Jean Watson Theory of Human Caring

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JeanWatson Theory of Human Caring


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CHC-Center For Human Caring


LGSN-Lewis Gale School of Nursing

UCHS-Universityof Colorado Health Sciences

WCSI-Watson Caring Science Institute


Undeniably,the formal recognition of the concept of caring in nursing as an areaof study is relatively new. The evolution of the caring theory ofnursing has often been led by nursing theorists that have been boldenough to step into other disciplines in pursuit of searching fordifferent ways of thinking and defining the clinical practice ofnursing. The development of new and different worldviews has openedthe window for nursing theorists to develop varying contexts forreflecting the patterns and processes of defining the practice ofnursing. Dr. Jean Watson is one of the pioneers of decrypting thepractice of nursing from a caring point of perspective by developinga nursing theory of built on human caring. Employing Walker andAvant`s criteria for theory critique, this script will analyze theJWTHC. It will start with giving a brief background on the theorist,explain the origin of the theory, discuss its main concepts andprinciples, and analyze its logical adequacy concerning itsgeneralizability, parsimony, logical fallacy, testability, andusefulness.

Backgroundof the Theorist

Accordingto Morrow (2014), Margaret Harmon Jean was born on the 10th of June1940, in West Virginia. Growing up in the small town Welch, HarmonJean was always surrounded by a loving and caring extended family.Embarking on her journey of education, Harmon Jean attended highschool in West Virginia, after which she went to Roanoke`s LGSN(Virginia). Harmon Jean then graduated in 1961 with a diploma innursing. Soon after graduating, Dr. Watson got married to DouglasWatson and then moved to Colorado where they got two daughters in1963 and 1964 (Morrow, 2014).

Whilein Colorado, Dr. Watson decided to increase her level of education.Earning all her higher degrees from the Boulder`s University ofColorado, she swiftly advanced through her studies in the field ofnursing. In 1964, Jean Watson earned an undergraduate nursing degree.Two years later, she acquired a master of science in mental healthnursing and psychiatry. Dr. Watson lastly received her Doctorate ofPhilosophy degree in educational psychology and counseling in 1973(Revels, Goldberg, &amp Watson, 2016).

Afteracquiring her doctoral degree, Jean Watson worked in bothadministrative and facultative positions in Denver`s branch of UCHSSchool of Nursing for seven years. It is around the 1980s that Dr.Watson and her colleagues instituted the first CHC in Colorado, whichwas committed to employing the knowledge of human caring in clinicalpractice, leadership, and administration (Revels, Goldberg, &ampWatson, 2016). To date, the center has partnered with countriesaround the world to progress the embracement of human caring as acentral concept in the clinical practice of nursing.

Dr.Jean Watson officially unveiled one of the newest theoriesintegrating the concept of caring in nursing in 1979. In her nursingphilosophy, Dr. Watson incorporated religious viewpoints into thepractice of nursing as a profession (Revels, Goldberg, &amp Watson,2016). Her principal aim was to discover new knowledge and insightsconcerning human behavior in health and illness in pursuit oflearning how a caring relationship would serve to improve therelationship between patients, doctors, and an institution`smanagement (Morrow, 2013).

In2003, Dr. Watson founded the WCSI, a non-profit corporation whoseprimary purpose was to spread her theories and conceptual frameworkfor the practice of nursing as a career (Revels, Goldberg, &ampWatson, 2016). Dr. Watson has contributed to the scripting of manybooks and journals focusing on caring and the clinical practice ofnursing. She is also renowned for her input to research in thepractice of nursing (Morrow, 2014).

Originof the Theory

Dr.Jean Watson coined her theory to solve some of the problems she hadpersonally encountered with the profession of nursing. Her majorissue emanated from the fact that &quotnursing was drifting awayfrom the core principle for which it was founded on caring&quot(Watson, 2014). She was unimpressed by how all the clinicalactivities of nursing were only focused on illness, physicalcondition, setting, and medication. The theory originated from Jean`slonging to introduce new scopes and dimensions to the clinicalpractice of patient care.

Accordingto the JWTHC, &quotthe care of patient extends beyond the physicalrealm (therapeutic) and transcends into a spiritual realm where apatient and nurse can nurture a transpersonal caring relationship&quot(Sofhauser, 2016). Through advancing her theory, Dr. Watson wantedthe profession of nursing to discern new insights regarding humanillness and health as well as to learn how to be in a professional,caring relationship that is not only meant to benefit an individualbut the universe in entirety (Boykin &amp Schoenhofer, 2013).

Thenew nursing aspect of including genuinely human dimensions wereinspired by questions about the self and personal experiences likedeath, life, culture, personhood, caring, change, suffering, and soon (carative factors) (Revels, Goldberg, &amp Watson, 2016). Inother words, Jean Watson developed the blueprint for identifyingnursing as a distinct profession that considered the carative factorsas separate but juxtaposed to medicine (curative).

Asstated by Watson (2014): &quotAll the concepts and principles of mytheory were derived from my professional and personal experiencesthat were empirically grounded, clinically inducted, and combinedwith my experimental, philosophical, and innovative experience.&quotTherefore, Dr. Jean Watson`s theory was built on her experiences,perceptions, beliefs, and personal values about the inexpressiblequestions regarding the clinical practice of the profession ofnursing that goes beyond medicine.


FromJean Watson`s point of perspective, Watson-Druée (2015) observesthat nursing is all about caring for a patient which transcends thephysical realms of the practice of nursing into the spiritual realm.Herein, a nurse and a patient nurture and form a transpersonal caringrelationship that can promote wellness and hasten the process ofrecuperating (Watson, 2014). Dr. Watson`s main idea is that if anurse and a patient are brought together in an appropriateenvironment that inspires trust, spiritual knowledge, and acceptance,both of them can form a spiritual relationship in which they strivefor equanimity and good health (Morrow, 2014). Dr. Watson believesthat apart from helping a patient to overcome their physical illness,a nurse should get involved with healing sickness transcending intopersonal and spiritual realms (Revels, Goldberg, &amp Watson, 2016).

Sofhauser(2016) points out that with the JWTHC, a lack of healing is presumedto be triggered by disequilibrium in the body, mind, and spirit. Dr.Jean`s nursing theory reminds nurses that they have a profound effecton the lives of patients beyond providing therapeutic assistance.Watson-Druée (2015) explains that this is because a nurse has theprofessional capacity to help promote healing and the attainment ofwellness, or can make a patient feel unsafe and neglected whicheventually leads to the worsening of illness within a patient.Essentially, the meaning of the JWTHC is that the profession ofnursing is more than just addressing the physical needs of persons.It also entails the meeting of the spiritual requirements of aperson, not forgetting the significance of trust, respect, emotionalstability, acceptance, and healing a whole individual and not theirparts suffering from an illness (Watson, 2014).

MetaparadigmConcepts of the JWTHC

Asstated by Revels, Goldberg, and Watson (2016), the major concepts ofthe JWTHC are the human being (self), the environment, health, andnursing.


Throughher caring lens, Sofhauser (2016) observes that Dr. Jean’sdefinition of a human being is a creature that exists in the universein three forms: body, mind, and spirit. These perspectives ofexisting are in turn swayed by self which is distinctive. JeanWatson`s consideration of a person as a creature in the universeemphasizes the interrelation between the individual (self) and theenvironment which outlines Jean Watson`s concept of the environment(Revels, Goldberg, &amp Watson, 2016). The JWTHC focuses on thetherapeutic use of self through the nurturing of transpersonalrelationships with patients and their families to eventually bringrecuperation and wholeness (unity of the person`s mind, body, andspirit) (Watson, 2014). The JWTHC acknowledges the coherence betweenlife and environmental networks that transfer from one person toothers, to the community, and ultimately, to the world.


Inher nursing theory, Jean Watson defines the environment as thesetting in which human beings live their daily lives which isdifferent from each person`s perspective (Watson, 2014). Within theseenvironments, there are other aspects of a place, time, and spacethat can be viewed from different cultural, social, personal,national, or global perspectives. The human environment can also beinfluenced by the economic and political beliefs that affect thecustoms, values, and expectations of an individual (self)(Watson-Druée, 2015). As such, Jean Watson expresses the environmentas the fabric where human social experiences are created through theinteraction of a person with his/her surroundings. Jean Watson speaksabout how the environment expands the consciousness and awarenessthat promotes wholeness (unity of an individual`s mind, body, andspirit) and healing. This explains why the JWTHC acknowledges thesignificance of making a patient`s room a scared, soothing, andhealing atmosphere (Sofhauser, 2016).


Accordingto Watson (2014), the subjective definition of health as the mereabsence of disease is erroneous because the physical assessment of aperson`s health status is not accurate. In her earlier works, sheargues that health is an internal experience realized with a person`sharmony within the mind, body, and spirit (equanimity). The perceivedhealth status of an individual is dependent on the harmony ordisharmony of these spheres of human existence at any given moment.Therefore, in the framework of the JWTHC, Boykin and Schoenhofer(2013) observe that physical assessment does not take preference overthe harmony of the mind, body, and soul when indicating the health ofa person. This is because as one is better placed to experience therealself, the more chances one has of achieving equanimity.


Consistentwith other proficient scholars in the profession of nursing, Dr. Jeancorresponds to the fact that caring is the originalcore principle of nursing. According to Dr. Watson, a nurse ismorally obligated to help a patient understand illness and thesuffering that comes with it so as to promote the restoration of thebalance between a patient’s mind, body, and soul (Boykin &ampSchoenhofer, 2013). However, Watson (2014) notes that for a nurse torestore an individual`s balance and harmony, he/she must be inharmony. The caring processes entail providing measures of comfort,helping a person alleviate pain, suffering, and stress, as well asmeasures of promoting the realization of wholeness (equanimity) andhealing (Revels, Goldberg, &amp Watson, 2016).

Elementsof the JWTHC

Theworks of Morrow (2014) indicate that three core elements make up theJWTHC: the carative factors, the caring moment, and the transpersonalcaring relationship.

TheCarative Factors

Watson(2014) identifies the carative factors as the core elements of theclinical practice of nursing. She employs the term carative factorsjuxtaposed to the conventional therapeutics` curative factors. JeanWatson`s carative factors honor the three dimensions of humanexistence (mind, body, and soul), the subjective experiences, and thespiritual life worldviews of patients (Revels, Goldberg, &ampWatson, 2016). In all, Dr. Jean outlines ten carative factors thatcan be used to define the meaning of caring in the metaparadigmconcept of self:

  1. The formation of a humanistic-altruistic system of values.

  2. The installation of faith and hope by being genuinely present and supporting a sense of well-being.

  3. The fostering of loving-kindness to self and others, which necessitates a nurse to explore and feel an emotion as it presents itself.

  4. The development of a human caring (human-trust) relationship which includes warmth, empathy, and congruence. Watson (2014) acknowledges the importance of a nurse establishing rapport with a patient through efficient modes of verbal and non-verbal communication.

  5. The promotion of the approval of the conveyance of sentiments between a nurse and a patient, whether positive or negative.

  6. The encouragement of creative problem-solving processes by using systematic scientific methods of decision making.

  7. The support and promotion of genuine interpersonal teaching and learning that attends to meaning and wholeness since a nurse should give emphasis on the learning process as much as the process of education.

  8. The provision of a healing mental, socio-cultural, spiritual and/or corrective mental environment at all levels, which a nurse can manipulate to provide protection and support for a patient`s physical and psychological health.

  9. The provision of human needs assistance based on Maslow`s hierarchy of needs. In this carative factor, a nurse should promote the health of a patient by attending to their needs to make them feel valued.

  10. The allowance of the existential-phenomenological forces that can help a nurse open and attend to the mysterious dimensions of a patient`s life and death (Watson, 2014).

AsJean Watson continued to evolve her nursing theory, she presented theconcept of the Caritas process to replace the carative factorsthrough which a nurse can experience a greater spiritual dimensionwhen caring for a patient. The translation of the carative factorsinto the clinical process of Caritas is as follows:

  1. The practice of equanimity for self and other through practicing loving-kindness.

  2. Being genuinely present, and facilitating and maintaining a belief system that is a personal worldview of self and a patient.

  3. The fostering of loving-kindness to self and others that goes beyond ego to open to others with compassion and sensitivity.

  4. Establishing and maintaining an authentic relationship based on helping and trusting.

  5. Being always present to support the conveyance of sentiments (whether good or bad).

  6. The inspired use of one’s maximum potential and all the means of acquiring knowledge to help patients recuperate.

  7. Participating in authentic teaching-learning processes.

  8. Establishing an environment that encourages the realization of healing and wholeness (equanimity).

  9. Supporting the provision of the most basic human requirements with intentional loving-kindness that potentiates wholeness.

  10. Embracing the existential-phenomenological scopes of human existence by helping a patient accept the realities of life and death (Revels, Goldberg, &amp Watson, 2016).

TranspersonalCaring Relationship

Asstated by Boykin and Schoenhofer (2013), a transpersonal caringrelationship symbolizes a particular kind of human connection thatdepends on a nurse’s moral obligation to preserve human dignity,loving-kindness consciousness, and vocational experience.Watson-Druée (2015) notes that Jean Watson uses the wordtranspersonal to mean going beyond one`s self to create room for adeeper spiritual connection with a patient to promote healing,comfort, and equanimity. A transpersonal caring relationship is adescription of how a nurse goes beyond objective physical examinationto expressing the precedence for a patient`s inner and subjectivemeaning concerning their health status. A nurse`s caringconsciousness is essential to provide the connection of a patient`sperspectives. As such, a nurse and a patient connect for a mutualsearch for wholeness, meaning, and healing for the sake of spiritualtranscendence of the process of illness and suffering (Sofhauser,2016).


Asmentioned by Watson (2014), a caring instance is created after apatient and a nurse connect self-to-self, fashioning an opportunityfor the practice of loving-kindness. At this time, a nurse and apatient connect on a self-to-self level to enable a nurse tounderstand a patient from his/her frame of reference. The referenceframe consists of a patient`s totality of human experiences thatinclude thoughts, spiritual beliefs, sentiments, expectations,perceptions, meanings, traditions, and so on (Sofhauser, 2016). Allthese experiences are based on a patient`s past, present, andimagined future. When a nurse and a patient connect on a spiritualself-to-self level, Morrow (2014) observes that the event expands thelimits of trust and openness through which choices are made to allowthe expansion of human capabilities towards the realization ofequanimity mirrored as higher levels of health.

Assumptionsof the JWTHC

Thesame work of Morrow (2014) perceptively states that the JWTHC makesseven assumptions:

  1. Loving-kindness is fundamental in the clinical practice of patient care.

  2. The clinical practice of loving-kindness can be efficiently rendered only on a self-to-self level.

  3. The practice of loving-kindness causes the gratification of human needs.

  4. Apart from promoting individual health, the practice of competent caring encourages the health of the family and society.

  5. A caring environment is one that provides a patient with the opportunity to choose the best action for their frame of reference at a given point in time.

  6. Caring responses acknowledge a patient as he or she presently is, as well as how he or she may become in the future.

  7. Caring science is corresponding to the science of curing (Morrow, 2014).


Sofhauser(2016) points out that the dynamic interplay of the theory`s elementsand concepts is what coins the major relationships in the JWTHC. Theauthor explains that a Caritas process is established when thecarative factors are utilized in practice. It is this process thatcreates a loving-kindness relationship between a nurse and a patient.In this human-to-human connection, trust and openness are encouraged,which leads to the emergence of a caring moment (Morrow, 2014). Inturn, these caring moments help a patient to choose the bestalternative for their frames of reference through which they can makechoices to allow the expansion of their self-capabilities towards therealization of equanimity mirrored as higher levels of health.Therefore, the interrelation and interplay of the fundamentalelements and concepts of the JWTHC support the logical adequacy ofthe theory.



JeanWatson`s nursing theory is widely employed in the clinical practiceof nursing, implying that it has lots of generalizability. The modelhas been used as a loving-kindness model for older adults concerningequanimity and the quality of life (Watson, 2014). What`s more, theJWTHC has been used as a conceptual framework for guiding communityhealth nurses towards a holistic approach to the practice of nursing(Revels, Goldberg, &amp Watson, 2016). Dr. Watson`s theory has alsobeen used to guide nurses in the professional health sector towardsconstructing relationships with patients to help them achieveequanimity and recuperate. In addition to this, the theory has beenused by Christian-based institutions because of its holistic view ofself (Watson, 2014). The theory has also been used on terminally illpatients to help them improve their quality of life by achievingharmony in their minds, bodies, and souls before their demise(Watson, 2014). In addition to clinical settings, the JWTHC has beenapplied in administrative, research, and educative processes (Boykin&amp Schoenhofer, 2013). All these facts substantiate that the JWTHChas lots of generalizability because of its extensive application.


Asstated by Watson-Druée (2015), the JWTHC is not parsimonious becauseits premises are clearly defined and are easy to follow. The theoryis concise since it is organized and the roles of a nurse and patientare clearly outlined. What`s more, the Caritas process is easy tounderstand because Jean Watson arranges it in ten steps that are easyto follow. Still, consistent terminology and diagrams (Appendix) makethe theory easier to understand (Watson, 2014). In light of all thesefacts, the JWTHC is not parsimonious.


Morrow(2014) perceptively states that the only logical fallacy in JeanWatson`s nursing theory is that it assumes every person as naturallycaring. This is a fallacy because it is not absolute for allindividuals to be caring despite the fact that they experiencedifferent levels of caring from one stage of life to the next. It isfallacious because some highly qualified nurses do not engageloving-kindness themselves while executing their vocational duties.


Sofhauser(2016) observes that the JWTHC is testable within the framework ofscientific paradigms (human) it suggests and the phenomenologicalmethods she used to substantiate the realization of equanimity withthe enhancement of human experience. Between 1981 and 1983, JeanWatson undertook fieldwork in an aborigine tribe in WesternAustralia. It is these findings that she based her theory oftranspersonal caring relationship. This has been questioned byWatson-Druée (2015), who contends that her results cannot be used ina 21st-century setting because of rapid changes in scientifictechniques and paradigm shifts in the society. Therefore, she arguesthat for the JWTHC to be tested, it has to be transposed into themore sophisticated 21st-century setting that considers the validityof results. To this effect, Watson-Druée (2015) observes that theJWTHC cannot be of assistance to a green individual seeking for basictheoretical knowledge in the relatively new concept of human caring.


First,Revels, Goldberg, and Watson (2016) observe that Watson`s nursingtheory has been used in several research studies involving the carefor the dying and improvement of the quality of life. The theory hasalso been used in practice to improve nurse-patient relationshipsthrough a holistic interaction designed to improve health careoutcomes. Also, in a practice setting, Watson (2014) observes thatthe theory has been employed to promote healing, preserve respect,and uphold patient dignity. In education, the theory has been used toguide the development of nursing curriculum that has the concept ofcaring as the core principle of the profession of nursing (Boykin &ampSchoenhofer, 2013). Similarly, in administration, the theory hashelped hospital executives to draft effective clinical practicemodels for nurses to follow to the letter by encouraging aprofessional ethic of loving kindness and ethos (Watson, 2014).Evidently, the JWTHC has a broad spectrum of its usefulness.

Advantagesand Disadvantages

JeanWatson`s theory has the benefit of enhancing nurse-patientinteraction (Morrow, 2014). Since it is personal in nature, the JWTHCis also beneficial because it improves the outcomes of medicalintervention since a patient is considered wholly and not partly(Sofhauser, 2016). What`s more, the theory places a patient as a toppriority in the backdrop of the general society (Watson, 2014). Theclient, in this case, becomes the focus of intervention. This makesthe clinical practice of nursing easy because personalization makesthe profession less technical and generic in nature. The greatestdisadvantage of Jean Watson`s approach, according to Sofhauser(2016), is that it provides a generalized framework that focuses moreon the psychosocial needs of a patient and sidesteps the biophysicalneeds. This is particularly limiting because the author notes thathealth is also influenced by the biophysical requirements of aperson, which also need to be addressed when a nurse is seeking toimprove the health of a patient.

Applicationin Clinical Settings

Asstated by Boykin &amp Schoenhofer (2013), when a nurse is planningto apply Jean Watson`s theory in a clinical setting, he/she must beconscious of a patient as a whole regardless of the existence of anillness so as to create a loving-kindness experience. Additionally,the JWTHC encourages nurses to instill hope and faith in theirpatients through the utilization of kind words, nurturing, caringgestures, and always being authentically present to offer assistance(Watson, 2014). The JWTHC prompts nurses to ensure the availabilityof non-threatening environments that encourage the expression ofpatient sentiments whether positive or negative.

Essentially,the objective of the application of the JWTHC in a clinical settingis to ensure that a nurse meets a patient`s physical, spiritual,mental, and socio-cultural preferences for well-being and wholeness.The application of the theory goes beyond the administration ofmedicine to cure illnesses and performing standardized procedureswhen caring for a person experiencing disharmony in the mind, body,and soul. Its application entails the execution of nursing relatedresponsibilities built upon on a loving-kindness framework (Watson,2014).


Asthis paper has exemplified, the JWTHC essentially proposes thatnursing contributes to more than just the physical healing process ofa patient. By designating the carative factors/Caritas process, JeanWatson provides a theoretical framework through which nurses canimprove the outcomes of treatment processes by considering theindividual frames of reference for each patient in pursuit ofequanimity and healing. Despite the fact that the theory has somelimitations, it`s applicability and generalizability has proven it tobe a useful framework to the profession of nursing. The caringfactors and moral ideas proposed by Dr. Jean Watson serve to evolvethe practice of nursing and deepen the roles of nurses in thesustenance of humanity.


Boykin,A., &amp Schoenhofer, S. (2013). Nursingas Caring: A Model for Transforming Practice.Eagle Publishers. Print.

Morrow,M. (2014). Caring Science, Mindful Practice. NursingScience Quarterly,27(3),263-264. Doi: 10.1177/0894318414534468

Revels,A., Goldberg, L., &amp Watson, J. (2016). Caring Science: ATheoretical Framework for Palliative Care in the EmergencyDepartment. InternationalJournal for Human Caring,20(4),206-212. Doi: 10.20467/1091-5710-20.4.206

Sofhauser,C. (2016). Intention in Nursing Practice. NursingScience Quarterly,29(1),31-34. Doi: 10.1177/0894318415614629

Watson,J. (2014). Integrative Nursing Caring Science, Human Caring, andPeace. IntegrativeNursing,101-108. Doi: 10.1093/med/9780199860739.003.0008

Watson-Druée,N. (2015). A feel for smart thinking. NursingStandard,26(44),63-63. Doi: 10.7748/ns.26.44.63.s55


Illustrationof the JWTHC