Application of Nursing Theories to Direct Care in Women Living with Breast Cancer

Various philosophers have developed theories that apply in various fields. The connection between these theories helps to find solutions to everyday problems, such as care in nursing. Jean Watson's philosophy and theory of human caring is a crucial tool that can be used to enhance care, especially in women living with breast cancer. Another philosopher, Edmund Husserl, developed the theory of knowledge development. The nursing practice involves three major components: aesthetic, ethics, and science. Nurses deliver these components using the philosophy of care, which is an essential part of the nursing profession since it relates to health, environment, and person, the three components of care. Therefore, philosophy increases nurses' ability to develop and theorize knowledge. It provides nurses with a new way of comprehending practice, analyzing it, and incorporating it into care. This paper evaluates the interconnectedness of Edmund Husserl's knowledge development related to Jean Watson's philosophy and theory of human caring and explores how Jean Watson's theory of human caring can help direct care in women living with breast cancer.

Link Between Edmund Husserl’s Theory and Jean Watson’s Philosophy

Jean Watson's Philosophy and Theory of Human Caring

Watson perceives “carative factors" as the primary guide to nursing. She contrasts conventional medicine's term curative factors with carative to indicate caring with love. She derived the word from the term "Caritas," meaning give special attention, appreciate, and cherish (Watson & Woodward, 2020). Jean Watson states in her theory that the human is valued and should be cared for, assisted, understood, nurtured, and respected. Generally, she refers to the human being as a fully functional integrated self, different from and greater than the sum of their parts (Nikfarid et al., 2018). Watson's theory states that “Nursing is concerned with restoring health, caring for the sick, preventing illness, and promoting health” (Watson & Woodward, 2020). Therefore, nursing concentrates on the treatment of diseases and health promotion. She argues that care is crucial to nursing practice and produces better outcomes than simply medical care. The theory urges nurses to demonstrate and practice care since caring promotes growth (Nikfarid et al., 2018). Besides, the model states that a caring environment welcomes individuals without discrimination and looks to what they may become. In her theory, Watson makes several assumptions that make up her theory (Nikfarid et al., 2018). First, she assumes that practicing and demonstrating care can only be effective if implemented interpersonally. Therefore, several individuals must come together to ensure care is successfully implemented in nursing practice to yield maximum outcomes.

Watson also assumes that satisfaction of certain human needs results from carative factors extracted from caring. She asserts that a caring environment provides chances for patients to develop as they have the opportunity to choose the best actions for themselves at any period (Leone-Sheehan, 2021). She further relates the science of caring to the science of curing and states that caring practice is essential to nursing and should be implemented in all nursing practices. Watson incorporates four major concepts in her philosophy and theory of caring: nursing, society or environment, health, and human being. Caring exists in every society, and there are individuals within the society who have cared for others (Nikfarid et al., 2018). However, the attitude of caring is not generational nor hereditary. Instead, it spreads through the profession's culture as an exclusive way to cope with the environment (Watson & Woodward, 2020). A transpersonal caring relationship is an element of her theory, which describes how care practitioners show concern towards the patient's deeper and subjective meaning towards their care (Nikfarid et al., 2018). Another important aspect of the theory is caring occasion, which involves when a nurse and the patient come together, resulting from caring. The occasion helps create a spiritual connection between the nurse and another person, enhancing emotional and physical interaction.

Edmund Husserl’s Knowledge Development

Edmund Husserl stated that philosophy could only become its separate and rigorous science if it suspends and brackets away from the natural attitude. Husserl also insisted that phenomenology is a science of consciousness rather than empirical things (Boyce-Gihson, 2018). The theory of knowledge normally includes consideration of a priori knowledge, such as the modal relations knowledge. Being aware is a conscious, deliberate experience, according to Husserl (Boyce-Gihson, 2018; Rheinberger, 2020). The broadest definition of knowledge is the deliberate possession of truth, whether mediated or immediate. The possession of truth is immediately founded knowledge since it involves an interaction with the facts themselves (Boyce-Gihson, 2018). Truth obtained from facts apart from the ostensibly known fact, such as induction and deduction, is known as mediately based knowledge. Husserl argues that to have truth entails making sound judgments (Boyce-Gihson, 2018). His theory of knowledge holds that specific mental activities can directly present their objects to varying extents and degrees. He states that in order to understand intuition, one must first understand what precedes and underpins the different structures of mediate knowledge.

The interconnectedness of Husserl's Theory and Watson's Theory

Husserl uncovered an essential belief that an individual behaving and perceiving things similar to another individual will usually have similar viewpoints relative to the other individual. It means that assuming the position of an individual and sharing their feelings helps to develop knowledge about their present state. Similar to Husserl's theory, Watson includes understanding a person's viewpoint to comprehend their needs and pains (Nikfarid et al., 2018). According to Watson’s tenth carative factor, allowing for existential-phenomenological forces enables the nurse to reconcile and moderate the incongruity inherent in understanding the patient holistically while adhering to the hierarchical ordering of requirements (Watson & Woodward, 2020). This enables the nurse to support the patient in acquiring the fortitude and courage necessary to face life or death. Phenomenology is a method for comprehending the patient via the lens of his or her point of reference. The analysis of human existence is known as existential psychology.

Husserl’s theory depicts phenomenology as a technique of studying lived experiences of individuals at the conscience level of understanding. Knowledge development helps provide in-depth knowledge about lived experiences, broadens people's view of the world around them, educates their perspectives, and defines their position. Therefore, it incorporates both philosophy and science. Watson also considers major concepts in her theory, including nursing, society or environment, health, and human being (Leone-Sheehan, 2021). She stresses the need to understand the society and the environment surrounding the needs of individuals. As part of the environment, Watson suggests providing the, protective, supportive, and corrective spiritual, socio-cultural, physical, and mental environment as part of the carative factor. Such an environment enhances safety, privacy, and comfort (Nikfarid et al., 2018).

There is a connection between knowledge development and philosophy. Watson's philosophy and theory of human care provide nurses with a new way of thinking and increase their ability to develop and theorize knowledge, consistent with Husserl's theory of knowledge development (Leone-Sheehan, 2021).. Philosophy’s influence on nursing knowledge can be seen in the epistemology and ontological dimensions (Watson & Woodward, 2020). In nursing, ontology explores the nature of illness, health, environment, personhood, and nursing. Nursing epistemology, on the contrary, develops, identifies, and validates available knowledge in nursing (Rheinberger, 2020). Edmund Husserl introduced a distinction between material and formal ontology. In his assertion, material ontology involves synthetic a priori judgments while formal ontology is descriptive and involves analytic a priori judgments. Watson also covers the aspect of ontology in nursing since she explores and discusses the four major concepts in the philosophy and science of caring, including society, human beings, health, and nursing (Rheinberger, 2020).

Application of Watson’s Theory in Lived Experiences of Women

Women suffering from breast cancer have several issues to deal with in their respective lives. Therefore, Watson’s theory seems to be the best tool to care for these patients. Watson stresses the humanistic aspect of nursing as they conflict with nursing practices and scientific knowledge. 

Women from the Midwestern US

Krigel et al. (2014) explored women's lived experiences with metastatic breast cancer to determine some of the challenges they experience and possible interventions. Participants from two rural communities and metro areas in the midwestern US mentioned experiencing changes in self-image, altered relationships, and role functioning. The women also mentioned having no information concerning their health state and ways to manage their symptoms, which made them live in uncertainty (Krigel et al., 2014). Participants were confused since they were not aware of the ongoing surveillance, survivorship care, and treatment aspects that the oncology should manage. Due to uncertainty, patients reported struggling to find information on metastatic disease through the internet, which added more pressure to their life (Krigel et al., 2014). These participants raised concerns of frustrations and a sense of loss since they could not maintain their previous roles in the family or sustain full load at work (Krigel et al., 2014; Leone-Sheehan, 2021). Women in this population also expressed their frustrations due to role reversal and communication problems since their children assumed the caring role instead of them. Participants felt different in terms of their comfort when asking for help. However, most of them stated that they felt uncomfortable (Krigel et al., 2014). Self-image is an important aspect of human existence. Participants in this population recorded having loss in physical self and their general value. Some of the physical losses they mentioned include hair loss, port scar, weight loss, and loss of a breast or a port.

Watson’s theory of human caring could be beneficial to this population to direct their care. Watson states that nurses should create a personal relationship with patients to understand their needs and create a caring environment (Nikfarid et al., 2018). As such, addressing the issue of uncertainty and interpersonal relation can help involve patients in their care. Nurses should also provide necessary information and guidance to the women to improve their quality of life (Leone-Sheehan, 2021).. For instance, organizing a cancer care team to provide professional advice to the patients can help provide them with recommended diets, skincare products, and pain relief methods, which are essential in symptom management as they complained. Watson also suggests the use of faith-hope as part of the curative and carative process (Nikfarid et al., 2018). Providing spiritual help to the team can help eliminate distress and provide hope to the frustrated individuals, improving the quality of their care. Implementing these practices can help direct their care. Besides, as part of the caring suggested by Watson, nurses can engage the patients in some specific exercises to avoid stress, fatigue, depression, and anxiety (Nikfarid et al., 2018). Most of the participants reported feeling useless since they are helped with most of the things, if not all. Therefore, engaging them in regular exercise can help enhance their physical and psychological wellbeing, enhance body awareness, and improve their immunity.

Black and South Asia Women Living in the UK

Patel et al. (2014) also presented lived experiences of Black and South Asia women living in the UK. Their experiences revealed that despite having similar concerns as white women, the culturally specific concerns also influenced their experiences. The women mentioned receiving support from various support groups, friends, colleagues at work, and family members. Besides, black women reported receiving unlimited support and care from the community. However, the case was different from the South Asian women since they were not warmly welcomed in their community since people made mean remarks about them, causing distress and delaying their recovery (Patel et al., 2014). Women from this population also held different spiritual views about the perceived cause of cancer. While others accepted their fate and the fact that cancer resulted from some force beyond their control, others placed much pressure on themselves by believing that they had committed a crime that possibly made God punish them.

Like the women in the previous case study, these participants also had body image concerns due to altered appearance, femininity issues, and the use of appearance-related products (Patel et al., 2014). Most of the women that showed concerns about body image were single or divorced due to the fear of meeting a new intimate partner with their current look. Even though most women in this group expressed satisfaction with their care team, some were dissatisfied with their care since the nurses did not provide them with adequate information on their care or pay attention to their needs (Patel et al., 2014). South Asian women expressed their cultural concerns since most of them felt uncomfortable and embarrassed being treated by male nurses (Leone-Sheehan, 2021).. The need to avoid male examiners caused some of them to avoid examination and treatment procedures in some cases. These were some of the lived experiences of black and south Asian women, which require proper intervention to address adequately.

Applying Watson’s theory could be beneficial to this population as it will address most of their problems. Some of the approaches to the Watson’s theory of human care that could be incorporated in the case of Black and South Asian women include prayer, meditation, and the technique of centralization, which helps to establish a spiritual link with the patient (Watson & Woodward, 2020). These techniques can be adopted under the theory of transpersonal care. Research on healing power and prayer, under Watson’s phenomena of faith and hope, indicate that they help to enhance a caring environment. Spiritual solidarity can also help eliminate some unwanted perspectives about the existence of cancer (Watson & Woodward, 2020). Providing spiritual support to the group that believes the cancer is a punishment from (Leone-Sheehan, 2021). God can help change their perspective, eliminating distress and anxiety. This population seems to be more spiritual, and they also have more cultural concerns. Therefore, multicultural canceling will help create a connection between the nurses and the patient regardless of their gender (Nikfarid et al., 2018). Most of the Asian women recorded being embarrassed while dealing with male practitioners. Jean Watson advised that it is important to abstain from judgments on how therapists from different cultures organize themselves or behave. Following Watson’s carative factors, a multicultural counseling model will comply with his first factor, “formation of an altruistic-humanist value system” (Nikfarid et al., 2018). This factor will help the South Asian women to tolerate their differences with the male practitioners and see other people the way they see the world.

Australian Women’s Experiences

Despite being from different regions, women share some experiences while undergoing breast cancer treatment. Elmir et al. (2010) provided an insight into the lived experiences of Australian women fighting the burden of breast cancer. All the participants in this study went through chemotherapy and had adverse experiences throughout their treatment process. Despite having a family history with breast cancer or not, all the Australian women mentioned the emotional response they had after being diagnosed with breast cancer (Elmir et al., 2010). The shock had an impact on their mental health since it led to several other associated impacts. Also, the Australian women mentioned their experience of being overwhelmed with responsibilities despite going through treatment and related surgeries. Some of them stated that they were solely responsible for household activities and were forced to execute them even in their conditions (Elmir et al., 2010). Apart from coping with household activities, all the women also experienced pressure from the external workforce since they were working at the time of their diagnosis (Elmir et al., 2010). Due to financial constraints, some of the women were forced to work in their condition.

As mentioned in the two previous case studies, Australian women also mentioned living with uncertainty and fear. These women described the fear of possible recurrence of cancer after the surgery (Watson & Woodward, 2020). The fear made the participants implement some changes in their daily lives. Besides, they feared being undesirable and unattractive to men. The fear of leaving their family due to death overwhelmed most of them, and they expressed their feelings of not dying. Watson's theory can help drive care in some of the experiences indicated by Australian women (Leone-Sheehan, 2021).. For instance, nurses can organize with the community to provide financial assistance to the less fortunate members to avoid putting pressure on them to work while undergoing treatment (Nikfarid et al., 2018). Also, as part of the care, it is important for the various organizations to provide sick leave to members diagnosed with chronic diseases such as breast cancer to provide them with adequate time to undergo treatment (Nikfarid et al., 2018). Also, in line with Watson's transpersonal care, it is essential to implement strategic counseling programs to provide emotional support to patients diagnosed with breast cancer to avoid possible uncertainties caused by fear (Watson & Woodward, 2020).

Swedish Women’s Lived Experiences

Lindwall and Bergbom (2009) specifically studied the experiences of Swedish women with breast cancer concerning the changes in their bodies due to the disease and associated treatment. The study involved women who believed that their bodies were no longer attractive and it had failed them (Lindwall & Bergbom, 2009). The struggle to live with an undesirable body was real, and they indicated disappointment with their body. However, despite the frustrations, it is difficult to control the body during breast cancer therapy (Lindwall & Bergbom, 2009). Therefore, applying Watson's theory of transpersonal care, the nurses should develop an interpersonal relationship with these patients to convince them that they still have value despite the changes in their bodies (Watson & Woodward, 2020). Also, creating strong spiritual solidarity will help to convince the women that God loves them the way they are, and as such, they should not be ashamed. 

Iranian Women’s Lived Experiences

In order to expand the scope of the subject and determine the consistency of experiences of cancer patients, Joulaee et al. (2012) explored Iranian women lived experiences of living with breast cancer. Some of the experiences highlighted by this population include emotional dizziness, living with fear, lack of confidence, and living with fear. Iranian women mentioned that the first impact of being diagnosed with breast cancer is the feeling of loss, including loss of both body and mind (Joulaee et al., 2012). Most of them stated that they feel bad when they look into the mirror. These women also struggle with rejection since some husbands abandon them because they feel they are not good women anymore. Besides, Iranian women mentioned uncertainty as another experience that leads to distress and anxiety. Apart from the fear of dying anytime, others claim that they can no longer rely on their previous abilities due to emotional and physical distortion caused by the disease and some treatment procedures (Joulaee et al., 2012). Emotional dizziness also emerged among these women since they explained that they were not sure whether the passion reported among the community resulted from real love or the fact that they were sick. These women also reported the feeling of being a burden to people around them (Joulaee et al., 2012). For instance, one participant claimed that her daily life is full of needs, and she just requests, and she is supplied with the need. As a result, she feels like a burden to the friends and children who do everything for her.

The ultimate solution to uncertainty, as indicated in Watson's theory, is creating a spiritual connection with the patient. Turning traditional nursing tasks into deliberate healing and developing healing-care rituals helps to improve care (Leone-Sheehan, 2021).. As patients go through chemotherapy, it is essential to implement measures that would eliminate anxiety, especially during antineoplastic care (Watson & Woodward, 2020). According to Watson, assessing the patient's needs and their opinion is also a major step in showing care (Watson & Woodward, 2020). Further emotional support can be provided through the application of Gestalt Theory. It is a guided technique that relates to transpersonal theory, and it enables nurses to have a holistic view of the patient (Nikfarid et al., 2018). This helps to understand the patient's needs and address them precisely, enhancing care.

Conclusion

Watson's philosophy and theory of human caring have the potential to bring hope and love to women with breast cancer in adverse mental and physical conditions. Watson bases her theory on ten caring factors, including developing a relationship based on love and hope, gaining support from friends and family, and applying spirituality. The lived experiences of women from various parts of the world battling the same challenge indicate how worse breast cancer can be. Therefore, nurses should strive to be caring instead of just applying scientific knowledge and nursing practices. Watson’s theory provides nurses and the entire community with a new way of thinking about practice, analyzing it, and incorporating it into care. Some of the prominent interventions developed from Watson’s theory include prayers, spiritual connection with the patient, spiritual solidarity, multicultural counseling model, and Gestalt-Therapy intervention.

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