Evidence Based Practice Jean Watson’s Theory of Caring

1. Evidence Based PracticeJean Watson’s Theory of Caring Deidre Bringold, Jennifer Edgell, Tammy Garcia, Jessica Hull, Jody Montgomery, Carol Young

2. Nursing Model • The evidenced based research presented in this journal is Jean Watson’s theory of caring. • The theory focuses on caring for the patient as a whole, mind, body and soul rather than as an illness. • This theory dwells on the importance of building meaningful relationships between nurses and patients instead of making patients feel as if they are nothing more than a burden that the nurse has to care for.

3. Rationale • The rationale for using this theory as a frame work for practice is to explore alternative ways to help our patients. • Nursing is far more than curing a patient. • Nursing is about healing, not only body, but mind and soul as well. • Watson, discuss paradigms that can help nurture a strong healing relationship between the patient and nurse that embraces the patient as a whole. • Nurses can build relationships with their patients. • These relationships will improve the patient’s quality of care because the patient will trust the nurse more and open up to the nurse about different things that might be beneficial for the patient’s medical care.

4. Research Studies Selected • Complimentary therapies and healing practices: faculty/student beliefs, attitudes and implications for nursing education. Reviewed by Jessica Hull • Rediscovering the Art of Healing Connection by creating the Tree of Life Poster; A Pilot Program for Hospitalized Older Adults. Reviewed by Deidre Bringold • The Effectiveness of Watson’s Caring Model on the Quality of Life and Blood Pressure of Patients with Hypertension. Reviewed by Carol Young

5. Research Studies Selected • Creating a Profile of a Nurse Effective in Caring. Reviewed by Tammy Garcia • Taking the eagle's view: using Watson's Conceptual Model to investigate the extraordinary and transformative experiences of nurse healers. Reviewed by Jennifer Edgell • The lived experience of using Watson's actual caring occasion to treat depressed women. Reviewed by Jody Montgomery

6. Research Review #1 • This journal encompassed Watson’s theory by providing alternatives to the normal medical treatment generally seen in practice. • Each alternative was based on the healing processes of mind, body and soul. • The article stepped out of the journal “medical” treatment and discussed the power of healing relationships and caring in general.

7. Research Review #1 • The article stated that alternative treatments and healing practices when paired with basic treatment plans can be proven to be as successful and in some cases more successful than the average treatment alone. • Some of the alternative treatments and healing practices discussed that seem to be beneficial were: massage, music, healing touch, prayer, spiritual healing, and effective listening.

8. Research Review #1 • The article touched base not only on the benefits to the patients but also the benefits to the nurse-patient relationship. • The reasoning behind this study was to determine if patients’ healing, benefited from alternative forms of therapies and what the attitudes of nursing students and faculty was towards the therapies. • The study was held at a university-based nursing program.

9. Research Review #1 • There were definitely some limitations with this study. Evidence in general was lacking. • Most of the information if not all was based on personal experience from the nurse. • No patient opinions of studies were obtained or conducted. • Also those who participated were with students with little floor experience or faculty members with lack of floor experience. • Only 134 individuals participated all of who were a part of the same university and curriculum.

10. Research Review #1 • This study was very informative and most definitely related to Watson’s theory of caring. • I think that this information could be used to help build curriculum in nursing programs based on the art of healing rather curing. • Far too often we focus on the disease and medications and studies that we forget about the caring aspect of nursing. • This information could be used to help build programs based on the positive effects for patients and overall nursing relationships.

11. Research Review #1 Reference Halcon , L, Chlan, L, Kreitzer, M, & Leonard, B. (2003). Complimentary therapies and healing practices: faculty/student beliefs, attitudes and implications for nursing education. Journal of Professional Nursing, 19(6), Retrieved from http://www.professionalnursing.org/article/S8755-7223(03)00133-9/pdf doi: 10.1016/S8755-7223(03)00133-9

12. Research Review #2 • Watson’s idea of building relationships was conveyed in this study by having the patient share information about himself/herself to the caregiver by using the Tree of Life posters. • These posters allowed the patients to talk to the nurse about certain subjects they were comfortable talking about. • The facility was able to come up with this idea using Watson’s theory of human caring as their foundation.

13. Research Review #2 Research Findings • The facilities saw that they needed to improve their relationship between nurses and patients. • The hospital piloted this program called the Tree of Life, in which, the facility had the patients pick topics of importance to them and write them on a tree poster. • When a nurse goes in to a patient’s room they are to pick a topic from the tree that the patient put on the tree, and discuss that topic with the patient so that they can build more meaningful relationships.

14. Research Review #2 • This program was proposed in hopes that it would make patients feel like they are really being cared for, and aren’t just another duty to perform on the nurses busy list of things to do. • This study was done in rehabilitation sub-acute units, with diagnoses such as stroke, hip or knee replacements. • During this study the researchers noticed, based on surveys the participants took before and after the study, that there was an improvement in the quality of care given to the patients by the nurses.

15. Research Review #2 Limitations • This study was a little biased as they only used patients that volunteered. • There was not a control group. • The facility used a limited amount of patients, and these patients volunteered to be in the study. • With the busyness of the hospital the facility was not the ideal location to perform this research.

16. Research Review #2 Implications • This Tree of Life program is a simple way to address the need for nurses to build relationships with their patients. • This program could be generalized to hospitals in most places in the United State to improve the quality of care. • If nurses continue to build these relationships nurses can gain more information about their patients, which will help improve how nurses care for patients.

17. Research Review #2 Reference Pipe, T.B., Mishark, K., Hansen, P., Hentz, J.G., Hartsell, Z.(2010). Rediscovering the Art of Healing Connection by creating the Tree of Life Poster; A Pilot Program for Hospitalized Older Adults. Journal of Gerontological Nursing, 36(6), 47-56.

18. Research Review #3 • Hypertension affects many people. • As nurses, we can have a positive effect on our patients with the care we give to treat hypertension. • By using Watson’s Caring Model as a guide a study was done comparing care given by nurse researchers to patients with hypertension. •  The goal of the study was “to determine the effectiveness of a nurse’s caring relationship according to Watson’s Caring Model on the blood pressure and the quality of life of patients with hypertension”. (Erci et al., 2003)

19. Research Review #3 • The study took place in Turkey in 2000 with 52 hypertensive patients from four healthcare units. • Pre and post tests were given. • Nurse researchers were trained to utilize Watson’s Caring Model. • The patients were visited for three months on a weekly basis.

20. Research Review #3 Research Questions • How does the Watson Caring Model affect quality of life and blood pressure? • Is there a correlation between quality of life and blood pressure?” (Erci et al., 2003) Aim • To determine the relationship between the quality of life and hypertension, and the effect of Watson’s Caring Model on the quality of life and the blood pressure of a group of patients with hypertension in Erzurum, Turkey.” (Erci et al., 2003)

21. Research Review #3 • Nurse researchers used Watson’s Caring Model and the 10 carative factors. • Mind-body-spirit is the basis of Watson’s care plus understanding how to comfort the patient, educate and offer compassion. • The goal was to establish a trusting and caring relationship which would lead to compliance. • Previous teaching regarding hypertension was that it would “go away”.

22. Research Review #3 • Patients hypertension began to improve as the caring relationship and the understanding of the disease, diet was understood and followed and researchers “created a healing environment at all levels (physical as well as nonphysical)” (Erci et al., 2003). • Patients were educated on diet, exercise, medication compliance, coping with stress and measuring blood pressure regularly. • Some researchers noted a relationship between education and nursing care given to the patient with an increase in quality of life.

23. Research Review #3 • Researchers believe the results of the study concluded Watson’s Caring Model increased quality of life and decreased blood pressure. • “The researchers believe that this is because the model considers persons holistically together with their physical, psychological and social environment, and increases problem solve capacity.” (Erci et al., 2003) • According to this study, Watson’s Caring Model can be recommended in the future for nurses to use for their hypertensive patients to lower their blood pressure and improve the quality of life.

24. Research Review #3 Reference Erci, B., Sayan, A., Tortumluoglu, G., Kilic, D., Sahin, O., & Gungormus, Z. (2003) The effectiveness of watson’s caring model on the quality of life and blood pressure of patient’s with hypertension. Journal of Advanced Nursing, 41(2), 130-139.

25. Research Review #4 Two surveys: 1) Caring Factory survey (CFS)-the patient’s perspective • 20 items to assess the patient’s perspective of care from the nurse • Scoring on a 7 point Likert Scale • Score of 7 indicates the highest agreement to the statement • Score of 4 indicates neutral agreement to the statement • Score of 1 indicates the least agreement to the statement

26. Research Review #4 2) Health Care Environment Survey (HES)-the nurse’s perspective on her working environment • 86 items to assess the staff perception of the work environment including • Relationships with managers, coworkers, physicians • Scoring on a 7 point Likert Scale • Score of 7 indicates the highest agreement to the statement • Score of 4 indicates neutral agreement to the statement • Score of 1 indicates the least agreement to the statement

27. Research Review #4 • 85 pairs of nurse/patient • Data Analysis from both evaluations • Data was correlated to profile the nurses identified as the most caring The findings: • The most caring nurses work scheduled hours, not more • Age of nurse didn’t matter. The most caring nurses in the study did have the most professional experience regardless of age. • The most caring nurses were most affected by stress in relationships with patients • They enjoyed coworker relationships • They most often provided the continuity of care from admission to discharge

28. Research Review #4 Limitations of the study • New area of study • Research for theoretical studies are not fully developed • Liberal statistical parameters • Small sample size Implications for Practice • The ability to have a “profile” of a caring nurse • Help educators develop a curriculum that helps prepare “caritas” nurses • Better patient outcomes if the patient feels a connective relationship with the nurse

29. Research Review #4 Critical Reflection • Further studies needed • Restore core values and caring back into healthcare • Better patient outcomes? • Caring nurses=Better patient outcomes? • Caring nurses=cost effectiveness? • Personality tests prior to employment-caring test prior to employment?

30. Research Review #4 Reference Bent, K., Nelson, J., Persky, G.J., Watson, J., (2008). Creating a Profile of a Nurse Effective in Caring. Nursing Administration Quarterly. Caring Competencies for a Complex Health Care Environment: Part 1. 32(1): 15-20, January/March 2008.

31. Research Review #5 • Watson’s conceptual model of caring/healing was used study of the extraordinary and transformational experiences of nurse healers • 11 participants selected purposively from those having a lengthy and committed experience as practitioners of healing • Question: “Please describe your emotional and spiritual experiences associated with your coming to be a nurse healer?” • The conversations were analyzed thematically using van Manen’s eclectic approach to hermeneutic phenomenology (Hemsley et al., 2006)

32. Research Review #5 Research findings • Analysis revealed one unifying theme • Walking Two Worlds • Connection between the inner world of nurse healer and indigenous healer or shaman • Symbolized by the eagle moving back and forth between/within different realities • Played significant roles in their inner journeys

33. Research Review #5 5 essential themes 1) Belonging and connecting • A journey in their lives around feeling that they belong in the world of people • Most had a sense of isolation early in life which they moved from in their own healing journeys • Within the isolation was a sense of connection with spiritual reality 2) Opening to spirit • Central to the sacred journeys of the participants was the spiritual opening aligned with the life path of a healer

34. Research Review #5 3) Summoning • The transition to the path of a healer was tumultuous for some of the participants, and made against their will • The participants were “summoned” to the role which is a significant concept in the study (Hemsley et al., 2006) 4) Wounding and Healing Journey • It was necessary for the participants to come to terms with their own “woundedness” in order to become of valuable service to others (Hemsley et al., 2006) • There is value of suffering in their spiritual journeys

35. Research Review #5 5) Living as a healer • Meeting the unique challenges that living in 2 worlds requires • Finding balance in living in more than one reality

36. Research Review #5 Limitations • Very small study, only 11 participants • This study was biased as they only used selected participants • There was not a control group • Results based only on the participants input, patients were not consulted Credibility • van Manen’s eclectic approach to hermeneutic phenomenology provides methodological congruence

37. Research Review #5 Implications • Revealed information regarding the deeper, transformative experiences of nurses as healers • Shared consciousness of transpersonal fields • Watson’s Conceptual model needs to incorporate the understanding that holistic consciousness can encompass the experience of multiple realities

38. Research Review #5 Reference Hemsley, M., Glass, N., & Watson, J. (2006). Taking the eagle's view: using Watson's Conceptual Model to investigate the extraordinary and transformative experiences of nurse healers. Holistic Nursing Practice, 20(2), 85-94. Retrieved from CINAHL Plus with Full Text database.

39. Research Review #5 Reflection • Healing and caring concept by Watson is more than an ideal; she states “transcendent with the coevolving human in the universe” (Hemsley et al., 2006) • Important to the advancement of nursing as a healing profession • Sharing the healers’ stories would benefit the profession • Opportunity to recognize how nurses can learn from each other about the innate healer in all of us

40. Research Review #6 • Depression affects many women. • By using Watson’s Caring Occasions to treat depressed women, we can assist female patients through this difficult time in their lives. • The purpose of this study was “to describe the essential structure of the lived experience of depressed women who enter therapy and experience Watson’s actual caring occasion (ACO) within the transpersonal caring relationship (TCR)” (Mullaney, 2000).

41. Research Review #6 • The rationale for using this model of care was to decrease patients’ depressive episodes and reduce clinician time • The study took a sample of 11 depressed women as they related their subjective experiences in therapy over 6 months • All participants stated that Watson’s ACO “caused them to persist in treatment and adopt health –seeking behaviors” (Mullaney, 2000).

42. Research Review #6 Limitations • small study • select group of participants • patients, as well as care givers were consulted after the study • studied 6 months

43. Research Review #6 Research Findings • 100 % of participants stated that experiencing Watson's actual caring occasion caused them to continue treatment and adopt health-seeking behaviors. • findings support the expense of appropriate clinician time for holistic healing in the transpersonal caring relationship

44. Research Review #6 Reflection • Watson's holistic approach and caring model proves that as nurses, we can impact the patient's outcome and teach healthier lifestyles. By using the ACO, all of the patient's experienced a change and sought out healthy behaviors.

45. Research Review #6 Reference Mullaney, JA. (2000). The lived experience of using Watson's actual caring occasion to treat depressed women. Journal of Holistic Nursing, 2000 Jun;18(2):129-42.

46. Jean Watson’s Theory of Caring Overall impressions • Jean Watson’s Theory of Caring touches many facets of nursing practice and has shown to be beneficial in improving patient quality of care and outcomes. • The affects of the nurse taking on the role of healer are not limited to the patient, but also can profoundly change the nurse. The End