Nurses are with patients often during the most difficult times in
their lives. Jesus gives a perfect example of healing for Christian nurses in
the Bible “Christ healed a lame man not only physically but spiritually” (Luke
5:7, The Life application Bible). Caring for patient’s physical needs can be
challenging. How does a nurse care for the soul of the patient? The theorist
Jean Watson, in the Human Caring theory identifies ways of caring for the
patients mind, body, and soul (Mc Ewen & Wills, 2011).
Overview of nursing theory:
Watson’s (2009) theory identifies ways caring can be facilitated
into practice. In the human caring theory Watson (2009) asserts that it is the
nurse’s responsibility to care for the mind, body, and soul of the patient (Watson,
2009). Accordingly Watson’s (2009) theory rebuilds the love and empathy that’s
lost behind medical science and technology (Alvarez, 2013). The human caring theory
defines the meaning and purpose of the work the nurse performs (Watson, 2009). Similarly
the human caring philosophy states that the more connected the nurse is with
the patient, the more healing takes place (Lukose, 2011).Watson’s (2009) theory
is based on four major principals: health, a person as a whole, nursing, and
ten needs significant to the human experience of caring (McEwen & Wills,
2011).
Beliefs outlined in Watson’s theory
1) “Human
beings are persons of worth that requires understanding, love, respect, care
and nurturing. A person’s spiritual side is just as important as their body” (Alvarez,
2013, p.4).
2) “A
requirement of health is a union of mind, body and spirit. Health requires the
patient’s perceived self and experience self are in harmony” (Alvarez, 2013,
p.4).
3) “Caring
requires the nurse to intertwine both scientific and ethical care to develop a
transpersonal caring relationship with the patient” (Alvarez, 2013, p.4).
4) “The
ten carative factors need to be addressed by the nurse in the role of caring
for a holistic patient experience” (Alvarez, 2013, p.4).
Watson’s ten needs significant to the human
experience
1) “A
human system of ethics is required to practice caring at its highest level”
(Alvarez, 2013, p.4).
2) “Trust
and hope are needed by both the patient and the nurse to form a therapeutic
caring relationship” (Alvarez, 2013, p.4).
3) “Empathy
for self and others is necessary to understand the meaning behind an experience
of illness” (Alvarez, 2013, p.4).
4) “Establishing
therapeutic relationships with patients is necessary for treating a person as a
whole” (Alvarez, 2013, p.4).
5) “The
ability for the patient to be able to express all feeling in an environment of
safety is necessary for healing” (Alvarez, 2013, p.4).
6) “Care
that is individualized to the patient and uses both the art and science of
nursing is the most desirable form of caring” (Alvarez, 2013, p.5).
7) “Learning
and teaching includes the spiritual aspects of being where both the patient and
nurse benefit from the experience” (Alvarez, 2013, p.5).
8) “An
environment created by the nurse that supports holistic care of the patient is
optimal for healing” (Alvarez, 2013, p.5).
9) “The
provision of support in a holistic manner, when needed by the patient, is a
professional as well as moral obligation of the nurse” (Alvarez, 2013, p.5).
10) “The incorporation of divine energy into
patient care includes such ideals of love, forgiveness, charity, hope and faith”
(Alvarez, 2013, p.5).
Many hypothetical applications can be derived from Watson’s (2009)
theory (Alvarez, 2013). Watson (2009) theory is strongly divine in nature (Alvarez,
2013). Watson (2009) believes that by demonstrating virtues such as love,
forgiveness, and charity a nurse could change the environment around the
patient thereby, assisting in healing (Alvarez, 2013). Creating an optimal
caring atmosphere encourages the growth of the patient and the nurse in areas
of self-control, spiritual maturity, and healing (Alvarez, 2013). To establish
the most favorable curative setting the nurse must have a strong moral core and
exercise the utmost of ethical behavior (Alvarez, 2013, p.5). While caring for
patients it is essential the nurse endorses both the worth and completeness, of
both the one receiving care and the one giving it (Alvarez, 2013). Treating
every individual as a complete unique, special person, is the essence of the
caring that nurse’s should provide for optimal healing.
Exemplar: My encounter with the Smith’s
“A man’s life is not his own; it is not for a man to direct his
steps” (Jeremiah 10:23). I read this sign hanging over the hospital chapel for
the last ten years. I always stop in the chapel to have a moment of prayer
prior to starting my shift. I often pray for guidance and help for the upcoming
shift. This sign took on a greater meaning the night, I cared for the Smiths. I
will never look at that sign the same way again.
I was the charge nurse on the late night shift. I was making my
first set of rounds for the night, individually checking each patient on the
unit, while receiving report at the patient’s bedside from the outgoing nurse.
As we gave report, we asked each patient about their pain level, and assisted
with toileting and repositioning. Before
leaving the room we moved any objects the patient may need within their reach.
I dimmed the lights and
reminded the staff that it was quiet time on the unit. I placed the signs out
on the top of the front desk that explained the importance of quiet time. The
same announcement came over the intercom as it always does. “Visiting hours are
now over, we kindly ask all visitors to leave and return between the hours of
9:00 am and 8:00 pm”. “Have a good night and God bless”. I was thankful for a quiet night. I came to
the last nursing pod for inspection. One of the younger nurses came to me and
stated,” Mrs. Smith and her husband are patients tonight; they had been in a
serious car accident”. “The family has decided to place, Mrs. Smith on comfort
measures after many tears”.
Working in a small
community hospital many of the patients are routinely cared for by the staff.
Mrs. Smith and her husband were well known by everyone. They were a vivacious
couple in their nineties. They square danced every Saturday, despite weekly
blood transfusions given to her husband.
I walked up and saw an unexpected site; Mrs. Smith’s children were
surrounding her bed talking and chuckling about the antics of their very spunky
mother. The patient’s white head lay on a flowered pillowcase. The nurse had
put pink lipstick on Mrs. Smith. The patient lay in her bed her respirations
were shallow and her eyes closed but, she appeared comfortable.
I knocked on the door
introduce myself to the family. I let them know if there was anything the staff
could do for them please let me know. The scene was so serene it would have
been easy to miss, Mr. Smith. Mr. Smith was a tiny pale man, with his hands
over his face sitting on a small gray trash can. He had a large bandage on his
head and blood was starting to stain the white cotton netting over his left
eye. I touched his slight icy shoulder. Lightly he squeezed both of my hands in
familiar recognition. He looked up into my eyes. In his deep brown eyes, I
could see an indescribable sorrow. He said softly “we were best friend since
the fifth grade.” He looked down but, continued to squeeze my hand ever so
slightly. A small gold cross laid between a deep hallow in his neck.
I excused myself from the
room and I brought back a lounge chair and warm blanket for Mr. Smith. I placed
a chair by his wife’s bedside for him to sit in and gave him a warm cup of
coffee. I pulled out the Gideon Bible we have in all the bedside dressers and
sat in on the table next to him. He smiled slightly and said “you remembered
how I like my coffee”. I cleaned and changed the bandage on his head. I again
told the family if there was anything they needed let me know and I left the
room to continue with my duties.
During a later nursing round in the evening, I found Mr. Smith
sitting quietly by his wife’s bedside alone. It was apparent that his wife was
near the end of her life. He was softly stroking her hair. The Bible I gave him
lay open on the bedside behind him. Underlined were the words, “Blessed are
those who morn, for they should be comforted” (Mathew, 5:4). I asked if I could
come in. I sat quietly beside him, placing my hand on his knee. Slowly he began
to talk. Mr. Smith stated “we were
married for seventy -seven years”. “We had eight children”. I said “that’s a
lot of children”. “He chuckled”. “We had a lot of hard years but they were all
good.”
After a long silence, Mr. Smith stated” so you think she is in
pain” in a slow southern drawl. I assured him the morphine that the nurse just
gave his wife would take care of any pain. I made him aware that Mrs. Smith
could still hear what he had to say. He began to talk to her about their life
together. I asked him if he wanted me to leave. Mr. Smith stated “I just can’t
do this alone but, I didn’t want my babies to see their mother die.” “I told
them to go home.” “That would have been their Mother’s wishes”. I sat by his
side while he continued to talk to his wife about their many years together.
It was apparent that Mrs.
Smith’s hour of death was close. Mr. Smith asked me pray with him. We held
hands and prayed as she took her last breathes. Mr. Smith asked God to please
let his wife know that it was ok to go without him. He stated he would be up
there as soon as he could. He asked forgiveness for the car accident. Then he thanked
God and his wife for their life together. Before her last breath he kissed her
goodbye.
Mr. Smith, turned to me warm tears running down his sunken wrinkled
cheeks. “How do I let go of seventy- seven years?” We both hugged tightly and
wept. I stated,” I don’t know Mr. Smith, I just don’t know.” “All I can say is
God is present with us right now.” We continued to hug and cry. He looked up at
me and said “God has sent an angel to care for me in my greatest hour of need”
as he stroked my cheek.
The next day at the ten o’ clock shift meeting, I shared my
experience with my peers. A discussion started on how, as nursing professional
the staff, could better serve patients and families, during the challenging
times of illness. There was an exchange of experiences, we all had with death
and dying. Through this exchange, learning and support for each other was
occurring. I believe by sharing our stories we were becoming better nurses.
Application of the theory
The theory created by Jean Watson (2009) combines the medical and
scientific sides of nursing to create an optimal healing environment. Jean
Watson (2009) suggests practical ways to implement her theory on nursing units.
I have demonstrated some of these practices in the above exemplar. One suggestion
by Watson (2009) is to create a healing environment. Much of the physical environment around the patient is
under the control of the nursing staff (Watson, 2009).This is demonstrated
in the exemplar during nursing rounds
when the lights are dimmed, visitors were asked to return in the morning, and reminding
staff be conscious of the noise level. Another example of this in the exemplar is
bringing the patient a warm blanket, a cup of coffee and a recliner. When the
nurse is aware of subtle changes in the environment that can bring comfort to
the patient, healing occurs (Watson, 2009).
Another practical suggestion given by Watson (2009) is to place
positive affirmations and reminders about caring practices around the nursing
units (Watson, 2009). This modality of caring is demonstrated in the exemplar
by the sign over the chapel door. I also assert it can be recognized in the
fact that the last thing the patients hear every night prior to going to sleep,
is God bless, over the intercom. Placing the sign at the front desk reminding
others of the importance of quiet time, is an example of the human caring
theory being used in everyday nursing practice, placing examples of caring
practice for all to see.
Watson (2009) also suggests creating Caritas circles to share
caring moments (Watson, 2009). A caritas circle is brief amount of time nurse’s
set apart to share quality and safety issues during their shift (Watson, 2009).
This caring practice was demonstrated in the nightly nursing meeting in the exemplar.
This brief meeting also gives the nurses time to engage in another carative
measure. According to Watson (2009) it is important to create a healing
environment for the nurse as well as: intentionally pausing, breathing, and
being mindful of the nursing practice you are engaging in (Watson, 2009).
In the beginning of the exemplar it talks about bedside report and
caring rounds.
Watson (2009) suggests in her theory that
engaging in caring rounds and bedside reports are a perfect examples of the
caring nurses provide (Watson, 2009). When the nurse’s give report at the
bedside the patient is an active participate in his or her own care. By
performing caring rounds the patient’s physical as well as emotional needs are
met. Touching, Mr. Smith leg when speaking to him also is Watson (2009) theory
in action. Watson (2009) also suggests therapeutic touch to establish caring
communication between the nurse and patient (Watson, 2009).
Similarly Watson (2009) also suggest nurse’s
be given healing places to restore their souls (Watson, 2009). Without
restoring the soul of the nurse, optimal care is impossible (Watson, 2009). This
part of the theory was demonstrated in the exemplar by praying in the chapel
prior to starting nursing duties. The exemplar presented in this paper
demonstrates that the theories in Jean Watson’s (2009) human caring theory are
practical and simple to implement into everyday nursing practice.
Conclusion:
Jean Watson’s (2009) theory attempts to preserve the fullness and
understanding of the patient experience (Alvarez, 2013). The purpose of this
exemplar is to demonstrate that through applying the principles of the human
caring theory to practice, the nurse brings meaning and purpose not only to the
work of the nurse but, to the patient (Watson, 2009).Growth and healing occur
for both the patient and the nurse through shared human experience (Lukose,
2011). Similarly Watson’s (2009) theory gives the structure for nurse’s to
build a therapeutic relationship on (Alvarez, 2013).
References
Alvarez, J. (2013). Analysis of Jean
Watson’s Theory of Human Caring. Unpublished
manuscript, Department of Nursing, Liberty University,
Lynchburg,Virgina.
Lukose, A. (2011). Developing a practice model of Watson’s theory of
caring. Science Quarterly, 24, 27-30.
http://dx.doi.org/10.117710894318410389073
McEwen, M., & Wills, E. (2011). Theoretical basis for nursing (3rd ed.). Philadelphia, Baltimore,
New York, London, Buenos Aires, Hong Kong, Sydney, Tokyo: Wolters Kluwer
Lippincott Williams and Wilkins.
Watson, J. (2008). The
philosophy and science of caring. Boulder, CO: University Press of
Colorado.
Theory-Based Exemplar Final Paper
