Jean Watson: The Theory of Transpersonal

Caring
Jean Watson
Summary
Jean Watson earned her BSN, then her masters degree
with an emphasis in nursing and psychiatric-mental health
nursing, and later her Ph.D. in educational psychology and
counseling. She has received numerous honors and awards
both as a professor at the University of Colorado, where she graduated from, and as a dedicated
scholar and theorist for the betterment of nursing practices. Because of Watsons extensive
education and nursing background, the ideas and application of caring by nurses everywhere
have changed and will continue to change for the better, well into the future. Her Theory of
Transpersonal Caring is a theory of holistic caring. The theory is founded upon the personal
relationship between the patient and nurse because, in the opinion of Watson, the spiritual care
that a patient receives is just as important as the physical and mental care in the healing process.
This theory is an evolving theory that is able to change and adapt to particular situations and the
surrounding circumstances that surround all encounters. The theory also heavily embodies the
nursing paradigm of person, environment, health, and nursing. The person is seen in a holistic
way and environmental and spiritual aspects are very important to the health of the person and
how nurses form relationships and care for patients. Jean Watsons theory aims to implicate
nursing practice, education and research through transforming the technological, prescriptive
focus of modern nursing into a caring practice that addresses the physiological, emotional,
psychological, and spiritual self. In reference to education, this theory and its unique approach to
patient care is currently taught in college classrooms and upheld in healthcare facilities
internationally. Research is currently being conducted to test the effectiveness of transpersonal
caring.
Education and Nursing Specialty
Jean Watson began her nursing education at the Lewis Gale Hospital School of Nursing
in her hometown of Roanoke, Virginia. She graduated in 1961 and went on to further her
education. Watson moved to Colorado and enrolled at the University of Colorado, Boulder. In
1964, she earned her baccalaureate degree in nursing. Two years later, Watson received her
Masters of Science at that same university. During her undergraduate and graduate education
experiences, Watson focused her studies on nursing and psychiatric-mental health nursing
(George, 2010). Having a passion for continuing her education, in 1973 she graduated with her
Ph.D. in educational psychology and counseling. She has since than earned ten honorary
Doctoral degrees including seven International Honorary Doctorates (Sweden, United Kingdom,
Spain, British Columbia and Quebec, Canada, Japan). She also received an international Kellogg
Fellowship in Australia and a Fulbright Research Award in Sweden. Soon after graduating with
her doctorate from the University of Colorado, Watson joined the teaching profession. In
recognition of her outstanding teaching accomplishments, she was named a distinguished
professor emerita at the university for her continued dedication to scholarly works and went on
to earn an endowed Chair in Caring Science at the University Of Colorado School Of Nursing
Murchinson-Scoville (Currentnursing.com, 2012). As a dedicated theorist and spokeswoman,
Watson made an incredible impact on the research side of nursing by contributing to the
foundation of the Center for Human Caring in Colorado. Because of her contributions, she
became the President of the National League of Nursing and later assumed the role of the Dean
of Nursing at the same institute. As her nursing theory would indicate, Watson has been a
dedicated researcher who focuses on the psychiatric side of nursing and the great impact caring
has on the healing of those patients that experience hardship and loss. With a focus on the caring
side of nursing, Watson developed the caring theory which describes the ideals of nursing as
providing compassion and comfort to the patients and families while they are a part of the
healthcare system. Because of her extensive work to better the education of nurses and her
impact on the field of nursing as a whole, Watson was awarded the Living Legend Award from
the American Academy of Nursing (of which she is a fellow contributor) in 2013 (Watson
Caring Science Institute, 2014). She has continued her work at Anschutz Medical Center and
recently founded the Watson Caring Science Institute. This is an international non-profit
foundation dedicated to continuing research on the philosophies, theories, and practices of
human caring. Throughout her education and professional teaching career, Watson has written
numerous articles and books emphasizing and applying her theory to the present day field on
nursing.
Theory, Concepts, and Propositions
Jean Watson developed the Theory of Transpersonal Caring, which is essentially caring
for the purpose of promoting healing, preserving dignity, and respecting the wholeness and
interconnectedness of humanity (George, 2010 p. 454). Watsons theory links together the
nursing profession and caring, which in a metaphysical and spiritual sense is based in loving care
for Watson (George, 2010). In a way, this outlook on nursing is an attempt to provide a more
holistic approach to caring for a patient; no longer is it all about only the physical well-being of
the patient but it is now also about the emotional and spiritual well-being of a patient. It seems
vital to healing because a patient with a more positive attitude will keep a positive outlook on the
healing process and will be more readily available for participation in exercises or other healing
practices.
Watsons theory is originally based around three major concepts: transpersonal caring
relationship, the 10 carative factors, and caring occasion/caring moment (George, 2010). More
dimensions have evolved over time, such as expanded views of self and person, the importance
of caring-healing consciousness within the human-environment energy field, consciousness as
energy; forgiveness and surrender as highest level of consciousness, an unbroken wholeness and
connectedness of all, nursing arts that involve the human heart and soul as well as the that of the
mind and hands, that love is the ultimate form of transcendent healing, and that nurses are sacred
in the healing environment (George, 2010).
Transpersonal Caring Relationship is the connection between the nurse and the patient
(George, 2010). This relationship is at the core of the theory because it is somewhat a connection
between two hearts. Watson thinks, in this concept, that caring for ones self is vital to caring for
other individuals (George, 2010).
The next concept in the theory is the Ten Carative Factors, now called the clinical
caritas processes. These caratives are the characteristics, identified by Watson, as those that
make up a caring relationship and are based upon a nurses conscious, moral commitment to his
or her patients to facilitate healing in a way that maintains dignity (George, 2010). The carative
factors are the forming of humanistic-altruistic values, faith-hope, being sensitive to self and
others, helping-trusting, caring relationships, promoting and accepting feelings and emotions,
engaging in caring processes that are creative, individualized, and problem solving, promoting
transpersonal teaching-learning, attending to a holistic environment, assisting with gratification
of basic human needs while preserving human dignity and wholeness, and lastly allowing for
existential-phenomenological and spiritual dimensions of caring and healing that cannot be fully
explained scientifically through modern Western medicine (George, 2010).
Caring Occasion/Caring Moment is the third major concept in the Theory of
Transpersonal Caring. It is the time when nurses come together with individuals and have a
unique opportunity, special to the dynamics of that relationship, to affect a patients healing
process both spiritually and physically (George, 2010). This is particularly special because it
should remind us, as prospective nurses, that we each have an individual capability to change a
patients outcome regardless of if they are our patient or not because we can all have that focal
point in time and space with a patient.
Watsons theory has four metaparadigms that it adheres to: person, health and illness,
environment, and nursing (George, 2010). Person refers to the spiritual aspect of life, believing
that the human experience is part of spirituality instead of spirituality being part of the human
experience (George, 2010). Health is the harmony and togetherness within mind, body, and soul
while illness is believed, by Watson, to be a result of a troubled soul instead of a physical
condition (George, 2010). Environment is simply the environmentspiritual, physical, mental
that is most conducive to healing in the patient (George, 2010). The nursing metaparadigm of
professionalism aids in the formation of the expert nurse and helps develop proper interventions
for all aspects of an individuals health (George, 2010).
Application of the Nursing Metapardigm to Jean Watsons Theory of Caring
Person
Watsons theory is centered on the caring, trusting relationship between the nurse and the
patient on a spiritual and holistic level.
The person or patient described in the caring theory is seen as, a unity of mind-body-
spirit/nature (Masters, 2013). The theory also describes a person as someone whose
consciousness is closely connected to the universe; however even though the mind is not
physically tied to the body they still interact (George, 2010). The formation of a transpersonal
relationship begins when the nurse and the patient separately explore and understand their
individualized spiritual ideas and needs. A person must be able to understand their own sense of
self and spirituality before they are able to attend to others needs. Then, according to Watsons
10 caritas, spirituality must be applied to create an authentic, sustaining, supportive and creative
relationship (Masters, 2013).
Environment
A caring nurse-patient relationship needs an appropriate environment to meet health and
spiritual needs. One important aspect
is providing the proper teaching for the patient in a caring manner. This is achieved by treating
the patient as a complex system that is drastically affected by changes in its environment. The
nurse must understand all components of the patients environment and realize that they are a
huge part of the patients environment and have a wide influence based on the caring relationship
they have established. The environment must also be holistic as Watson explains in one of her
caritas, Creating a healing environment at all levels, subtle environment of energy and
consciousness whereby wholeness, beauty, comfort, dignity, and peace are potential (Masters,
2013).
Health
Watsons caring theory cannot be achieved without the evaluation of our own values,
spirituality, and sense of self which leads to
a healthy mind and body. We are unable to care for others without first caring for ourselves. A
caring relationship related to health and healing produces, harmony, wholeness, and comfort
(Masters, 2013), in the patient and those caring for them. On the other hand, illness is related to
disequilibrium between the inner self and anything in the environment or the persons physical
body. A healthy person is described as someone who feels good about the stage of life they are in
and feel loved throughout the caring process (George, 2010).
Nursing
Watson views nursing as human science which is a product of utilizing nursing and other
scientific knowledge to provide care in
a holistic way. Her theory supports the idea that nursing involves, helping people to gain a
higher degree of harmony within the mind, body and soul . . . [which] is achieved through caring
transactions (McCance, McKenna & Boore, 1999). Caring transactions are a product of the
caring relationship created between the nurse and the patient. One of Watsons caritas expresses
the importance of being creative or the art of nursing in providing care and solving problems as
they arise. Creativity is very important in creating an individualized care plan related to the
patients spiritual and health needs (George, 2010).
Theorys Implication to Nursing Practice, Education and Research
Implication to Nursing Practice
Caring is the foundation of Watsons nursing theory. In the modern healthcare industry,
the main focus tends to be on developing new medical technology and treating physical ailments.
Watsons focus, however, is on addressing the mind, body, and spirit of an individual and
promoting self-healing. While competence in nursing skills is considered an essential aspect of
care, the highest levels of medico-technological competence do not necessarily reflect
transpersonal caring (George, 2010, p.469). Transpersonal caring is to present oneself as a
positive energy and presence for his or her patients, to develop a strong interpersonal nurse-
patient relationship, and to carry out nursing interventions with a compassionate heart. It is to
treat patients with utmost respect and to preserve their dignity and autonomy.
The Transpersonal Caring theory attempts to aid the patient in a holistic wayproviding
assistance with basic needs, creating a healthy environment, and cultivating the spiritual self. It
takes the steps of the nursing process (ADPIE) and revises it in order address the whole of a
person. In Assessment, it identifies any problems that the client is facing. It is understood that
physical problems affect the emotional and spiritual well-being of the person. In the Diagnoses
step, the nurse takes these problems and transcribes them into terms that are used in the nursing
profession. Planning includes formulating interventions that address both the physical and
psychological well-being of the person. In the Implementation phase, one carries out these
interventions in a loving and caring way. Evaluation is used to determine the effectiveness of not
only the intervention, but also studies the response of the patient.
Jean Watson discusses several ways that her theory can be put into practice in everyday
nursing situations in her article Caring Science and Human Caring Theory: Transforming
Personal and Professional Practices of Nursing and Health Care. Some of these practices
include: Intentionally pausing and breathing, preparing self to be present before entering
patients room; engaging in centering exercises and mindfulness practices, either individually or
collectively; (and) placing magnets on patients door with positive affirmations, and reminders of
caring practices (Watson, 2009, p. 475). These kinds of practices create an environment that
promotes self-healing and restoration, as well as more positive nurse-patient relationships and
interactions. This theory is applicable to any setting, place, or situation where the integrity,
wholeness, and soul of humanity is of concern (George, 2010, p. 467).
Implication to Education
The Transpersonal Caring theory is very much respected and well-known. Many colleges
and universities, such as those found in North America, Sweden, Finland, Japan, and Norway,
coordinate this theory into their nursing education models (George, 2010). The implementation
of this theory requires education not only in the technological skills of nursing practice, but also
in the realm of liberal arts, placing a strong emphasis on the subjects of philosophy, ethics, and
values. Its curriculum takes aspects of both the Western and Eastern world, which is why this
theory is so widely used. Students are taught to reject the practice of linear thinking and
mechanically following the steps of the nursing process. Instead, they are to go beyond
clinical views of medical illness and pathology and enter into a deeper subjective human
dimension related to self-knowledge, self-control, self-caring, and even self-healing potential.
(George, 2010, p. 469).
Numerous hospitals utilize this theory, calling it Caritas Nursing. This kind of nursing aims
to bring back compassionate, loving, and interpersonal care back into the healthcare practices
and facilities. This idea of Caritas Nursing was formulated by Jean Watson, herself. Hospitals
that practice this kind of nursing include: Baptist Hospital of Miami, Florida; Resurrection
Health facility in Chicago, Illinois; Central Baptist Health hospital in Lexington, Kentucky; and
Bon Secours St. Francis Hospital in Charleston, South Carolina. Many of the hospitals that
practice Caritas Nursing are of Magnet Recognition (Watson, 2009).
Implications to Research
Many studies have been conducted that aimed to test the effectiveness of Jean
Watsons theory. Several types of experiments have also been implemented including quasi-
experimental designs which focuses on physiological outcomes and uses standardized scales,
phenomenology, and quantitative descriptive surveys (George, 2010). While there is criticism
over the fact that Watson tends to focus less on the physical and more on the spiritual, it can be
said that many of the hospitals that use the Transpersonal Caring theory as their central
foundation to nursing practice tend to have reports of high patient satisfaction. Currently, several
countries such as Canada, Ireland, Japan, Portugal and South Korea are researching Watsons
theory and formulating new models related to transpersonal care. A couple of the most
prominent topics of research deal with the formation of healing environments and discovering
indicators of healing relationships and processes. It is suggested that, in order to test these areas,
one should utilize a research design that integrate multiple perspectives and ways of knowing
(including aesthetics and metaphysical), [which are] most congruent with the philosophy and
values of the theory of transpersonal caring (George, 2010, p. 468).
References
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Nursing Theories: http://currentnursing.com/nursing_theory/Watson.html
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Masters, K. (2013). Framework for professional nursing practice. In K. Masters (Ed.), Role
development in professional nursing practice (3rd ed.)
(pp.47-87). Retrieved from
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McCance, T. V., McKenna, H. P., & Boore, J. P. (1999). Caring: theoretical perspectives
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Watson Caring Science Institute. (2014, May). Dr.Jean Watson. Retrieved from Watson Caring
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http://watsoncaringscience.org/about-us/jean-bio/

Watson, J. (2009). Caring science and human caring theory: transforming personal and
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