ESSENCE AND MORAL

IDEAL OF NURSINGJaime R. Soriano.RN.RM.MSN.RT.

Meaning of Caring• Watson (1985, 2005) defines caring as a

science and her operational definition of caring science as an evolving philosophical

ethical-epistemic field of study that is grounded in the discipline of nursing and informed by related fields (Watson, 2005)

Major assumptions of the science of caring in nursing as follows:

Meaning of Caring

a. Caring can only be effectively demonstrated and practiced interpersonally.b. Caring consists of carative factors that result in the satisfaction of certain human needs.c. Effective caring promotes health and individual or family growth.d. Caring responses accept a person not only as he or she is now but as what he or she may become.

Major assumptions of the science of caring in nursing as follows:

Meaning of Caring

e. A caring environment offers the development of potential while allowing the person to choose the best action for himself or herself at a given time.f. Caring is more “healthogenic” than is curing. The practice of caring integrates biophysical knowledge with knowledge of human behavior to generate or promote health and to provide ministrations to those who are ill. A science of caring is therefore complementary to the science of curing.g. The practice of caring is central to nursing.

Meaning of Caring

• Watson (1988) believes that human life is a gift to be cherished – process of wonder, awe and mystery, holds the view that humans are

valued to be cared for, respected, nurtured, understood and assisted, as a fully functional

integrated self based on the philosophical belief that the humans are greater than and different from the sum of their parts, instead

of reducing the human to body systems.

Constructs of Caring

• Watson bases her theory for nursing practice on the following 10 carative factors. Each has dynamic phenomenological component that is relative to the individuals involved in the relationship as encompassed by nursing. The first three imnterdependent factors serve as the “philosophical foundation for the science of caring”. As Watson’s ideas and values have evolved, she translated the 10 carative factors into caritas processes. In caritas processes, there is a decidedly spiritual dimension and overt evocation of love and caring.

Constructs of Caring

Carative Factors and Caritas Process

CARATIVE FACTORS CARITAS PROCESS

APPLICATION AND SIGNIFICANCE OF CARING IN

NURSING

The formation of humanistic-altruistic system of values

Practice of loving-kindness and equanimity within the context of caring consciousness

Humanistic values and an altruistic approach to life bring meaning to one’s life through relationships with other people as Adler (1927) believed that everyone tends to develop social interest as the individual outgrows egoism and strives for superiority over self. The formation of humanistic-altruistic value system is considered first and most basic factor for the science of caring and enhances the other factors

Constructs of Caring

Carative Factors and Caritas Process

CARATIVE FACTORS CARITAS PROCESS

APPLICATION AND SIGNIFICANCE OF CARING IN

NURSING

The instillation of faith-hope

Being authentically present and enabling and sustaining the deep belief system and subjective life-world of self and one being cared for

The formations of a humanistic-altruistic value system and the third factor of instillation of faith-hope complement each other. The individual needs to recognize and have feelings in order to develop sensitivity to self and to others, which, in turn, provides one with a foundation for empathy with others.

Constructs of Caring

Carative Factors and Caritas Process

CARATIVE FACTORS CARITAS PROCESS

APPLICATION AND SIGNIFICANCE OF CARING IN

NURSING

The cultivation of sensitivity to one’s self and to others

Cultivation of one’s own spiritual practices transpersonal self going beyond the ego self

The recognition of feelings leads to self-actualization through self acceptance for both the nurse and the patient. As nurses acknowledge their sensitivity and feelings, they become more genuine, authentic and sensitive to others (Watson 1979).

Constructs of Caring

Carative Factors and Caritas Process

CARATIVE FACTORS CARITAS PROCESS

APPLICATION AND SIGNIFICANCE OF CARING IN

NURSING

Development of a helping-trusting, human caring relation

Developing and sustaining a helping trusting authentic caring relationship

Watson suggests that development of a helping-trusting relationship depends on the first three factors as they may determine the quality of one’s relationship. The other characteristics affecting the development of human relationships provided by Watson (1985) are: • Congruence• Empathy and • Non possessive

warmth.

Constructs of Caring

Carative Factors and Caritas Process

CARATIVE FACTORS CARITAS PROCESS

APPLICATION AND SIGNIFICANCE OF CARING IN

NURSING

Development of a helping-trusting, human caring relation

Developing and sustaining a helping trusting authentic caring relationship

Watson (1985, 1988) also states that communication needs to be considered within the context of developing a helping-trusting relationship. Communication consisting of all the cognitive, affective and behavioral responses has three basic types of communication:a. Somatic levelb. Action levelc. Language level

Constructs of Caring

Carative Factors and Caritas Process

CARATIVE FACTORS CARITAS PROCESS

APPLICATION AND SIGNIFICANCE OF CARING IN

NURSING

The promotion and acceptance of the expression of positive and negative feelings

Being present to, and supportive of, the expression of positive and negative feelings as a connection with deeper spirit and self and the one-being cared for.

The fifth factor of promotion and acceptance of the expression of positive and negative feelings is an inherent part of the development of a helping-trusting relationship. Emotions, rather than cognition, play a central role in people’s behavior as indicated by Izard (1977) who maintains that emotions constitute the primary motivational system of human beings.

Constructs of Caring

Carative Factors and Caritas Process

CARATIVE FACTORS CARITAS PROCESS

APPLICATION AND SIGNIFICANCE OF CARING IN

NURSING

The promotion and acceptance of the expression of positive and negative feelings

Being present to, and supportive of, the expression of positive and negative feelings as a connection with deeper spirit and self and the one-being cared for.

Though both cognition (thoughts) and affect (feelings) and the non-rational emotional aspect of an event should be focused on in caring behaviours, as Watson (1985) states, because feelings alter thoughts and behavior, and they need to be considered and allowed in caring relationship.

Constructs of Caring

Carative Factors and Caritas Process

CARATIVE FACTORS CARITAS PROCESS

APPLICATION AND SIGNIFICANCE OF CARING IN

NURSING

The systematic use of a creative problem-solving caring process

Creative use of self and all ways of knowing as part of the caring process; to engage in the artistry of caring-healing practices

Watson (1985) argues that the use of the scientific problem solving method allows the nurse to draw on common principles.

Constructs of Caring

Carative Factors and Caritas Process

CARATIVE FACTORS CARITAS PROCESS

APPLICATION AND SIGNIFICANCE OF CARING IN

NURSING

The promotion of transpersonal teaching-learning

Engaging in genuine teaching-learning experiences that attends to unity of being and meaning attempting to stay within other’s frame of reference

Interpersonal/transpersonal teaching-learning involves processes engaged in by both the nurse and the patient. Watson (1985) explicates that it includes the issues of imparting information as well as consideration of the nature of learning and what interpersonal/transpersonal processes facilitate learning.

Constructs of Caring

Carative Factors and Caritas Process

CARATIVE FACTORS CARITAS PROCESS

APPLICATION AND SIGNIFICANCE OF CARING IN

NURSING

The provision of supportive, protective and/or corrective mental, physical, societal and spiritual development

Creating healing environment at all levels (physical as well as nonphysical, subtle environment of energy and consciousness, whereby wholeness, beauty, comfort, dignity and peace are potentiated

As Watson (1985) points out, a number of variables, which affect a person’s life and wellbeing should be considered in day-to-day nursing care. Watson (1985, 1988) discusses those functions as promotion a supportive, protective and/or corrective mental, physical, societal and spiritual environment, some of which are external, whilst others are internal to a person.

Constructs of Caring

Carative Factors and Caritas Process

CARATIVE FACTORS CARITAS PROCESS

APPLICATION AND SIGNIFICANCE OF CARING IN

NURSING

The assistance with gratification of human needs

Assisting with basic needs, with an intentional caring consciousness, administering “human care essentials”, which potentiate alignment of mindbodyspirit, wholeness, and unity of being in all aspects of care

Assistance with gratification of human needs involves a great deal of information and subparts, through conceptually it are only one broad carative factor (Watson 1985). Based on the different human needs, Watson (1985, 1988) categorizes lower order and higher order needs. The lower order needs are (1) the biophysical food and fluid need, (2) the elimination need, and (3) the ventilation need. Human activity and sexuality needs are also classified as lower order needs, but they are labelled psychophysical rather than biophysical.

Constructs of Caring

Carative Factors and Caritas Process

CARATIVE FACTORS CARITAS PROCESS

APPLICATION AND SIGNIFICANCE OF CARING IN

NURSING

The assistance with gratification of human needs

Assisting with basic needs, with an intentional caring consciousness, administering “human care essentials”, which potentiate alignment of mindbodyspirit, wholeness, and unity of being in all aspects of care

The higher order needs are designated psychosocial. They include 91) the achievement need, (2) the affiliation need, and (3) the need for self actualization. Keeping in mind the holistic-dynamic framework for viewing human needs, the factor of assistance with the gratification of human needs leads to a more complete development of each human need, which are all equally important for quality nursing care and the promotion of optimal health

Constructs of Caring

Carative Factors and Caritas Process

CARATIVE FACTORS CARITAS PROCESS

APPLICATION AND SIGNIFICANCE OF CARING IN

NURSING

The allowance for existential-phenomenological-spiritual forces

Opening and attending to spiritual-mysterious, and existential dimensions of one’s own life-death; soul care for self and the one-being cared for.

Watson considers this factor as difficult to understand. It is included to provide a thought-provoking experience leading to a better understanding of the self and others.