Dr. Watson brings to attention 'Palmer's epistemology as ethics' yet the epistemology, in the view of Palmer to be 'informed by cosmology' has great power in that it may either "form of deform the human soul" and thereby also form or deform the nurse's "way of being/becoming more human and humane (Palmer 1993; as cited by Watson, 2005) III. Brief Analysis of Watson's Caring Mode

The model of caring in nursing model as proposed by Dr. Jean Watson is one that is fairly simplistic in nature that has as its key concepts the factors of love, kindness and empathy. In making an identification of the applications of Dr. Watson's model the work of Chantal (nd) is reviewed in which Chantel relates that the application of Watson's Caring in Nursing Model may be through interaction with the patient by asking pertinent questions that will engage the patient while at the same time convey to them that the nurse genuinely cares about them as a 'whole' person. Example of questions are stated by Chantal (n.d.) as follows:

Tell me about your health?

What is it like to be in your situation?

Tell me how you perceive yourself in this situation?

What meaning are you giving to this situation?

Tell me about your health priorities?

Tell me about the harmony you wish to reach?

These specific questions according to Chantal may be used to assess the patient's perspectives about their own healthcare.

As Watson's theory evolved into what she refers to her 'Caritas' processes which have replaced the carative factors one is able to "observe a greater spiritual dimension in these new processes." (Chantal, nd) Caritas is stated to "originate from the Greek vocabulary, meaning to cherish and to give special loving attention." (Ibid) Watson's 'Caritas' are stated as follows:

Practice of loving kindness and equanimity within context of caring consciousness.

Being authentically present, and enabling and sustaining the deep belief system and subjective life world of self and the one-being-cared-for.

Cultivation of one's own spiritual practices and transpersonal self, going beyond ego self, opening to others with sensitivity and compassion.

Developing and sustaining a helping-trusting, authentic caring relationship.

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.

Creative use of self and all ways of knowing as part of the caring process; to engage in artistry of caring-healing practices.

Engaging in genuine teaching-learning experience that attends to unity of being and meaning, attempting to stay within others' frames of reference.

Creating healing environment at all levels (physical as well as non-physical), subtle environment of energy and consciousness, whereby wholeness, beauty, comfort, dignity, and peace are potentiated.

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 the embodied spirit and evolving spiritual emergence.

Opening and attending to spiritual-mysterious and existential dimensions of one's own life-death; soul care for self and the one-being-cared-for. (Watson, 2001, p. 347)

While the research did not turn up a diagram for the caring model of nursing as proposed by Dr. Jean Watson what was discovered was a care rating survey which is illustrated the following chart labeled Figure 2.

Care Rating Scale Survey

Source: http://www2.uchsc.edu/son/caring/content/Articles/CaringFactorScale.pdf

III. Nursing Theory- Strengths and Limitations of Watson's Caring Model

Nursing Theories have been presented in several different conceptual forms which have been defined in the work of Jacqueline Fawcett entitled: "Contemporary Nursing Knowledge: Analysis and Evaluation of Nursing Models and Theories" as: (1) Grand Theories; and (2) Middle-Range Theories. The following chart shows the Derivation of grand theories and middle-range theories from a conceptual model.

Derivation of Grand Theories and Middle-Range Theories from A Conceptual Model

Conceptual Model

Grand Theories

Middle Range Theories Middle Range Theories

Source: Fawcett (2005)

Watson's theory is stated by Fawcett (2005) to be a 'Middle Range" theory.

One limitation of Watson's theory is the failure to "knowledge that although the term caring is included in several conceptualization of the discipline of the nursing (Morse, Solberg, Neander, Bottorff & Johnson, 1990), it is not a dominant theme in every conceptualization and, therefore, does not represent a discipline-wide viewpoint (Wilson, 1994) Indeed caring reflects a particular view of nursing and a particular kind of nursing (Eriksson, 1989)" (Fawcett, 2005) Furthermore, caring "cannot be generalized across national and cultural boundaries (Mandelbaum, 1991) (Fawcett, 2005) Fawcett points out that...

Caring is a way of using knowledge."(Fawcett, 2005) Watson's nursing theory is however, stated to be one that is 'unique' in nature, because as stated in the work of Fawcett (2005) many theories are "borrowed from other disciplines." (Fawcett, 2005)
Chantal, in the work entitled: " states that the following self-reflective questions should be those asked of oneself by the nurse:

What is the meaning of caring for the persons and their families? For myself?

How do I express my caring consciousness and commitment to the persons and their families? To working colleagues? To other health care professionals? To my superiors? To the institution?

How do I define the person, environment, health/healing, and nursing?

How do I make a difference in people's life and suffering?

How can I be informed by the clinical caritas processes in my practice?

How can I be inspired by Watson's caring theory in my practice?

Such questions can help the nurse reflect upon his/her caring practice and contribute to the meaningfulness of professional life.

IV. Barriers in the Application of Watson's Caring Theory

Barriers are reported to application of Watson's caring model in the work of Linda Ryan entitled: "The Journey to Integrate Watson's Caring Theory with Clinical Practice" who states that one of those barriers is presented in the "fast-paced environment" of today's healthcare practice setting. Other perceived barriers included "a diverse nursing staff, many of whom had no previous exposure to nursing theoretical concepts." (Ryan, nd) What was discovered and reported in the work of Ryan (nd) is the fact that the nurses "realized that although they might have been from different cultures, with different educational backgrounds working in different nursing specialties, they did share with other nurses a common mission and purpose as described by this nursing theory." (Ryan, nd) These discussions led to the establishment of a special bond between these nurses in the realization of their "uniquely essential role" in healthcare provision. Furthermore they were able to 'rekindle the spirit" of nursing. The Caring Advocates is reported in the work of Ryan to be a group of participants that worked in the initiative which Ryan supports. After having attained a level of knowledge of Watson's theory of nursing this group set a goal to "share their theory with their nursing colleagues and make the theory an integral part of nursing practice. The strategies that they used in accomplishing these goals are stated as follows:

Weave the caring theory into the existing corporate nursing philosophy.

Introduce the revised corporate nursing philosophy and the caring theory to fellow nursing leaders.

Allow the nursing leadership team to develop tactics to best integrate the caring theory within their individual units.

Use the caring theory as a component of recruitment and selection of new nurses.

Introduce the revised corporate nursing philosophy and the caring theory to newly hired nursing personnel during orientation.

Weave the caring theory into the nursing job descriptions and clinical ladder.

Incorporate the nursing theory into future educational offerings, emphasizing the holistic nursing perspective.

Incorporate the carative factors into the clinical documentation system.

Revise nursing shift-report tools to enhance communication of individual patient preferences.

10. Empirically measure the impact of the initiative to integrate the caring theory into clinical practice. (Ryan, nd)

Summary & Conclusion

What was discovered by the Caring Advocates was the precise factor in nursing that Dr. Jean Watson attempts to relate in her works and that was the 'spirit' of nursing. The 'spirit' of nursing is elusive when definition is sought however, that integral component of the provision in healthcare that nursing contributes in the component within the model as purported by Dr. Watson which makes the difference in the experiential relationship that exists between the nurse and the patient in the healthcare setting. Nursing, although a profession, is as ancient as the recounted sufferings of mankind whether it be plagues, or battle injuries and whether it be nursing unto life or in the unfortunate instances, nursing unto death. The nurse is the 'caregiver' within a society and in ancient times there were caregivers within those societies as well. These ancient caregivers were generally reported to be those who were naturally drawn to the healing arts and traditions and were thus for their profession chosen due to their natural abilities, their individual inclinations and for their spirit of love and of kindness that added to the artful care which they were inherently it seemed ready to provide to others. Indeed, Watson's theory of caring may be empirically not easily proven, yet Watson has pinpointed a precise component in nursing that the Caring Advocates and other nursing professionals understand not only infuses their practice with energy but provisions a…