Theoretical Basis for Nursing

Theoretical Basis for Nursing

Jean Watson’s (2008) Philosophy and Science of Caring, a recent publication, builds on her previous work, Nursing: Human Science and Human Care: A Theory of Nursing. This theory is one of the newest of nursing’s grand theories, having only been completely codified in 1979, revised in 1985 (Watson, 1988), and broadened and advanced more recently (Watson, 2005, 2008). Watson called her earlier work a descriptive theory of caring and stated that it was the only theory of nursing to incorporate the spiritual dimension of nursing at the time it was first conceptualized. The theory was both deductive and inductive in its origins and was written at an abstract level of discourse. Theoretical Basis for Nursing

It is somewhat difficult to categorize Watson’s work with the works of other nursing theorists. It has many characteristics of a human interaction model, although it also incorporates many ideals of the unitary process theories, which are discussed in  Chapter 9 . Watson (2005) has always described the human as a holistic, interactive being and is now explicit in describing the human as an energy field and in explaining health and illness as manifestations of the human pattern (Watson, 2008), two tenets of the unitary process theories. Parse (2004) points out, however, that although theorists profess belief in unitary human beings, other definitions and relationships still separate theories from the interactive process paradigms and the unitary process nursing paradigms. Based on overall considerations, the philosophy and science of caring reflects the interactive process nursing theories. Theoretical Basis for Nursing

Background of the Theorist

Jean Watson was born in West Virginia and attended Lewis Gale School of Nursing in Roanoke, Virginia. She earned a bachelor’s degree in nursing, a master of science degree in psychiatric–mental health nursing, and a doctorate in educational psychology and counseling, all from the University of Colorado (Neill, 2002). Watson is an internationally published author, having written many books, book chapters, and articles about the science of human caring (Watson, 1994, 1996, 1999, 2005, 2008).

Watson is the former Dean of the School of Nursing at the University of Colorado, and she founded and directed the Center for Human Caring at the Health Sciences Center in Denver. She has received numerous awards and honors (Neill, 2002) and is currently Distinguished Professor of Nursing and Dean Emerita at the University of Colorado Denver College of Nursing and Anschutz Medical Center, “where she held an endowed chair in Caring Science for 16 years. She is a fellow of the American Academy of Nursing and past president of the National League for Nursing” (Watson Caring Science Institute and International Caring Consortium [WCSIICC], 2013). Some of her honors include Fetzer Institute Norman Cousins Award; an International Kellogg Fellowship in Australia; a Fulbright research award in Sweden; and 10 honorary doctoral degrees, including those from Sweden, United Kingdom, Spain, British Columbia and Quebec in Canada, and from Japan (WCSIICC, 2013). Theoretical Basis for Nursing

Philosophical Underpinnings of the Theory

Watson (1988) noted that she drew parts of her theory from nursing writers, including Nightingale and Rogers. She also used concepts from the works of psychologists Giorgi, Johnson, and Koch, as well as concepts from philosophy. She reported being widely read in these disciplines and synthesized a number of diverse concepts from them into nursing as a science of human caring. In a recent work, Watson (2005) continues to “bridge paradigms and point toward transformative models for the 21st century” (p. 2).


Major Assumptions, Concepts, and Relationships

The value system that permeates Watson’s (1988, 2008) theory of human caring includes a “deep respect for the wonders and mysteries of life” (1988, p. 34) and recognition that spiritual and ethical dimensions are major elements of the human care process. A number of assumptions are both stated and implicit in her theory. Additionally, several concepts were defined, refined, and adapted for it. From this, 10 carative factors were developed ( Box 8-4 ; Watson, 1985, 2008). Theoretical Basis for Nursing

Box 8-4: Watson’s 10 Carative Factors

· 1. Humanistic–altruistic system of values

· 2. Faith–hope

· 3. Sensitivity to self and others

· 4. Developing helping–trusting, caring relationship

· 5. Expressing positive and negative feelings and emotions

· 6. Creative, individualized, problem-solving caring process Theoretical Basis for Nursing

· 7. Transpersonal teaching–learning

· 8. Supportive, protective, and/or corrective, mental, physical, societal, and spiritual environment

· 9. Human needs assistance

· 10. Existential-phenomenologic and spiritual forces

Source: Watson (1999, 2005).


Watson (2008) describes the tenets of caring science and sacred science. She proposed that caring and love are universal and mysterious “cosmic forces” that comprise the primal and universal psychic energy. Further, she believes that health professionals make social, moral, and scientific contributions to humankind and that nurses’ caring ideal can affect human development. Further, she believes that it is critical in today’s society to sustain human caring ideals and a caring ideology in practice, as there has been a proliferation of radical treatment and “cure techniques,” often without regard to costs or human considerations. Theoretical Basis for Nursing

Explicit assumptions that were derived for Watson’s (2005) work include:

·  An ontologic assumption of oneness, wholeness, unity, relatedness, and connectedness.

·  An epistemologic assumption that there are multiple ways of knowing.

·  Diversity of knowing assumes all, and various forms of evidence can be included.

·  A caring science model makes these diverse perspectives explicitly and directly.

·  Moral-metaphysical integration with science evokes spirit; this orientation is not only possible but also necessary for our science, humanity, society-civilization, and world-planet.

·  A caring science emergence, founded on new assumptions, makes explicit an expanding unitary, energetic worldview with a relational human caring ethic and ontology as its starting point (Watson, 2005, p. 28).


Watson (1988) defined three of the four metaparadigm concepts (human being, health, and nursing). She coined several other concepts and terms that are integral to understanding the science of human caring ( Table 8-7 ). Her 10 carative factors are caring needs specific to human experiences that should be addressed by nurses with their clients in the caring role. She continues to value those carative factors (Watson, 2008 Theoretical Basis for Nursing

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