Nursing: The Philosophy and Science of Caring, Revised Edition / Edition 1

by Jean Watson

Overview

Jean Watson's first edition of Nursing, now considered a classic, introduced the science of human caring and quickly became one of the most widely used and respected sources of conceptual models for nursing. This completely new edition offers a contemporary update and the most current perspectives on the evolution of the original philosophy and science of caring from the field's founding scholar.
A core concept for nurses and the professional and non-professional people they interact with, "care" is one of the field's least understood terms, enshrouded in conflicting expectations and meanings. Although its usages vary among cultures, caring is universal and timeless at the human level, transcending societies, religions, belief systems, and geographic boundaries, moving from Self to Other to community and beyond, affecting all of life.
This new edition reflects on the universal effects of caring and connects caring with love as the primordial moral basis both for the philosophy and science of caring practices and for healing itself. It introduces Caritas Processes, offers centering and mediation exercises on an included audio CD, and provides other energetic and reflective models to assist students and practitioners in cultivating a new level of Caritas Nursing in their work and world.

Product Details

ISBN-13:	9780870818981
Publisher:	University Press of Colorado
Publication date:	05/31/2008
Edition description:	REV
Pages:	336
Product dimensions:	5.50(w) x 8.40(h) x 0.80(d)

About the Author

A fellow of the American Academy of Nursing and a past president of the National League for Nursing, Dr. Jean Watson is Distinguished Professor of Nursing and holds an endowed Chair in Caring Science at the University of Colorado at Denver and Health Sciences Center. She also founded the original Center for Human Caring. Watson is a widely published author and has received many awards, including six honorary doctoral degrees. Her theory of human caring and model of caring science are used around the world.

Read an Excerpt

Nursing

The Philosophy and Science of Caring

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By Jean Watson

University Press of Colorado

Copyright © 2008 Jean Watson
All rights reserved.
ISBN: 978-0-87081-898-1

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CHAPTER 1

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 dimensions 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 activities, experiences, questions, and processes transcend illness, diagnosis, condition, setting, and so on; they were, and remain, enduring and timeless across time and space and changes in systems, society, civilization, and science.

The original (1979) work has expanded and evolved through a generation of publications, other books, videos, and CDs, along with clinical-educational and administrative initiatives for transforming professional nursing. A series of other books on caring theory followed and have been translated into at least nine languages. The other major theory-based books on caring that followed the original work include:

• Nursing: Human Science and Human Care. A Theory of Nursing (1985). East Norwick, CT: Appleton- Century-Crofts. Reprinted/republished (1988). New York: National League for Nursing. Reprinted/republished (1999). Sudbury, MA: Jones & Bartlett.

• Postmodern Nursing and Beyond (1999). Edinburgh, Scotland: Churchill-Livingstone. Reprinted/republished New York: Elsevier.

• Assessing and Measuring Caring in Nursing and Health Science (ed.) (2002). New York: Springer (AJN Book of Year award).

• Caring Science as Sacred Science (2005). Philadelphia: F. A. Davis (AJN Book of Year award).

Other caring-based books I coedited or coauthored are extensions of these works but are not discussed here (see, for example, Bevis and Watson [1989], Toward a Caring Curriculum, New York: National League for Nursing [reprinted 1999, Sudbury, MA: Jones & Bartlett]; Watson and Ray [1998] [eds.], The Ethics of Care and the Ethics of Care, New York: National League for Nursing; Chinn and Watson [1994], Art and Aesthetics in Nursing, New York: National League for Nursing). See also Web site (Watson 2004a) for complete citations of books and publications.

Nursing: The Philosophy and Science of Caring (1979) provided the original core and structure for the Theory of Human Caring: Ten Carative Factors. These factors were identified as the essential aspects of caring in nursing, without which nurses may not have been practicing professional nursing but instead were functioning as technicians or skilled workers within the dominant framework of medical technocure science. This work has stood as a timeless classic of sorts on its own. It has not been revised since its original publication; only reprints have kept it alive, thanks to the University Press of Colorado.

This (2008) edition is an expanded and updated supplement of the original text, with completely new sections replacing previous sections while other sections that remain relevant are included with only minor revisions. I have been advised to retain the original text in this revision so essential parts of it remain alive, since the original 1979 version may eventually go out of print. Thus, this work retains core essentials of the original text while updating that text with new content, bringing the original book full circle with my own evolution and changes in the work across an almost thirty-year span.

To provide the context for this evolution (before I address revisions of the original text), I provide a brief overview of the focus and content of the other books that serve as a background for my evolving work, all of which emerged from the original text of Nursing: The Philosophy and Science of Caring.

My second book, Nursing: Human Science and Human Care, A Theory of Nursing, was first published in 1985 and has been republished by the National League for Nursing (1988) and Jones and Bartlett (1999). It expands on the philosophical, transpersonal aspects of a caring moment as the core framework. This focus places the theoretical ideas more explicitly within a broader context of ethics, art, and even metaphysics as phenomena within which nursing dwells but often does not name, articulate, or act upon.

As has been pointed out in contemporary postmodern thinking, if a profession does not have its own language, it does not exist; thus, it is important to name, claim, articulate, and act upon the phenomena of nursing and caring if nursing is to fulfill its mandate and raison d'être for society. This second theory text seeks to make more explicit the reality that if nursing is to survive in this millennium, it has to sustain and make explicit its covenant with the public. This covenant includes taking mature professional responsibility for giving voice to, standing up for, and acting on its knowledge, values, ethics, and skilled practices of caring, healing, and health.

What was/is prominent in the second "theory" book is the explicit acknowledgment of the spiritual dimensions of caring and healing. There is further development of concepts such as the transpersonal, the caring occasion, the caring moment, and the "art of transpersonal caring" (Watson 1985:67). Further, in this work, as reflected in the title, distinctions are made with respect to the context of human science in which nursing resides: for example,

• A philosophy of human freedom, choice, responsibility

• A biology and psychology of holism

• An epistemology that allows not only for empirics but also for the advancement of aesthetics, ethical values, intuition, personal knowing, spiritual insights, along with a process of discovery, creative imagination, evolving forms of inquiry

• An ontology of time and space

• A context of inter-human events, processes, and relationships that connect/are one with the environment and the wider universe

• A scientific worldview that is open. (Watson 1985:16)

Thus, a human science and human caring orientation differs from conventional science and invites qualitatively different aspects to be honored as legitimate and necessary when working with human experiences and human caring-healing, health, and life phenomena.

In this work one finds the first mention of "caring occasion," "phenomenal field," "transpersonal," and the "art of transpersonal caring," inviting the full use of self within a "caring moment" (Watson 1985: 58–72). The caring occasion/caring moment becomes transpersonal when "two persons (nurse and other) together with their unique life histories and phenomenal field (of perception) become a focal point in space and time, from which the moment has a field of its own that is greater than the occasion itself. As such, the process can (and does) go beyond itself, yet arise from aspects of itself that become part of the life history of each person, as well as part of some larger, deeper, complex pattern of life" (Watson 1985:59).

The caring moment can be an existential turning point for the nurse, in that it involves pausing, choosing to "see"; it is informed action guided by an intentionality and consciousness of how to be in the moment — fully present, open to the other person, open to compassion and connection, beyond the ego-control focus that is so common. In a caring moment, the nurse grasps the gestalt of the presenting moment and is able to "read" the field, beyond the outer appearance of the patient and the patient's behavior. The moment is "transpersonal" when the nurse is able to see and connect with the spirit of others, open to expanding possibilities of what can occur. The foundation for this perspective is the wisdom in knowing and understanding that "[w]e learn from one another how to be more human by identifying ourselves with others and finding their dilemmas in ourselves. What we all learn from it is self-knowledge. The self we learn about or discover is every self: it is universal. We learn to recognize ourselves in others" (Watson 1985:59).

This human-to-human connection expands our compassion and caring and keeps alive our common humanity. All of this process deepens and sustains our shared humanity and helps to avoid reducing another human being to the moral status of object (Watson 1985:60).

This second work concludes with a sample of human science methodology as a form of caring inquiry. Transcendental phenomenology is discussed as one exemplar of a human science–Caring Science experience of loss and grief experienced and researched among an Aboriginal tribe in Western Australia. Poetry and artistic, metaphoric expressions emerge within the "outback" research experience, using this extended methodology. Such an approach was consistent with the findings and experiences in this unique setting, in that this methodology allowed for a "poetic" effect in articulating experiences as felt and lived, transcending their facts and pure descriptions (descriptive phenomenology).

Thus, the transcendent views were consistent with transpersonal dimensions and provided space for paradox, ambiguity, sensuous resonance, and creative expressions, going beyond the surface phenomenology (Watson 1985:90–91). For example: "In other words, how could cold, unfeeling, totally detached dogmatic words and tone possibly teach the truth or deep meaning of a human phenomenon associated with human caring, transpersonal caring and grief, and convey experiences of great sorrow, great beauty, passion and joy. We cannot convey the need for compassion, complexity, or for cultivating feeling and sensibility in words that are bereft of warmth, kindness and good feeling" (Watson 1985:91). The result is poetizing; "it cannot be other than poetic" (Heidegger quoted in Watson 1985:98).

Such an exemplar of methodology invites a union between the humanities and art with science, one of the perennial themes of my work. Finally, this second book launched my ideas and set the foundation for the next evolution of my work on Caring Science that followed.

The third book, Postmodern Nursing and Beyond (1999), brought focus to the professional paradigm that is grounded in the ontology of relations and an ethical-ontological foundation before jumping to the epistemology of science and technology. The focus of this work was the need to clarify the ontological foundation of Being-in-Relation within a caring paradigm, the unity of mind-body-spirit/field, going beyond the outdated separatist ontology of modern Era I medical-industrial thinking. In this book the spiritual and evolved energetic aspects of caring consciousness, intentionality, and human presence and the personal evolution of the practitioner became more developed. This evolution was placed within the emerging postmodern cosmology of healing, wholeness, and oneness that is an honoring of the unity of all.

This postmodern perspective, as developed in the third book, attempts to project nursing and health care into the mid-twenty-first century, when there will be radically different requirements for all health practitioners and entirely different roles and expectations between and among the public and health care systems (Watson 1999: xiii). Prominent in this text is an emphasis on the feminine yin energy needed for caring and healing, which nursing, other practitioners, and society alike are rediscovering because the dominant system is imbalanced with the archetypal energy of yang, which is not the source for healing. Nursing itself serves as an archetype for healing and represents a metaphor for the deep yin healing energy that is emerging within an entirely different paradigm. What is proposed is a fundamental ontological shift in consciousness, acknowledging a symbiotic relationship between humankind-technology-nature and the larger, expanding universe. This evolutionary turn evokes a return to the sacred core of humankind, inviting mystery and wonder back into our lives, work, and world. Such views reintroduce a sense of reverence for and openness to infinite possibilities. Emphasis is placed on the importance of ontological caring-healing practices, grounded in an expanded consciousness and intentionality that intersect with technological treatments of advanced medicine. In this work, Nightingale's original blueprint for nursing is evident and embodies all the caring-healing nursing arts and rituals, rediscovered and honored for new reasons. Metaphors of ontological archetype, ontological artist, and ontological architect are used to capture the roles and visions for nursing into this millennium/Era III medicine and nursing (Watson 1999:xiv–xv).

My most recent theoretical book, Caring Science as Sacred Science (2005) (which received an American Journal of Nursing [AJN] Book of the Year award in 2006 in the category of research), expands further upon the earlier works on caring. This work places Caring Science within an ethical–moral–philosophically evolved, scientific context, guided by the works of Emmanual Levinas (1969, French) and Knud Logstrup (1997, Danish).

This latest work on Caring Science seeks a science model that reintegrates metaphysics within the material physical domain and reinvites Ethics-of-Belonging (to the infinite field of Universal Cosmic Love) (Levinas 1969) as before and underneath Being-by-Itself alone — no longer separate from the broader universal field of infinity to which we all belong and to which we return from the earth plane.

Levinas's "Ethics of face" — as in facing our own and others' humanity — is explored as a metaphor for how we deepen and sustain our humanity for survival of the human, in contrast to "totalizing" the human condition and cutting us off from the infinite source of life and the great Cosmic field that unites us all. Logstrup's "ethical demand" brings forth the notion of "Ethics of Hand," in that he reminds us of the sovereign, unarticulated, and often anonymous ethical demand that "we take care of the life which trust has placed in our hands" (Logstrup 1997:18).

Caring Science as Sacred Science text identifies these basic assumptions (Watson 2005:56):

• The Infinity of the Human Spirit and evolving universe

• The ancient and emerging cosmology of a unity consciousness of relatedness of All

• The ontological ethic of Belonging before Our Separate Being (Levinas 1969)

• The moral position of sustaining the infinity and mystery of the human condition and keeping alive the evolving human spirit across time, as in facing and deepening our own and others' Humanity (Levinas 1969)

• The ethical demand that acknowledges that we hold another person's life in our hands; this sovereign expression of life is given to us, before and beyond our control with expressions of trust, love, caring, honesty, forgiveness, gratitude, and so on, beyond ego fixations and obsessive feelings that are negative expressions of life (Logstrup 1997)

• The relationship between our consciousness, words, and thoughts and how they positively or negatively affect our energetic-transpersonal field of Being, Becoming, and Belonging; thus, our consciousness affects our ability to connect, to "be-in-right-relation" with Source: the infinite universal Cosmic field of LOVE.

(Continues...)

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Excerpted from Nursing by Jean Watson. Copyright © 2008 Jean Watson. Excerpted by permission of University Press of Colorado.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

Contents

Acknowledgments,
Preface: Opening-Entering: A New Beginning Almost Thirty Years Later,
Interlude,
PART I. BACKGROUND,
PART II. CARING SCIENCE AS CONTEXT,
Chapter 1. Nursing: The Philosophy and Science of Caring,
Chapter 2. Carative Factors/Caritas Processes: Original and Evolved Core for Professional Nursing,
Chapter 3. Caritas Processes: Extension of Carative Factors,
PART III. FROM CARATIVE FACTORS TO CARITAS PROCESSES,
Chapter 4. From Carative Factor 1: Humanistic-Altruistic System of Values to Caritas Process 1: Cultivating the Practice of Loving-Kindness and Cultivating the Practice of Loving-Kindness and Equanimity Toward Self and Other as Foundational to Caritas Consciousness,
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,
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,
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,
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,
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,
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,
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,
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,
Chapter 14. Administering Sacred Nursing Acts — Further Development of Carative Factor / Caritas Process 9,
Chapter 15. From Carative Factor 10: Allowance for Existential-Phenomenological Forces to Caritas Process 10: Opening and Attending to Spiritual/Mysterious and Existential Unknowns of Life-Death,
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,
Chapter 17. The Seven Chakras: An Evolving Unitary View of the Basic Needs Energy System,
Chapter 18. The Caritas Nurse/Caritas Nursing and the Chakra Systems,
PART V. HEALTH, HEALING, HUMANITY, AND HEART-CENTERED KNOWING FOR CARITAS NURSING,
Chapter 19. Human Experiences: Health, Healing, and Caritas Nursing,
PART VI. CRITIQUING NURSING EDUCATION,
Chapter 20. Caritas Curriculum and Teaching-Learning,
Epilogue,
ADDENDA,
Postscript: Prescript,
Bibliography,
Index,

Editorial Reviews

"Nursing pioneered a human caring focus in nursing. The book is foundational for caring practice and so provides an accessible and informative resource, both for nurses in clinical practice and for students studying human caring at undergraduate and graduate levels."
—Adeline Falk-Rafael, RN, PhD, Professor and Associate Director, York University School of Nursing


"Watson reviews and revises all components of [her] theory and includes examples of qualitative research studies in caring scholarship and clinical practice. An extensive bibliography and a compact disc with meditation exercises complete this new edition. Summing up: recommended."
—M.P. Tarbox, CHOICE Magazine


"Nursing, The Philosophy and Science of Caring is a positive, upbeat, depiction of what nursing should be. The poetry and artwork not only add to the text, but incorporate art with science, much as Watson called for in nursing education. The book will be useful for the numerous healthcare settings who are using Watson's (2008) theory of caring as the theoretical guide in delivering healthcare education."
—Sandra Schmidt Bunkers, RN; PhD; FAAN, Nursing Science Quarterly

From the Publisher