Application of a Theory to Nursing Practice

In this paper, I will use Jean Watson’s Human Caring Science theory to discuss an example from my practice, and reflect on the theory to practice gap I see in nursing. A reflection on its significance to my nursing philosophy will follow.

Exemplar

 I was triaging patients, when our registration clerk came to me and said, “Sangeeta, this lady keeping coming up to me and saying her daughter is having chest pain and feels unwell”.  I knew this individual had previously approached my two colleague triage nurses as well, so I asked them if they had seen the patient and they said, “No, she said her daughter is 26 years old and feeling unwell.  She is sitting in the chair and she looks fine, she can wait her turn.”.  I ask the clerk to send the patient to my desk.  I ask the patient to tell me what she is feeling and what made her come into the hospital today. She takes a deep breath and touches her chest and says I don’t feel good.  I started taking the triage process while I was checking her vitals. The patients mother tells me that the patient has a history of SVT, had an ablation a year ago, and mid conversation I notice that the monitor is reading the patients heart rate as 245 bpm.  I finished the triage quickly and do an ECG which confirmed my suspicion that the patient is in SVT. I rushed the patient to our acute area, where the patient was chemically converted to sinus rhythm within 10 minutes.

Theoretical Framework

 The theoretical framework I would like to use to evaluate this scenario is Jean Watson’s Human Caring Science.  Jean Watson first codified this theory in 1979 and later revised in 1985 (Chinn & Kramer, 2017).  Watson called her theory as descriptive, and the only one at the time to incorporate the spiritual dimension of nursing (Chinn & Kramer, 2017).  Watson’s theory shares characteristics with the human interaction model and the unitary process theories (Chinn & Kramer, 2017; Clarke, Brewer & Watson, 2009). Watson describes humans as holistic and interactive beings, and health and illness are manifestations of patterns that humans that follow (Chinn & Kramer, 2017). 

 Watson’s theory has theoretical underpinnings of Nightingale and Rogers, and theoretical concepts from philosophy and psychology (Chinn & Kramer, 2017).  Watson’s idea behind using human caring” as the tenets of theory was to acknowledge the involvement nurses have with humans (Chinn & Kramer, 2017). 

Key Tenets

 The tenets of the Theory of human caring science are caring and love. Jean Watson believed that through caring nurses can contribute to the human development, and as health professionals we can make social, moral and scientific contributions to humankind (Chinn & Kramer, 2017). Watson believed that the focus of the bio-medical approach with radical cure techniques have little regard to human considerations (Chinn&Kramer, 2017). 

Assumptions from Watson’s work included six assumptions:  The Ontological assumption of oneness, wholeness, unity, relatedness and connectedness, an epistemologic assumption of what ways of knowing which can include various forms of evidence.  A model based on caring science is direct, and the integration of science is necessary for humanity.  The emergence of a caring science, with new assumptions, and unitary worldview based on the ethic of human caring and ontology is the starting point (Chinn & Kramer, 2017). 

The Major concepts significant to the science of human caring are the caritas process, transpersonal caring relationship, and the caring moment (Caruso, Cisar & Pipe, 2008). 

Caritas process

The caritas process is a way of cultivating mindfulness in one’s practice.  The result of a positive “caritas” is the establishment of therapeutic relationship and respect with the patient (Caruso, Cisar & Pipe, 2008).  The caritas process involve: practicing loving kindness, being authentically present, cultivating own spiritual practices, developing a helping-trusting and caring relationship, being present to the expression of positive and negative feelings, using ways of knowing as part of the caring process, engaging in genuine teaching-learning experience, creating healing environment at all levels, assisting with basic needs, and attending to mysterious dimensions of one’s life-death (Chinn & Kramer, 2017; Caruso, Cisar & Pipe, 2008). 

Transpersonal caring relationship

 The second component of Watson’s Human caring science theory is Transpersonal caring relationship.  This relationship process involves caring for the other through intentionality and conscious focus, going beyond the ego and connecting with the spiritual dimensions of self, others, and the universe (Watson, 2002).  This intentionality is not focused on a goal directed outcome or a specific purpose but cooperating with the emerging order (Watson, 2002).  When intentionality and caring consciousness are incooporated into nursing practice, one operates ethically as well as scientifically (Watson, 2002). 

The caring moment

 Care and Caring are one of the integral tenets of nursing. Interactions between the nurse and the patient occur when both come together in a focal time and space. A caring moment occurs when the interaction is focused on intentionality and caritas consciousness creating opportunity for healing (Caruso, Cisar &Pipe, 2008).

Application

 Watson’s theory of human caring science looks beyond the bio-medical model and to the spiritual aspect of establishing a caring relationship between the nurse and the patient.  I chose this exemplar because I think it exemplifies the aspects that nurses have a challenge with in today’s busy environments.  I will be applying the theory by focusing on three of the ten factors of caritas process

Caritas process

Practicing loving kindness:  One of the things I endeavor to do in my practice is practicing loving kindness. Working in the emergency department, this process of Watson’s caritas process can be challenging, but I also understand that being in a hospital is one of the challenging things for our patients.  Illness can make one vulnerable, and patients look for someone reliable and who will treat them with the dignity that all of us are deserving of.  Practicing, loving kindness in an environment where at times caring for patients takes precedence above all self is challenging. However, it is also one of the values that I think is of prime importance in nursing practice.  When we get so busy that we try to take care of the patient, beyond ourselves, but in doing that we get “compassion fatigue” and forget that the reason we are in this profession is because we are committed to providing care to others with kindness, compassion and empathy (Watson, 2007).  Humanistic altruistic vales such as these not only provide the basis of caring but also are the principles for optimal patient-centered care (Watson, 2007). 

Being authentically present to/enabling/sustaining/honoring deep belief system and subjective world of self and other: When the clerk came to me regarding the patient, I talked to the patient’s mom and the patient, I saw they were scared and the patient was visibly uncomfortable. As an emergency nurse I learned very early on never to dismiss anyone symptoms, to honor patient’s beliefs, and it is my personal philosophy that if I ask a patient to wait, I make sure that they are vitally stable and are not in distress because of pain.  When I saw that heart rate was 245 bpm, I wanted to reassure the patient and her mother that we would help her and take care of her. I see many instances at work, where in the chaos of the situation, the patient and family is forgotten. Being authentically present and engaging in a caring-healing relationship is a deliberate choice that requires the cultivation of a caring consciousness (Caruso, Cisar & Pipe, 2008). 

Using ways of knowing as part of the caring process: In this situation, I used my personal knowing, unknowing, and empiric knowing, and ethical knowing.  Personal knowing when I used my experience as an emergency nurse to give attention to the patient.  I demonstrated unknowing, when even though I did not know what the experience was seeking care for, I went ahead and talked to the patient, took a history, and preceded to provide care for her.  I demonstrated empiric knowing, when I took the patients vital signs, knowing that it would tell me if she is vitally stable, I went ahead and performed an ECG when the monitor showed a heart rate of 245 because I needed to what rhythm the patient was in. When I saw that the patient was in SVT, I knew the patient would need an intravenous, and I proceeded to call the patient, and get the patient into the area she needed to be to stabilized.  I used ethical knowing, when I used my personal philosophy to go ahead and take the patient ahead of the other patients waiting, knowing that unless I make sure that the patient is okay, I would not be able to ensure a positive outcome.

SIGNIFICANCE TO PERSONAL PHILOSOPHY STATEMENT

 The theory of human caring science is significant to personal philosophy statement because I believe it best encapsulates the way I approach my nursing practice.  My personal philosophy of nursing is to work with the patient to ensure that I can help them in their journey of health and illness with a caring presence, empathy, compassion, and collaboration. These goals can be hard to achieve in stressful nursing environments, but through self-reflection and self-inquiry, it is possible to develop transpersonal care competencies (Clark, 2016; Joseph, C.B., 2014).  Applying the caritas process, helps nurses create a transpersonal caring relationship with the patient, and promotes satisfaction (Clark, 2016; Watson & Foster, 2003).  In order for the transpersonal caring experience to take place, recognition of the interconnectedness and interdependneness is essential, because it prevents us from separating the human being from spirit (Clark, 2016). Working in a chaotic and stressful health care environment, can shift our focus from approaching the patient with our core values and instead concentrate on accomplishment of tasks and skills (Johnson-Otero, M, 2009; Clark, 2016; Carter et al., 2008). While organizations may promote value of caring in the organization, the challenge occurs when there is a lack of support in order for the staff to achieve their caring principles.  For transpersonal caring to take place, organizations need to support use of theories such as Watson’s in the workplace (Clark, 2018). 

REFLECTION

Even though I was aware of the importance of reflective praxis and mindfulness in nursing practice, I do not always take the time to engage in it. Reflection is a way to overcome the theory to practice gap (Sitzman, K, 2002).  The situation I described, is something I have encountered countless times, and it always makes me wonder, when did we as nurses start paying more attention to tasks and “getting things done” than we do to listening to our patients and establishing a caring-healing relationship with our patient?  The only way is for nurses to take action on the underlying social conditions that cause these inequities. I do not think my colleagues are unfair nurses, but I think we as nurses need to listen to patients, and identify situations that could be dangerous.  At the end of the situation, I was glad that this patient was not ignored, received the care she needed in a timely manner, and had her faith in the system and nurses sustained.

 Through this course I learned the importance of reflection and mindfulness in nursing practice. A lot of times, we face situations which we find frustrating. In times such as these, reflecting on what is important to my praxis, being mindful of the end reason why I chose the profession of nursing.  I have always had a sensitivity to the pain of others, to the idea of fairness, and seeing the look of powerlessness, confusion, and loss of control in a patient’s eyes has no rewards.

 One way, I would bring my learning to my workplace is by having an informal discussion with my colleagues perhaps starting with colleagues I know share similar thoughts as myself.  This is a good way to brainstorm what can be ways of improving patient care in the workplace.  Additionally, collaborating with inter-professional team, that is the physicians, the social workers, the unit clerks will allow for equal opportunity for different ideas to grow and ways to improving care in the organization. One of the biggest barriers, is the culture of the organization that is, the unwillingness to try new ways because there of a lack of time and the continuous pressures from the patients or management. That being said, availability of times and presence of pressures are valid points, but there are always for such issues to be resolved for best patient outcomes, which is the ultimate goal of everyone in the organization.

References

• Carter, L. C., Nelson, J. L., Sievers, B. A., Dukek, S. L., Pipe, T. B., & Holland, D. E. (2008). Exploring a culture of caring. Nursing Administration Quarterly, 32(1), 57-63. doi:10.1097/01.NAQ.0000305948.69311.44
• Chin, P. L, & Kramer, M. K. (2018).  Knowledge Development in Nursing: theory and process. Tenth edition. St. Louis, Missouri: Elsevier.
• Clarke, P. N., Watson, J., & Brewer, B. B. (2009). From theory to practice: Caring science according to watson and brewer. Nursing Science Quarterly, 22(4), 339-345. doi:10.1177/0894318409344769
• Johnson-Otero, M. M. (2009). Letter on “creating a healing environment: An innovative educational approach for adopting jean watson’s theory of human caring”. Nursing Administration Quarterly, 33(3), 197.
• Joseph, C. B. (2014). Caring science, mindful practice: Implementing watson’s human caring theory by kathleen sitzman and jean watson: (2014). new york: Springer, 152 pages, $40.00, softcover, ISBN: 978-0-8261-7153-5. Journal of Hospital Librarianship, 14(4), 410. doi:10.1080/15323269.2014.950916
• Sitzman, K. L. (2002). Interbeing and mindfulness: A bridge to understanding jean watson’s theory of human caring. Nursing Education Perspectives, 23(3), 118.
• Watson, J. (2002). Intentionality and caring-healing consciousness: A practice of transpersonal nursing. Holistic Nursing Practice, 16(4), 12-19. doi:10.1097/00004650-200207000-00005
• Watson, J., & Foster, R. (2003). The attending nurse caring model: Integrating theory, evidence and advanced caring-healing therapeutics for transforming professional practice. Journal of Clinical Nursing, 12(3), 360.
• Watson, J. (2007). Watson’s theory of human caring and subjective living experiences: Carative factors/caritas processes as a disciplinary guide to the professional nursing practice. Texto & Contexto – Enfermagem, 16(1), 129-135. doi:10.1590/S0104-07072007000100016