The science of caring pertains to the humanitarian approach of treatment of an individual and any associated events and experience. Caring science is thus an integration of art and compassion, with its foundation originating from the concepts of relationships and connection between human beings. One of the most acclaimed philosophies of nursing is the Theory of Caring, which was conceived by Jean Watson. This theory acknowledges the life is connected to several areas, including one’s self, other individuals, the rest of the community and the entire world and the whole universe (Watson, 1994).
This paper will discuss the principles behind the nursing theory of caring, including interpretations and philosophical concepts that have shaped in concept. In addition, the approaches employed in this particular nursing theory will also be presented. The nursing theory of caring has revolutionized the method of providing care to patients, as well as generated new disciplines in the field of nursing. Such novel methodology will thus provide great relevance to health services and its associated professions.
Historical background of the theory of caring
In 1975, Jean Watson, then a faculty at the School of Nursing of the University of Colorado, formulated a nursing theory that integrated concepts from the fields of education, psychology and clinical medicine. It was Watson’s personal goal to combine meaning into the field of nursing, as well as to introduce a form of focus in healthcare delivery. In addition, she was keen into using the logic of ethics into the nursing profession in order to improve the methods of healthcare to the people. Watson was also active in her role as faculty, attending several meetings that involved modification and re-designing of the course curriculum for nursing students. During this time, Watson had grown more aware of the concept of healing, not only in the physiological sense, but also in the spiritual sense. This novel and unique method of providing care to a patient in order to heal thus involves several aspects which are called carative factors. It is understood that this theory of caring balances the power of medicine and spiritual healing into a distinct nursing field.
The ten carative factors
At the inception of the Theory of Caring in 1979, ten factors were identified as core components of this particular nursing approach. These ten factors served as the prime focus and main format for this nursing theory. To date, the ten carative factors have evolved and are now considered as clinical caritas, in order to include the fluidity of the original concept and allow further expansion of the theory’s nursing directions (Watson, 1995).
The first carative factor of Watson’s Theory of Caring involves the development of a value scheme that is both humanistic and philantrophic. This factor allows the patient to maintain his sense of dignity amidst illness and helplessness during his stay in the hospital. Another carative factor involves the introduction of faith in the patient as he is being treated in the hospital. The patient is also encouraged to keep his hopes up during medical treatment. The Theory of Caring also cultivates a patient’s sensitivity to both himself and others and this carative factor is based on the altruistic approach that compassion is the ultimate cure to all ailments. Another carative factor is the development of a relationship between the nurse and the patient. The principle behind this factor is that the sense of trust enhances a faster healing in a patient because his energies are enhanced in a positive way and thus his physiological functions are also influenced to normalize. This particular carative factor is also associated with the delivery of healthcare with a personal touch.
Another carative factor employed in the Theory of Caring is the promotion of positive emotions to the patient in order for the patient to feel that he is well cared for. The positive emotions that are given by a nurse to the patient instill a sense of belongingness and this enhances the healing process of the patient. At the same time, any negative sentiments that are expressed by a patient during his stay in the hospital are accepted by a nurse who follows the dogma of the Theory of Caring. The patient’s expression of negative sentiments are also helpful because this provides a way for the patient to air out his disappointments and frustrations and the presence of a nurse to listen to the patient’s sentiments serves as some form of medium that may be equivalent to counseling or psychotherapy.
Another carative factor that is included in the Theory of Caring is the systematic employment of a problem-solving procedure in order for the patient to assess his current medical condition. The nurse also employs the carative factor of promoting transpersonal teaching as well as providing a supportive environment to the patient. The nurse who follows the Theory of Caring also assists in helping a patient with his personal needs. Lastly, this particular nursing theory allows spiritual concepts to be used for the healing of the patient.
Application of the theory of caring
Presence has been defined as “a relational style within nursing interactions that involves being with, as well as doing with” (McKivergin, 1994). Nursing presence is a key component that enables patients to revolve the suffering experience into a perception for possible improvement strategies designed for their well-being. With their compassionated support, nurses help individuals to gain a broader knowledge on the nature of their disease and assist in determining possible options that can lead them to the utmost level of health and healing. The core of nursing presence necessitates establishment of nurse-patient relationship for mutual understanding of circumstances and goal directness of the situation for possible achievements of the desired outcomes. Attributes of presence include “the ability to care, self-awareness, commitment to helping, knowledge and expertise, skills of listening and touching” and the focus on confronted circumstances (McKivergin, 1994). The focused shared moments with the patient and family help the nurse to identify the key turning point necessary for patient’s healing process. Parse (1992) emphasized that therapeutic presence is the “primary mode of practice in nursing” as cited by McKivergin (1994). The importance of the nurse being available to understand and be with another, physically present and using self as a therapeutic agent in every encounter gives the “opportunity to heal and be healed.”
Presence can be categorized into three levels: physical presence, psychological presence and therapeutic presence. The combination of physical and psychological presence leads to therapeutic presence, relating self to the patient as a whole being to a whole being, using all of her or his resources of body, mind, emotions, and spirit (McKivergin, 1994). The scenario I described above could be defined as therapeutic presence, wherein significant patient’s outcomes were accomplished throughout the range of my course of actions. The fundamental needs of my patient were discovered by being fully present and consciously relating my whole being to his whole being. The use of therapeutic model enabled me to use aesthetic ways of discovering the obstructions in the hidden pathways preventing the healing process. According to Covington (2003), “being with another, compassionately and authentically” provides headway for the nurse to fully understand the circumstances and create a prospect of healing.
The role of a nurse as a therapeutic agent was carried out successfully by getting deeply involved with the situation using the nurse’s inner energy of caring, being open and listening with solid awareness, and “developing and sustaining a helping-trusting, authentic caring relationship” (Ryan, 2005). Tirelessly, I remained active throughout my presence assisting my patient to reveal the hidden cause of his emotional distress. Using different strategies, such as talking to him, encouraging to him talk by reassuring that I was there to listen and help, shaving him, giving him a bed bath to make him feel better, showing that I cared, offering drinks, watching TV together, and holding his hand when he was crying. I felt his pain and I could not let him suffer. By just being physically present I could not achieve any significant outcome for my patient, therefore by using a therapeutic approach, I figured out the cause of his distress and advocated for the best interest of my patient. Hence, the therapeutic presence is the core of nursing practice in any given situation, which enables nurses to carry out their role successfully and provides the opportunity for promotion of health and healing status of the patient.
A nurse’s therapeutic approach should be present and effectively carried out in any given situation. A suffering individual deserve nurses’ help to stabilize his condition of distress. As nurses, our role is to care and advocate for the best possible outcomes for our patient, therefore by simply just documenting on patient’s chart as “emotionally disturbed” will not resolve the problem. Our presence is a “method of meeting a patient’s needs and facilitating healing during a time of suffering (Covington, 2003). Mutual collaboration and searching beyond the surface involving spiritual and holistic approach will not just help to build a nurse-patient relationship but it helps the nurse to explore the fundamental needs of the patient and the opportunity to help the patient through her/his advocacy.
When caring for people, nurses must follow the guidelines established by the college of nurses. The mission of the college of nurses is to protect the public’s right to quality of nursing practice and to ensure that nurses’ role is being carried out efficiently in all occasions. According to the guidelines, the core of nursing is the therapeutic nurse-patient relationship, which should be established and maintained as a key concept by using knowledge and skills, and application of professional attitude and behavior when caring for patients. The relationship is based on trust, respect, empathy and professional intimacy, and requires appropriate use of the power inherent in the care provider’s role. The guidelines emphasize that nurses must work consistently with the clients to ensure that all professional behavior and actions meet the therapeutic needs of the client. The guidelines highlight that every nurse is accountable for his decision and action and for maintaining competencies in every day of practice. This strong foundation requires that all nurses provide a therapeutic nurse-patient relationship and provide care to patients under the scope of practice according to their needs, which will in turn, lead to significant outcomes. My presence in the scenario described above has fully met the standards of practice, by using therapeutic approach and being competent in caring for my patient.
The presence of nurse enables the clients to achieve better outcomes in the process of a disease towards health promotion and healing. Nurses use different types of presence, but the prerequisites of the nursing profession are to build a therapeutic nurse-patient relationship and mutual understanding under any circumstance. The nurse is expected to “relate to the patient whole being to whole being, using all of his or her resources of mind, body, emotions, and spirit” (McKivergin, 1994). Each interaction provides the opportunity for both the nurse and patient to be in motion, heading toward the wholeness.
The methodology of teaching in the field of nursing requires that the teacher’s work is reliable and his credibility in the service is not questionable. There are several methods that the teacher has applied in the teaching process (Akinsaya and Williams, 2004). One of them is rehearsal. This is where the teacher ensures that the students revisit what they have learnt continuously. This helps the student familiarize with this new information and eventually comes to understand and it becomes a part of him. The teacher must also involve the students in self-evaluation (Butterworth et al., 1998). This is where the students are allowed to maybe practice what they have learnt on their own. A student may want to test his understanding without necessarily getting the instructions from the teacher. Another very effective method is testing the students (Caviglioli and Harris, 2004). The teacher sets examinations on what he has taught. This requires the students to constantly revise in order to perform well in the tests. There is no short cut if one desires to pass their tests and qualify to become nurses as it is only through performance that one’s competence is detected.the chance to be entrusted with the noble jobs of having to ensure and restore people’s health is given to those who have qualified in the school only. Efficient learning is also achieved when the teacher speaks slowly to ensure that every student has grasped what is being taught (Taylor, & Pearson, 2002).
The teacher should also organize instructional material in the order in which the plan of action is to take place. This has the advantage of ensuring that no work is left undone. The teacher also knows what is to be taught. The teacher at the same time is not allowed to make any assumptions that the information given has been understood. The students are allowed to explain in their own words what they have understood. This will straight away tell the teacher if the students have understood or not (Caviglioli et al., 2002). The teacher then checks whether there is need for the student to repeat a class or not.The student will also have the areas they haven’t understood redone with the teachers help.
Another key issue is about the concepts of learning and the theories that are known to underpin the approach (Jarvis, 2002). It is imperative for the intellectual functioning and personalities of those involved to be understood. There is the importance of knowing when the students learn and what they are most adept at learning. There is a great need to be aware of the interests of each individual. In all, the essence here is the diversity of their learning diversities.
The need for all these is to enable the detection of the nursing theories that are likely to undermine this process. It is a known theory that gender matters when it comes to the issue of teaching and facilitating others. As a matter of fact, nursing is thought widely to be a discipline for the females. This is evident in the ratio of the women to men in the field (Jensen, 1995). It is thus almost acceptable to say that more females are willing to respond. This is seen to underpin the whole process because there is an imbalance based on gender. Again the notion that women make better nurses than men dictates that men overlook the opportunities to join the field of nursing. Noting that the learning styles of the students are different and varied, special attention should be paid to each. There are the students who would prefer learning in a small group of people as they are intimidated by large groups of people. Such students will waste more time looking at the crowd and responding to the effects that the presence of them has on them. It is realized that the student has not taken in any of the information being given out. Such students should see to it that they are in are class where they are comfortable in their presence. This will ensure that the learner has utilized his time well and is able to account for his time with the output of what has been learned (Jarvis et al., 2003).
Summary
The presence of a nurse is a unique experience because it allows interaction and influence on a patient’s life. Nurses are generally designated to augment a patient’s condition during his stay in a healthcare facility. This presence is sometimes viewed as a compulsory task for nurses. However, the direct therapeutic effect of the presence of a nurse on a patient has not been examined adequately. Society has created a nurse stereotype which typically portrays these individuals are mere assistants of a physician and bathing associates of patients. The shared moment of a nurse and a patient who is unbearably suffering by himself provides guidance for proper course of action, often resulting in greater patient satisfaction and healing potentialities. During a nurse-patient interaction, nurses establish their presence by using a human care transaction “mind-body-soul with another’s mind-body-soul in a lived moment” (Watson, 1985).
References
- Akinsaya C and Williams M (2004): Concept mapping for meaningful learning. Nurse Educ. Today, 24:41-46.
- Bahn D (2001): Social learning theory: Its application in the context of nurse education. Nurse Educ. Today, 21:110-117.
- Barrow EJ, Lyte G and Butterworth T (2002): An evaluation of problem-based learning in a nursing theory and practice module. Nurse Educ. Prac. 2:55-62.
- Benner P (1984): From novice to expert. California: Addison Wesley.
- Burnard P (1985): Learning human skills: A guide for nurses. Heineman.
- Butterworth T, Faugier J and Burnard P (1998): Clinical supervision and mentorship in nursing. Cheltenham: Stanley Thornes.
- Buzan T (2000): Use your head (Revised ed.). London: BBC Books.
- Caviglioli O and Harris I (2004): Reaching out to all thinkers. Stafford: Network Educational Press.
- Caviglioli O, Harris I and Tindall B (2002): Thinking skills and eye Q: Visual tools for raising intelligence. Stafford: Network Educational Press Ltd.
- Department of Health (2001): Valuing people: A new strategy for learning disability in the 21st Century.
- Department of Health (1998): A first Class Service: Quality in the new NHS. London: HMSO.
- Department of Health (1999): Making a difference: Strengthening the nursing midwifery and health visiting contribution to health and healthcare. Department of Health.
- Department of Health (1999): Saving lives: Our healthier nation. London: HMSO.
- Dilts R and Epstein T (1995): Dynamic learning. California. Meta Publications.
- Dimond B (2002): Legal aspects of nursing. Harlow: Longman.
- ENB and DoH (2001): Preparation of mentors and teachers: A new framework of guidance. January issue.
- Ewles R and Simnett T(1999): Promoting health a practical guide, 4th ed. London: Bailliere Tindall.
- Fowler I (ed.) (1998): Handbook of clinical supervision: Your questions answered. London: Mark Allen Publishing Ltd.
- Glen S and Wilkie K (eds.) (2000): Problem-based learning in nursing: A new model for a new context? Hampshire: Palgrave.
- Glen S and Leiba T (2002): Multi-professional learning for nurses. London: Palgrave.
- Honey P and Mumford A (1992): The manual of learning styles. Berkshire: Peter Honey.
- Jarvis P (ed) (2002): The theory and practice of teaching. London: Kogan Page.
- Jarvis P, Holford J and Griffin C (2003): The theory and practice of learning, 2nd ed. London: Kogan Page.
- Jensen E (1995): Brain-based learning and teaching. California: Turning Point Publishing.
- Kenworthy N and Nicklin PJ (2000): Teaching and assessing in nursing practice: An Experiential Approach. London: Kogan Page.
- Watson J (1994): Applying the art and science of human caring. New York, NY: NLN Publications.
- Watson J (1995): Nursing and the philosophy and science of caring. Niwot, CO: University of Colorado Press.