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Unformatted text preview: Nursing The Philosophy and Science of Caring Figure 1: Frontispiece: The Creation of Adam: detail of the hands of God and Adam, by Michelangelo Buonarroti (1475–1564). Detail of the ceiling of the Sistine Chapel, Vatican Palace, State of the Vatican City. Photo credit: Scala / Art Resource, New York. Nursing The Philosophy and Science of Caring REVISED EDITION JEAN WATSON, PhD, RN, AHC-BC, FAAN Distinguished Professor of Nursing Murchinson-Scoville Endowed Chair in Caring Science University of Colorado–Denver, Anschutz Medical Center Aurora U n i v ersity Press of Colorado © 2008 by Jean Watson Published by the University Press of Colorado 5589 Arapahoe Avenue, Suite 206C Boulder, Colorado 80303 All rights reserved Printed in the United States of America The University Press of Colorado is a proud member of the Association of American University Presses. The University Press of Colorado is a cooperative publishing enterprise supported, in part, by Adams State College, Colorado State University, Fort Lewis College, Mesa State College, Metropolitan State College of Denver, University of Colorado, University of Northern Colorado, and Western State College of Colorado. The paper used in this publication meets the minimum requirements of the American National Standard for Information Sciences—Permanence of Paper for Printed Library Materials. ANSI Z39.48-1992 Library of Congress Cataloging-in-Publication Data Watson, Jean, 1940– Nursing : the philosophy and science of caring / Jean Watson. — Rev. ed. p. ; cm. Includes bibliographical references and index. ISBN 978-0-87081-898-1 (pbk. : alk. paper) 1. Nursing—Philosophy. 2. Nursing—Psychological aspects. 3. Nurse and patient. 4. Helping behavior. I. Title. [DNLM: 1. Nurse-Patient Relations. 2. Nursing Care—methods. 3. Philosophy, Nursing. WY 87 W3393n 2008] RT84.5.W37 2008 610.7301—dc22 2008001410 17 16 15 14 13 12 11 10 09 08 10 9 8 7 6 5 4 3 2 1 This new edition is dedicated to my grandchildren, Demitri, Alma, and Theo Ervedosa and Gabriel and Joseph Willis. My gratitude and love to my beautiful daughters, Jennifer and Julie. I am so blessed to have them in my life and my life’s work; they are often my best teachers. I also wish to honor the teachings, support, and lessons learned from my late husband, Douglas, who was with me for the duration of the writing of the first edition of this book. The students at the University of Colorado, and students and colleagues around the world, continue to inspire and inform me about the deeper nature of this work and its potential for generating love and caring globally, opening new horizons for caring, healing, and peace in the world. I am always learning from these inspirited others who make this framework a living presence in their personal and professional lives in nursing and health care. The focus of this work is not for every nurse but for the Caritas Nurse who is on the journey toward the deeper caring-healing dimensions of nursing and is on the personal-professional path of authenticity and evolution of consciousness, bringing Love, Spirit, purpose, and meaning back into his/her life and life’s work in the world. This work serves somewhat as a continuing message to the next generation of nurses and health practitioners engaged in and committed to Caritas practices. My special gratitude goes to those students, practitioners, and colleagues around the world who are being and doing “The Work.” As I often say, I sit at your feet in awe. I also remind all: I write and teach what I am learning, needing continually to learn. contents Acknowledgments Preface: Opening-Entering: A New Beginning Almost Thirty Years Later Interlude Part I. Background xv xvii xxi 1 Part II. Caring Science as Context 13 Chapter 1. Nursing: The Philosophy and Science of Caring 15 • Basic Assumptions of Caring Science • Premises of Caring Science • Working Definition of Caring Science • Caring: Science-Arts-Humanities 17 18 18 19 vii Contents • Ontological “Competencies”: Caring Literacy • Examples of (Ontological) Caring Literacy • Watson’s Caritas Literacy Dimensions: A Work in Progress 22 24 25 Chapter 2. Carative Factors / Caritas Processes: Original and Evolved Core for Professional Nursing 29 • Core Aspects Theory of Human Caring • Moving from Carative to Caritas 29 • Core Principles/Practices: From Carative to Caritas • Emergence of Caritas Nursing and the Caritas Nurse 34 Chapter 3. Caritas Processes: Extension of Carative Factors • Caring and Love • Value Assumptions of Caritas • Caritas Process—Cultivating the Practice of Loving- Kindness and Equanimity Toward Self and Other as Foundational to Caritas Consciousness Part III. From Carative Factors to Caritas Processes 33 34 39 39 41 42 45 Chapter 4. From Carative Factor 1: Humanistic-Altruistic System of Values to Caritas Process 1: Cultivating the Practice of LovingKindness and Equanimity Toward Self and Other as Foundational to Caritas Consciousness • Beginning Centering Exercise • Centering Exercise • Additional Exercise: Cultivation of a Practice of Gratitude and Forgiveness 47 50 51 54 • Toward a Formal Practice of Mindfulness–Insight Meditation: Loving-Kindness and Equanimity • Loving-Kindness 56 58 Chapter 5. 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 viii 61 Contents Chapter 6. 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 • Integration of Factors and Processes • Educational Note/Reminder 67 68 69 Chapter 7. From Carative Factor 4: Developing a Helping-Trusting Relationship to Caritas Process 4: Developing and Sustaining a Helping-Trusting Caring Relationship Chapter 8. Theoretical Framework for Caritas / Caring Relationship 71 77 • Caritas/Caring Relationship • Transpersonal Caring Relationship • Assumptions of a Caritas Nurse: Transpersonal 77 Caritas Consciousness Relationship • A Caring Moment • Holographic Premises of Caritas Consciousness/ Relationship • Other Nursing Examples Consistent with Transpersonal Caritas Consciousness • Halldorsdottir Model: Biocidic to Biogenic (Caritas) Caring • Florence Nightingale as Original Theoretical Foundation for Caring/Caritas Consciousness Relationship • Reminders • Relationship-Centered Caring Model 81 78 82 83 83 85 86 87 88 Chapter 9. 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 101 Chapter 10. 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 107 ix Contents • Reconsidering Evidence-Based Practice • Asking New Questions About “Evidence” • Caritas Process • Philosophical Perspective for Caring Science: Caritas 110 Processes • Documentation of Caring 114 112 113 116 Chapter 11. 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 125 Chapter 12. 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 129 • Comfort • Safety • Privacy • Human Dignity • Clean Aesthetic Surroundings • Expanded Levels of Environmental 129 Conceptualization • What We Hold in Our Heart Matters in Creating a Caritas Environment • Caritas Environmental Field Model 137 131 133 133 135 139 140 Chapter 13. 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 143 Chapter 14. Administering Sacred Nursing Acts—Further Development of Carative Factor / Caritas Process 9 • Human Need for Food and Fluid • Significance of the Food and Fluid Need for Caritas Nursing  149 149 152 Contents • Human Need for Elimination: “Toileting”/Bathing/ Personal Appearance 154 • Significance of the Elimination Need for Caritas Nursing 156 • Human Need for Ventilation: “Breathing” • Significance of the Ventilation Need for Caritas 157 Nursing • Human Need for Activity-Inactivity • Significance of the Activity-Inactivity Need for Caritas Nursing • Human Need for Sexuality/Creativity/Intimacy/ Loving • Significance of the Sexuality Need for Caritas Nursing • Human Need for Achievement: Expressivity, Work, Contributing Beyond Self • Significance of the Achievement Need for Caritas Nursing • Human Need for Affiliation: Belonging, Family, Social Relations, Culture • Significance of the Affiliation Need for Caritas Nursing • Human Need for Self-Actualization/Spiritual Growth • Significance of the Self-Actualization Need for Caritas Nursing 158 159 169 171 174 176 179 180 185 185 187 Chapter 15. From Carative Factor 10: Allowance for ExistentialPhenomenological Forces to Caritas Process 10: Opening and Attending to Spiritual/Mysterious and Existential Unknowns of Life-Death • The Evolved Caritas Nurse • Conclusions 191 194 195 Part IV. Expanding Knowledge-Building Frameworks for Reconsidering Caritas Nursing: The Energetic Chakra-Quadrant Model Chapter 16. Integral Model for Grasping Needs in Caritas Nursing 201 203 xi Contents Chapter 17. The Seven Chakras: An Evolving Unitary View of the Basic Needs Energy System 207 • Chakra Energy Body System • Biophysical Needs and Corresponding Energetic 211 Chakra System • Human Evolution—Higher-Consciousness Energy Systems 212 216 Chapter 18. The Caritas Nurse / Caritas Nursing and the Chakra Systems • Chakra Summary 223 225 Part V. Health, Healing, Humanity, and HeartCentered Knowing for Caritas Nursing 227 Chapter 19. Human Experiences: Health, Healing, and Caritas Nursing 231 • Healing Our Relationship with Self/Other/ Planet Earth/Universe 233 • Bettering Our Understanding of Human Suffering: Helping to Transform Its Meaning • Suffering • Deepening and Expanding Our Understanding of Living and Dying: Acknowledging the Shadow/ Light Cycle of the Great Sacred Circle of Life • Preparing for Our Own Death 234 236 238 239 Part VI. Critiquing Nursing Education 243 Chapter 20. Caritas Curriculum and Teaching-Learning 245 • Bringing the Heart and Mind Together for Caritas Education • Objectivism as Mythic Epistemology— Epistemology-as-Ethic • Nightingale as Exemplar of Understanding “Epistemology-as-Ethic” xii 245 247 248 Contents • The Analytic and Experimental as Mythic Epistemology 249 • Parts and Wholes: The Rhetorical and Haunting Questions for Nursing Education 250 • Addressing the Rhetorical Educational Questions and Issues for the Twenty-First Century • Reconsidering Nightingale as Exemplar and Model • Caring Science as Context for Nursing Education • Professional Nursing Education for Tomorrow • Conclusion 251 251 252 256 258 Epilogue 263 Addenda 265 I. Examples of Inter/National Sites Advancing Caring Science 267 II. Charter: International Caritas Consortium (ICC) 277 III. Draft of Working Document on “Caritas Literacy” ICC Project 281 IV. International Caring Data Research ICC Projects 289 V. The Watson Caring Science Institute 295 Postscript: Prescript 297 Bibliography 299 Index 307 xiii This page intentionally left blank acknowledgments Kathryn Lynch, an advanced nursing student and my research associate at the University of Colorado–Denver and Rush Presbyterian University, is specially acknowledged as a gift to me during the writing of this book. She has offered her talents to support me and my activities and requests related to this book and also to other professional work emerging from my writings. She has created new templates for my Web site ( ) and helped to update and maintain it. Further, she has served as Web master and assistant to the emerging international group, the International Caritas Consortium (www. caritasconsortium.org), whose members convene to share their work in this area, learn from each other, and offer guidance to others who wish to pursue this Caring Science/Caritas model as a direction for their professional and personal lives and work. xv Ac k n o w l e d g m e n t s I want to recognize and thank Darrin Pratt and the University Press of Colorado for their continuing interest and support in keeping this work alive and updated for a new generation of faculty, students, and practitioners. This new, revised edition seeks to keep the caringhealing values, concepts, hopes, and vision alive in the world for all those committed to a Philosophy and Science of Human Caring as the foundation for nursing and health care and for sustaining humanity itself. xvi Preface Opening-Entering: A New Beginning Almost Thirty Years Later I sit in the quiet of Mexico, my secret, sacred space, on my birthday with a sense of nostalgia and my questionable notions of life and cycles of time. I sit in the quiet, reengaging with my very first book on the philosophy and science of caring in nursing. The original work (1979) presented this framework as the foundation, the soul, the core and essence of nursing as a discipline and a profession. I now ponder a total renewal, revision, and update of this work, bringing life to it at this point in time, having undergone and experienced several life evolutions, changes, even transformations of self and systems, including the deepening of the “theory.” I reconnect with my life cycle as well as the career cycles of my work, both as the beginning and ending and as the continuing cycle of this time. Just as the high tide comes at noon and the low tide recedes at sunset, I place myself with the rhythm of the sea. My mood is in xvii P r efac e harmony with the ocean swells as they rise and fall with each cycle of the waves. So, I prepare to revise and update this original work as I come full circle in reviewing my life, my work, and my career, moving to another rhythmic space for this time in my personal and professional life world. Or rather, I let it all move me, take me, wash over me, prepare me for a new space in my thinking and reconnecting—like a new wave upon the shore, yet with familiarity of the oceanic sea-of-thinking, which still runs through my life and my collected work on caring. I am continually writing, teaching, pondering what I need to learn. Not knowing how this revised edition will unfold but open to its emergence, I invite others to enter into and follow my path into the future. At this moment I am both somber and celebratory as I journey into the process. Caring begins with being present, open to compassion, mercy, gentleness, loving-kindness, and equanimity toward and with self before one can offer compassionate caring to others. It begins with a love of humanity and everything that is living: the immanent, subtle, radiant, shadow-and-light vicissitudes of experiences along the way— honoring with reverence the mystery, the unknowns, the impermanence and changes but actively, joyfully participating in all of it, the pain, the joy, and everything. Thus, to begin, I invite you to enter into a centering, mindful process, a reflective pause, and a contemplative meditation: Just take a deep breath and appreciate yourself, your life, in all its fullness/emptiness, whatever you are feeling just now, pondering briefly what is emerging for you in relation to your personal calling into nursing and your continuing reason and purpose for remaining. I invite you to briefly dwell in silence, open your heart as well as your mind; offer a sense of gratitude for your life and all that has brought you to this point in time. Thus, you begin to realize with this entering space of pause, silence, breath, and gratitude that this evolved work is more than a new edition of an original work; it evokes a contemplative, reflective quieting down. This work invites a return to one’s inner core to xviii Figure 2. Jean Watson (author) in Boulder, Colorado, on University of Colorado campus. Photo by AliveStudios.com. P r efac e reconnect with the timeless collective foundation and very soul of this ancient, pioneering, and noble profession. It is hoped that this continuing work will arouse a remembering of why you entered this field, reconnecting with what is keeping you involved and the knowledge, values, and practices that are essential if you, other nurses, and nursing itself are to sustain the enduring and timeless gift of offering informed, moral, knowledgeable, compassionate human caring-healing services to sustain humanity in our daily work and in the world. I am truly honored and blessed because you are part of my journey. I thank you for being a sojourner on this path. JW xx Figure 3. Young Girls Walking by Edouard Vuillard, c. 1891. Interlude You/We who do not know the future of nursing and health care We/You who know too much of the past Now step into new space You/We create new options Envision new hopes And possibilities not yet dreamt of— Vibrating possibilities Waiting to unfold for humanity, for health, for healing For Being-Doing-Becoming Nursing in a new tune. Learning a new song— A new sound, a new rhythm, a new Voice Opening to that which might be, not conforming to what already is And which no longer serves Self, society You/We the old and new As you encounter anyone who tells you Nursing is less than what you know and believe Bless them and turn away. If what anyone tells you is fear-based, limited, or limiting Also bless them and turn away. Turn toward love and caring from own deep self. You are the source of your own power and possibilities JW This page intentionally left blank Part I Background 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 grounded, and combined with my philosophical, ethical, intellectual, and experiential background (Watson 1997). My quest and my work have always been about deepening my own and everyone’s understanding of humanity and life itself and bringing those dimen- Background sions into nursing. Thus, the early work emerged from my own values, beliefs, perceptions, and experience with rhetorical and ineffable questions. For example, what does it mean to be human? What does it mean to care? What does it mean to heal? Questions and views of personhood, life, the birth-death cycle, change, health, healing, relationships, caring, wholeness, pain, suffering, humanity itself, and other unknowns guided my quest to identify a framework for nursing as a distinct entity, profession, discipline, and science in its own right—separate from, but complementary to, the curative orientation of medicine (Watson 1979). My views were heightened by my commitment to (1) the professional role and mission of nursing; (2) its ethical covenant with society as sustaining human caring and preserving human dignity, even when threatened; and (3) attending to and helping to sustain human dignity, humanity, and wholeness in the midst of threats and crises of life and death. All these activiti...
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