transpersonal caring

THEORY OF TRANSPERSONAL CARING by JEAN

WATSON

A CASE STUDY PRESENTED IN GRADUATE SCHOOL

COLLEGE OF NURSINGST. PAUL UNIVERSITY DUMAGUETE

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS IN

N212 ADVANCE ADULT NURSING IVMASTERS OF SCIENCE IN NURSING

PREPARED BY: JORE LAJOT ROCO, BSN-RN

BACKGROUND OF THE CASEDiabetes 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 OverviewThis 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 OVERVIEWFurthermore, 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 theoretical- philosophical-ethical framework for the profession and discipline of nursing and clarify its mature relationship and distinct intersection with other health sciences.

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 master’s 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

Watson’s 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 Watson‘s 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 Watson‘s 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 nursing‘s “collective caring-healing role and its mission in society as attending to, and helping to sustain, humanity and wholeness” (George, 2008).

WATSON’S THEORY AND NURSING’S 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

- One’s soul possesses a body that is not confined by objective space and time


ILLNESS- Subjective turmoil or disharmony within

a person’s 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.

WATSON’S THEORTY AND NURSING’S 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).


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 self-healing wherein a sense of inner harmony is restored regardless of the external circumstances

JEAN WATSON’S ASSESSMENT TOOL

Assessment tool for the Caregivers Never Always

Deliver my care with loving kindness 1 2 3 4 5 6 7

Meet my basic human needs 1 2 3 4 5 6 7

Have helping and trusting relationship with me 1 2 3 4 5 6 7

Create a caring environment that helps to heal 1 2 3 4 5 6 7

Value my personal beliefs and faith, allowing for hope 1 2 3 4 5 6 7

THEORY OF TRANSPERSONAL CARING It’s essence is authentic caring for the purpose

of preserving the dignity and wholeness of humanity

Theory emerged from the theorist’s own beliefs, values and perceptions about human life, health and healing.

Watson sees nursing’s “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 life’s 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


• Orientation of the nurse’s intent, will and consciousness toward affirming the subjective/ intersubjective significance of the person.

• The nurse’s ability to assess and realize, accurately detect and connect with the inner condition of another

• The nurse’s ability to assess and realize another’s 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 nurses’s own life history and previous experiences


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 person’s 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 FACTORS1. Forming a humanistic-altruistic system of values. 2. Enabling and sustain faith-hope3. Being sensitive to self and others4. Developing a helping-trusting, caring relationship

(seeking transpersonal connections). 5. Promoting and accepting the expression of

positive and negative feelings6. Engaging in creative, individualized, problem

solving caring processes. 7. Promoting transpersonal teaching-learning

TEN CARATIVE FACTORS8. 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 wholeness10. 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 one‘s self and to others becomes cultivation of one‘s own spiritual practices and transpersonal self, going beyond ego self, opening to others with sensitivity and compassion.


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.


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 non-physical, 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 one‘s own life- death; soul care for self and the one-being-cared-for

CARING OCCASION/ CARING MOMENTOccurs 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.


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.


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 Watson‗s 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 researcher‘s 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 client‘s inadequacy to state the exact dates and medications that she has took prior to admission.

THEORY APPLICATIONMrs. 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-fowler‘s 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 APPLICATIONAs 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 client‘s 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 APPLICATIONThe 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 client‘s 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 APPLICATIONAs 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 APPLICATIONAs 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 APPLICATIONThe 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).

CONCLUSIONRECOMMENDATIONREFLECTION

THANK YOU FOR LISTENING AND GODBLESS

Everything happens for a reason to them who loves the Lord

Documents

transpersonal caring