competence and healing intention.

Each carative factor has a dynamic phenomenological component that is relative to

individuals involved in the relationship as encompassed by nursing. The 1st three
independent factors serve as the “philosophical foundations for the science of
caring:

1)Formation of humanistic-altruistic system of values: humanistic and altruistic

values are learned early in life but can be greatly influenced nurse educator.

2)instillation of faith and hope: It promotes holistic nursing care and positive
health within the patient population.it describe nurse role in developing effective
nurse patient interrelationship and in promoting wellness by helping the patient
adopt health seeking behaviours.

3)cultivation of sensitivity to self and others: The recognition of feelings leads to

self-actualization through self-acceptance for both the nurse and the patient.

As nurse acknowledges their sensitivity and feelings, they become more genuine,
authentic and sensitive to others.

4)Development of a helping trust relationship: The development of a helping

trust relationship between the nurse and the patient is crucial for transpersonal
caring. A trusting relationship promotes and accepts the expression of both positive
and negative feelings.

Helping trust relationship involves

 Congruence- Being Real, honest, genuine and authentic.

 Empathy- ability to experience and thereby, understand the other person’s

perceptions and feelings and to communicate those understandings.

 Non-possessive warmth- It is demonstrated by a moderate speaking volume, a

relaxed, open posture and facial expressions that are congruent with other
communication.

 Effective communication- It has cognitive, affective and behavior response

components.

5)Promotion and acceptance of the expression of positive and negative

feelings:

Nurse must recognize both +van and –ve feeling . she must be aware of the
feelings and analyze the situation in emotional and intellectual understanding

6) Systematic use of the scientific problem solving method in decision making:

 Use of nursing process is scientific method of problem solving

7)Promotion of interpersonal teaching learning:

 It allows the patient to be informed and shifts the responsibility for wellness
and health to the patient

 The nurse facilitates teaching-learning and enables the patient to provide

self-care, determine personal needs, and provide opportunities for their
personal growth.

8)Provision for supportive , protective and corrective mental, physical

,sociocultural and spiritual environment:

 Nurse must recognize the influence that internal and external environment has on
health and illness of individuals.

 External environment variables include comfort, privacy, safety and clean aesthetic
surroundings.
 Internal environment include mental and spiritual well-being and socio-cultural
beliefs of an individual.

9) Assistance with gratification of human needs:

Watson describes this carative factor as being a systematic way of attending to an

individual’s comfort well-being including symptom management

Watson’s ordering of Needs

 Lower Order Needs (Biophysical Needs)

o The need for fluid and fluid, elimination and ventilation.

 Lower Order Needs (Psychophysical Needs)

o The need for activity, inactivity, sexuality.

 Higher Order Needs

o The need for achievement, affiliation

o Interpersonal- Intrapersonal needs such as self-actualization.

10) Allowances for existential phenomenological forces:

 It describes data of immediate situation that help people understand the

phenomena in question Existential psychology is the study of human
existence using phenomenological analysis.

 Phenomenology is a way of understanding people from te way things appear

to them, from their frame of reference.

Watson believes that the nurses are responsible to go beyond the 10 curative
factors and to facilitate patient’s development in the area of health-
promotion through preventive health actions. This goal is accomplished by
teaching patients personal changes to promote health, provide situational
 support, teaching problem-solving methods and recognizing coping skills
and adaptation to loss.

Transpersonal caring relationship:

 Transpersonal goes beyond the ego self and beyond the given moment,
reaching to deeper connections to spirit and with the broader universe.
 Transpersonal seek to connect with and embrace the spirit and soul of other
through the concept of caring and healing and being authentic relation in
moment.
 Trans personal caring can be given by inner consciousness.
 Nurse enter the phenomenal field of other and determine the another
person’s condition and uniqueness of moment
 The nurse enters into and remains within the frame of reference of another
person and connects herself to inner world of meaning and spirit.
 The person is viewed as a whole and complete regardless of illness and
disease.

Caring moment and caring relation:

 Caring moment become transcendent whereby experience and perception
take place.
 A caring moment involves action and choice by both the nurse and other.
 Caring moment present the opportunity to decide how to be in moment, in
relation, and what to do in moment.
 There is a feeling of connection at spirit level and it opens the possibility for
healing and human connection at a deeper level.

Caring (healing) consciousness:

 The transpersonal dimension of caring moment is affected by nurse’s

consciousness in caring moment, which in turn affects the field as a whole.
 The whole caring healing loving consciousness is contained within a single
caring moment
  The caring healing process is not only connected with one who is caring and
one who is being cared for but is connected with the other human and with
the higher energy of the universe.
 The caring healing loving consciousness of the nurse is communicated to
one being cared for.
 It transcends time, space and physicality.

Caring healing modalities: it include the caring model

 It is considered a philosophical and moral/ethical foundation for professional

nursing.
 It offer a framework that embraces and intersect with
art,science,humanities,spirituality,and new dimensions of mind body spirit
medicine and nursing .
 It is a initiative and opportunity to interact with ideas, experiment with and
grow with philosophy,and live it and put it in one’s personal /professional
life.

Fawcett’s trade of concept:

Health:

 Watson believe in health promotiom,restoration and illness pvention.

 Health refers to unity and harmony with in the mind, body and soul.
 It is associated with the degree of congruence between self as perceived and
the self as experienced.
 Watson seeks to search for spiritual aspects of health and healing,
acknowledging the metaphysical/spiritual level,attending to nonphysical
,spiritual dimensions of existence.

Nurse:

Acc to jean Watson:

  Nurse include life experiences of her in caring the patient
 Nurse is to be sensitive to one’s feeling,thoughts, experience and develop the
her own and that of patient’s potentials.
 She cultivate the higher self consciousness.

 Nurse focuses on health promotion and treatment of disease.

 Holistic care is central to nursing practice.

 Nurse has opportunities to obtain advanced education and engage in higher

level of analyses of problem and concern in their education and practice that
has allowed the nurses to combine its humanistic orientation with relevant
science.
 Nurse incorporates both art and science in her caring healing process
 She care the patient with interpersonal relationship and consider the person
as a whole
 Caring occasions involve actions and choice by nurse and client. If the
caring occasion is transpersonal, the limits of openness expand as do human
capacities.
 She is responsible for another person as separates the one person from
another in being.
 She develop a helping trusting relationship with patient
 She develops authentic communication with patient.
 A nurse protects, enhance, and preserve my patient’s dignity, humanity,
wholeness, and inner harmony.”

Environment:

 Focus of care is both internal and external environment

 Healing environment comes through the intentional use of consciousness.
 Focus is on internal and external environment such as stress, comfort,
privacy, safety, and clean aesthetic surrounding.
 Watson situate the body with in the spirit
 Posivite interaction with the environment help to potentiate the self healing
capability
  According to Watson caring (and nursing) has existed in every society. A
caring attitude is not transmitted from generation to generation. It is
transmitted by the culture of  the profession as a unique way of coping with
its environment

Human being:

 Watson categorized the human needs in term of biophysical needs such as

food and fluid ,elimination and elimination, psychophysical needs such as
achievement and affiliation, interpersonal needs such as self actualization .
 Watson views human being in the dimensions of body, mind and spirit.
 Human being has metaphysical potential for self healing and transdence to
higher level of consciousness
 Human being has ability to change the environment with coparticipatant
agents of change
 Nursing is to help the person to gain higher level of harmony through
transpersonal caring.
 Self actualization is concerned with the pursuit of life goals and this factor
help person to explore meaning in life.
 Nursing is to help individual to gain more self knowledge , self control,and
readiness for self healing.
 Every human being is unique.
 She adopts a view of the human being as:  “….. a valued person in and of
him or herself to be cared for, respected, nurtured, understood and assisted;
in general a philosophical view of a person as a fully functional integrated
self. He, human is viewed as greater than and different from, the sum of his
or her parts”.

Assumptions related to – Human care values

1. Care and love comprise the primal and universal psychic energy.

2. Care and love, often are looked, are the cornerstones of humanness, nourishment of
these needs, and fulfills humanity.
3. The ability to sustain the caring ideal and ideology in practice will affect the
development of civilization and determines the nursing contributions to society.

4. Caring for the self is the pre-requisite to caring for others.

5. Historically, nursing has held a human care and caring stance in regard to people
with health- illness concerns.

6. Caring is a central- unifying focuses of nursing practice- the essence of nursing.

7. Caring, at the human level, has been increasingly de-emphasized in the health-care
system.

8. Technological advancements and institutional constraints have sublimated

nursing’s caring foundations.

9. A significant issue for nursing today and in the future is the preservation and
advancement of human care.

10.Only through interpersonal relationships can human care be effectively

demonstrated and practiced.

11.Nursing’s social, moral and scientific contributions to mankind and society lie in
its commitments to human care ideals in theory, practice and research.

Assumptions related to science of caring in nursing :

Caring can only be effectively demonstrated and practiced only

interpersonally

Caring consist of caring factors that result in satisfaction of certain

human needs

Effective caring promotes health and individual or family growth

Caring response accept person not only as he/she is now but what a
person can become A caring environment offers the development of
potential while allowing the person to choose the best action for
himself/herself at a given time.

Caring is more than curing

 The practice of caring is central to nursing

Application of Watson theory:

Nursing education:

 A two year curriculum of serial seminars designed to support new hiers in

their clinical, educational and professional growth now include a unit on self
care to promote healing and self growth
 Caring modalities is used in pain management unit

 Watson’s theory is being taught in numerous baccalaureate nursing curricula

including Bellarmine College in Worcester Massachusetts; Indian State
University in Terre Haute, Indian and Florida Atlantic University in Boca
Raton Florida.

 Watson’s emphasizes that both the core and trim of nursing is necessary in
curricula of nursing Core of Nursing includes those aspects of nurse-patient
relationship resulting in a therapeutic outcome trim of nursing includes the
procedures, tasks and techniques used by various practice settings.

 Clock hrs are designed to respond to immediate needs and to encompass a

diverse range of topics from conflict resolution ,professional development ,
to health treatment plans, physiology of medical diagnosis and in service on
new technologies and pharmacological interventions.

Nursing practice:

 Holistic approach is being instituted in various institutions

 Watson theory is clinically validated in various populations and settings

 Clinical settings include- critical care units, neonatal intensive care units,
pediatric and gerontological care units.

 Population include women who have had newborns in intensive care units
and women identified as socially at risk, post-myocardial patients, oncology
patients, persons with AIDS and elderly.

Nursing research:
  Watson caring is used in conceptual and theoretical development.

 Jean Watson hopes that nursing research will incorporates and explore
aesthetic, metaphysical empirical and contextual methodologies.

 Abstractness of the concept of caring and the clinical reality (e.g. brief
interactions with patients afforded by outpatient or office visits) has limited
the development of knowledge base in Watson’s caring theory.

 Research and practice must focus on both the subjective and objective
patient outcomes in determining whether caring is essence of nursing

Conceptual framework for guiding community health nursing practice:

 Watson’s concepts of caring is extents from person-person relationship to

person-community relationship
 Goal of nurse is to enhance community self determination
 Principles of health promotion and models of caring are tenets of primary
health care
 Watson’s theory, which recognizes the whole in the parts, supports a focus
on the wholeness of a community, aggregate, or population, while still
attending to individual and families within it.
 In extrapolating ideas of mind body spirit to the community-
 Body of the community may refer to physical attributes of the environment,
the services it offers and the demographics of a community.
 Mind- refers to a community’s cultural norms, laws and political structures.
 Spirit- refers to the community’s value systems.
 Community spirit may be exemplified in the community’s value system
 Health according to Watson is unity and harmony within body-mind-spirit
and with the world. Harmony within the various aspects of community as
well as its relationship to the outside world reflects health, while disharmony
is indicative of illness
 Watson assertion of caring involve helping a person gain more self
knowledge, self control,and readiness for self healing. Health promoting
 actions identified by Ottawa charter such as strengthening community action
is consistence with this aspect of transpersonal caring

 Another of the Ottawa’s Charter’s 5 health promoting actions- the

development of personal skills is demonstrated in Watson’s caring factor
related to transpersonal teaching-learning.

The other three carative factors health-promoting actions- creating

supportive environments, building healthy public policy and
reorienting health services toward health-promotion approach are
encompassed by carative factor that tends to support, protection or
correction of socio-political environments.

 Watson theory guide community health nurse to examine and address

social,economic,political and other environmental determinant of health.
 Watson’s caring relationship in clarifying values and being authentically
present to the client is applied in community.
 The reflective and creative use of the problem-solving process is consistent
with the contemporary ideas of health promotion because according to
theory, it occurs within the context of a relationship of mutuality where the
community health goals are paramount and there is least opportunity for the
community’s active and equal participation in the process
 Transpersonal teaching-learning is an important part of the health-education
in which community health nurses frequently engage
 Human needs assistance is described by Watson as a systematic way of
attending to client’s needs and again can be applied to communities. The
promotion of self-responsibility and development of personal skills are an
integral part of this carative factor
 Allowance for existential- phenomenological- spiritual forces in community
health promotion acknowledges the wholeness of community and may help
the community find meaning in the face of disaster

Future application:
 In future nurses will realize the importance of having nursing theories to
guide their work.
  Nursing will be based on evidence based care that will improve the quality
of care and professional accountability
 In future nurses and physician will practice side by side as equally valued
colleagues who share expertise in different area.
 Future caring will involve alleviating suffering on all different levels of
world.
 Nurses are in convienent position to serve as advocate and to care for others,
weather in the environmental world, social world or personal world
 In future nurse robots will be in existence but nurse robots can perform only
basic nursing care activities whereas nursing caring is something restricted
wholly to human beings.
 Nurses engage with human being through communion which is basic context
of caring.
 Techonolgy will be only cure the body while nurses will care the entity of
body,soul and spirit.
 Depression will be the major disease of future and nursing resources will be
earmarked for the well being of human soul and spirits
 When people have reached the harmony and balance in their body,soul and
spirit they will be more concerned with well being o other human being.

Robots will allow the patients to stay at home and will feel less vulnerable in their
homes.

Watson’s theory and nursing process

 Watson points out that 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. Watson elaborates the two
processes as:
1.      Assessment
 Involves observation, identification and review of the problem; use of
applicable knowledge in literature.
 Also includes conceptual knowledge for the formulation and
conceptualization of framework.
  Includes the formulation of hypothesis; defining variables that will be
examined in solving the problem.
2.      Plan
 It helps to determine how variables would be examined or measured;
includes a conceptual approach or design for problem solving. It
determines what data would be collected and how on whom.
3.      Intervention
 It is the direct action and implementation of the plan.
 It includes the collection of the data.
4.      Evaluation
 Analysis of the data as well as the examination of the effects of
interventions based on the data. Includes the interpretation of the
results, the degree to which positive outcome has occurred and
whether the result can be generalized.
 It may also generate additional hypothesis or may even lead to the
generation of a nursing theory.

Critique of Watson theory:

Clarity:
 Watson theory uses nontechnical yet sophisticated language
 She increase the inclusion of metaphor, personal reflection art work, poetry
make her complex concepts more tangible and aesthetically appealing.
Simplicity:
 Watson draws a number of discipline to formulate her theory
 It is viewed as complex when considering existential phenomenological
nature of her work
Generality:
 The generality is limited by emphasis placed on psychosocial aspect than the
physiological aspect of caring.
 Watson theory must be internalized to practice and the nurses who want
clear guidelines may not feel secure when try to rely on this theory
Empirical precision:
 Watson theory is descriptive and evolving as nature and welcome inputs by
others.
  The methodology relevant to studying transpersonal caring and developing
nursing as a human science and art can be classified as qualitative,
naturalistic or phenomenological.
 Watson acknowledge that a combination of qualitative and quantitative
inquiry may also be useful
Derivable consequences:
 Watson theory provide a useful and important metaphysical orientation for
delivery of nursing care
 It help nurses and patient find meaning and harmony in period of increasing
complexity

Examples of theory application:

1. Presurgical clinics is established in united states in 1990 :
Nurses in presurgical clinics had lot of work load which make them
frustrated , unsatisfactory, cold, harried. Nurses in PSC sought to
deliberately change the way care was delivered. In response to theses
critique the pre surgery nursing practice model based on Watson’s caring
theory was developed. with the help of model nurses came to know patient
in authentic relationship.

2. Nurse caring for military personnel during Persian gulf war:

Overriding theme for nurses was “it is what we are here for” demonstrate the
commitment of nurses for care and sacrifice. The nurses provided care based
on the Watson caring theory.

Research related to Watson’s theory

 Saint Joseph Hospital in Orange, California has selected Jean Watson’s
theory of human caring as the framework base for nursing practice.
 The effectiveness of Watson's Caring Model on the quality of life and blood
pressure of patients with hypertension. J Adv Nurs. 2003 Jan;41(2):130-9.
 This study demonstrated a relationship between care given according to
Watson's Caring model and increased quality of life of the patients with
hypertension. Further, in those patients for whom the caring model was
 practised, there was a relationship between the Caring model and a decrease
in patient's blood pressure. The Watson Caring Model is recommended as a
guide to nursing patients with hypertension, as one means of decreasing
blood pressure and increase in quality of life.
 Martin, L. S. (1991). Using Watson’s theory to explore the dimensions of
adult polycystic kidney disease . ANNA Journal, 18, 403-406 .
  Mullaney, J. A. B. (2000). The lived experience of using Watson’s actual
caring occasions to treat depressed women . Journal of Holistic Nursing,
18(2), 129-142
 Martin, L. S. (1991). Using Watson’s theory to explore the dimensions of
adult polycystic kidney disease . ANNA Journal, 18, 403-406

Conclusion
 Watson provides many useful concepts for the practice of nursing.
 She ties together many theories commonly used in nursing education and
does so in a manner helpful to practioners of the art and science of nursing.
 The detailed descriptions of the carative factors can give guidance to those
who wish to employ them in practice or research.
 Using her theory can add a dimension to practice that is both satisfying and
challenging

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centaury updates-Jean Watson. Nursing science quarterly.15(3).214-219.
2. Rushtan particia, Scott. E Jared, Callister Clark Lynn. (2008). It’s what we
are here for. Nurses caring for military personnel during the Persian gulf
wars. Nurses outlook.56.179-186.
3. Flanagan Jane. April (2009) .Patient and nurse experiences of theory based
care. Nursing science quarterly.22(2).160-172.
4. Gamez Granados Genoveva.(2009) Nurses patient relationship as a caring
relationship. Nursing science quarterly.22(2).126-127.

5. Swanson, K. (1991). Empirical development of a middle range theory of

caring. Nursing Research 40(3), 161-66.
 6. Falk, R., & Adeline, R. (2000). Watson’s philosophy, science and theory of
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