Nursing Theory: An Application of Watson’s Theory of Caring Model

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Nursing is a profession that often advocates for professionalism, collaboration, prevention, and education to promote and meet a high standard of care. There are many reasons that propel an individual into becoming a nurse, but the trait of caring is often commonly noted. Under the theory of Jean Watson, the essence of nursing involves caring. A large component of a nurses’ role is to not only help restore the patient to optimal health but to also help them find meaning in their illness or suffering to help promote a harmonious balance (Lukose, 2011, p.27).  Jean Watson’s “Theory of Human Caring focuses on how nurses care for their patients, and how the act of caring relationships and healing promotes better health than simple medical cures (Watson, 2009). This paper seeks to apply Watson’s theory to the case scenario of Mrs. Crane, an elderly woman who presented to the emergency room due to an acute exacerbation of chronic obstructive pulmonary disorder (COPD). I will illustrate Watson’s theory in creating three care priorities and goals when caring for Mrs. Crane.

Watson’s Theory of Caring

Jean Watson is known to be the leading theorist in Developmental Theory, which is based off phenomenological psychology and the philosophy of Carl Rogers (Petiprin, 2016). The theory revolves around four major concepts: human being, health, environment and society, and nursing and makes 7 assumptions (Petiprin, 2016). The conceptual elements of the theory revolve around “the caritas process (see appendix A), the transpersonal caring relationship, caring moments and caring occasions, and caring–healing modalities” (Watson, 2012). Within this belief, the assumptions of Watson’s model follow that care can only be effectively demonstrated through interpersonal relationships, which in turn leads to more effective health promotion and both individual and familial growth. In this, a caring environment is noted to be one that promotes the development of individual potential in allowing patients to actively take part in choosing the best actions for themselves (Nursing Theory, 2016).

Watson has proclaimed that caring is a “moral ideal” (Watson, 1988, p 54). Hence, patients should be cared for in a holistic manner, with which not only their body should be acknowledged but also their mind and soul. Nurses should encourage self-disclosure as this will help to lead to new discoveries and the development of a strong and trusting relationship. Patients cannot simple be healed as an object but that individuals are part of their environment and the inclusion of ethical, scientific, and personal practices should be applied (Ozan, Okumus, & Lash, 2015, p.26).

The contact between two individuals, specifically the nurse and patient, can help assist in the recovery process and promote harmony within the mind, soul, and body. The holistic perspective seeks to increase the patients’ sense of self-knowledge, self-healing, and self-reverence. The theory emphasizes that nursing should aim to promote self-determination, self-control, and choice, which is often rooted in empowerment. In caring for patients, it is not simply just a concern but alsoa moral idea in which nurses aim to not only preserve human dignity but also enhance and protect it. By empowering patients, everyone is given a right to participate or formulate their own care goals in promoting health. As Watson’s theory views illness, as not only being objective, but also subjective to the patient’s experience (Nursing Theory, 2016).

Applying Watson’s Theory of Caring Model to a Patient Care Scenario

Focusing on Watson’ theory of human caring and applying it to a case scenario, I will use this model to identify three nursing priorities. The first being the relief of symptoms and patient comfort (ex. Offering pillows for support), the second involves establishing a strong patient-provider relationship in gaining a better understanding of her health, nutritional, and social history (Lukose, 2011, p.27). Lastly, I would assess her knowledge of the disease and management of symptoms due to the ineffective airway clearance she’s been experiencing.  

Addressing the Three Client Issues

Watson’s first carative factor involved forming a humanistic and altruistic set of values. My first goal as a nurse would be to help get Mrs. Crane as comfortable as possible while helping to mitigate her symptoms. In this initial stage of interaction, it would be imperative that I give her insight into the plan of care. Since Mrs. Crane appears to be short of breath I would initiate her oxygen therapy and medications prescribed and encourage her to remain in her bed to avoid further exacerbating her symptoms. This plan of action would be the start of my caring moment. Being unable to breathe and placed in a hospital setting can be a stressful experience for many patients, allowing Mrs. Crane to feel safe in her situation by assisting her through the oxygen therapy can help facilitate a sense of control in having her personal wishes fulfilled (Torheim & Kvangarsnes, 2014, p. 743). Research indicates the sense of being seen or heard is often most important to patients, particularly when they are treated as a ‘commodity’, rather than a human being (Torheim & Kvangarsnes, 2014, p. 744). Being able to assess Mrs. Crane’s emotional and mental needs would be important for me to address in asking open ended questions (Childs, 2005, p. 285). Oftentimes, anger can accompany illness, particularly with chronic illness and the sense of helplessness in relying on other individuals, being able to keep open dialogue and paying close attention to Mrs. Crane would facilitate the introduction of Watson’s fourth and eighth carative factor (helping-trust relationship and supportive and protective environment).

Watson’s theory also encourages a holistic approach be used, specifically, the social history of the patient, which would allow the nurse to form a bigger picture on how to approach the patients care (Childs, 2005, p. 284). It was noted on her admission to the emergency room (ER) that Mrs. Crane has been consistently losing weight over the past month. Details of the environment Mrs. Crane lives in (ex. Does she have a partner), would help provide a more successful care plan when she is discharged. One important aspect to consider would be meal preparation, particularly for an individual who is in poor health or weak. While Mrs. Crane may feel well enough to make her meal, she may feel too tired or weak to eat because of the large amounts of energy expenditure in the preparation phase. Other aspects of Mrs. Crane’s environment would be to consider financial burdens or access to quality foods that she can tolerate. Along with having address the feeling of safety, this interaction helps to address the physiological needs of the patient, which draws upon the ninth carative factor which relates to Maslow’s hierarchy (see Appendix B).

Most importantly, addressing Mrs. Crane’s level of understanding about her illness and helping to improve her sense of belong, self-esteem and self-actualization would be central to the theory of caring. Having recurring COPD exacerbations would take a toll on her ability to achieve her full potential and participate in activities. I would sit down with Mrs. Crane and listen to her concerns and what may have provoked her recent exacerbation. As it is evident from the chart data she has been assessed and given orders for medication delivery, it would be imperative that I sit down with her and review the findings and find out her own feelings about the situation. Since she has had difficulty breathing, it would be expected that initially her mental state may be reduced and therefore she would not have been an active participant in asking or answering questions meaningfully (Torheim & Kvangarsnes, 2014, p 745). Particularly, Watson’s theory would want to understand how well Mrs. Crane has perceived the care that was delivered to her (RUSH, 2017). 

The inability to participate in her daily activities would also hinder her ability to maintain intimate relationships and interactions with friends, which would likely also impact her feelings of accomplishment. It would also be important to encourage Mrs. Crane to talk about her known or unknown spiritual views and feelings. Incorporating these beliefs into her care plan would help to see her as a unique person. She may feel disappointed in how she has experienced an exacerbation or how others view her. Making myself authentically present using strategies like eye contact would be important particularly in maintaining hope and faith in the treatments prescribed to minimize her symptoms. Addressing these factors and what they mean to her would be important in addressing the firth, seventh, ninth and tenth carative factors.

The Theory of Caring and Goal Setting.

Clearly understanding Mrs. Crane’s goals of care is vital for success, particularly because she is not disease free and is short of breath and has difficulty sleeping. A holistic approach to Mrs. Crane’s care must be applied in her goal setting and decisions regarding interventions should be explored together. Applying Watson’ theory of human caring, the following goals would be important to implement. The first goal would involve addressing her activities of daily living and psychosocial issues. This would involve follow up weekly phone calls to assess her following discharge for one month. The second goal would be to help her maintain her nutrional intake by monitoring her weight and hemoglobin levels weekly upon discharge which were noted to be high in her lab results. By monitoring her upon discharge, I would be able to continue to facilitate the patient-nurse relationship and have a better understanding of her functioning outside of the hospital.

Following the seventh carative factorit would be imperative to engage Mrs. Crane in transpersonal teaching and learning to find solutions to how she can participate fully in fulfilling her daily activities. With COPD patients, there is concern about their increased dependence on others, decreased energy, and lack of control over their symptoms (Bauldoff, 2012). By focusing on these aspects, I am also able to help decrease the likelihood of Mrs. Crane developing depression and anxiety, which would have implications on her social interactions, physical abilities, and role perception. Working with Mrs. Crane to combine her emotional, spiritual, and physical needs would be important in helping her plan activities she enjoys and feels she has the capacity to participate in (Fotokian, 2017). Understanding her life story, perhaps her role in her family or community, would be important to address including the introduction of energy conservation techniques to help her accomplish or participate in things that are meaningful to her (Fotokian, 2017).  Perhaps she used to enjoy taking walks with her friends but feels she cannot participate anymore. Building her confidence in participating in activities could involve helping her from her chair to her walker or using the walker to go to the washroom. Understanding these factors and building up tolerance that aligns with her values will help Mrs. Crane feel more comfortable in completing her activities when discharged. 

In addressing nutrional intake, I would want to take steps to understand how Mrs. Crane makes her meals and what kind of supports she feels may benefit her. For example, while it may be beneficial to arrange for a program to bring meals to Mrs. Crane, perhaps this diminish her sense of being in not being able to prepare her own foods or live independently. As a nurse, I could explore her feelings towards how important meal preparation and food mean to her and come up with a plan together to ensure she is meeting her daily nutrional needs (Adventist Hinsdale Hospital, 2013). Arranging for a dietician to come in to speak to her about simple meals she can prepare on her own but meet her caloric and protein intake for energy expenditure might fit her values better (Yazanpanah, Moosavi, Heidarnazhad, & Haghani, 2010, pg 374). In doing this I would have used the scientific-problem solving method (ie. Carative factor #6) for decision making by providing skilled intervention to support her nutrional needs and understanding of the importance of food to her.

Conclusion

Watson’s model helps to reinforce the idea that caring should be central to every decision or action that a nurse makes in practice. By utilizing her theory in the case scenario of Mrs. Crane, both nurses and nursing students can understand at a deeper level what it truly means to be a nurse. Focusing on aspects like psychosocial care is important in priority and goal setting, particularly in understanding Mrs. Crane’s lived experiences with COPD and its impacts and meaning towards her own life. By adopting this model as framework to assist in patient care, in emphasizing the importantof addressing emotional needs rather than just the patients’ basic medical needs (ex. Disease management).  When patients feel cared for and included in their treatment plan, there is more space for increasing their knowledge and understanding of their illness (Torheim & Kvangarsnes, 2014, p 747). Hence, the most important message from Watson’s theory is that the science of curing is complimentary to the science of caring and therefore the practice of caring is the most central component in nursing.

References

Adventist Hinsdale Hospital. (2013). Dr. Watson’s caring theory. Retrieved from http://www.keepingyouwell.com/ahh/aboutus/nursing-magnet-journey/dr-watsons-caring-theory

Bauldoff, G.S. (2012). When breathing is a burden: how to help patients with COPD. American Nurse Today, 7(8). Retrieved from https://www.americannursetoday.com/when-breathing-is-a-burden-how-to-help-patients-with-copd-2/

Childs, A. (2005). The complex gastrointestinal patient and Jean Watson’s theory of caring in nutrition support. Gastroenterology Nursing, 29(4), 283-88. Retrieved from https://pdfs.semanticscholar.org/54cc/4b87b15a735581daec5a14a6d1c84da9355e.pdf

Fotokian Z, Mohammadi Shahboulaghi F, Fallahi-Khoshknab M, & Pourhabib A (2017) The empowerment of elderly patients with chronic obstructive pulmonary disease: Managing life with the disease. PLOS ONE, 12(4). https://doi.org/10.1371/journal.pone.0174028

Lukose, A. (2012). Developing a practice model for Watson’s theory of caring. Nursing Science Quarterly, 24(1).27-30. doi: 10.1177/0894318410389073

Ozan, Y.D., Okumus, H., & Lash, A.A. (2015). Implementation of Watson’s theory of caring: a case study. International Journal of Caring Science, 8(1), 25-35. Retrieved from
http://www.internationaljournalofcaringsciences.org/docs/4-Lash%20-%20Original.pdf

Petiprin, A. (2016). Jean Watson nursing theory. Retrieved from
http://www.nursingtheory.org/theories-and-models/watson-philosophy-and-science-of-caring.php

Torheim, H. & Kvangarsnes, M. (2014). How do patients with exacerbated chronic pulmonary disease experience care in the intensive care unit?. Scandinavian Journal of Caring Science, 28(4), 741-48. doi: 10.1111/scs.12106

Watson, Jean. (2007). Watson’s theory of human caring and subjective living experiences: carative factors/caritas processes as a disciplinary guide to the professional nursing practice. Texto & Contexto – Enfermagem16(1), 129-135. https://dx.doi.org/10.1590/S0104-07072007000100016

Watson, J. (2012). Human Caring Science: A Theory of Nursing. 2nd ed. U.S: Jones & Bartlett Learning: Sudbury, MA.

Yazanpanah, L., Moosavi, F., Heidarnazhad, H. & Haghani, H. (2010). Energy and protein intake and its relationship with pulmonary function in chronic obstructive pulmonary disease (COPD) patients. Acta Medica Iranica, 48(6), 374-9. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21287476

 

Appendix A

Watson’s Ten Carative Factors

Adapted from:Communication Theory. (1983).Maslow’s hierarchy of needs.Retrieved from https://www.communicationtheory.org/maslow’s-hierarchy-of-needs/

 

 

 Appendix B

Maslow’s Hierarchy of Needs

 

Adapted from:Communication Theory. (1983).Maslow’s hierarchy of needs.Retrieved from https://www.communicationtheory.org/maslow’s-hierarchy-of-needs/