Theoretical Foundations - Jean Watson

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Running Head: NOTES ABOUT NOTES ABOUT CARING

Notes About Notes About Caring: Jean Watson’s Theory Applied to LGBTQ Nursing

Colten Boyd

November 10, 2023

NURS 6600

Argyle

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Description

Jean Watson's Nursing Theory of Caring is a foundational framework that

emphasizes the significance of caring in nursing practice. Born Margaret Jean Harman,

Jean Watson first became a nurse in 1964 with her BSN. Two years later, she

graduated with her Master’s degree in nursing, and later received a Doctorate in

Educational Psychology and counseling in 1973. It was around this time that Watson

had established the Nursing theory of Human Caring. After she had become a PhD, Dr.

Jean Watson served as faculty and administration for the University of Colorado, wrote

several books about nursing and nursing theory, and helped establish the first PhD

Nursing program at the University of Colorado. Later in the year 2005 she would be a

pivotal character in the development of the first clinical doctorate program, that would

later be the DNP program (Willis, 2017). After the development of her Theory of Human

Caring, Watson had two significant life events, the total loss of her left eye and soon

after that the loss of her husband who she considered to be her “physical and spiritual

partner, and her best friend” (Willis). Dr Jean Watson’s Theory of Human Caring has

had a profound impact on the way nurses approach patient care and the career paths of

all DNP.

Theory Description

At its core, Watson's Theory of Human caring is also referred to as Watson’s

Transpersonal Theory of Caring, and it teaches that caring is central to the nursing

profession and that it goes beyond the technical aspects of healthcare. Transpersonal,

as described by Jean Watson herself as being values of deep connectedness, of

relationship, subjective meaning, and shared humanity (Watson, 2002). Alternatively it

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is the act of going beyond the default or normal state of the self, the ego, the conscious

person and experiencing and perceiving the world beyond the simple limits of a singular

person and their identity in a way that is connected with the ‘cosmos’ and all of those

around you. The theory has strong relations to several theorists that have strong ties in

psychology including Abraham Maslow, Carl Rogers, and Pierre Teilhard de Chardin

who are recognized with their development of the concept of transpersonal (Clark,

2016). Jean Watson describes human caring being made up of four categories; health,

nursing, environment, and human beings (Gonzalo, 2016). Health being the

homeostatic congruency between mind, body, and soul; Nursing being the science of

ethical human care; Environment being the social determinant of how one is expected

to be and behave; and Human Beings defined as a valued person who is to be cared for

(Gonzalo). The theory emphasizes the importance of forming authentic connections with

patients, showing empathy, and promoting healing through the therapeutic use of self.

The theory includes several key components to integrate together such as the

ten "Carative Factors" in and the transpersonal caring relationship, the aim being to

enhance the human experience of both the patient and the nurse. The Carative Factors

emphasize the importance of compassion, trust, and holistic care in nursing. They

encourage nurses to embrace altruistic values, inspire faith and hope, nurture trusting

relationships, listen authentically to patients' stories, integrate scientific problem-solving

with caring, balance teaching to individual needs, create healing environments that

respect human dignity, and minister to physical, emotional, and spiritual needs

(Gonzalo). Additionally, the theory encourages nurses to remain open to the mysteries

of human existence and the potential for miraculous moments in healthcare. These

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Carative Factors serve as the foundational principles for providing patient-centered and

compassionate care.

Development and History

As stated prior, Jean Watson developed her Nursing Theory of Caring in the late

1970s as a response to what she perceived as a lack of emphasis on the human side of

nursing. Her experiences as a nurse, educator, and researcher influenced the

development of this theory, which sought to bring humanity back into the forefront of

healthcare. The loss of her eye and her husband, Watson had a deeper understanding

of her own theory, as described in her third published book titled “Postmodern Nursing

and Beyond” in the year 1999. In the book she stated she was “attempting to integrate

these wounds into my life and work” (Watson, 1999). This book was published one year

after the loss of her husband. Her theory had integration from her studies within

Psychology that was integrated and applied to her nursing experience.

Theorist's Background

Jean Watson, a renowned nurse theorist, holds a Doctorate in Educational

Psychology and Counseling. Her extensive background in nursing education and her

clinical experiences played a pivotal role in shaping her theory. She also has a number

of awards and honors; such as an impressive total of 13 honorary degrees, including

nine from esteemed international universities such as Göteborg University in Sweden,

Luton University in London, and the University of Montreal in Quebec, Canada. In 1993,

she was honored with the National League for Nursing (NLN) Martha E. Rogers Award,

where she later served on the Executive Committee and Governing Board, including a

term as president from 1995 to 1996. The NLN also recognized her with an honorary

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lifetime holistic nurse certificate in 1997. Her contributions to nursing were further

acknowledged when she was named a distinguished professor at the University of

Colorado School of Nursing in 1992 and received the Distinguished Nurse Scholar title

from New York University in 1998. In 1999, she assumed the Murchison-Scoville

Endowed Chair of Caring Science at the University of Colorado. Jean Watson's

international impact is equally impressive, with her receiving a Fulbright Research and

Lecture Award in Sweden and other parts of Scandinavia in 1991, an International

Kellogg Fellowship in Australia in 1982, and participating in lecture tours and projects in

numerous countries worldwide. Her commitment to relationship-centered care practices

led to her being awarded the Fetzer Institute's national Norman Cousins Award in 1999,

among other recognitions. In 2015 and 2016, she received additional honors from

institutions such as Notre Dame University, the United Nations, and the International

Society for Caring and Peace in Japan. Jean Watson's enduring legacy in the field of

nursing is a testament to her exceptional contributions and dedication to compassionate

and holistic patient care (Willis).

School of Thought Classification

I would most likely apply the Theory of Human Caring to the Caring/Becoming

School of thought. In our textbook it is described as coming about in the 1980’s, around

the time that this theory came about from existential philosophy and for the purpose of

bringing about equity (Meleis, 2016). Within this school of thought, the questions that

are asked are “What do nurses do?” and “How do nurses do what they do?”. Watson’s

theory is centered around healing people and has a focus on humanistic caring. Things

that are taught by caring theorists include the following: caring is central to the process

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of bringing the lives of patients and nurses together, caring is central to the discipline of

nursing, and nurses who actually integrate caring into their practice leaver have been

transformed (Meleis). This is a beautiful and also heartbreaking concept when you look

into the way that healthcare is run today in some places, especially within acute care.

Influences

The development of the Nursing Theory of Caring was influenced by Watson's

study of various philosophical and nursing theories including the above-mentioned

individuals in psychology: Abraham Maslow, Carl Rogers, and Pierre Teilhard de

Chardin. I would include Florence Nightingale into this as well. In Jean Watson’s Written

Theory of Human Caring states in the conclusion “Consistent with the wisdom and

vision of Florence Nightingale, nursing is a lifetime journey of caring and healing,

seeking to understand and preserve the wholeness of human existence across time and

space and national/geographic boundaries, to offer heart-centered compassionate,

informed knowledgeable human caring to society and humankind” (Watson,

Woodward, 2020). Both nursing theorists emphasize a holistic approach to patient care.

They both recognize that it includes not only the physical but also the psychological,

social, and spiritual dimensions of well-being. Nightingale's belief in the significance of

the healing is echoed in Watson's theory, which underscores the creation of a caring

and nurturing atmosphere for patients (Light, 1997).

Literature Review

Watson’s theory has been utilized a number of times in articles and in books.

Use of Google scholar searching for “Jean Watson Theory of Human Caring” yields

20,400 and a search within Ebscohost yields 164,629 within the domain allowed by

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Idaho State University and with a limitation of full text only it has 13,128 results that are

open to idaho state university students and faculty. Past literature has demonstrated the

theory's applicability to diverse populations, including LGBTQ individuals. Studies have

explored its use in acute care, primary care, and mental health settings, showing its

versatility (Kamen, Alpert, Margolies, Griggs, Darbes, Smith-Stoner, & Norton, 2019).

With use of boolean searches, to search the same as above and to include “LGBTQ

with an ‘AND’ search brought one article that did not fully fit the themes of human caring

in regards to LGBTQ healthcare. That said, Watson’s theory works directly with the

topic because of its inclusivity and its caring approach to treatment and nursing. The

theory has influenced healthcare practices by encouraging a more holistic and patient-

centered approach. In addition, it has played a role in shaping policies related to patient-

centered care and nursing education.

Evaluation

One of the strengths of Jean Watson's Nursing Theory of Caring is its ease of

adoption. Its principles align with the core values of nursing, making it a natural fit for

nursing practice. In fact, I did not know that this was a theory prior to reading about her

life and theory; mostly because it is the core of and the whole point of being a nurse.

While widely recognized, some healthcare institutions and professionals may face

challenges in fully adopting the theory due to time constraints and the need for cultural

shifts in healthcare settings. Additionally, further testing and research are needed to

quantify its impact comprehensively. A limitation of the theory is the difficulty in

measuring caring empirically, which has led to skepticism among some healthcare

professionals. We have all seen a nurse where we felt that they could have cared a little

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more, but because it is case by case and hard to gauge with no scale, then it really

cannot be measured. One area that requires attention in Jean Watson's Nursing Theory

of Caring is the development of more concrete measurement tools for assessing caring

behaviors. This would help address the skepticism and promote wider adoption. To

reduce limitations and improve adoption, research efforts should focus on developing

valid and reliable instruments to measure caring behaviors and their impact on patient

outcomes. Additionally, further education and training in the theory may help healthcare

professionals better understand and apply its principles.

Critique

Watson’s theory outlines a change of focus for nurses from curing a patient to

caring for a patient. The concept is laid out clearly and directly. Is the theory complex?

The concepts within Jean Watson's Theory of Human Caring can be complex due to

their interdisciplinary nature and their exploration of nursing care. However, the theory

also strives for clarity and emphasizes the need to be interconnected, providing a

holistic framework for nursing practice that values human caring and the nurse-patient

relationship. Its adaptability and cultural sensitivity are additional strengths (Watson &

Woodward). The level of complexity and clarity experienced by individuals studying or

applying the theory may vary based on their familiarity with nursing theory and their

specific educational and practice context. Jean Watson's Theory of Human Caring has

had a significant influence on nursing practice, education, and research since its

development in the late 1970s. It has been widely applied in various healthcare settings,

although the extent of its application can vary by region and institution. The degree of

application may vary, with some nurses and institutions incorporating the theory more

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extensively than others. In my experience, the more an organization focuses on

numbers, productivity, and profit, the less nurses are able to apply this nursing theory.

In regards to my population of focus, I would say that the theory focuses well on

patient focused care. Applying Jean Watson's Caring Theory to LGBTQ care as a

Doctor of Nursing Practice involves recognizing the unique needs and challenges that

LGBTQ individuals may face in healthcare settings and providing care that is holistic,

compassionate, and respectful. A DNP could do this by establishing a caring

environment, developing a caring relationship, being present, promoting inclusivity,

respecting autonomy, addressing holistic needs, advocating for LGBTQ health,

providing culturally competent care, offering emotional support, and collaborating with

LGBTQ organizations.

The theory's greatest strength lies in its emphasis on the human connection

between nurses and patients, promoting healing beyond the physical aspects of care.

Its holistic approach aligns with contemporary healthcare's movement towards patient-

centered and culturally sensitive care. To reduce limitations, the theory should be

continuously refined through ongoing research, particularly in the area of measurement

tools. Efforts should be made to integrate it more comprehensively into nursing curricula

to ensure that future generations of nurses are fully educated in its principles.

Application

The application of Jean Watson's Nursing Theory of Caring to LGBTQ healthcare

is particularly relevant in the context of addressing the unique healthcare needs of

LGBTQ individuals. The theory's emphasis on empathy, understanding, and the

creation of a therapeutic caring relationship aligns with the goals of providing culturally

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competent and inclusive care to LGBTQ patients. This theory is well-suited for LGBTQ

healthcare because it recognizes the importance of respecting individuals' identities,

promoting trust, and addressing the psychosocial aspects of healthcare. It encourages

nurses to provide care that acknowledges the unique challenges and experiences of

LGBTQ individuals, fostering a more inclusive and supportive healthcare environment.

For some, it would encourage them to take a caring approach to treating these patients

despite their difference in beliefs. I believe that all people should be treated the same

way, and advocate strongly for trans and queer rights, but there are many people that

have a difference of belief. Through Jean Watson’s theory, the care provided will not

only provide the best care they can but should assist the nurse to leave a “transformed

person” with a better understanding of this person’s/population’s point of view and the

challenges they experience.

With use of the 7 step analysis, it goes as follows: The specific aspect of practice

being analyzed is the application of Jean Watson's Nursing Theory of Caring in LGBTQ

healthcare. The intended purpose of applying Watson's theory in LGBTQ healthcare is

to provide compassionate, holistic, and patient-centered care to LGBTQ individuals.

Assumptions supporting these intended purposes include the belief that caring is

fundamental to nursing, that healthcare providers should address the physical,

emotional, and spiritual needs of individuals, and that a strong nurse-patient relationship

is crucial for optimal patient outcomes. Queer individuals benefit from the application of

Watson's theory in healthcare as it ensures that their unique needs, concerns, and

identities are acknowledged and respected. It promotes their physical, emotional, and

psychological well-being, because the theory emphasizes the need for holistic care. The

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disadvantage would be for queer individuals who do not receive care that aligns with

Watson's theory, as they may experience discrimination, lack of empathy, and a less-

than-optimal healthcare experience. This is not the goal of the theory, but because of

other influences, it can be a possible downfall. Cultural and social norms, discrimination,

and healthcare policies, all contribute to societal influences that affect this theory.

Discrimination and stigma against LGBTQ individuals in society can hinder the full

implementation of a caring and inclusive healthcare approach. To mitigate potential

harm and improve the application of Watson's theory in LGBTQ healthcare,

implementation of cultural competency training for healthcare providers, queer-inclusive

policies and practices within healthcare institutions, the creation of safe and welcoming

healthcare environments for LGBTQ individuals. These would be most successful if

done in collaboration with and while being led by LGBTQ advocacy organizations and

individuals within that community to promote awareness and sensitivity (Nixon, Yeung,

Shaw, Kuper, & Gibson, 2017).

Conclusion

Jean Watson's Nursing Theory of Caring stands as a foundational framework in

nursing practice It emphasizes the importance of compassion, empathy, and holistic

care. Born out of a desire to rekindle the human side of nursing, this theory has made a

profound impact on healthcare practices, education, and research. By applying

Watson's theory to LGBTQ healthcare, nurses and healthcare providers have the

opportunity to create a caring and inclusive healthcare environment where the unique

needs and concerns of queer individuals are acknowledged and respected. Jean

Watson's Nursing Theory of Caring embodies the essence of nursing as a caring

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profession. It calls for healthcare providers to go beyond the technical aspects of

healthcare and to recognize the shared humanity that connects us all. It is a call to

transform not only the way we care for patients but also ourselves, leaving us with a

better understanding of diverse perspectives and the challenges faced by the LGBTQ

community.

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References

Clark, C. S. (2016). Watson’s human caring theory: Pertinent transpersonal and

humanities concepts for educators. Humanities, 5(2), 21.

Gonzalo, A. (2016). Jean Watson: Theory of Human Caring. Nurseslabs.

https://nurseslabs.com/jean-watsons-philosophy-theory-transpersonal-caring/

Kamen, C. S., Alpert, A., Margolies, L., Griggs, J. J., Darbes, L., Smith-Stoner, M., ... &

Norton, S. A. (2019). “Treat us with dignity”: a qualitative study of the

experiences and recommendations of lesbian, gay, bisexual, transgender, and

queer (LGBTQ) patients with cancer. Supportive Care in Cancer, 27, 2525-2532.

Light, K. M. (1997). Florence Nightingale and holistic philosophy. Journal of Holistic

Nursing, 15(1), 25-40.

Meleis, A. I. (2016). Theoretical Nursing (6th ed.). Wolters Kluwer Health.

https://bookshelf.vitalsource.com/books/9781496381736

Nixon, S. A., Yeung, E., Shaw, J. A., Kuper, A., & Gibson, B. E. (2017). Seven-Step

Framework for Critical Analysis and Its Application in the Field of Physical

Therapy. Physical Therapy, 97(2), 249–257. https://doi.org/10.2522/ptj.20160149

Watson, J. (1999). Postmodern nursing and beyond. The nursing profession: Tomorrow

and beyond, 299-310.

Watson, J. (2002). Intentionality and caring-healing consciousness: A practice of

transpersonal nursing. Holistic nursing practice, 16(4), 12-19.

Watson, J., & Woodward, T. (2020). Jean Watson's theory of human caring. SAGE

Publications Limited.

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Willis, D. (2017). Watson’s philosophy and theory of transpersonal caring. Nursing

Theorists and Their Work. 9th ed. St. Louis-MI: Elsevier, 66-78.

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