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= Transpersonal Caring Theory =

Application
The Transpersonal Caring Theory was influenced by and has found its influence primarily in the field of nursing. It is applied in all areas of nursing practise, education and research. .

Background
Watson's theory was influenced by many philosophers and thinkers of humanisitc psychology, including Abraham Maslow, Stanislav Grof, and Antony Suitch. Humanistic psychology is a branch of psychology which emerged in the 1950's. It called for introspection, and described self-awareness as building block for self-growth. Humanistic psychology set the stage for the emergence of transpersonal psychology from which many ideas of the transpersonal caring theory are derived. Transpersonal is defined as: "reaching beyond the personal realm of transcending the singular, personal state". Other intellectual influences include the phenomenological psychology of Carl Rogers. Rogers concept of empathy was outlined by Watson as the key for the healing-trusting relationship a nurse tries to develop. Watson underlined the inspiration she got from different indigenous cultures including Australia, New Zealand, Indonesia, The Republic of China, Thailand, India, and Egypt. Watson combined her personal beliefs about life, philosophical background, and clinically induced experience to form the transpersonal caring theory.

Transpersonal caring theory
Transpersonal caring theory states that “humans cannot be treated as objects and that humans cannot be separated from self, nature, and the larger workforce”, according to Jean Watson. Watson believes that the human process of nursing establishes a great value on the relationship between the recipient of care and the nurse

The term transpersonal refers to the inter-subjective relationship between two persons in which both affect and are affected by the other. There is an union between those two individuals.

The role that intentionality plays in the theory is also emphasized, in that we strive to be with and cooperate with the emerging field before us, rather than trying to manipulate or change it, and to align one´s consciousness toward caring-healing presence with the patient.

A deeper level of connected authenticity is needed than a script, within which the nurse performs her job according to standardized impersonal instructions for each patient, can provide.

Following Watson’s theory transpersonal human caring, it is stated that there are ten processes which offer the patients and nurses an opportunity to gain satisfaction in many ways.

1. Embrace: Altruistic Values

2. Inspire: hope and faith to others

3. Trust: Self and Others by Nurturing Individual Beliefs, Personal Growth and Practices

4. Nurture: Trusting, helping, Caring Relationships

5. Forgive: Accept Positive and Negative Feelings

6. Deepen: Scientific Problem-Solving Methods for Caring Decision Making

7. Balance: Teaching and Learning to Address the Individual Needs

8. Co-Create: Physical and Spiritual environment

9. Minister: To Basic Physical, Emotional and Spiritual Human Needs

10. Open: Mystery and Allow Miracles to Enter

Experiments related to Human Caring Theory
The book “Caring Science, Mindful Practice: Implementing Watson's Human Caring Theory” by K. Sitzman and J. Watson does not only entail a description of the Human Caring Theory, but also several experiments, which support the theory. Two of them are described in the following.

A small research study about effective nursing interventions was conducted.
The researcher observed an occupational health nurse in a local hospital. The nurse that was being observed was responsible for assessing the workstations of the hospital employees in order to check whether improvements could be made. Possible improvements were supposed to avoid medical conditions related to workstations which are poorly designed. The observed nurse appeared to be highly successful in terms of patients compliance and less pain and injury. Based on this, the researcher expected that this would be the result of a friendly, warming working method.

The results of the study showed that patients felt cared for due to the nurse paying focused attention through mirroring, eye-contact, as well as verbally validating concerns. 24 minutes was the average time the interaction lasted. It was also reported that during the intervention, the nurse never touched the patient directly, nor did she engage in conversations that had less to do with the patient's medical condition. The nurse did not display personal warmth nor friendliness.

Based on the results of this study, it was concluded that the most effective way to care, love and trust are best maintained by having intentions, being attentive, present, immediate, and mindful. Warmth, maternal affection, and friendliness may be components of caring but they are not necessary, especially in regards to working with people who do not respond well to the latter characteristics.

Candace M. Leonard - The use of a meditation room to decrease the stress of the emergency room nurse
The following study was conducted in order to provide emergency room (ER) staff with a meditation room in which the staff is given the opportunity to meditate and relax. The aim of the study was to determine whether this proves effective in reducing the stress of ER staff and therefore increase patient satisfaction.

The study was conducted in a stretcher storage room in the city emergency room. Participants consisted of nurses, doctors, technicians, secretaries, registrars, EVS, pharmacists, security managers, and educators.

The stretcher storage room was given the name ‘’Zen Den’’. Calming music, positive quotes, and scented candles were put in the room. The room was painted in a soft, brown colour, and it is located near the ER. Staff also had the opportunity to write in a journal and to read Jean Watson Caritas cards.

The results were positive and the room was used on a daily basis by some of the staff members. Due to increased wellbeing, the staff was more able to care for the patients and thus, patient’s satisfaction increased.

Watson’s Theory of Transpersonal Caring - Factors Impacting Nurses Professional Caring
In 2012, a study by Christine Vandenhouten, Sylvia Kubsch, Margaret Peterson, Jennifer Murdock and Leslie Lehrer aimed at identifying the factors that impact nurses’ perceived professional caring based on Watson’s Theory of Transpersonal Caring.

The perceived application of professional caring serves as the dependent variable, which was measured by the Carative Factors Scale, based on the 10 carative factors, and the Transpersonal Caring Scale, based on the 10 caritas processes. Specific demographic factors and familiarity with Watson’s theory of transpersonal caring constituted the independent variables.

In total, five research questions were under investigation: “(1) Does the extent of perceived application of professional caring increase with familiarity with Watson’s theory of transpersonal caring? (2) Do nurses differ in their perceived application of professional caring behaviors by level of nursing education? (3) Are there differences in perceived levels of application of professional caring behaviors among RNs according to selected demographic variables (age, gender, years in nursing, employment setting)? (4) Is there a difference in RNs perceived application of caring behaviors based on Carative Factors Scale and the Transpersonal Caring Scale? (5) Is there an association between familiarity with Watson’s theory and level of nursing education?” (Vandenhouten, Kubsch, Peterson, Murdock, Lehrer, 2012)

Although there were no significant differences in the nurses’ perceived application of professional caring based on their nursing education level, the results showed that a greater familiarity with the theory of transpersonal caring was positively related to their perception of applied professional caring behaviour.

In addition, nurses’ perception of professional caring behaviour was greater when measured with the Carative Factors Scale than when measured with the Transpersonal Caring Scale, which the authors attributed to the difficult language found in the caritas processes.

Finally, the study showed that not only familiarity with Watson’s theory of transpersonal caring contributed to a greater perceived application of professional caring, but also experience in the field of nursing was positively related.

Jean Watson
Dr. Jean Watson is a distinguished professor, nurse theorist, and founder and director of the nonprofit Watson Caring Science Institute. In 2013, she was awarded the American Academy of Nursing's 'Living Legend' award, its highest honor.

She is best known for her Theory of Human Caring and Ten Caritas Processes, which serve as a blueprint for professional nursing practice.

Watson was born on june 10, 1940 in Williamson West Virginia. She gratuated from the Lewis Gale School of Nursing in Roanoke, Virginia, in 1961. She continued her nursing studies and received her BSN (Bachelor of Science in Nursing) from the University of Colorado in 1964. She went on to complete her Ph.D. in Educational Psychology and Counseling from the same university and earned her Ph.D in 1966. She has since earned ten honorary doctoral degrees and has extensive experience working in mental health nursing and caring science. Her continued research is focused in the area of human caring and loss.

Watson created the Theory of Human Caring between 1975 and 1979 from her personal views of nursing. Her hope at the time was that her theory would help distinguish nursing science as a separate and important entity from medical science. Her work was influenced by her teaching experience and was created as a way to find common meaning among nurses from all over the world.

Watson's theory was first published in 1988. Since that time, she has produced more than 20 books on caring, and her teachings are used by clinical nurses and academic programs all over the world.

Implications
Watson’s theory is unique in its ability to address the needs of both the patient and the nurses “the centrality of human caring and on the caring-to-caring transpersonal relationship and its healing potential for both the one who is caring and the one who is being cared for” (Watson, 1996).

That humans are not treated as objects but rather as individuals, implies that focus of caring need to be at the individual and what’s best for the person in cooperation with the carer, so doing best for the patient while incorporate what is best for the nurse who cares. Being authentically present during patient care, with meaningful communication can positively influence the healing process of the patient.

This theory means to be important in the daily science of human caring, because it reflects the personal engagement, interaction and support of nurses to care for their patients and their needs which can go beyond the visible but through the mind-body-spirit wholeness

Limitations
The theory is focussed more on the psychosocial needs of the patient rather than the biophysical needs which can be regarded as a limitation because health consists of both psychosocial and biophysical components. This is also limiting in a sense that psychosocial needs may be interpreted differently by others and hence the theory may become less practical for every day nursing practice. By including also the biophysical component, this misinterpretaton may be prevented.

Another limitation is that the theory contains abstract concepts which make interpretation variable. However, Watson meant to propose such a global and abstract theory, which is typical for a so-called grand theory.

References