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THEORY OF

TRANSPERSONAL
CARING by JEAN
WATSON

A CASE STUDY PRESENTED IN GRADUATE


SCHOOL
COLLEGE OF NURSING
ST. PAUL UNIVERSITY DUMAGUETE
IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS IN
N212 ADVANCE ADULT NURSING IV
MASTERS OF SCIENCE IN NURSING

PREPARED BY: JORE LAJOT ROCO, BSNRN

BACKGROUND OF THE CASE


Diabetes mellitus is a group of metabolic
diseases in which defects in insulin secretion or
action result in high blood sugar level. 90% to
95% of people with diabetes have type 2
diabetes mellitus(Williams, 2011). The person
with diabetes has an increased tendency toward
endothelial dysfunction. This may account for the
development of fatty streaks in these patients.
Diabetic patients also have alterations in lipid
metabolism and tend to have high cholesterol
and triglyceride levels that eventually leads to
Coronary Artery Disease.

OCCURRENCE/ STATISTICS OF THE CASE

Globally in 2013 - almost 382


million
people
suffer
from
diabetes for a prevalence of
8.3%.
In the Philippines - 3.2 million
cases of diabetes in 2014 where
9% of adults 18 years and older
had diabetes.

Case Overview
This is a case study of a 51 year old female client who
lives at Bais City applying the theory of Human Caring
by Jean Watson. Client described general health as good
for the past years yet claimed to have no consultation
visits and admissions. Client does not do self-breast
exam regularly. She frequently has cough and shortness
of breath for the past few days and exhibited body
malaise and weakness. Listens to the advice of the
physicians and nurses and follows it accordingly.
However, client verbalized that some prescribed tests
by her physician was undone because of financial
issues. Client does not smoke but claimed to be an
active second hand smoker because of her environment
at home where her husband and son smoke.

CASE OVERVIEW
Furthermore, the appetite of the client is poor for the
past few days and claimed to experience nausea and
vomiting at times. Client admitted that she loves to
eat sweets and sometimes skips her meals because of
work. Client defecates irregularly where she defecates
2-3 times per week only. She also verbalized that she
sleeps 8-9 hours at home unlike with her stay at the
hospital where she cannot sleep properly and soundly.
Client uses her reading glasses at times but is still
able to read even without her glasses. During her stay
in the hospital, her siblings help her pay with her bills
and some savings that his husband have. She prays to
God for her fast recovery.

RATIONALE
The researcher became interested in
applying the theory of human caring by
Dr. Jean Watson in caring for a client
with DM and CAD.
The researcher also seeks to develop
caring
as
an
ontological
and
theoreticalphilosophical-ethical
framework for the profession and
discipline of nursing and clarify its
mature
relationship
and
distinct

JEAN WATSON

Earned a diploma from Lewis Gale Hospital


School of Nursing in Roanoke, VA
A baccalaureate in nursing degree from the
University of Colorado, Boulder
A masters degree in psychiatric mental
health nursing from the University of Colorado
Health Sciences Center, including deanship of
the School of Nursing from 1983 to 1990
Founding Director of the Center for Human
Caring.

JEAN WATSON

Distinguished Professor at the


University of Colorado

President of the National League for


Nursing from 1995 to 1996

ASSUMPTIONS/
PREPOSITIONS

Caring can be effectively demonstrated


and practiced only interpersonally.
Caring consists of carative factors that
result in the satisfaction of certain human
needs.
Effective caring promotes health and
individual or family growth.
Caring responses accept person not only
as he or she is now but as what he or she
may become.

ASSUMPTIONS/
PREPOSITIONS

A caring environment is one that offers the


development of potential while allowing
the person to choose the best action for
himself or herself at a given point in time.
Caring is more health genic than is
curing.
A
science
of
caring
is
complementary to the science of curing.
The practice of caring is central to nursing.

PHILOSOPHICAL
BACKGROUND

Watsons work has reflected a blend of Eastern


and Western beliefs in what she refers to as
emergency/ converging paradigm
Influenced by Whiteland, Kierkegaard,
deChardin, Carl Rogers, Nightingale, Henderson
, Leininger, Martha Rogers and Gadow.
Watson expresses the hope that such a
relational ontology can heal not only individuals
but unhelathy health care, sociopolitical and
cultural institutions as well.

DISCUSSION OF THE
THEORY

Major Conceptual elements


Transpersonal caring relationship
Ten carative factors
Caring occasion/ caring moment

DISCUSSION OF THE
THEORY

The Theory of Human Caring was developed


between 1975 and 1979.
Emerged from Watsons own views of nursing,
combined and informed by my doctoral studies
in and social psychology.
Was also influenced by the involvement of
Watson who has an integrated academic
nursing curriculum and efforts to find common
meaning and order to nursing that transcended
settings, populations, specialty, subspecialty
areas, and so forth (George, 2008).

DISCUSSION OF THE
THEORY

The essence of Watsons theory is authentic


caring for the purpose of preserving the
dignity and wholeness of humanity.
Watson describes the theory as having
emerged from her own values, beliefs and
perceptions about human life, health and
healing (Watson, 1996).
Watson sees nursings collective caringhealing role and its mission in society as
attending to, and helping to sustain,
humanity and wholeness (George, 2008).

WATSONS THEORY AND


NURSINGS METAPARADIGM
PERSON
Human is viewed as a valued
person in and of him or
herself
Fully functional integrated
self that is greater than and
different from the sum of his
or her parts
Can go forward, through the
use of mind, to higher levels
of consciousness
Ones soul possesses a body
that is not confined by
objective space and time

WATSONS THEORY AND


NURSINGS METAPARADIGM
ILLNESS
Subjective turmoil or disharmony within
a persons inner self or soul at some
level or disharmony within the spheres
of the person
Illness connotes a felt incongruence
within the person such as an
incongruence between the self as
perceived and the self as experienced.

WATSONS THEORTY AND


NURSINGS METAPARADIGM
HEALTH
Is viewed holistically, as the unity
between the physical, social,
mental and spiritual self, with all
parts working together in harmony
and functioning to their full
capacity.
Is a perceived by the patient and is
influenced by their own unique life
experiences (Bernick/2004).
Entirely
includes a individuals
physical, social, aesthetic and
moral realms, not just their
behaviour
and
physiology
(George/2002).

WATSONS THEORY AND


NURSINGS METAPARADIGM
NURSING
Nursing consist of knowledge , thoughts, values,
philosophy, commitment and action with some degree
of passion. It is related to human care transactions
and intersubjective personal human contact with the
lived world of the experiencing person
Consist of transpersonal human-to-human attempts to
protect, enhance and preserve humanity by helping a
person find meaning in illness, suffering, pain and
existence
Help another to gain self-knowledge, control and selfhealing wherein a sense of inner harmony is restored
regardless of the external circumstances

JEAN WATSONS ASSESSMENT TOOL

Assessment tool for the Caregivers

Never

Always

Deliver my care with loving kindness

Meet my basic human needs

Have helping and trusting relationship with me

Create a caring environment that helps to heal

Value my personal beliefs and faith, allowing for hope

THEORY OF
TRANSPERSONAL CARING

Its essence is authentic caring for the purpose


of preserving the dignity and wholeness of
humanity
Theory emerged from the theorists own beliefs,
values and perceptions about human life, health
and healing.
Watson sees nursings collective caring-healing
role and its mission in society as attending to,
and helping to sustain, humanity and wellness
To caring and healing work with others during
their most vulnerable moments of lifes journey

THEORY OF TRNSPERSONAL
CARING

Caring is independent to caring


According to Watson, knowledge and
practice for a caring-healing discipline
are primarily derived from the arts and
humanities and an emerging human
science that acknowledges a
convergence of art and science.

TRANSPERSONAL CARING RELATIONSHIP

Defined as human-to-human connectedness


occurring in a nurse-patient encounter wherein
each is touched by the human center of the
other.

Transpersonal caring relationship depends on:

The moral commitment, intentionality and


consciousness needed to protect, enhance,
promote
and
potentiate
human
dignity,
wholeness and healing wherein a person creates
or cocreates his or her own meaning for
existence, healing, wholeness and caring

TRANSPERSONAL CARING RELATIONSHIP

Orientation of the nurses intent, will and


consciousness toward affirming the subjective/
intersubjective significance of the person.
The nurses ability to assess and realize, accurately
detect and connect with the inner condition of another
The nurses ability to assess and realize anothers
condition of being-in-the-world and to feel a union
with the other
The caring-healing modalities potentiate harmony,
wholeness and comfort and promote inner healing
The nursess own life history and previous
experiences

TRANSPERSONAL CARING RELATIONSHIP

Recent elaboration on the concept of a


transpersonal caring relationship describes
this relationship occurring within a caring
consciousness wherein a nurse enters
into the life space or phenomenal field of
another person is able to detect the other
persons condition of being, feels this
condition within self and responds in such
a way that the person being cared for has
a release of feelings, thought and tension.

TEN CARATIVE FACTORS


1.
2.
3.
4.

5.

6.

7.

Forming a humanistic-altruistic system of values.


Enabling and sustain faith-hope
Being sensitive to self and others
Developing a helping-trusting, caring relationship
(seeking transpersonal connections).
Promoting and accepting the expression of positive
and negative feelings
Engaging in creative, individualized, problem
solving caring processes.
Promoting transpersonal teaching-learning

TEN CARATIVE FACTORS


8. Attending to supportive, protective and/or
corrective mental, physical, societal and
spiritual environments.
9. Assisting with gratification of basic
human needs while preserving human
dignity and wholeness
10. Allowing for, and being open to,
existential-phenomenological and spiritual
dimensions of caring and healing that
cannot be fully explained scientifically
through modern Western medicine.

CLINICAL CARITAS
PROCESSES

Formation of humanistic-altruistic system of values


becomes practice of loving kindness and
equanimity
within
the
context
of
caring
consciousness.
Instillation
of
faith-hope
becomes
being
authentically present, and enabling and sustaining
the deep belief system and subjective life world of
self and one-being- cared-for.
Cultivation of sensitivity to ones self and to others
becomes cultivation of ones own spiritual practices
and transpersonal self, going beyond ego self,
opening to others with sensitivity and compassion.

CLINICAL CARITAS
PROCESSES

Development of a helping-trusting, human caring relationship


becomes developing and sustaining a helping-trusting, authentic
caring relationship.
Promotion and acceptance of the expression of positive and
negative feelings becomes being present to, and supportive of,
the expression of positive and negative feelings as a connection
with deeper spirit of self and the one-being- cared-for.
Systematic use of a creative problem-solving caring process
becomes creative use of self and all ways of knowing as part of
the caring process; to engage in artistry of caring-healing
practices.
Promotion of transpersonal teaching-learning becomes engaging
in genuine teaching-learning experience that attends to unity of
being and meaning, attempting to stay within others frames of
reference.

CLINICAL CARITAS
PROCESSES

Provision for a supportive, protective, and/or corrective mental,


physical, societal, and spiritual environment becomes creating
healing environment at all levels (physical as well as nonphysical, subtle environment of energy and consciousness,
whereby wholeness, beauty, comfort, dignity and peace are
potentiated).
Assistance with gratification of human needs becomes assisting
with basic needs, with an intentional caring consciousness,
administering human care essentials which potentiate
alignment of mind body spirit, wholeness, and unity of being in
all aspects of care, tending to both embodied spirit and evolving
spiritual emergence.
Allowance for existential-phenomenological- spiritual forces
becomes opening and attending to spiritual-mysterious and
existential dimensions of ones own life- death; soul care for self
and the one-being-cared-for

CARING OCCASION/ CARING


MOMENT
Occurs whenever nurse and other (s)
come together with their unique life
histories and phenomenal field in a
human-to-human transaction and is a
focal point in space and time has a greater
field of its own that is greater than the
occasion itself arises from aspects of itself
that become part of the life history of each
person, as well as part of some larger,
deeper, complex pattern of life

NURSING PROCESS OF THE THEORY


Assessment
- Involves observation, identification and
review of the problem; use of applicable
knowledge in literature. Also includes
conceptual knowledge for the formulation
and conceptualization of framework.
Includes the formulation of hypothesis;
defining variables that will be examined in
solving the problem.

NURSING PROCESS OF THE THEORY

Plan - It helps to determine how variables


would be examined or measured; includes
a conceptual approach or design for
problem solving. It determines what data
would be collected and how on whom.

Intervention - It is the direct action and


implementation of the plan. It includes the
collection of the data.

NURSING PROCESS OF THE THEORY


Evaluation
- Analysis of the data as well as the
examination of the effects of interventions
based
on
the
data.
Includes
the
interpretation of the results, the degree to
which positive outcome has occurred and
whether the result can be generalized. It
may also generate additional hypothesis or
may even lead to the generation of a
nursing theory.

OBJECTIVES

Explore theory-based approaches to the holistic care of


patient with Diabetes Mellitus type 2 with Coronary
Artery Disease that can assist health care professionals
in this specialty to provide effective nursing care.
To determine what are the important caring behaviors
as perceived by patients and how frequently are such
caring behaviors attended to by nurses.
To find out if there is a discrepancy between patient
perceptions of important caring behaviors and those
attended to by nurses.
To ascertain the effectiveness of Watsons theory of
Human caring in assisting patient with Diabetes
Mellitus and Coronary Artery Disease.

SIGNIFICANCE OF THE
STUDY

To the patient with Diabetes and CAD


To the Significant others of the
patient
To the Nurses
To the Nursing Students
To the Future Researchers
To the Community

SCOPE AND DELIMITATION

Background of the case of the client, CAD secondary to DM,


the statistics of the case, the theoretical background of the
theorist used upon delivering care to the client, the
significance of the study and the theory application
This case study also includes the researchers conclusion,
insights and recommendation. Also, this case study includes
the anatomy and physiology of the systems involved the
laboratory results of the client and the pathophysiology of the
diseases mentioned above and the relationship of DM and
CAD.
On the other hand, some of the barriers that the researcher
have seen in making this case study is the hot environment
and crowded room of the client that disturbs the client in
narrating events prior to admission and during the
assessment process.

LIMITATIONS OF THE STUDY

Upon assessment of the client at the


Ward, client was experiencing shortness of
breath that affects her ability to answer
questions of the researcher thoroughly
and elaborately.
The clients inadequacy to state the exact
dates and medications that she has took
prior to admission.

THEORY APPLICATION
Mrs. CRT is a 51-year-old Filipino who was referred to
Negros Oriental Provincial Hospital from Bais District
Hospital for further management. She described her
general health as good prior to admission. She
experienced nausea and vomiting, body malaise and
weakness and lost her consciousness prompting her
admission. Upon receiving the client lying on bed in a
semi-fowlers position, the researcher introduced herself to
the client with proper eye contact and in a calm manner
(CCP 2, CCP 7) and the members of the family present and
opened her connectedness to self and others (CCP 1, CCP
2, CCP 3, CCP 6), respected the client and her significant
others that were present (CCP 1, CCP 9) and honored
human dignity (CCP 1, CCP 3, CCP 6).

THEORY APPLICATION
As the starting point of a good conversation, the researcher
asked the client her name and what would be her preferred name
that the researcher would call her in the entire span of care (CCP
2). Also, the researcher asked for consent to the client being a
participant for a case study, the purposes and goals of the study
and her rights to refuse. Luckily, the client gave her consent and
smiled and expressed her gratefulness of her being part of the
study. Afterwards, the researcher established rapport to the client
by respecting the clients perceptions of the world and her
unique needs, by viewing the client as whole and by showing a
non-judgmental attitude (CCP2, CCP 4, CCP 6, CCP 8 and CCP 9).
The researcher then asked the client if she is of a comfortable
position and her needs as of the moment, the client then
expressed that she wants to be on a sitting position (CCP 4, CCP
8, and CCP 9). The researcher then assisted the client to raise
her head and be comfortable on a sitting position (CCP 4).

THEORY APPLICATION
The researcher positioned the IV stand where the client will be
more comfortable with the IV tube that is present (CCP 4, CCP 8).
As the conversation continued, the researcher allowed the
members of the family present to get involved and be part of the
conversation (CCP 9). The researcher has taken into
consideration the uniqueness of the clients case from the others
(CCP 4, CCP 6). During the conversation, the researcher allowed
the client and the family members to communicate and
elaborate further (CCP 4, CCP 6). Also, the researcher showed
active listening which also stimulates the client to express her
concerns more (CCP 3, CCP 4, CCP 6). However, in the middle of
the conversation, the client expressed her need to void; the
researcher extended her hand to assist the client as she stood
up from the bed and guided her into the comfort room as the
researcher was also positioning the IV fluid and tube properly
and accordingly (CCP 4, CCP 6, and CCP 8).

THEORY APPLICATION
As the researcher and the client reached the comfort room,
the researcher then gave privacy to the client as the IV
fluid was endorsed to the husband to the client and
instructed the husband the proper positioning (CCP 8). As
the client got out from the CR, the client apologized to the
researcher for the hassle of waiting for her. The researcher
then emphasized that it is perfectly fine (CCP 3). The
researcher then regarded the condition of the client after
walking, unfortunately, the client expressed shortness of
breath and dizziness (CCP 4). The researcher made the
client comfortable on bed, instructed to do deep breathing
and let the client rest then asked permission to the client
and the to the husband and son of the client to leave for a
while as the client could enjoys her rest time and be back
in an hour or two (CCP 4, CCP 8).

THEORY APPLICATION
As the researcher came back to the bedside of the
client, the client expressed that she is fine and to
continue the conversation that was interrupted. The
client expressed her need to be well again because of
some financial issues yet the husband of the client
insisted that it is okay and not to worry even a
centavo for it is his obligation and responsibility to
provide. However, the client verbalized her faith in
God and that nothing is impossible with God of which
the researcher respects and understands her belief
and level of spirituality (CCP 2, CCP 3, and CCP 6).
The client further discussed that she keeps on
praying every night for her fast recovery (CCP 3).

THEORY APPLICATION
The researcher on the other hand, did some random
health teachings to the client with regards to her
condition which includes the predisposing and
precipitating factors, possible complications and
preventions (CCP 4, CCP 6, CCP 7 and CCP 10). Also,
before ending the conversation, the researcher
asked the client if she have any concerns, issues,
clarifications with her condition and needs (CCP 7).
After a therapeutic conversation, thorough health
history taking and assessment, the researcher
expressed her appreciation and gratitude to the
client for her participation (CCP 3).

CONCLUSION
RECOMMENDATION
REFLECTION

Everything happens for a reason to them who loves the


Lord

THANK YOU FOR LISTENING


AND GODBLESS