A Moment of Caring

Dr. Watson's theory describes caring as the basis for nursing that can be demonstrated and practiced and consists of 10 carative factors. She describes a caring environment as one in which a person is accepted as the person he is and the person he can become. This environment offers potential development. Caring promotes health more so than curing and is the core of nursing (Current Nursing, nd).
Dr. Watson was born in West Virginia. She received her Bachelor's degree in nursing from the University of Colorado in 1964, Master's degree in 1966 from the University of Colorado, and her PhD from the University of Colorado in 1973. Dr. Watson is the founder of the original Center for Human Caring in Colorado. She is a widely published author and recipient of several awards and honors. Her research has been based in the area of human caring and loss.

The foundation of Dr. Watson's philosophy was first published in "The Philosophy and Science of Caring" in 1979. The relationship between human caring and nursing was the initial foundation for what would become the "Theory of Human Caring" in 1997 and "Nursing: Human Science and Human Caring" in 1988. Dr. Watson defined caring as the ethical and moral ideal of nursing that has interpersonal and humanistic qualities. It is a complex concept that involves knowledge, skills, and expertise. Holism, empathy, communication, clinical competence, technical proficiency, and interpersonal skills are the basis for caring (Alligood, 2006).

Dr. Watson believes that the main focus in nursing is on carative factors. Strong emphasis is placed on a liberal arts background in order for nurses to develop humanistic philosophies and a value system. Dr. Watson's theory includes four major concepts: human being, health, environment/society, and nursing. Her view of human is " -- a valued person in and of him or herself to be cared for, respected, nurtured, understood and assisted; in general a philosophical view of a person as a fully functional integrated self. He, human is viewed as greater than and different from, the sum of his or her parts" (Watson, 2007).
Health includes other factors than what's found in The World's Health Organization's definition. Three additional elements include the absence of illness, a general maintenance level of daily functioning, and a high level of functioning.

Nursing focuses on health promotion and treatment of disease. Holistic health care is central to caring in nursing. Caring is an art as well as a science. In order to be caring, one must have an education based in liberal arts and have an ability to connect with another human on a personal level. According to Watson, "Caring science includes arts and humanities as well as science. Transpersonal Caring acknowledges unity of life and connections that move in concentric circles of caring'"from individual, to community, to world, to Earth, to the universe" (Watson, 2007). All aspects of nursing and the universe are intertwined and are based in caring.

One of my first encounters with Watson's theory came early in my career. I was fresh out of nursing school. With my mentor, I was assigned to care for an elderly lady, we will call Shirley. She had come to the emergency department with a complaint of pain in both feet and fatigue. She came by ambulance and brought with her multiple trash bags of personal property.

Immediately apparent was the fact she had not bathed in a very long time. She had been seen in the ER many times previously for an array of complaints. She was known to be homeless and thought to be schizophrenic. Her usual reasons for coming to the hospital were for social services, such as a hot meal and a place to sleep for at least a little while. Her unkempt physical condition made for an unpleasant environment for the staff as well as other patients.

Her belongings consisted of what one might consider trash, and at one point, even included a dead cat. Her cat had died a few days prior to her ER visit and she did not want to throw him in the trash, so she carried him around with her among her most prized possessions. Social services and Adult Protective Services were contacted on her behalf multiple times. She was placed in housing and a case worker was assigned to oversee her affairs. She refused to live in the housing and chose to remain living on the streets. She had a pleasant personality and always seemed to be happy and laughing. She occasionally was overheard carrying on a conversation with herself.

I was curious to find out what was at the heart of Shirley's story was and how she had come to choose to live in such conditions. I talked to her case worker who told me some of the story. Shirley had been married to a wonderful man who was an attorney. She and her husband had one son, who was the joy of her life. The family lived in an affluent neighborhood and was known to be generous, not only to their friends, but also to many charities. Unfortunately, her husband suffered a heart attack and died when her son was a teenager.
She sold her expensive house and she and her son moved to a smaller home. She supported him through college and he moved home afterward to help care for her. He became a successful businessman. About 10 years before I met Shirley, her son was killed in a tragic car accident by a drunk driver.

She could not cope with her loss. Since her husband's death, one of her close friends had taken care of her finances, making sure all debts were paid and Shirley had spending money. She refused to live in the home that held so many painful memories of her son. She chose to become homeless. She acquired a pet cat that lived on the streets with her until his death. She continued to refuse help from anyone. She would not accept housing of any kind. She did, however, have access to her bank accounts so that she could eat.

This particular day, the weather was cold and icy. Shirley wanted a temporary warm place to sleep and some human interaction. She was looking for someone to care for her. On this visit, she complained that she was hearing voices and they were telling her to hurt herself. The triage nurse placed her in a room where she would be safe and comfortable. The plan was to have psych evaluate her and possibly admit her to their service for additional treatment. The expectation was that she would not be compliant with any outpatient treatment or medication, but the admission would remove her from the streets for a few days out of the cold weather. She would be safe and warm.

Unfortunately, there were no beds available in our psych facility and she would have to be placed in another facility. Shirley would remain in the ER until that placement could be made. This was Friday evening.I returned to work on Saturday evening to find Shirley still in the ER, still in the same room, and still extremely unkempt. Other patients began to complain about the smell in the department. Because it was a slow night, I suggested to my mentor that she and I take Shirley to the Medical Surgical floor and put her in the shower. Of course, she agreed that this was an excellent suggestion.
She and I took Shirley upstairs, convinced her to remove her tattered and torn clothing, and to step into the shower. As soon as she stepped into the warm water, she began to cry. I asked what was wrong. She said, "As many times as I've been here, no one has ever cared about me enough to help me get cleaned up." At this point, I wanted to cry with her, but I held it back.

I had gathered up some meager supplies for her shower'"some standard hospital soap, shampoo, toothpaste, and lotion. I began to help her wash. As I started to hand her the shampoo, she looked at me very sincerely and said, "What is this? I have never seen such a thing. I ONLY use Pantene." I could not believe that a person in her condition would disapprove of my choice of toiletries. I laughed so hard I cried.

That was the moment I realized I had been judgmental and did not know her at all. I had previously viewed her as a homeless lady that no one cared about. I learned that she was a kind, caring person who had a wonderful personality and sense of humor underneath several layers of dirt. I realized Shirley could teach me a great deal about caring; she taught me the meaning of nursing. She and I created an interpersonal relationship that promoted learning and teaching. She and I began to discuss her life and how she had ended up in the situation she was in. She opened up to me as if I was her best friend. She thanked me several times for simply taking the time to care for her. Her human needs were met and in the process, and both she and I were rewarded with simple gratification. Shirley was able to trust me enough to tell me her story and allow me to care for her, developing a helping-trust relationship. She returned to the ER on multiple occasions afterward, usually for a meal and a place to stay warm and rest. From time to time, I would overhear a coworker make a negative statement about her and her condition. I always reminded him or her that Shirley was a person and deserved to be treated as such.

Two years ago, she fell on the street corner and fractured her hip, requiring hospitalization and surgical repair. She developed a post-op pneumonia and died several weeks later.After the shower incident, I realized what nursing was all about. Caring is the core of the nursing profession. "Caring is more healthogenic than curing" (Watson, 2007). Caring is the essence of nursing. Medicine is focused on curing the patient, whereas nurses use carative factors to develop a deep, personal relationship with the patient for the purpose of promoting health and well-being.

Before I got to know her, I thought Shirley was simply an old crazy lady who lived on the streets with her dead cat. I was wrong. She was a human who had suffered many tragedies in her life, which made her the person she was. I accepted that person she had been, the person she was, and the person she could be.
This experience has made me a better nurse, and a better human. She opened my eyes and my heart. I learned not to judge anyone by his outward experience. She taught me that everyone deserves caring and compassion. I think of her often. Perhaps she is still with me, guiding me through my day-to-day caring.

References

Alligood, M., Tomey, A., (2006). Nursing Theory: Utilization

& Application, 3^rd ed. Elsevier Mosby. St. Louis, MO.

Current Nursing, (2009). Nursing Theories, A companion

to nursing theories and models.

Retrieved November 22, 2009 from

http://currentnursing.com/nursing_theory/Watson.htm

Watson, J., (2007). University of Colorado Denver, College

of Nursing. Caring Theory Defined.

Retrieved November 22, 2009 from http://www.nursing.ucdenver.edu/faculty/theory_caring.htm