The very act of nursing entails the conjunction between two distinct human beings, the patient and the nurse. To excel in nursing, as opposed to becoming a good nurse, one needs to have an in depth understanding of the self and of the patient (Alligood, Tomey, & Martha, 2009). It is on this premises that phenomenology is recognized as a paramount training tool in nursing (Watson, 2011a). Phenomenology departs from the data based form of academic learning to a consciousness and experience based learning that seemingly sharpens, realigns and modifies the primal nature thus creating nursing acumen. Among the fundamental aspects of nursing that can only be learnt and perfected through Phenomenology is the fundamental concept of caring.
From a nursing perspective, a caring moment is a paranormal inter-human interaction between a nurse and a patient which in itself has the capacity to generate a transcendence moment (Watson, 2011b). An ideal caring moment transcends to a spiritual level of connection between the nurse and the patient which is philosophically depicted as transforming both parties and forming part of their respective life histories. The concept of a caring moment is credited to American nursing theorist Jean Watson who came up with the nursing theory of human caring. The basic concept of this theory is focusing more on caring as opposed to medicating, as the integral part of nursing (Fewcett, 2010). The connection encompassed in a caring moment creates a transpersonal relationship in which an actual phenomenal field can be felt.
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The background of the Watson’s theory of human caring
Jean Watson premised the Watson’s theory on a combination of the study of nursing and a personal need for caring through the tragedies in her own life. From an academic perspective, Jean was initially a graduate of the Lewis School of Nursing in 1961. She then proceeded to the University of Colorado in Boulder where in 1964 she earned her Bachelor of Science in Nursing and a Master Science in psychiatric and mental health nursing in 1966 (Ozan, Okumus & Lash, 2015). The epitome of her career specific studies was in 1973 when she earned a Ph.D. in educational psychology and counseling, which is the basis of her in-depth understanding of nursing from an academic perspective.
From a patient’s perspective came the two tragedies of losing one of her eyes and losing her husband in one of the worst possible ways; suicide. It was in her moment of intense anguish that Jean rationalized that the kind of curative assistance she needed was beyond the academic expertise that emanates from nursing training (Wagner, 2010). It also required a human thought that goes over and above formal training. It is from being both an expert nurse and a critical patient at the same time that Jean had a phenomenological understanding of care.
Major concepts of Watson’s theory of human caring
Under this theory, care is defined as both a philosophy and a science and has four major concepts to wit the human being, health, environment/society and nursing (Wagner, 2010).
The Human Being
A human being under this theory adopts the definition by German philosopher Immanuel Kant who defined a human being as a fully functional integrated self. This definition goes beyond the anatomical man and brings the effect of a human being as a holistic being. The concept provides that a human being deserves to be cared for, respected, nurtured, understood, and assisted.
Watson’s theory considers caring to be cultural rather than primal or genetic. Good nursing can be developed from deductions from the caring nature in the society. This society creates an environment that allows for and facilitates healing (Wagner, 2010). The nurse as part of the society should both become part of this environment that brings healing and also help create an internal environment for healing within the patient.
The theory considers health from a holistic and all-encompassing perspective. The last item of consideration in the constitution of health is the absence of illness and further the absence of conscious effort to avoid illness. The primary element of health is however, the balanced connection between the human being as self-perceived and the human being as self-experienced (Ozan, Okumus & Lash, 2015). This creates the impression of a congruency between how the individual considers himself and how the same individual finds himself to be. Finally, health also involves the agreement between the trilogies of man to wit the body, the mind and the soul.
Nursing is definitely the fundamental concept of this theory as it is ought to be premised around developing harmony between the trilogies of man. Further, the nursing relationship should be reciprocal in nature between the patient and the nurse but guided by the carative processes. Whereas this relationship involves several other processes such as medication and therapy, caring must the most fundamental. Caring is considered as an ethical covenant owed by the nurse to current and future patient and runs much deeper than the normal service provider-client relationship (Wagner, 2010).
My patient-nurse interaction at a caring moment
There were two main aspects in my interaction with the patient. There was the medical and care-giver professional aspect where the patient was a customer per se and myself as the caregiver. In this relationship, I had to have a professional acumen to understand the prescriptions and medical regiments that the patient ought to receive. This was also coupled with some physical therapy and cleaning up. The second and most important element was an understanding that this was a human being in distress.
The fear of death or worse still incapacitating permanent miming will render the patient helpless. This aspect was better understood by the humanity in me than the professional acumen. I, therefore, approached the patient as an understanding human being who empathizes with a suffering fellow man. The knowledge that I had the ability to reassure the patient psychologically and help the patient medically had a great impression on me. The understanding that I was also human and cared also had a great understanding on the patient. It is the conjunction of these two feelings that led to my deduction that we shared a caring moment.
What I learned about myself during this interaction
As indicated earlier, there are some aspects of understanding proper nursing that can only be done from a phenomenological perspective. A personal understanding of self in a scenario of a caring moment is one such subject. In this regard, the academic research perusal study perspective is handicapped due to ontological and epistemological handicaps. An understanding of the self through experience is therefore not only the ideal way but also the only way for sufficiently learning about caring moments.
I was able to learn that there is a very thin line between empathy and pity. This is because from my studies, I was aware that showing pity would communicate to the patient that the situation is beyond salvage. Empathy on the other hand, would have the exact opposite impression. Although I immediately felt pity for the patient, I consciously controlled the outflow of the feeling. I also learnt that the holistic interaction created fulfillment in me and the understanding that I left the patient feeling better than I found both physically and emotionally generated extreme contentment within me.
How my caring was perceived by the patient
Initially, the patient was keen, alert, and seemingly petrified. The patient kept searching for reactions from me through which deductions about the patient’s situation could be made. This was a form of self-diagnosis through studying me. The searching eyes however, softened when they met mine and I could tell that the patient had both relaxed and developed hope. We gradually transmuted into general banter about politics and the weather as I undertook the routine procedures. By the time I was through with the procedures, we were like two old friends. The patient even indicated anticipation for the next session.
Enhancing the caring moment, interaction, or relationship
The first way to enhance the caring moment is to work on my self-control. It is hard enough to reassure the patient and this becomes harder when I have to also reassure myself. This self-control should generate objectivity during the painful parts of the caring moment such as physiotherapy. The patient was brave but in great agony, a fact that I was alive to but I believe that the agony was reduced by a higher level of skill on my part.
I should also improve my specific skills in patient handling especially in the sensitive undertakings such as physiotherapy. The patient interaction from my perspective went well but may have been awkward at departure. This is because I got carried away by the interaction and failed to anticipate the approach of departure time. Therefore, the final way of improvement is not getting out of character but always remember that I am a professional handling a patient. This will enable to anticipate and plan for every aspect during the caring moment.
Description of the nursing metaparadigm as it relates to the caring moment or interaction
I believe that the caring moment between the patient and I was congruent with the definition of nursing in Watson’s theory of human. When I first met the patient, there was a clear dissonance between the perception in the mind and the feeling in the body. This was cured through our interaction and it is the act of considering the patient as a fellow human and a friend that changed this. When this harmony was restored, an internal healing began to take place. Further, through reassurance and encouragement in words and attitude, an inner peace seemed to develop within the patient. I would consider this as harmony between the mind, body, and soul. When I gave the patient medication and performed physiotherapy, I managed to combine the external caring environment with internal caring environment to facilitate holistic healing.
Watson’s carative factors utilized in the caring moment
The first carative factor implement was the formation of a humanistic-altruistic value system. During the caring moment, the camaraderie attitude was maintained which enabled the patient to perceive a relationship of equals. At the very same instance, the carative factor of promotion of interpersonal learning was utilized as I was able to learn through the suffering of the patient that I was oversensitive in the circumstance and susceptible to pity or even a breakdown. Further, I also learnt a lack of incidence in some of my skills, something that I intend to improve on.
The third carative factor utilized was the provision for supportive, protective, or corrective mental, physical, socio-cultural, and spiritual environment. The patient was clearly scared and worried when the caring moment began. This had changed to a clearly jovial (under the circumstance) mood. The metamorphosis was clearly caused by the change of environment derived from the interactive caring moment. Finally, whereas I was unsure of the eventuality relating to the patient’s situation, I still promoted a positive feeling of hope to the patient. Whereas no false hope was verbally created, my overall demeanor clearly answered the inquisitive look on the affirmative. This created the impression that all was going to be well.
It is clear that nursing is more than a job and patients are more than customers. Providing good nursing moment calls for careful practical study of oneself and patient to develop the required skills as a professional and as a human being. Unfortunately, the extremely capitalist nature of our nation has made it difficult for nursing to be practiced this way. This has created an extreme ethical dilemma in the profession. Based on nursing theories, nurses know what they ought to do but have instructions to the contrary whose breach may lead to adverse consequences. To remedy this, regulations ought to be amended to allow for regulation of nursing work to be conducted by nurses without technocratic interference. If this is allowed, nurses will be able to provide good nursing services through adherence to the Watson’s theory of human caring.
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Fewcett, J. (2010). Nursing philosophies, models, and theories: A focus on the future. In M. R. Alligood, Nursing theorists and their work and Alligood: Nursing theory: Utilization and application, (7th ed. Pp 495-515). St. Louis: Mosby.
Ozan, Y. D., Okumuş, H., & Lash, A. A. (2015). Original Paper. Implementation of Watson's theory of human caring: A case study. International Journal of Caring Sciences , 8 (1), 25-35
Wagner, A.L. (2010). Core concepts of Jean Watson’s theory of human caring/caring science. Watson Caring Science Institute.
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