Transcript Evidence Based Practice Jean Watson’s Theory of Caring

Deidre Bringold, Jennifer Edgell, Tammy Garcia,
Jessica Hull, Jody Montgomery, Carol Young
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.
Rationale
 The rationale for using this theory as a frame work for practice
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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.
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
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
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.
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.
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.
Research Review #1
 There were definitely some limitations with this study.
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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.
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.
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/S87557223(03)00133-9/pdf doi: 10.1016/S87557223(03)00133-9
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.
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.
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.
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.
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.
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.
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)
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.
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)
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”.
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.
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.
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.
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
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
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
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
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?
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.
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)
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
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
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
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
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
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
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.
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
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).
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).
Research Review #6
Limitations
 small study
 select group of participants
 patients, as well as care givers were consulted after
the study
 studied 6 months
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
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.
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.
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