When nurses and nursing students first encounter the Theory of Human Caring, they often are baffled or overwhelmed by the words and phrases used by its author, nursing theorist Jean Watson, RN, PhD, AHN-bc, FAAN, a professor at the University of Colorado, Denver College of Nursing. A peek at Watsons Web site (www.WatsonCaringScience.org) may only add to the confusion. She talks of Love with a capital L, sells singing bowls (a type of standing bell used in meditation) and promotes a Million Nurses Global Caring Field Project that she says will radiate a field of Worldwide Energetic Caring Consciousness for Global Healing and Health for all.
But when nursing leaders and staff nurses describe how they use Watsons theory in their clinical practices, her ideas are at once familiar: listening to patients, seeing the person behind the disease, paying attention to what they themselves are doing moment to moment, learning to take care of themselves.
Nurses who practice Watsons theory say its a reminder that their primary purpose as healthcare professionals is not to assess vital signs, fill out forms or insert IVs, but also to help real, living people heal and provide comfort.
Giving Words to an Ethic
Watson estimates some 100 hospitals have adopted her caring theory as their practice guide in one way or another, most within the past five years. About 20 of these work directly with her on an ongoing basis, attending her International Caritas Consortium meetings in facilities around the country. Some are using the theory primarily in their nursing departments, others are implementing it hospitalwide.
This is not something new, says Randy Williams, RN, MSN, MBA, professional practice coordinator at Wake Forest University Baptist Medical Center in North Carolina, which has adopted Watsons theory as its clinical practice guide. Its just giving words to things we do every day.
Watsons theory has evolved since the late 1970s when she first developed it in response to what she saw as an increasing gap between the science of medicine, with its emphasis on technology and curing disease and the art of healing, which emphasized considering an entire person and the personal relationship between the caregiver and the patient.
It goes beyond patient-centered care, Watson says. It goes to the heart of the human-to-human connection.
As more hospitals apply for Magnet status or look for ways to guide their healthcare delivery, an increasing number are adopting nursing theories including Watsons to help define and recognize what nurses do.
Watson is looking at creating a way to measure results of how her theory is put into practice and perhaps designing a system of affiliation or accreditation through her Caring Science Institute. She has created a caring assessment tool for patients to rate their experience based on statements such as: My caregivers consistently provide care to me with loving kindness. Some hospitals are working on pilot projects, collecting data not only on patient satisfaction, but also on how nurses take care of themselves.
Ellen Gruwell, RN, MSN, a staff labor-and-delivery nurse at St. Josephs Hospital of Orange in California, says Watsons theory complements the hospitals core values of dignity, service, excellence and justice. Nurses are encouraged to take time with their patients, to connect with them in emotional and spiritual ways, she says. Were given the license to do that. That is a part of who we are.
Her theory speaks very well to the bedside nurse, says Anne Foss-Durant, RN, NP, MBA, chief nursing officer at Kaiser Permanente Antioch (Calif.) Medical Center, where the Theory of Human Caring has guided nursing practice for two years. In recent years, healthcare has become so complex, many nurses feel they are too busy or stressed to remember why they chose nursing, she says. Watson talks about comfort, compassion and self-care to nurses who believe their jobs have been reduced to filling out forms and passing meds, she says. The caring theory gives nurses a voice, she says. It focuses on centering and being in the moment, turning practices such as hand-washing into rituals that nurses can use to pause and center themselves and be present for the patient.
Besides direct patient care, some hospitals are incorporating Watsons theory into their education, hiring, job descriptions and staff programs. Some have created meditation rooms where nurses and other staff members can go when they take a moment for quiet reflection. Some use caritas coaches, who help nurses learn and interpret the 10 parts of Watsons theory.
Many hospitals encourage nurses to tell stories of how they practiced some part of Watsons theory. For instance, Williams says, one nurse at Wake Forest recently talked about a patient who spoke harshly to her because he wasnt being discharged as quickly as he wanted to be. Instead of getting upset, she responded courteously and offered to walk him out of the hospital after he was discharged. As they walked, the patient began crying and apologized, saying his wife had died recently and he was worried about making his daughter wait when she picked him up. The nurse reassured him she was there for him. She was creating a caring, healing environment that environment being herself so the patient could heal, Williams says.
At Winter Haven (Fla.) Hospital, some nurses have established nondenominational prayer circles and created and displayed posters demonstrating various caritas processes. They light candles, strike singing bowls and share caring moments at the start of meetings. Were known in this area as the Jean Watson hospital, says Mary Jo Schreiber, RN, MSN, chief nursing officer at Winter Haven.
At John C. Lincoln North Mountain Hospital in Phoenix, volunteer gatherings called circle of light involve a reflection session in which participants talk about what brought them into healthcare and special moments theyve had with patients. Its amazing how sharing those stories creates such a connection among the people in the group, says Barbara B. Brewer, RN, MALS, MBA, PhD, director of professional practice at Lincoln. Its my goal to help them remember why [they went into healthcare]and to re-energize them.
Not everyone immediately embraces the caring theory, nursing leaders say. Some have trouble with the language or wonder how they will find time to practice it. A few think it means they should be so emotionally involved with patients that they cant make objective decisions about care. These are misinterpretations, say nurses familiar with Watsons work. Caring does not mean a nurse can be incompetent just the opposite, they say. A nurse who cares makes sure patients do not suffer from medical errors or other mistakes. When Watson talks about loving patients, shes referring to a universal love of humanity and seeing them as people, Williams says.
As for the most common nursing concern lack of time Foss-Durant notes that when nurses really listen to patients, they usually spend less time running to a room to answer a call buzzer. If youre able to make that connection with the patient, youre going to become more efficient because youre not guessing what the patient needs, she says.
Watsons theory may not work for everyone, some nursing leaders say. But, they add, having a prevailing nursing care theory to guide practice can help a facility, particularly in tough economic times or when morale is low.
Schreiber recalls a period at Winter Haven when nearly 40% of the hospitals nursing positions were vacant. Some wondered whether the hospitals caring culture could survive, she says, but having Watsons theory in place reminded staff and administrators of their higher goals. You need the framework to remember who you are and why you are there, she says. This caring theory is embedded in the DNA of Winter Haven Hospital.