A Grand Nursing Theory...

Over the years nurses have attempted to define nursing. From these efforts, numerous theories have emerged. Many might consider these theories rather dry material, and in all honesty, this was probably my first conclusion as well. As I studied nursing theorists, I felt confused by the language. I was at a loss to see the purpose. However, for any students grappling with these same feelings, I would like to encourage you. The more you study them, the more you appreciate these nurses who spent a great deal of time and effort defining our profession, for ultimately this is what delineates a science.

The first nursing theorist was Florence Nightingale. Through the years numerous other nurses added to her theory and expanded upon the ever-changing profession with theories of their own. Defining these nursing theories or categorizing them can be quite a task and many have tried. Tomey and Alligood organized theories by scope. They coined the terms grand theory and middle range theory (McEwen & Wills, 2007). For the purposes of this presentation these are the terms, which will be utilized.

Grand theories are ambitious, abstract, broad and complex (McEwen & Wills, 2007). Middle range theories are more precise when it comes to nursing practice but are also more limited (McEwen & Wills, 2007).

Last year I performed a PowerPoint about Myra Estrin Levine. I found her grand Conservation Theory interesting and clinically applicable. However, this year I am going to study Jean Watson’s Theory of Human Caring. This is one of the most beautiful and ethereal grand theories.  Does she incorporate common nursing metaparadigms? Does she utilize the main nursing paradigm consisting of ways of knowing? Is this theory clinically applicable? Can it be used in different settings? Is it realistic? We shall see.

                          The Philosophy and Science of Caring by Jean Watson

Jean Watson grew up in the Appalachian Mountains, the youngest of eight children (Tomey & Alligood, 1998). She attended the Lewis–Gale School of Nursing, graduated, got married and moved to Colorado with her husband. She then attended the University of Colorado. Here she received her B.S.N., an M.S. in Psychiatric Mental Health Nursing and later her Ph.D. in Educational Psychology. Nursing: The Philosophy and Science of Caring by Jean Watson was first published in 1979 and later updated in 1985, 1988 and 1999 in Caring Science as Sacred Science (Johnson & Webber, 2010). Jean Watson has experienced a long and fruitful career as an instructor, coordinator and director of the Center for Human Caring at the University of Colorado in Denver. She has received numerous awards and grants and is a prolific writer and speaker.

The basis for the theory of human caring revolves around ten carative processes. Watson states that these ten carative processes are the core of nursing, procedures and tasks are the ‘trim.’ “Curing disease is the domain of medicine…the caring stance that nursing has always held is being threatened by tasks and technology (George, 1990).”

                                                       The Ten Carative Processes:

1. Humanistic-altruistic system of values

2. Faith-hope

3. Sensitivity to self and others

4. Developing helping-trusting, caring relationship

5. Expressing positive and negative feelings and emotions

6. Creative, individualized, problem-solving caring process

7. Transpersonal teaching-learning

8. Supportive, protective, and/or corrective, mental, physical, societal, and spiritual environment

9. Human needs assistance

10. Existential-Phenomenological and spiritual forces

 

Nursing has at its core the metaparadigm of person, environment, nursing and health. 

Watson has defined these in relationship to her theory. Watson’s metaparadigm definitions listed below are from Nursing Theories by Julia George (1990):

Person: “A valued person to be cared for, respected, nurtured, understood, and assisted.”

Environment: “Caring (and nursing) has existed in every society. Every society has had some people who care for others. A caring attitude is not transmitted from generation to generation by genes. It is transmitted by the culture of the profession as a unique way of coping with its environment.”

Nursing: “ A human science of persons and human health-illness experiences that are mediated by professional, personal, scientific, esthetic, and ethical human care transactions…Nursing involves understanding health, illness and the human experience...”

Health: “Unity and harmony within the mind, body, and soul; health is associated with the degree of congruence between the self as perceived and the self as experienced.”

The paradigm of nursing is often represented with Carper's Ways of Knowing. Are ways of knowing included in Jean Watson's theory? Yes, Carper's Ways of Knowing consist of empirical knowing, esthetic knowing, and ethical knowing and personal knowledge. Watson’s definition of nursing includes all these ways of knowing as evidenced by the next quote. "Nursing is a human science of persons and human health-illness experiences that are mediated by professional, personal, scientific, esthetic, and ethical human care transactions (George, 1990)." From casual observation Watson’s Theory of Human Caring probably represents the paradigm of nursing better than any other theory, clearly and succinctly.

           As beautiful and inspiring as these concepts sound, are they applicable and practical?

Applying grand nursing theories in any nurse practice setting and evaluating those applications can be difficult. Often qualitative research is necessary. Results of qualitative research are generally not as accepted for making evidence based practice changes as quantitative research methods. However, hopefully this will be changing. Watson states she does believe in the scientific method (empirical evidence) but she also feels that other ways of knowing are necessary to provide the holistic perspective (George, 1990). In order to measure the most beautiful and essential part of nursing, “Watson suggests that qualitative-naturalistic-phenomenological and descriptive phenomenological approaches are more useful (Johnson and Webber, 2010).” Some studies were found where the carative processes were applied with HIV patients and hypertensive patients. Both these studies indicated a positive response to the process of caring.

In conclusion, Jean Watson stated, “Traditional health care is a myth, this is medical care. True health care focuses on life style, social conditions and environment (George, 1990).” This is so true. Time and caring is what sets the nursing profession apart from medicine. As time goes on and the science of nursing continues to move in ever diverse directions, it will be increasingly imperative for nurses to hold fast to their roots in the philosophy of caring. If we lose sight of this aspect of the profession, we will lose the part of our science, which is most noteworthy and desirable, our overall identity.

In conclusion, I wanted to add a beautiful tribute to caring. Consequently, the next two blog posts have videos, which, I feel demonstrate the beauty of caring in song and dance during this month of October, national breast cancer awareness month. These videos reflect what we all know; caring is not unique to nurses. However, as nurses it is what we do and who we are...Put your pink gloves on and enjoy!

                                                           References

Alligood,Martha Raile; Marriner Tomey, Ann. (1998). Nursing Theorists and Their Work (4th ed.). (L. Wilson, Ed.) St Louis: Mosby.

        Eichelberger, Lisa Wright; Sitzman, Kathleen. (2004). Understanding the Work of Nurse Theorists : A Creative Beginning. Sudbury, Massachusetts: Jones and Bartlett Publishers, Inc.

George, J. B. (Ed.). (1990). Nursing Theories: The Base for Professional Nursing Practice (3rd ed.). Norwalk, Connecticut: Appleton and Lange.

Johnson, B. & Webber, P. (2010). An Introduction to Theory and Reasoning in Nursing. (3^rd edition) Tokyo: Wolters Kluwer: Lippincott Williams & Wilkins.

McEwen, Melanie; Wills, Evelyn. (2007). Theoretical Basis for Nursing (2nd ed.). (H. Kogut, E. Kors, & M. Zuccarini, Eds.) Philadelpia, PA: Lippincott Williams & Wilkins.

                                                           Photographs

“Theory” creative common license by Diolz Aslant Mohamed. Retrieved from Flickr 10/17/10

“Heart in Hand” creative common license by Eisenbahner. Retrieved from Flickr 10/17/10