Theory Comparison

Nursing theory constitutes the basis for a compassionate and committed approach to patient care and a comprehensive set of guidelines adopted through which this approach is widely centered. Nursing theories may be as broad as an entire conceptual framework or a basic practice philosophy that places patient comfort and care above all other considerations. Grand nursing theories encompass the widest possible scale for what the profession must instill in each of its members. Nursing theories are not simply a structural set of performance guidelines that may stress adherence to select staffing policies, rather they are in the best sense a philosophy of care-giving that incorporate para-medical knowledge and critical care aspects. While nursing theories range from Florence Nightingale’s environment theory to Imogene King’s goal attainment theory, the basic architecture is divided between a decidedly personal approach and a structural formality that stresses the basics.

Jean Watson’s theory of human caring is an ideal example of a comprehensive nursing theory. Watson’s approach is an integration of various disciplines and a re-definition of nursing as a separate and unique profession, with its own distinct philosophy and prescriptive mission statement. Watson focused her theory on the concept of “carative factors” as remaining distinct from curative factors (Watson, 2008). She saw the profession as more than an appendage of the physician, and nurses themselves as the wardens of compassion and caring, rather than support staff. Introducing a dimension of spirituality to the profession Watson stressed such revolutionary ideas as transpersonal caring: the awareness that patient care was a province of the human heart and that only by recognizing this irreducible relationship could nurses devote themselves to the direct needs of the patient that go far beyond the formal definitions of nursing and healing.

Watson proposed a radical re-assessment of the profession that in some measure reinvigorated the roots of nursing in terms of a spiritual relationship between the patient and the caregiver. Her mind/body/spirit unity transcended the boundaries of formal nursing and established an ideal that is considerably more grounded in the subjective compassion and empathy of the individual rather than a formal set of guidelines and evidence-based practices. Watson internalized the nursing experience, in some ways taking it back to its religious roots and reminding its practitioners of their obligation to more than just the demands of routine patient observation and comfort. She imagined nurses in a pluralistic sense as whole beings bonding in a holistic capacity whose benefits were beyond the boundaries of medical science (Watson, 2008).

Watson’s theoretical-philosophical orientation model could be understood as a more inspiring call to the profession, an appeal to a part of the individual that did not merely stress formal guidelines and a firm understanding of duties but an area of interpersonal potential and genuine commitment. Watson outlined ten areas of “clinical caritas’, the model that she would apply to substantive nursing in the hopes of creating and inspiring a new generation of nurses whose philosophical underpinning was based upon the idea that the nurse/patient relationship was multidimensional and contained advanced spiritual significance. These outlines were nothing less than transformative, and although they proposed to both re-define and re-invigorate the profession, they were not necessarily unique in that their applications were merely a fulfillment of the forgotten qualities of nursing philosophy. Watson’s tendentious model took nursing theory back to its organic roots: the symbiotic communion of healer and patient that was part of the original architecture of the philosophy.

Watson’s unique approach to nursing is outlined in ten factors that establish a comprehensive model for the profession as a distinct and separate sphere of medicine. She called her concept ‘clinical caritas’, which roughly translates to loving attention. Watson goes on to describe the terminology as being consistent with the relationship between love and caring, the transpersonal imprint that joins caregiver and patient in recovery. The process does not merely limit itself to a physical recovery, but a spiritual plain through which all human feeling, suffering, and experience are universal values that are bound together by human love and spiritual awareness (Watson, 1998). There are timeless values of nursing here, however Watson articulates a theory that reduces the standard nursing theories to mere surface outlines. This is an integrative model that is far more complex and interpersonal than the static models that are taught in nursing schools, it incorporates the traditional spiritual elements of nursing theory and the post-modern science that complements it.

Watson’s theory is both transformative and exceptionally basic: it posits a balance of spirituality and humanity that invigorates a profession far too often perceived as a lower tier of medicine (Watson, 2008). In this way, her theory could draw upon the most useful components of past, present, and future. Nursing wasn’t merely a supportive station staffed by undifferentiated automatons performing empty tasks, Watson transformed this impression and took it back to its organic roots, the essential purpose to not only ease the pain and suffering of patients but to offer them a healing relationship that focuses on the internal and external aspects of recovery. If the physician is the primary caregiver, the nurse is the dutiful attendant, ever aware of the needs and feelings of her patients. Watson’s theory expands this relationship past the impression of custodian into a spiritual or empathic capacity that erases the previous boundaries that have come to define nursing, and in certain respects trivialize the profession. By merging the science of recovery with humanistic elements of eastern philosophy and caring Watson united past and present: the science of medicine was also the threshold for caring.

Watson’s approach to nursing theory harkens back to the premise of Florence Nightingale’s description of ‘a calling’, a sacred duty to use one’s own humanity and capacity for empathy to help someone else, to ease their pain and suffering. We aren’t predisposed to think of nursing or nurses as spiritual beings whose inner dimensions are every as much a part of their job as the dispensing of pills and medications. Perhaps in a redemptive sense, Watson herself viewed the popular visage of the profession as merely a surface representation void of the deeper qualities that are common to nursing. Her revolutionary transpersonal theory made no distinctions between medical science and spirituality, one without the other was incomplete and even remote (Watson, 2008 ). Part of the issue was the de-spiritualization of nursing that occurred in the western perspective, the disposition to view medical science in a clinical detached sense that relegated outcomes to diagnostic accuracy and prescriptive insight. Watson proposed the long-forgotten acknowledgment of human wholeness and universality, the reminder that even in the modern age of runaway technology we dare not lose ourselves, our essential humanity, to the cold consolations of science.

Watson’s outline of carative factors stressed such values as faith and renewed hope and a system of altruism that might serve to invest the scientific aspects of medicine with a more compassionate and tactile surface. This was her basis for transpersonal teaching/learning, and it was her vision.

Margaret Newman’s Health as Expanding Consciousness Theory shares common virtues with Watson’s theory. In the same sense that Watson endeavored to expand consciousness about the forgotten human dimensions of caring, Newman proposed an expanded consciousness about health that did not merely focus on the ill, but rather on everyone. Newman addressed the needs and consequent hopelessness of patients whose conditions could not be altered for the better, and insomuch counseled them in the art of neglected consciousness and the values contained therein (Newman, 1992). Not unlike Watson, Newman was also very much aware of the universality of suffering and spirituality and made every effort to expand these considerations in her theory of nursing. Both theorists perceived an unnecessary schism between the science aspect of medicine and the irreducibly human dimensions of the field.

In proposing a higher level of consciousness Newman’s ambitious nursing theory encompasses a much wider range of application that transcends medicine, she is a firm believer in the lost methodology of the conscious being, lamenting the loss of this value to the modern age and its self-distancing from the spiritual roots of shared human experience. People instinctively understand illness in others, there are patterns of recognition and empathy that have become dulled by the detached quality of human existence in an arena of technology and efficiency. Her lost consciousness theory evokes considerably more than just a reevaluation of nursing and the primary functions of committed caregivers, she is articulating a clarion appeal for a reassessment of the human condition in the twentieth century, measuring in equal concern what has been gained and also lost in the process. Newman’s expanded consciousness is a model for dynamic self-assessment and self-awareness.

Both Watson’s and Newman’s theories share a common thread that summarily rejects the attenuated role of the nurse as essentially a para-professional appendage to physicians. Each theorist has attempted to project both backward and forward in expanding the conscious role of the nurse as a spiritual and physical mediator in the recovery process. Newman particularly centers her theory in a whole-human system of interconnectivity and collective reliance, proposing that the shared sense of natural—not dogmatic—spirituality is a constant and that it merely needs to be recaptured in an expanded consciousness movement (Newman, 1992). Newman suggests that patterns are tied to environment, and that illness is predictable in that respect. Here again there is a sense of Newman’s interconnectivity theory that supports her call for expanding consciousness, not merely in the often under-evaluated field of nursing, but extending to all human organization.

Not unlike Watson, Newman’s theories were transformative in that they began with an assessment of the current state of nursing and a necessary rollback to an earlier period when the nurse was a devout symbol of caring and faith. Nurses often speak in terms of a calling, and this particular reference explains a great deal not only about the profession but those who elect to enter into it as well. Certainly the demands of the profession demand extraordinary people, those who possess a greater capacity for giving, and empathy (Newman, 1992). Newman regarded the relationship between the nurse and the patient as a partnership, one in which both parties could grow, share a common ideal and expand each other’s consciousness. This professional ideal is very similar to the theory affirmed by Watson: nursing demands an acknowledgment of its own value by rejecting the restrictive definitions.

Holistic nursing is an expanded approach to nursing that takes into consideration not merely the symptoms of an illness but the entire being in a whole mind-body model that shares common features with both Watson and Newman’s theories. Holistic nursing is, in fact, the logical extension of Watsonian theory, a revitalized approach to the patient that treats symptoms as only one part of the whole. Although the model for holistic nursing is widely attributed to Florence Nightingale, there are certainly other significant antecedents that play a role. Sometimes referred to as evolved nursing the formal training for holistic nursing involves considerably more depth than ward protocol and custodial duties, this is a template that is at once multidimensional and yet beautifully resolved in a spiritual/tactile application (Dossey & Keegan, 2012). By removing the surface designations common to hospital staffing and permitting nursing to re-discover its organic roots in spiritual universality the cumulative effect is an enhanced recovery process and greater sense of purpose.

In Watson’s term “transpersonal’ commitment there is the fundamental essence of holistic nursing and its intended impact on the caring and treatment of the ill. In an age where medicine has merged with technology to a notable degree the human factors are often trivialized against the innovations and efficiency of modern technology, however these factors are discarded with a heavy toll. The common point of origin that joins past and present is indeed the human factors that animate healing and the caring that enables it (Watson, 1998). Holistic nursing posits these ineffable qualities that one human being can transmit to another as the basis for a humanistic approach to nursing that allows for advanced and beneficial technology but does not place these critical human factors behind it. By forgetting the meaning and impact of human counsel the system becomes in a certain sense dehumanized and mirrors the visage of the technology.

Holistic nursing is the return to the basics, the collective recognition that people demand human contact in equal measure with medication and impersonal diagnostics. Watson’s ‘art of transpersonal caring’ seems to conflict with the modernized regimentation applied to the nursing profession, the sense of automation and impersonalization that connects to endless administrative adjustments and efficiency models that at some point lost the essence of the profession (Morton & Fontaine, 2008). The very first reference to a nurse was found in Romans 16:1, her name was Phoebe. In 325: AD Christians constructed hospitals in every large community and the nuns who staffed these hospitals took care of the sick and dying. This was the bedrock of nursing, the irreducible spiritual roots of the profession that began as no less than a basic human commitment to spiritual healing in the purest sense.

As both Watson and Newman strive to articulate their theories, they convey this long-forgotten truth: medical science is also, and quite explicitly, human science. It is both a doorway to the ancient past and a clarion call to the future and its fundamental lessons are indeed timeless and ungoverned. As Watson expounds her theories the sense of openness and deeply personal connection that are at their heart becomes apparent: she is explaining the lost art of human consciousness, she describes the ‘caring moment’ as a personal epiphany, something both unexpected and equally liberating between the nurse and her patient. The transpersonal moment occurs when the nurse is able to fully connect with the spirit of others, to experience them in a communion of caring and healing that is the one immutable legacy of the nursing profession.

References

Dossey, B. M., & Keegan, L. (2012) Holistic Nursing: A Handbook for Practice, 6th Edition. Publisher: Jones & Bartlett.

Morton, P. G., & Fontaine, D. K. (2008) Critical Care Nursing: A Holistic Approach 9th edition. Publisher: Lippincott Williams & Wilkins.

Newman, M (1992) Health as Expanding Consciousness: Notes on Nursing Theories, 1st edition. Publisher: SAGE Publications, Inc.

Watson, J. (2008) Nursing: The Philosophy and Science of Caring, revised edition. Publisher: University Press of Colorado