Watson`s Theory of Transpersonal Caring applied to BSN

Report
Watson’s Theory of
Transpersonal
Caring applied to
BSN students
Seton Hall University
Emerging Nursing Theory NUR 8101
Dr. Marie Foley, PhD, RN, CSN-NJ
Jeannie Couper, MSN, RN-BC
November 17, 2011
Theory of Transpersonal Caring (WTTC) (1979)

Caring for the purpose of:

Promoting healing

Preserving dignity

Respecting the wholeness

Nursing is healing art and science dedicated to the pursuit of
harmonious and sacred relationships

Challenges nursing:

To rediscover its healing traditions

Expanding its mission for caring relationships
Based on Nightingale's concepts

Transform the professional

Used by schools and hospitals- return the human
element back into study and the practice of nursing

Advocates for liberal art education

Emphasis on philosophy and values

Watson’s intent was not to be prescriptive but a paradigm

Biomedical/natural science model ->postmodern/human science
perspective

Distinct from medicine with emphasis on disease and curing
Human Science Paradigm

Concerned predominantly with the meaning of the lived experience

Key elements of knowledge formation:


human environment
personal-life spirit or the human-to-human interaction

Multiple ways of knowing

Emphasis on “being” and cocreation of RN- pt interactions
“Ever evolving theory”

Employs language to reflect on own life journey and beliefs

10 “carative factors” → “clinical caritas processes”

↑ emphasis on metaphysical and spiritual dimensions (love)

“Love as an ethic” as the basis for caring-healing practices
adapted from Pearson Publication
Major conceptual elements

Original theory included:
 transpersonal caring relationship
 10 carative factors
 Caring occasion/moment

Current dimensions which evolved/ emerged from theory:
 Transpersonal mind/body/spirit oneness
 Importance of caring-healing consciousness
 Consciousness as energy
 Phenomenal field / unitary consciousness
 Advanced caring-healing modalities/ nursing arts
 Ultimate form of healing and transcendence is love
 Nurse as sacred healing environment
Nursing as Profession and Praxis

Caring in Nursing:

Reciprocal relationship btw nurse and “others

Nurse is the co-participant with patient (the change agent)

Coparticipants in a pattern of subjectivity-inter subjectivity

“Consciousness

Intentionality

Perceptions and lived experiences R/T caring, healing, and healthillness conditions given in a ‘caring moment’.

Experiences or meanings that transcend the moment and beyond
the actual experience” (Watson, 1996, p. 146).

Care is never separated from the context of the unity of mind-bodyspirit-nature

Profession exists in order to sustain caring, healing, and health
Nursing interventions, “human care processes”

Goals defined by Watson (1985/1988)

R/T mental spiritual growth for self and others

Finding meaning in one’s own existence & experiences

Discovering inner power & control

Potentiating instances of transcendence & self-healing

Nurse intervenes through “a way of being” & “presence”

Require a wide scope of knowledge

Presuppose a knowledge base and clinical competence

Require intent, a will, a relationship, & actions.

“heart-centered awareness & loving/caring consciousness”
Nursing student caring behaviors during
blood pressure measurement
Minnesota Baccalaureate Psychomotor Skills Faculty Group
(MBPSFG) Journal of Nursing Education, 2008, 47(3)
Study partially funded by Kappa Phi Chapter of STTI
and 6 participating nursing programs
Nursing student caring behaviors during
blood pressure measurement

Multi-site (6), non-experimental, descriptive study

Organizing framework: Watson’s Theory of Transpersonal
Caring and a combination of cognitive and connectionist
learning theories

teaching strategy included:

required reading: Caring made visible, Swanson, 1998

Video tape analysis

Feedback

BP measurement taught in nursing perspective based on
Watson’s theory of caring in the human health experience
Watson’s (1988) Theory of Transpersonal Caring
caring “operationalized”

Watson’s definition of caring:
A moral commitment to protect
human dignity & preserve
humanity

Caring conceptualized by Morse et al.
1990
A human trait, a moral imperative, an
affect, an interpersonal
relationship, and a therapeutic
intervention (MBPSFG,2008, p.
100)
Moral commitment illuminated in
research as interpersonal and
therapeutic interactions influencing
the pt’s experience and physical
response.
Involves intentionality
Morse, Solberg, Neander, Bottoff, and Johnson (1990)
Caring in human health experiences

Operationalized caring from the perspective of
the nurse and patient (Morse et al, 1990)

Intentionality : basis for teaching,
understanding, developing , and adopting
caring behaviors
Watson’s Theory of Transpersonal Caring
“operationalized” (1994)

Focused on five caring dimensions or
categories:

Respectful deference to others

Assurance of human presence

Positive connectedness

Professional knowledge and skills

Attentiveness to the other’s experience

Wolf, Giardino, Osborne, & Ambrose (1994)
Watson’s (1988)Transpersonal Caring Theory
“operationalized” by Wolf et al., 1994

Watson’s Carative Factors:

five caring dimensions:

1. Formation of a humanisticaltruistic system of values

Respectful deference to
others

2. The instillation of faithhope

Assurance of human
presence

5. Promotion and acceptance
of the expression of + and feelings

Positive connectedness

7. Promotion of
transpersonal teachinglearning

Professional knowledge and
skills

Attentiveness to the other’s
experience

4. development of a helpingtrusting relationship and #5.
Research Question:

“Is there a change in objective and subjective
caring behaviors demonstrated by
baccalaureate nursing students completing
blood pressure measurement when these
behaviors are taught in nursing psychomotor
skill curricula?”
Minnesota Baccalaureate Psychomotor Skills Faculty Group, 2008, p.100.
The Descriptive Study

Sample: Jr-level nursing students at 6 independent BSN prog

Teaching strategies:

BP measurement served as the forum for integrating caring
behaviors

Students viewed demonstration videotape of BP
measurement based on the objective tool (Caring Behaviors
During BP Measurement instrument )

Teaching included caring behaviors as an integral component
of professional nurses’ role

Student identification of caring and non-caring behaviors
The Descriptive Study continued

Evaluation: BSN students videotaped (VT) and
evaluated twice 8 weeks apart

VT analysis: reviewed for evidence of caring and noncaring behaviors

In response to analysis: Students discussed thoughts
and feelings

Specific instruction was not standardized amongst
BSN programs

Both tools created by the researchers
#1 Caring Behaviors During BP Measurement instrument

Designed as an objective tool:

30-item procedure (behavior present; 1= yes; 0= no)

Total score = sum of item procedure scores (max=30)

Content validity established via AHA/NHLB guidelines

Relevant caring behaviors (CB) r/t caring dimensions

Evaluators: faculty as patient-role player
#2 Role Player Survey of Caring Behaviors During BP
Measurement instrument


3-item Liker-scale evaluating student caring behaviors

A) respect

B) conveyed warmth and caring

C) conveyed competence

Score; 1= not at all 2= some 3=much
Documented the role players perception of caring during BP

5 Caring dimensions based on CBI consistent with WTTC

Content validity was established using caring dimensions as
described by Wolf, et al. ( 1994)
Objective Caring Behaviors During BP Measurement
Caring Behavior
Caring Dimension
Caring Behavior
Caring Dimension
1. Washes hands
D
9. Posture reveals relaxed muscle tone
2. Cleans equipment
D
10. Voice congruent with patient's emotions
A, B, C
3. Introduces self
A, B
4. Calls patient by preferred name
A, B
5. Explains procedure and elicits questions
A, B, E
6. Provides privacy
A
11. Leans toward patient when talking
B
12. Asks patient about comfort during
procedure
B, E
13. Physical contact is performed with a gentle
touch
C
7. Faces client throughout procedure A
14. Seats patient with feet flat on floor,
uncrossed legs
8. Maintains appropriate eye contact A
15. Uses right arm unless unable to do so
A = Respectful deference to others;
B = assurance of human presence;
C = positive connectness;
B
D = professional knowledge and skill;
E =attentiveness to the other’s experience
(Wolf et al. 1994)
A, D
D
Objective Caring Behaviors During BP Measurement
Caring Behavior
Caring Dimension
Caring Behavior
cont.
Caring Dimension
16. Gently supports patient's arm at heart
23. Inflates cuff to 30 mm Hg above estimated
level
C, D systolic
A, D
17. Measures arm for correct cuff size
D
24. Deflates cuff 2 mm Hg/second
A, D
18. Centers bladder of cuff over palpated
25. If mercury, keep centered at eye level
D
brachial artery
D
26. Obtains systolic and diastolic blood pressure
19. Wraps cuff gently, snugly, 1 inch above
D
antecubital
A, D
27. Allows 10 mm Hg before complete deflation
20. Use palpation or patient's reported
D
blood pressure to estimate systolic
D
28. Explains findings to patient
A, B, E
21. Deflates bladder, waits 15 to 30 seconds
A, D
A, D 29. Completes calmly, confidently
22. Applies stethoscope correctly
A = Respectful deference to others;
B = assurance of human presence;
C = positive connectness;
D
30. Obtains accurate blood pressure
D = professional knowledge and skill;
E =attentiveness to the other’s experience
(Wolf et al. 1994)
D
Comparison of Scores of Student Caring
Behaviors Before and After Role-Playing
Subjective data:
Score Range
Mean Score
SD
Caring Behavior Conveyed Pretest Posttest Pretest Posttest Pretest Posttest

Genuine respect
1-3
2-3
2.43
2.82
0.53
0.39

Warmth and caring
1-3
1-3
2.40
2.70
0.58
0.49

Competence
1-3
1-3
2.25
2.68
0.63
0.50
Minnesota Baccalaureate Psychomotor Skills Faculty Group, 2008, p.102
Findings and limitations

↑ in students’ subjective and objective caring behaviors

Greatest gains in professional knowledge and skill caring dimensions

Little to no gain in respect, presence, & attention to other’s
experience caring dimensions

Feedback is required in clinical settings as is facilitating understanding
within the nursing disciplinary context

Limitations included

Absence of a control group

Absence of standardized information, approaches to teaching and
learning, and varying methods to determine role-player inter-rater
reliability
Discussion and Evaluation of tool

↑ in students’ subjective and objective caring behaviors

Greatest gains in professional knowledge and skill caring dimensions

Little to no gain in respect, presence, & attention to other’s
experience caring dimensions

Caring dimensions addressed by tool:

A= respectful deference to others
14/30
46.6%

B= assurance of human presence
8/30
26.6%

C= positive connectedness
3/30
10%

D= professional knowledge and skill
18/30
60%

E= attentiveness to the other’s experience
3/30
10%
Further research

Additional research required with an experimental design
to broaden the understanding of the best practices assist
the student in the development of caring behaviors

Further expand the students development of caring
behaviors related to all psychomotor interventions
Congruency

Although the authors used Wolf et al. operationalized definitions

the study focused more on the skill acquisition

No mention of relationships

Poor

Did not stay focused on theoretical construct as refers to Benner and
Watson as well.
Contributions to nursing science

Noted by the authors as” a beginning step in identifying and
testing educational strategies for promoting psychomotor skill
development” (MBPSFG, 2008, p.104) within the human caring
and health experience).

The need to incorporate explicit instruction in caring behaviors
throughout psychomotor skill development
References
Fawcett, J. (2005). Contemporary Nursing knowledge: Analysis and
evaluation of nursing models and theories, 2nd Ed., Philadelphia: F.A.
Davis Company.
Jesse, DE. (2010). Watson’s philosophy and theory of transpersonal
caring In Nursing theorist and their works, 7th ed. (Eds.). In M.R.
Alligood & A. M. Tomey, Nursing theorist and their works, 7th Ed, (
pp. 91-112).
Johnson, B.P. & Kelley, J.H. (2011). Theory of transpersonal caring:
Jean Watson. In Julia B. George (Ed.). Nursing theories: The base for
professional nursing practice, 6th Ed. (pp. 454-478). Upper Saddle
River, NJ: Pearson.
Minnesota Baccalaureate Psychomotor Skills Faculty Group, 2008.
Journal of Nursing Education, 47(3), 98-104.

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