As a nurse establishing a caring relationship with a client is not easy. Jean Watson was the developer of a theory, which emphasizes how nurses express care to their patients. In this paper the author will discuss Jean Watson’s theory, background, descriptions of her four concepts; environment, human being, nursing, and health, also describe of an actual nurse-client relationship which includes the description of the caring moment between a nurse and her 10 year old patient, which includes the caring moment and use of four of Watson’s carative factors.
Jean Watson was born in a small town Appalachia Mountains of West Virginia on 1940. In 1961 she graduated from The Lewis Gale School of nursing. She earned her bachelor’s degree in 1964, and her master’s degree in psychiatric and mental health nursing in 1966. Later in 1973 she obtained her PhD in educational psychology and counseling (Nursing Theory, 2012). Watson’s theory is grounded by ten processes known as the “Caritas Processes” these 10 statements helped to provide and ethic or philosophy from, which we practice.
Caritas represent charity, compassion, and generosity of spirit (Arslam & Azkan, 2012). It connotes something very fine, indeed, something precious that needs to be cultivated and sustained. The original theory developed in 1979 was organized around ten carative factors (Arslam & Azkan, 2012). Jean Watson’s carative factors were a combination of interventions that were related to the human care process with full participation of the nurses with the patient. Watson’s philosophy and sciences of caring addresses how nurses express care to their patients.
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According to her theory, caring can be demonstrated and practiced by nurses. Caring for patients promotes growth; a caring environment accepts a person as he or she is and looks to what she or he may become (Watson Caring Science Institute, 2012). Watsons’s theory of caring has for major factors; human being, health, environment, and nursing (Nursing Theory, 2012). To Watson a human being was not only a body, but we should view a human as a whole, including their emotions (Arslam & Azkan, 2012).
Watson believed a person should be understood, respected, and assisted by a nurse (Arslam & Azkan, 2012). She described health as the unity of the body, mind, and soul (Watson Caring Science Institute, 2012). Watson described environment as the things that make the client feel comfortable that provides safety, reduces stress, and a clean place (Nursing Theory, 2012). This can include the work setting and how nurses present themselves to the client. She views nursing as a human science where we can combine art ethics of human to human process.
Nurses are to promote health, prevent illness, caring of the sick and returned health (Arslam & Azkan, 2012). According to Watson, the nurse’s role is to establish a caring relationship with the patient; this is achieved by the nurse going beyond an objective assessment (Watson Caring Science Institute, 2012). During the relationship there is a moment when the nurse and the patient come together in such a way that an occasion for human caring is created, Watson called this occasion the “Caring Moment” (Arslam & Azkan, 2012).
Working as a mental health nurse I have been able to develop a nurse-client relationship with my patients. However, there is a specific case that I will never forget the interaction with this patient makes me relate to Watson’s theory and the caring moment she describes in her theory. One evening working as a charge nurse in the children’s unit, “Sarah” a 10 year-old African American girl arrived to the unit via ambulance; she was coming directly from school where she was put on a 72- hour involuntary psychiatric hold because of her cutting her wrist with a blade and saying she wanted to die.
That day, her two years older sister had reported to her physical education teacher in school that her and her sister were both been sexually abused by their biological father at home. Immediately child services were notified and many school counselors attempted to talk to Sarah while still in school to get her side of the story but Sarah refused to share any information with anyone, instead she showed the school staff herself inflicted cuts on her both wrists saying “This helps my pain. ” At this moment the school called the department of mental health to evaluate Sarah.
When she arrived to the unit, she looked confused, scared, and tearful at times. She was still refusing to talk to anyone when asked about the situation stating “I just want to die. I introduced myself to Sarah with a smile, I explained to her she was put on a psychiatric hold and let her know what was coming next during the admission process to reduce her anxiety level (Townsend, 2008). The caring moment begins while doing Sarah’s nursing assessment and the question of her been sexually abuse had to come, when I asked her she states, “You are so pretty and nice can I stay and live here with you? In that moment my heart comes to my stomach and my eyes become watery, I stayed quite not knowing what to answer. Few seconds of silence came and suddenly she starts sharing information and even giving details of her sexual abuse from her father’s part. The information she gives me is very explicit and shocking coming from an innocent ten year old girl. Then she stands up and hugs me saying “I want to stay her with you please. ” I hugged her back and began crying inconsolable with Sarah, unforgettable, and priceless moment has marked my nursing career in a way that I know a nurse has to be sensitive to herself and to others.
During nurse- client interaction with Sarah I used four of Jean Watson’s carative factors. The fist carative factor I used was the installation of faith-hope, which means been authentically present, and enabling and sustaining the deep belief system (Arslam & Azkan, 2012). I tried to make Sarah feel comfortable by providing a quiet and calm place to perform her nursing assessment. I also tried to provide hope to her by making her feel cared for, I asked her if she was hungry and offered her some juice and some snacks, and I admired the beautiful hair and smile.
I asked her about her relationship with her mother and sister and asked her if she believed they loved her. I asked her these questions so she can reflect and realized there was people that loved and cared for her (Townsend, 2008). The second carative factor I implemented was the development of a helping-trusting human caring relationship that implies developing and sustaining a helping-trusting authentic relationship (Watson Caring Science Institute, 2012).
I implemented this factor by obtaining Sarah’s trust so she can express her feelings of her living situation at home which was extremely important to understand her situation and provide quality care and an individualized treatment. I maintain intermittent eye contact so she would feel acknowledge but not intimidated and I maintained myself at her height level at all times so she would not feel powerless (Townsend, 2008).
I explained to her the admission process at her age level letting her know as much as possible what to expect from the hospitalization and explain the program guidelines to her. I reassured her many times she was in a safe environment. The third carative factor I used was the promotion and acceptance of the expression of positive and negative feelings, to Watson this means being present to, and supportive of the expression of positive and negative feelings as a connection with deeper spirit of self and the one being cared for (Watson Caring Science Institute, 2012).
Sarah’s case was a very sensitive case which required the nurse to be very cautious in not making Sarah feel blame or judge for the situation, taking into consideration this a 10 year old with multiple self inflicted cuts in her wrist, she is feeling suicidal and there was a possibility of emotional and physical trauma. Even though it was extremely important to ask Sarah about her cuts and possible abused from her father I decided to focus on her positive feelings asking her about her siblings for example.
Per hospital protocol within the first 15 minutes of arrival patients are required to go through a body search to check for any contraband, signs of abuse or self harm. During this physical assessment I saw Sarah’s cuts, I had to ask her if she had cut herself and looking down she shake her head up and down. I stayed calm paying attention to my body language and gestures, a negative facial expression or gesture toward her behavior of cutting herself could have had a negative effect on the nurse-client relationship affecting her trust toward myself (Townsend, 2008).
In that moment I decided not to focus on finding out the reason she had to cut herself. I was there for Sarah listening to her, attentive in a calm environment, where she felt protected and cared for. I did not want her to feel pressured or judge. Later during the assessment she began speaking of her cuts and expressing her feelings. The fourth carative factor I used in Sarah’s care, which is the cultivation of sensitivity to oneself and to others. To Watson this meant the cultivation of one’s spiritual practices and transpersonal self, going beyond ego self (Watson Caring Science Institute, 2012).
I personally been a mother of a seven-year old at that time I immediately felt that need to protect her and make her feel safe. During the nursing assessment there was a moment where I became tearful when she was sharing details about the sexual abuse describing how sometimes she would rather urinate in her bed to avoid making noise so her father would not wake up and abused her that particular night. I became sensitive to her story, it was impossible not to show any emotions.
In personal reflection the nurse-client relationship with Sarah taught me that a nurse needs to cared for her patient and have compassion, which to me is what nursing is about compassion, and empathy. I was able to obtain Sarah’s trust which is extremely important not only in nursing over all but when dealing with trauma patients. Sarah was able to express her feelings and share crucial information with me. Personally I discovered I was meant to be a mental health nurse I felt rewarded when Sarah hugged me and cried with me.
I believed I made a difference in her life in that moment she felt safe and cared for. The author in this paper has described the four concepts of Jean Watson’s theory human being, environment, health, and nursing. Watson’s educational background and caritas model were briefly described. The author included an actual nurse-client relationship between a mental health nurse and a ten year old, including the caring moment and describing the implementation of four of the ten carative factors Jean Watson developed.
Arslam, A., & Azkan, A. (2012, March). A model Where Caring and Healing Meets:Watson's theory of Human Caring. Turkish Journal of Researcher and development in nursing, 14(2), 61-72. Nursing Theory. (2012). Jean Watson. Retrieved from http://www.nursing-theory.org Townsend, M. (2008). Psychiatric Mental Health Nursing (6th ed.). Philadelphia, PA: F.A Davi. Watson Caring Science Institute. (2012). Jean Watson's Theory. Retrieved from http://www.watsoncaringscience.org
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