Nursing

Nursing: The Philosophy and Science of Caring, Revised Edition

JEAN WATSON
Copyright Date: 2008
Pages: 336
Stable URL: http:/stable/j.ctt1d8h9wn
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  • Book Info
    Nursing
    Book Description:

    Jean Watson's first edition ofNursing, now considered a classic, introduced the science of human caring and quickly became one of the most widely used and respected sources of conceptual models for nursing. This completely new edition offers a contemporary update and the most current perspectives on the evolution of the original philosophy and science of caring from the field's founding scholar.A core concept for nurses and the professional and non-professional people they interact with, "care" is one of the field's least understood terms, enshrouded in conflicting expectations and meanings. Although its usages vary among cultures, caring is universal and timeless at the human level, transcending societies, religions, belief systems, and geographic boundaries, moving from Self to Other to community and beyond, affecting all of life.This new edition reflects on the universal effects of caring and connects caring with love as the primordial moral basis both for the philosophy and science of caring practices and for healing itself. It introduces Caritas Processes, offers centering and mediation exercises on an included audio CD, and provides other energetic and reflective models to assist students and practitioners in cultivating a new level of Caritas Nursing in their work and world.

    eISBN: 978-0-87081-979-7
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-xiv)
  3. ACKNOWLEDGMENTS
    (pp. xv-xvi)
  4. PREFACE: Opening-Entering: A New Beginning Almost Thirty Years Later
    (pp. xvii-xx)
    JW
  5. INTERLUDE
    (pp. xxi-xxii)
    JW
  6. PART I Background
    (pp. 1-12)

    Nursing: The Philosophy and Science of Caring(1979) was my first book and my entrance into scholarly work. This book was published before formal attention was being given to nursing theory as the foundation for the discipline of nursing and before much focus had been directed to a meaningful philosophical foundation for nursing science, education, and practice.

    The work “emerged from my quest to bring new meaning and dignity to the work and the world of nursing and patient care” (Watson 1997:49). The theoretical concepts were derived and emerged from my personal and professional experiences; they were clinically inducted, empirically...

  7. PART II. CARING SCIENCE AS CONTEXT
    • CHAPTER ONE NURSING: THE PHILOSOPHY AND SCIENCE OF CARING Revised Edition
      (pp. 15-28)

      The original text begins with a discussion of nursing as the Philosophy and Science of Caring. I now ponder suggesting that today, almost thirty years later, it perhaps could equally be framed asCaring: The Philosophy and Science of Nursing. Discussions and ambiguity remain as to the nature of Caring Science and its relation to nursing science. Rhetorical questions arise, such as, are there distinct differences between the two? Do they overlap? Do they intersect? Are they one and the same? These questions perhaps remain, but the present work offers a distinct position. By transposing the order of Nursing and...

    • CHAPTER TWO CARATIVE FACTORS/CARITAS PROCESSES: Original and Evolved Core for Professional Nursing
      (pp. 29-38)

      The background on my major books on Caring Theory, Philosophy, and Caring Science helps us see the evolution of my original work. This revised, updated edition builds upon the primary source material from the 1979 text and its evolution from what is known as the ten Carative Factors (CFs) toward tenCaritas Processes(CPs). Likewise, this revision incorporates ideas from my previous published works, summarized and developed as background in Section I.

      Table 2.1 includes the original 1979 Carative Factors (with minor edits from the 1985 book). The original ten Carative Factors, juxtaposed against the emergingCaritas Processes, are summarized...

    • CHAPTER THREE CARITAS PROCESSES: Extension of Carative Factors
      (pp. 39-44)

      Caritascomes from the Latin word meaning to cherish, to appreciate, to give special, if not loving, attention to. It represents charity and compassion, generosity of spirit. It connotes something very fine, indeed, something precious that needs to be cultivated and sustained.

      Caritasis closely related to the word “Carative” from my original (1979) text on Caring Science. However, now, using the termsCaritasandCaritas Processes, I invoke intentionally the“L” word: Love, which makes explicit the connection between caring and love, Love in its fullest universal infinite sense developed in the philosophy of Levinas (1969) and explored in...

  8. PART III. FROM CARATIVE FACTORS TO CARITAS PROCESSES
    • CHAPTER FOUR From CARATIVE FACTOR 1: Humanistic-Altruistic System of Values to CARITAS PROCESS 1: Cultivating the Practice of Loving-Kindness and Equanimity Toward Self and Other as Foundational to Caritas Consciousness
      (pp. 47-60)

      Preparing for any worthwhile endeavor requires the cultivation of skills to engage in doing the chosen work. One cannot enter into and sustainCaritaspractices for caring-healing without being personally prepared. It is ironic that nursing education and practice require so much knowledge and skill todothe job, but very little effort is directed toward developing how toBewhile doing the real work of the job. Nurses often become pained and worn down by trying to always care, give, and be there for others without attending to the loving care needed for self. This model invites, if not...

    • CHAPTER FIVE From CARATIVE FACTOR 2: Installation of Faith and Hope to CARITAS PROCESS 2: Being Authentically Present: Enabling, Sustaining, and Honoring the Faith, Hope, and Deep Belief System and the Inner-Subjective Life World of Self/Other
      (pp. 61-66)

      The original Carative Factor of faith and hope is closely tied to the expanded language that seeks to make it a little more explicit with respect to the level of authenticity required for human presence in the midst of the need for faith and hope, making more explicit the importance of honoring the deep belief system and subjective inner-life world of meaning the other person holds for his or her life and purpose and the presenting situation in which that person happens to find him- or herself. Another’s situation could be any of our situations, eliciting compassion and deep understanding...

    • CHAPTER SIX From CARATIVE FACTOR 3: Cultivation of Sensitivity to Oneself and Others to CARITAS PROCESS 3: Cultivation of One’s Own Spiritual Practices and Transpersonal Self, Going Beyond Ego-Self
      (pp. 67-70)

      This factor/process is a lifelong journey and a big order for professional practice. Here I continue to teach what I continually need to learn. This journey is a process of evolving and honoring one’s own inner needs, listening to the still, small voice inside, connecting with our deepest source for awakening into ourBeingandBecoming. In thisCaritas Process(CP) we return to the first CP: cultivation of loving-kindness and equanimity and entering into practices to cultivate them. In doing so, CP 3 naturally leads to a spiritual practice and becomes transpersonal; such a process connects us with spirit...

    • CHAPTER SEVEN From CARATIVE FACTOR 4: Developing a Helping-Trusting Relationship to CARITAS PROCESS 4: Developing and Sustaining a Helping-Trusting Caring Relationship
      (pp. 71-76)

      Relationship-centered caring is considered intrinsic to healing and the foundation for a deeper level of health care reform that goes beyond the superficial economic focus of change. The focus on relationship includes multiple layers of relationship:

      Practitioner to self

      Practitioner to patient

      Practitioner to community

      Practitioner to practitioner.

      The need exists to develop and sustain caring relationships as the core of professional practices in all health professions (Pew Fetzer Report 1994). In modifying the language of this Carative Factor, the main changes are related to making more explicit the authentic caring aspect of the helping-trusting relationship.

      In conventional psycho-therapeutic processes...

    • CHAPTER EIGHT Theoretical Framework for Caritas/Caring Relationship
      (pp. 77-100)

      Several conceptual and theoretical nursing/health-science frameworks in caring link caring and relationship with healing and broad health outcomes. The Caring Science context of my work has provided a foundation for research, practice, education, and nursing administration since the original text in 1979. This work has continued to evolve.

      Within the context of a caring-healing relationship, the Caring Science model posits an energetic nature forCaritas Consciousness: that caring consciousness emanates an energy that radiates from one party to the other. It alters the field in the moment, helping patients access their inner healing potential. This healing potential is a natural...

    • CHAPTER NINE From CARATIVE FACTOR 5: Promotion and Acceptance of the Expression of Positive and Negative Feelings to CARITAS PROCESS 5: Being Present to, and Supportive of, the Expression of Positive and Negative Feelings
      (pp. 101-106)

      This Carative Factor/Caritas Processextension is embedded in discussions in previous chapters of the transpersonal and the nature and differences between, for example, a noncaring relationship (biocidic) and a healing relationship (biogenic-transpersonal) (Halldorsdottir 1991). This factor may not need to be discussed separately, since it is inherent and intrinsically related to the development of an authentic trusting, caring relationship.

      However, because this dimension and dynamic of relationship building is so basic, it can be, and often is, taken for granted, not even recognized or attended to in professional practice. Thus, I continue to explore it here.

      It is through being...

    • CHAPTER TEN From CARATIVE FACTOR 6: Systematic Use of the Scientific Problem-Solving Method for Decision Making to CARITAS PROCESS 6: Creative Use of Self and All Ways of Knowing as Part of the Caring Process; Engage in the Artistry of Caritas Nursing
      (pp. 107-124)

      Professional nursing involves systematic logic, along with imagination and creativity. The nursing process is acknowledged as a systematic process that guides nurses’ decision making. However, it is important to acknowledge that a more expanded Caring/Caritas Processis not a systematic, linear process as it is often made out to be and as originally presented in my 1979 book. Indeed, of all the Carative Factors in the original book, this one has changed the most during my growth, maturity, and evolution over the years. In 1979 I had just completed my PhD—I was idealistic, naive, and enamored with research and...

    • CHAPTER ELEVEN From CARATIVE FACTOR 7: Promotion of Interpersonal Teaching and Learning to CARITAS PROCESS 7: Engage in Genuine Teaching-Learning Experience That Attends to Unity of Being and Subjective Meaning—Attempting to Stay Within the Other’s Frame of Reference
      (pp. 125-128)

      Nurses have long been clear about a teaching role, even though it often does not receive attention or systematic follow-through. Moreover, the intersubjective, relational aspect of the process is often not made explicit. For example, even though teaching and the imparting of health information, self-caring approaches, and so forth are mainstream, the dialectic, transpersonal aspects of teaching-learning and the importance of the caring relationship as context are often overlooked.

      Learning is more than receiving information, facts, or data. It involves a meaningful, trusting relationship that is intersubjective; the nature of the relationship as well as the form and context of...

    • CHAPTER TWELVE From CARATIVE FACTOR 8: Attending to a Supportive, Protective, and/or Corrective Mental, Physical, Societal, and Spiritual Environment to CARITAS PROCESS 8: Creating a Healing Environment at All Levels
      (pp. 129-142)

      Comfort measures can be supportive, protective, and even corrective of a person’s inner and outer environments. The environment of hospitals, while dramatically improved over the past two decades, is still too inflexible and bound by tradition, controls, schedules, and routines to meet the individual needs of patients and family members.

      Some of the comfort measures identified in my original text still hold today as basic guidelines (Watson 1979). These and other approaches continue to serve only as examples but are consistent with Nightingale’s views that still need attention (Watson 1979:90).

      Remove noxious stimuli from the external environment (bright lights, loud...

    • CHAPTER THIRTEEN From CARATIVE FACTOR 9: Assistance with Gratification of Human Needs to CARITAS PROCESS 9: Administering Sacred Nursing Acts of Caring-Healing by Tending to Basic Human Needs
      (pp. 143-148)

      One of the privileges of nursing and its role in interacting with humanity is that nurses have access to the human body. Nurses have the intimate honor of helping others gratify their most basic human needs, especially when vulnerable. It seems that somewhere along the way nursing detoured from this connection and forgot that one of the greatest honors one can have is to take care of another person when in need. It is the ultimate contribution to society and to people’s human needs—a gift to civilization (Watson 2005).

      As nurses begin to work from aCaritas Consciousness, they...

    • CHAPTER FOURTEEN Administering Sacred Nursing Acts—Further Development of CARATIVE FACTOR/CARITAS PROCESS 9
      (pp. 149-190)

      With the backdrop of the discussion of broader views of human needs, it can now be stated that the human need for food and fluid is both physical and metaphysical; it is more than the need for survival. In all cultures and occasions, eating and food have intrinsic meaning for emotional relationships, communication, and feelings of love, friendship, contentment, comfort, support, social life—good feelings. We do not simply ingest food and fluid; we incorporate the associated sensations, surroundings, the other’s human presence, sound, energetic mood, the consciousness, if you will, of the person preparing or offering the food. We...

    • CHAPTER FIFTEEN From CARATIVE FACTOR 10: Allowance for Existential-Phenomenological Forces to CARITAS PROCESS 10: Opening and Attending to Spiritual/Mysterious and Existential Unknowns of Life-Death
      (pp. 191-200)

      This factor in the original (1979) work is perhaps the most difficult one for people to grasp, in part because of the language and terms. All I am trying to say is that our rational minds and modern science do not have all the answers to life and death and all the human conditions we face; thus, we have to be open to unknowns we cannot control, even allowing for what we may consider a “miracle” to enter our life and work. This process also acknowledges that the subjective world of the inner-life experiences of self and other is ultimately...

  9. PART IV. EXPANDING KNOWLEDGE-BUILDING FRAMEWORKS FOR RECONSIDERING CARITAS NURSING:: THE ENERGETIC CHAKRA-QUADRANT MODEL
    • CHAPTER SIXTEEN Integral Model for Grasping Needs in Caritas Nursing
      (pp. 203-206)

      As discussed in previous work (Watson 2005), Wilber’s Integral Model (Wilber 1998, 2001a, 2001b) provides a Caring Science/Caritascontext for grasping the totality of a broader disciplinary focus for providing views of the body and thus basic nursing care. In Wilber’s Four-Quadrant Integral Model we move toward greater depth to comprehend multiple ways of Knowing and Being and Becoming—an approach that integrates and includes subtle and dense matter, body, soul, and Spirit (Wilber 1998:102). This model seeks to point toward integration of the immanent with the transcendent-transpersonal, the sacred with the ordinary (Watson 2005).

      The four-quadrant model offers a...

    • CHAPTER SEVENTEEN The Seven Chakras: An Evolving Unitary View of the Basic Needs Energy System
      (pp. 207-222)

      The ancient archetypal Eastern chakra system of energy anatomy or power centers of the human energy system comes into play in deepening our understanding of basic needs and how to assist another with his or her basic needs. This view goes beyond Maslow’s (1968) Hierarchy of Needs Model and incorporates both physical and nonphysical needs as one integrated energetic system. This ancient yet evolved energetic chakra system can be seen as an overlay on the Wilber Integral Quadrant Model. It invites the more advancedCaritas ConsciousnessNurse to move from focusing exclusively on the dominant right side of the quadrant...

    • CHAPTER EIGHTEEN The CARITAS NURSE/CARITAS NURSING and Chakra Systems
      (pp. 223-226)

      One of the characteristics that distinguishes aCaritas NurseandCaritas Nursingfrom ordinary, routine nursing is where and when the nurse places his or her awareness of the deeper dimensions of the entire human energetic range. For example, it could be posited that a routine nurse, not fully awake, could technically be competent and carry out routine care practices at the basic physical, right quadrant level, but he or she would not be aCaritas Nurseor be practicing fromCaritas Consciousness.

      The ordinary nurse is more likely practicing from the ego-mind and operating more from the task-based, outer-world–...

  10. PART V. HEALTH, HEALING, HUMANITY, AND HEART-CENTERED KNOWING FOR CARITAS NURSING
    • [PART V. Introduction]
      (pp. 227-230)

      Over a century ago, Florence Nightingale established nursing’s focus within a context of health and wholeness that contained yet transcended body-physical, limited approaches to health and healing; thus, she embraced the human spirit and nonphysical phenomena that reside within as well as without. She advocated that nursing focus on health and human experiences that affect all humanity across time and space, all ages, nationalities, races, and varieties of human circumstances that we share. Such a focus transcends disease and illness while still accommodating those realities of nursing.

      Within the context ofCaritas Nursing, it can be made more explicit that...

    • CHAPTER NINETEEN Human Experiences: Health, Healing, and CARITAS NURSING
      (pp. 231-242)

      It seems to me that one of the reasons we have been limited and restricted in our evolution, in the ways we have defined ourselves, our jobs, and our science is because we have failed to see that work in the field of caring-healing intersects with the very tasks of not only “facing our humanity,” but deepening our humanity. Indeed, the very endeavors we are embarked upon with respect to being human are the very endeavors we mirror, reflect, and engage in as part of our caring-healing work with self and other. Just what are these human tasks that intersect...

  11. PART VI. CRITIQUING NURSING EDUCATION
    • CHAPTER TWENTY CARITAS CURRICULUM and Teaching-Learning
      (pp. 245-262)

      This chapter extends the concept ofCaritasteaching and learning to nursing education. It explores the nature of professional nursing and health-sciences education and curricula from a moral, philosophical framework ofCaritasthinking, encompassing an expanded view of nursing as a human-caring science. Contemporary theories and philosophies of caring and healing and their relevance to nursing and health-sciences education are integrated in the framework. A focus on educating students for a values-based practice morally guided to create reflective, humaneCaritaspractitioners is explored, along with current and futuristic pedagogies directed toward transformative teaching and learning. Previous works in nursing education...

  12. EPILOGUE
    (pp. 263-264)

    Since the publication of my 1979 work, the philosophy and science of caring has continued to evolve through my various publications, global interactions, professional activities, relationships, and diverse speaking engagements. In the past half decade or so, caring theory as a guide for transforming clinical practice has evolved into advanced clinical models of caring scholarship and professional practices. This work is transforming self and systems as nurses reengage and more fully actualize nursing within a caring-healing, Caring Science context. Thus, in small and grand ways, nursing is being transformed from the inside out through these changes. Some of these changes...

  13. ADDENDA
    • ADDENDUM I Examples of Inter/National Sites Advancing Caring Science
      (pp. 267-276)
    • ADDENDUM II Charter: International Caritas Consortium (ICC)
      (pp. 277-280)
    • ADDENDUM III Draft of Working Document on “Caritas Literacy” ICC Project
      (pp. 281-288)
    • ADDENDUM IV International Caring Data Research ICC Projects
      (pp. 289-294)
    • ADDENDUM V The Watson Caring Science Institute
      (pp. 295-296)
  14. POSTSCRIPT: PRESCRIPT
    (pp. 297-298)
  15. BIBLIOGRAPHY
    (pp. 299-306)
  16. INDEX
    (pp. 307-313)
  17. Back Matter
    (pp. 314-314)