The Philosophy and Science of Caring has four major concepts: human being, health, environment/society, and nursing.
Jean Watson refers to 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. Human is viewed as greater than and different from the sum of his or her parts.”
Health is defined as a high level of overall physical, mental, and social functioning; a general adaptive-maintenance level of daily functioning; and the absence of illness, or the presence of efforts leading to the absence of illness.
Watson’s definition of environment/society addresses the idea that nurses have existed in every society, and that a caring attitude is transmitted from generation to generation by the culture of the nursing profession as a unique way of coping with its environment.
The nursing model states that nursing is concerned with promoting health, preventing illness, caring for the sick, and restoring health. It focuses on health promotion, as well as the treatment of diseases. Watson believed that holistic health care is central to the practice of caring in nursing. She defines nursing as “a human science of persons and human health-illness experiences that are mediated by professional, personal, scientific, esthetic and ethical human transactions.”
The nursing process outlined in the model contains the same steps as the scientific research process: assessment, plan, intervention, and evaluation. The assessment includes observation, identification, and review of the problem, as well as the formation of a hypothesis. Creating a care plan helps the nurse determine how variables would be examined or measured, and what data would be collected. Intervention is the implementation of the care plan and data collection. Finally, the evaluation analyzes the data, interprets the results, and may lead to an additional hypothesis.
Watson’s model makes seven assumptions:
- Caring can be effectively demonstrated and practiced only interpersonally.
- Caring consists of carative factors that result in the satisfaction of certain human needs.
- Effective caring promotes health and individual or family growth.
- Caring responses accept the patient as he or she is now, as well as what he or she may become.
- A caring environment is one that offers the development of potential while allowing the patient to choose the best action for him or herself at a given point in time.
- A science of caring is complementary to the science of curing.
- The practice of caring is central to nursing.
The first three carative factors are the “philosophical foundation” for the science of caring, while the remaining seven derive from that foundation. The ten primary carative factors are:
- The formation of a humanistic-altruistic system of values, which begins at an early age with the values shared by parents. The system of values is mediated by the nurse’s life experiences, learning gained, and exposure to the humanities. It is perceived as necessary to the nurse’s maturation which in turn promotes altruistic behavior toward others.
- The installation of faith-hope, which is essential to the carative and curative processes. When modern science has nothing else to offer a patient, a nurse can continue to use faith-hope to provide a sense of well-being through a belief system meaningful to the individual.
- The cultivation of sensitivity to one’s self and to others, which explores the need of nurses to feel an emotion as it presents itself. The development of a nurse’s own feeling is needed to interact genuinely and sensitively with patients. By striving to become more sensitive, the nurse is more authentic. This encourages self-growth and self-actualization in both the nurse and the patients who interact with the nurse. The nurses promote health and higher-level functioning only when they form person-to-person relationships.
- The development of a helping-trust relationship, which includes congruence, empathy, and warmth. The strongest tool a nurse has is his or her mode of communication, which establishes a rapport with the patient, as well as caring by the nurse. Communication includes verbal and nonverbal communication, as well as listening that connotes empathetic understanding.
- The promotion and acceptance of the expression of both positive and negative feelings, which need to be considered and allowed for in a caring relationship because of how feelings alter thoughts and behavior. The awareness of the feelings helps the nurse and patient understand the behavior it causes.
- The systematic use of the scientific method for problem-solving and decision-making, which allows for control and prediction, and permits self-correction. The science of caring should not always be neutral and objective.
- The promotion of interpersonal teaching-learning, since the nurse should focus on the learning process as much as the teaching process. Understanding the person’s perception of the situation assists the nurse to prepare a cognitive plan.
- The provision for a supportive, protective and/or corrective mental, physical, socio-cultural, and spiritual environment, which Watson divides into interdependent internal and external variables, manipulated by the nurse in order to provide support and protection for the patient’s mental and physical health. The nurse must provide comfort, privacy, and safety as part of the carative factor.
- Assistance with satisfying human needs based on a hierarchy of needs similar to Maslow’s. Each need is equally important for quality nursing care and the promotion of the patient’s health. In addition, all needs deserve to be valued and attended to by the nurse and patient.
- The allowance for existential-phenomenological forces, which helps the nurse to reconcile and mediate the incongruity of viewing the patient holistically while at the same time attending to the hierarchical ordering of needs. This helps the nurse assist the patient to find strength and courage to confront life or death. Phenomology is a way of understanding the patient from his or her frame of reference. Existential psychology is the study of human existence.
Watson’s hierarchy of needs begins with lower-order biophysical needs, which include the need for food and fluid, elimination, and ventilation. Next are the lower-order psychophysical needs, which include the need for activity, inactivity, and sexuality. Finally, are the higher order needs, which are psychosocial. These include the need for achievement, affiliation, and self-actualization.