Journal of Nursing
Caring and the Professional Practice of Nursing
Caring and nursing have always been thought of synonymously. Most individuals choose nursing as a profession because of their desire to care for other individuals. Caring as a central concept has led to the development of several caring theories. Two well known theories were developed in the 1970’s, Leininger’s Theory of cultural care and Jean Watson’s Theory of human caring (McCance, McKenna, Boore 1999).
Jean Watson defines caring as a science. She states; Caring is a science that encompasses a humanitarian, human science orientation, human caring processes, phenomena, and experiences. Caring science includes arts and humanities as well as science. A caring science perspective is grounded in a relational ontology of being-in-relation, and a world view of unity and connectedness of all. Transpersonal Caring acknowledges unity of life and connections that move in concentric circles of caring-from individual, to others, to community, to world, to Planet Earth, to the universe. Caring science investigations embrace inquiry that are reflective, subjective and interpretative as well as objective-empirical; Caring science inquiry includes ontological, philosophical, ethical, historical inquiry and studies. In addition, caring science includes multiple epistemological approaches to inquiry including clinical and empirical, but is open to moving into new areas of inquiry that explore other ways of knowing, for example, aesthetic, poetic, narrative, personal, intuitive, kinesthetic, evolving consciousness, intentionality, metaphysical-spiritual, as well as moral-ethical knowing. Caring science is an evolving new field that is grounded in the discipline of nursing and evolving nursing science, but more recently includes other fields and disciplines in the Academy, for example, Women/Feminist studies, Education, Ecology, Peace Studies, Philosophy/Ethics, Arts and Humanities, Mindbodyspirit Medicine. As such, caring science is rapidly becoming an Interdisciplinary Transdisciplinary field of study. It has relevance to all the health, education human service fields and professions (Watson 2003).
Caring behaviors are defined as; Behaviors evidenced by nurses in caring for patients.
The top ten caring behaviors, derived from nursing literature are; attentive listening, comforting, honesty, patience, responsibility, providing information so the patient can make an informed decision, touch, sensitivity, respect, calling the patient by name (Taber’s 1993).
Some Caring behaviors are evident in other professions. Law enforcement is noted for their honesty and respect. Psychologists are comforting and require attentive listening skills to help their patients. Teachers must possess patience, attentive listening, sensitivity, and great responsibility to mold our children into productive adults. The lists of professions are endless.
Madeleine Leininger subscribed to the central tenet that “care is the essence of nursing and the central, dominant, and unifying focus of nursing” (Leininger 1991). Watson describes nursing as a human science, with the major focus being the process of human care for individuals, families, and groups. Her theory is based on a form of humanism and has its origins in metaphysics (philosophy of being and knowing) (McCance, Mckenna, Boore 1999).
The goal of nursing with Watson’s theory is centered around helping the patient gain a higher degree of harmony within the mind, body, and soul. It is achieved through caring transactions. Watson’s ten carative factors, referred to as interventions of the theory, are presented in table one. (McCance, McKenna, Boore 1999). It also involves the transpersonal caring relationship. Transpersonal caring is demonstrated in an event or actual caring occasion.
Transpersonal conveys a concern for the inner life. The patient is viewed as whole and complete, regardless of illness or disease (Watson 2003). The transpersonal nurse seeks to connect with, embrace the spirit or soul of the patient, through the processes of caring and healing (Watson 2003).
Caring in the nursing profession takes place every time a nurse-to-patient contact is made. The nurse enters the world of the patient in order to come to know the patient as a caring person, and that it is from this “epistemology” that the caring of nursing unfolds (Schoenhofer 2002). That caring makes a difference to the patient’s sense of well being. Caring may occur without curing but curing cannot occur without caring (Watson 2003).
It is with that belief that nurses care for patients in the hope that we contribute to the cure or wellbeing of that patient.
Hope and commitment are ingredients of caring. Hope is described as more than mere wishful thinking, but as an awareness of the moment alive with possibilities (Schoenhofer 2002).
Hope may be the only crutch a patient has to keep their optimism. Nurses care enough to honor that hope and support the patient. We view that patient as whole and complete. The second carative factor of Jean Watson’s ten carative factors is faith-hope (see table one).
Hope is guided by our commitment as nurses to our patients. It is also clouded with preconceived beliefs and morals that we are reared with.
I am a field nurse in a for-profit hospice organization. Caring is a central concept to the delivery of hospice care. The patients we encounter are in a variety of settings, such as, own home, nursing home, retirement center, family home, or a friend’s home. They are often frightened with the knowledge of their imminent death and in unfamiliar surroundings. They rely on the nurse and the delivery of care to help them feel physically better.
As a hospice nurse we also view the patient as a spiritual being. That means reaching out to the patient and forming a deeper connection to the spiritual self. It means becoming one.
The one caring and the one being cared for are interconnected (Watson 1997). It’s experiencing human connection at a deeper level than a physical interaction (Watson 2003)
The nurse must have an inner peace with her own mortality. The nurse must be comfortable with death and dying and possess a deep understanding and acceptance of all life cycles and be prepared for their own death (Watson 2002). Caring is directed to a pain free death with dignity and a belief of a spiritual transformation or journey after death.
Caring centers on the person, preserving dignity and humanity. It is a commitment to alleviate another’s vulnerabilities by providing attention and concern for each human life (Watson 2002). Hospice is holistic focused caring. Our goal is to offer the dying patient the opportunity to die in the comfort of their own home surrounded by those who care. The dying patient in the nursing home is offered the opportunity to die with a caring nurse holding their hand. Often the nursing home patient has no family or living relatives that can share in the dying experience. The hospice nurse will be the one to care for the dying patient and ease his journey. This relates to the carative factor number eight of Jean Watson’s ten carative factors, it states; supportive, protective, and/or corrective mental, physical, societal and spiritual environment, and that is what we hope to achieve with the dying patient (see table one).
Hospice also cares for the family. Caring approaches to nursing affect the nurse and the family being cared for. This can be very challenging with dysfunctional families. Our focus is always centered on the patient while dealing with the family. We must be guided by caring, compassion, tenderness, gentleness, loving kindness, and equanimity for self and others.
Caring in hospice goes beyond the actual death. Bereavement contact is done on a routine basis for a year after the death. Nurses often attend services for the deceased to say goodbye and receive closure with that patient and family.
by Teresa Vance, RN
I’ve related most of my understanding of the caring model to hospice care because that is my area of expertise. However, the caring models are used in a variety of settings, such as, major hospitals, organizations, feminists groups, and major universities. A model of caring includes a call for both art and science. It offers a framework that embraces and intersects with art, science, humanities, spirituality, and new dimensions of mindbodyspirit medicine (Watson 2003). Caring can save the life of a patient, offer a death with dignity, and convey trust and commitment to patients, families, and staff.
Nursing is a caring profession that is honored as the spiritual, spirit-filled practice that it is. I believe it is a calling for a special spiritual person who cares about the spirituality of others. Little girls care for their dolls; boys care for their trucks; parents care for their children; sons and daughters care for elderly parents; and nurses care for the sick.
The humanistic nature of nursing is reflected in the caring model. Caring is the central concept in the discipline of nursing. I would not want to imagine nursing without the concept of caring. Would you?
Table 1 Watson’s 10 Carative Factors (McCance, McKenna, and Boore 1999)
1. Humanistic-altruistic system of values
3. Sensitivity to self and others
4. Helping-trusting, human care relationship
5. Expressing positive and negative feelings
6. Creative problem-solving caring process
7. Transpersonal teaching-learning
8. Supportive, protective, and/or corrective mental, physical, societal and spiritual environment
9. Human needs assistance
10. Existential-phenomenological-spiritual forces
Leininger, M. M. (1991). Culture care Diversity and Universality: A Theory of Nursing. National League of Nursing Press, New York. P 35.
McCance, T. V.; McKenna, H. P.; Boore, J. R. P. (1999). Caring: theoretical perspectives of relevance to nursing. Journal of Advanced Nursing, Dec99, 30(6), 1388-1396.
Schoenhofer, S. O. (2002). Choosing personhood: intentionality and the theory of Nursing as caring. Holistic Nursing Practice, July 2002. 16(4), 36-40.Taber, C. W., 1870-1968. Taber’s Cyclopedic Medical Dictionary, Ed. 17. p 322. Philadelphia: F. A. Davis Company.
Watson, J. (1988). New dimensions of human caring theory. Nursing Science Quarterly. 1(4), 175-181.
Watson, J. (1996). Watson’s theory of transpersonal caring. In P. H. Walker & B. Nueman (Eds.), Blueprint for use of nursing models: Education, research, practice, and administration. 141-184. NY: NLN Press.
Watson, J. (1997). The theory of human caring: Retrospective and prospective. Nursing Science Quarterly. 10(1), 49-52.
Watson, J. (1999). Post modern nursing and beyond. Edinburg, Scotland, UK: Churchill-Livinstone: Harcourt-Brace.
Watson, J. (2002). Intentionality and caring-healing Consciousness: A practice of transpersonal nursing. Holistic Nursing Practice. July 2002. 16(4), 12-19.
Watson, J. (2003). Jean Watson and the theory of human caring. Theory overview. Retrieved on February 14, 2003, from http://ww2.uchsc.edu/son/caring/content/wct.asp.
Watson, J. (2003). Jean Watson and the theory of human caring. Definition description.
March 20, 2003
Teresa Vance, RN
Billie R. Tower BSN Nursing program