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Transpersonal Caring Theory
The Transpersonal Caring Theory, also called Theory of Transpersonal Caring or Theory of Human Caring, was first introduced by Jean Watson in her book Nursing: The Philosophy and Science of Caring in 1979. The theory states that nursing requires transpersonal experiences through mutual caring between the nurse and the patient, in order to achieve a complete healing process. Transpersonal experiences can be understood as experiences that are exceeding the realm of the self, and thus, incorporate the interaction with another, wider aspect of life. More precisely, the nurse incorporates and interacts with the patient, in place of restricting the attention to herself. According to holism, both persons are viewed and treated as a whole, including self, nature and spirits, instead of reducing the patient to a disease or its symptoms and the nurse to a job and its duties. The theory argues against Mechanism (philosophy), where humans are depicted as objects, and is instead influenced by Humanism and the Eastern worldview, i.e. viewing humans as living beings and focusing on relationships instead of on the individual, respectively. The building blocks of Watson’s theory are composed of the 10 “carative factors” that are explained in the "theory" section.

Life and education
Jean Watson is a nurse theorist who was born on 10th of June in 1940 in Williamson which lies in West Virginia. She went to the University of Colorado where she received her Bachelor of Science and Nursing in 1964 and a master of science in nursing in psychiatric and mental health nursing in 1966. At the same university, she further completed her Ph.D. in Educational Psychology and Counseling in 1973.

Watson achieved ten doctoral degrees. Her further research focused on nursing. She developed the Theory of Human Caring between the years 1975 and 1979, which was influenced by her teaching experience and aimed to find common meaning from nurses all over the world. It was first published in 1988. Until now Watson published over twenty books about caring. Her teachings are used by academic programs and by clinical nurses around the world. In the 1980s, Watson and her colleagues established the Center for Human caring at the University in Colorado where projects in human caring and clinical, educational and community scholarship activities are sponsored.

In 1998, Watson´s husband Douglas died whom she cared for before. She saw her suffering and the care for her husband as a way to experience her own nursing theory herself. Later, Watson created a non-profit foundation in 2008: The Watson Caring Science Institute.

Her Philosophy of Caring
Watson´s philosophy of caring deals with the way how nurses express care to their patients. An integral approach to health care is needed for the practice of nursing, says Watson, since a caring environment accepts the patient as he or she is and promotes growth. Watson defined three metaparadigm concepts in nursing: person, health and nursing. The person is seen as a fully functional integrated self and as greater than only the sum of his or her parts. Health is seen as an adaptive-maintenance level of daily functioning, a high level of overall physical, mental and social functioning, the absence of illness and the efforts leading to this absence. Nursing is seen as a science of persons and health-illness experiences mediated by scientific, professional, personal and ethical human transactions.

Carative factors and caritas processes
Watson's development of carative factors was motivated by Eriksson's theory of caritative caring. Eriksson described the term carative in caring science as charity, love and the intention of all caring. The science of caring is, therefore, based on the original meaning of Caritas, the spiritual generosity of love for other human beings, rather than on the Latin term for charity. For the science of caring, Watson lists ten caring needs. In her carative factors, she offers guidelines for the nurse-patient interaction in a caring role. These principles start with three factors that form the philosophical basis, from which the remaining seven factors are derived.

They consist of:

10 carative factors
Watson aims to illustrate the essence of caring with ten carative factors, which intensify a warm-hearted climate within human caring. They consist of:


 * 1) The instillation of faith-hope.
 * 2) The cultivation of sensitivity to one’s self and to others.
 * 3) Development of a helping-trust relationship became development of a helping-trusting, human caring relation.
 * 4) The promotion and acceptance of the expression of positive and negative feelings.
 * 5) The systematic use of the scientific problem solving method for decision making became systematic use of a creative problem solving caring process.
 * 6) The promotion of transpersonal teaching-learning.
 * 7) The provision of supportive, protective, and (or) corrective mental, physical, societal, and spiritual environment.
 * 8) The assistance with gratification of human needs.
 * 9) The allowance for existential-phenomenological forces became allowance for existential-phenomenological spiritual forces.
 * 10) The formation of a humanistic-altruistic system of values.

10 caritas processes
Watson later establishes ten carative processes with clearer definitions for the actual application in nursing:


 * 1) Sustaining humanistic-altruistic values through the practice of loving-kindness, compassion and equanimity with self and other.
 * 2) Being authentically present, enabling faith/hope/belief system; honoring subjective inner, life-world of self and other.
 * 3) Being sensitive to self and others by cultivating own spiritual practices; moving beyond ego to transpersonal presence.
 * 4) Developing and sustaining loving, trusting-caring relationship.
 * 5) Allowing for expression of positive and negative feeling; authentically listening to another person’s story.
 * 6) Creatively problem-solving/ “solution-seeking” through caring process; full use of self and artistry of caring-healing practices via use of all ways of knowing.
 * 7) Engaging in transpersonal teaching and learning within context of caring relationships; staying within other’s frame of reference.
 * 8) Creating healing environment at all levels, whereby authentic caring presence potentiates wholeness, beauty, comfort, dignity, and peace.
 * 9) Reverently assisting with basic needs as sacred acts, touching mindbodyspirit of other, sustaining human dignity.
 * 10) Opening to spiritual, mystery, unknowns; allowing for miracles.

The factors and processes facilitate healing, honour, wholeness and contribute to the evolution of humanity.

Hierarchy of needs
The hierarchy of needs has been logically derived from the previously mentioned carative factors:


 * Lower Order Biophysical Needs or Survival Needs, which includes basic human needs like food, fluid and ventilation


 * Lower Order Psychophysical Needs or Functional Needs, which includes the need for activity and inactivity, as well as sexuality
 * Higher Order Psychosocial Needs or Integrative Needs, which includes the need for achievement and affiliation
 * Higher Order Intrapersonal-Interpersonal Need or Growth-seeking Need, which includes a need for self-actualization

The Theory
The Transpersonal Caring Theory, is a theory developed by Dr. Jean Watson and is used in humanistic nursing care. It is based on Watson’s view that caring lies at the core of nursing.

Nursing is defined by Jean Watson as caring. Her idea of nursing is that of an intersubjective human process, focused on helping the patient achieve a higher degree of harmony in a holistic manner. This harmony is accomplished through the development of transpersonal relationships and caring transactions, in which the patient-nurse transpersonal relationship is a reciprocal relationship.

The Transpersonal Caring Theory is based on 3 core principles: The 10 Caritas Processes, previously also known as the 10 Carative Factors; the caring moment or caring occasion; and transpersonal care.

The 10 Caritas Processes, which are explained above, build the foundation of the theory.

The caring moment refers to a connection between nurse and patient as humans. It describes a turning point, a deep consciousness, and the intentional choice of caring for somebody. According to Watson’s website it “Requires presence-centering-search for meaning; [a] new level of authenticity” and creates potential for “healing and wholeness”.

The last core principle of Transpersonal Caring Theory is transpersonal care, which seeks to connect the soul in the moment through the processes of caring, healing and having a genuine patient-nurse bond.

Furthermore, the Theory of Transpersonal Caring is based on 7 assumptions. Those assumptions are as follows:


 * 1) Caring can be effectively demonstrated and practiced only interpersonally.
 * 2) Caring consists of carative factors that result in the satisfaction of certain human needs.
 * 3) Effective caring promotes health and individual or family growth.
 * 4) Caring responses accept the patient as he or she is now, as well as what he or she may become.
 * 5) A caring environment is one that offers the development of potential while allowing the patient to choose the best action for him or herself at a given point in time.
 * 6) A science of caring is complementary to the science of curing.
 * 7) The practice of caring is central to nursing.”

Jean Watson’s theory of transpersonal caring moves past the scientific practice of nursing to create a genuine relationship framework. Human spirit and inner healing occurs only when caring science and scientific caring is being combined. Furthermore, while executing this theory of transpersonal caring, nurses discover a more significant practice to make a more rewarding profession.

The goal of the Transpersonal Caring Theory is the idea that compassion is a part of the soul and positive actions will arise out of humanistic-altruistic values. Creating a helping-trusting relationship promotes the healing processes within the mind-body-spirit wholeness.

Practice model
Watson developed a practice model by interconnecting the four main elements of this theory:


 * 1) Caritas process - nurses are encouraged to give care and embrace the patient’s healing process. This includes taking care of the patient both on a physical level and on a spiritual level.
 * 2) Transpersonal caring relationship - The relationship between nurse and patient, where both are open to connect, embracing the other’s soul.
 * 3) Caring moment - Thanks to the connection and the availability of both nurse and patient, an opportunity of taking care can be created.
 * 4) Caring healing modalities - Thanks to the relationship that has been formed between nurse and patient, the nurse is able to heal on a deeper level. The healing modalities are influenced by the interconnection and energy between the patient, nurse and the universe.

This practice model could be applied to nursing classes, but also to parenting and marriage preparation classes. Considering Watson’s Transpersonal Caring Theory is directly connected to how nurses care for patients, it is appropriate to consider how the theory is applied in nursing and the education of nurses. A variable combination of the ten caritas processes are utilised regularly in nurse-patient interactions. An anecdote adapted from an educational worksheet demonstrates this briefly:

A nurse meets a patient scheduled for amputation; she has met him before during a previous surgery - Caritas 4; she had thought of creative solutions to how the patient would remember to take his medication - Caritas 6; This particular patient has always been liked by the nurse - Caritas 1. (these caritas processes refer to those outlined previously)

This example of a nurse-patient interaction applies and can therefore be linked to the Caritas processes of the caring theory. It also provides a framework of how the theory works in action and is applied in nursing. It is important to note that the Caritas processes themselves are the application of the theory and that they provide a bridge between the theoretical and practical.

By following Watson’s caring theory the nurses are able to perform caring interactions with their patients and provide and facilitate a healthy healing environment for patients as well as their families. This also allows for the nurse in question to grow and develop a pattern of self actualisation. In conclusion the application of the caring theory is accomplished through the utilisation of the ten caritas processes, implying that the nurse is emotionally engaged with their patients and is open to gain insight into novel emotional and spiritual experiences whilst facilitating the recovery of their patients.

The integration of Watson’s transpersonal caring theory can be achieved as early as the educational level. Nursing schools whose curriculum include transpersonal caring theory, increase the actualisation of transpersonal caring in everyday work life. However, the integration of the caring theory into nursing education programmes does not automatically lead to its application. The execution of caring skills may depend on a workplace that aligns itself with the caring theory and thereby supports an atmosphere, in which theory-based nursing is possible.

What makes the Transpersonal Caring Theory so important for nurses, is that it maintains a positive and constructive setting amidst a commonly stressful and often negative work environment. The basis for challenging this pattern lies in the curriculums of nursing education, and including this needed process of cultivating an adequate mindset towards caring in order to form an outlook that can aid guide their practice. The integration of the theoretical caritas processes in a practical environment allows nurses to realise their contribution and necessity in the field of healthcare according to a study by Ryan (2005). As stated by Watson (2006), the theory acts as a set of ethical guidelines for the discipline.

Watson's transpersonal caring theory can be applied at the hospital unit level. Taking The AMITA Health Resurrection Medical Center Chicago as an example, Ryan outlines ten strategies used in this approach. Among others, these strategies emphasise the merging of Watson’s and the existing nursing philosophy and the exchange of care experiences to illustrate the carative factors. Furthermore, long-term integration is taken into account by making the familiarity with nursing theory a prerequisite for the application process and career advancement.

In 2009, Gallagher-Lepak and Kubsch proposed a transpersonal caring intervention (TCI) guideline that is based on Watson’s ten carative factors and a total of 126 clinical stories provided by registered nurses. The authors’ aim is to provide potential nursing activities that correspond to each of the ten caractive factors. This guideline is supposed to help nurses gain a more real-world understanding of the transpersonal caring theory and facilitate its implementing in day-to-day practice.

Nonetheless, it is argued that the theory’s complexity hinders its implementation.

Effects
As a result of successful integration of the transpersonal caring theory, both patients and nurses benefit from enhanced mental health due to increased empowerment and decreased stress levels. Furthermore, patients report relief of agony that contributes to enhanced physical health.

Besides individuals’ benefits regarding mental and physical well-being, the implementation of Watson’s theory elevates collaboration and professionalism among the nursing staff as well as enhanced self-organisation that forms a suitable environment in which patient care can be provided.

Additionally, the implementation of caring theory facilitates discussion and reflection about the core values underlying the nursing profession and re-awakens the essence of its practice. In turn, this has an impact on the self-perception of nurses as a valuable and unique contribution to the overall healthcare system. Moreover, sharing one common caring vision and language creates a bond and unity among employees.

Criticism
The Transpersonal Caring Theory does not give clear guidelines how to achieve authentic caring-healing relationships. Therefore, it is difficult for nurses to use the theory on its own due to the fact that it consumes time put Caritas (making explicit connections between caring and love) into practice. Furthermore, people consider her personal growth emphasis as a quality the person may have or may not have. Lastly, it is difficult to conduct a research based on the scientific method however, the qualitative nursing approaches counteract this.