watson’s theory of transpersonal caring applied to bsn students
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Watson’s Theory of Transpersonal Caring applied to BSN students. Seton Hall University Emerging Nursing Theory NUR 8101 Dr. Marie Foley, PhD, RN, CSN-NJ Jeannie Couper, MSN, RN-BC November 17, 2011 . Theory of Transpersonal Caring (WTTC) (1979 ). - PowerPoint PPT PresentationTRANSCRIPT
Watson’s Theory of Transpersonal Caring applied to BSN students
Seton Hall UniversityEmerging Nursing Theory NUR 8101 Dr. Marie Foley, PhD, RN, CSN-NJJeannie Couper, MSN, RN-BCNovember 17, 2011
Theory of Transpersonal Caring (WTTC) (1979)
Caring for the purpose of: Promoting healing Preserving dignity Respecting the wholeness
Nursing is healing art and science dedicated to the pursuit of harmonious and sacred relationships
Challenges nursing: To rediscover its healing traditions Expanding its mission for caring relationships
Based on Nightingale's concepts Transform the professional Used by schools and hospitals- return the human
element back into study and the practice of nursing
Advocates for liberal art education Emphasis on philosophy and values Watson’s intent was not to be prescriptive but a
paradigm Biomedical/natural science model ->postmodern/human
science perspective Distinct from medicine with emphasis on disease and
curing
Human Science Paradigm Concerned predominantly with the meaning of the lived
experience
Key elements of knowledge formation: human environment personal-life spirit or the human-to-human interaction
Multiple ways of knowing
Emphasis on “being” and cocreation of RN- pt interactions
“Ever evolving theory” Employs language to reflect on own life journey
and beliefs 10 “carative factors” → “clinical caritas
processes” ↑ emphasis on metaphysical and spiritual dimensions (love)
“Love as an ethic” as the basis for caring-healing practices
adapted from Pearson Publication
Major conceptual elements Original theory included:
transpersonal caring relationship 10 carative factors Caring occasion/moment
Current dimensions which evolved/ emerged from theory: Transpersonal mind/body/spirit oneness Importance of caring-healing consciousness Consciousness as energy Phenomenal field / unitary consciousness Advanced caring-healing modalities/ nursing
arts Ultimate form of healing and transcendence
is love Nurse as sacred healing environment
Nursing as Profession and Praxis Caring in Nursing:
Reciprocal relationship btw nurse and “others Nurse is the co-participant with patient (the change agent) Coparticipants in a pattern of subjectivity-inter subjectivity
“Consciousness Intentionality Perceptions and lived experiences R/T caring, healing, and
health-illness conditions given in a ‘caring moment’. Experiences or meanings that transcend the moment and
beyond the actual experience” (Watson, 1996, p. 146). Care is never separated from the context of the unity of mind-
body-spirit-nature Profession exists in order to sustain caring, healing, and
health
Nursing interventions, “human care processes” Goals defined by Watson (1985/1988)
R/T mental spiritual growth for self and others Finding meaning in one’s own existence &
experiences Discovering inner power & control Potentiating instances of transcendence & self-
healing Nurse intervenes through “a way of being” &
“presence” Require a wide scope of knowledge Presuppose a knowledge base and clinical
competence Require intent, a will, a relationship, & actions. “heart-centered awareness & loving/caring
consciousness”
Nursing student caring behaviors during blood pressure measurement
Minnesota Baccalaureate Psychomotor Skills Faculty Group
(MBPSFG) Journal of Nursing Education, 2008, 47(3)
Study partially funded by Kappa Phi Chapter of STTI and 6 participating nursing programs
Nursing student caring behaviors during blood pressure measurement Multi-site (6), non-experimental, descriptive study Organizing framework: Watson’s Theory of Transpersonal
Caring and a combination of cognitive and connectionist learning theories
teaching strategy included: required reading: Caring made visible, Swanson, 1998 Video tape analysis Feedback BP measurement taught in nursing perspective based
on Watson’s theory of caring in the human health experience
Watson’s (1988) Theory of Transpersonal Caring caring “operationalized”
Watson’s definition of caring: A moral commitment to protect
human dignity & preserve humanity
Morse, Solberg, Neander, Bottoff, and Johnson (1990)
Caring conceptualized by Morse et al. 1990 A human trait, a moral
imperative, an affect, an interpersonal relationship, and a therapeutic intervention (MBPSFG,2008, p. 100)
Moral commitment illuminated in research as interpersonal and therapeutic interactions influencing the pt’s experience and physical response.
Involves intentionality
Caring in human health experiences
Operationalized caring from the perspective of the nurse and patient (Morse et al, 1990)
Intentionality : basis for teaching, understanding, developing , and adopting caring behaviors
Watson’s Theory of Transpersonal Caring “operationalized” (1994)
Focused on five caring dimensions or categories: Respectful deference to others Assurance of human presence Positive connectedness Professional knowledge and skills Attentiveness to the other’s experience
Wolf, Giardino, Osborne, & Ambrose (1994)
Watson’s (1988)Transpersonal Caring Theory “operationalized” by Wolf et al., 1994
Watson’s Carative Factors: 1. Formation of a humanistic-
altruistic system of values 2. The instillation of faith-
hope 5. Promotion and acceptance
of the expression of + and - feelings
7. Promotion of transpersonal teaching-learning
4. development of a helping-trusting relationship and #5.
five caring dimensions: Respectful deference to
others Assurance of human
presence Positive connectedness
Professional knowledge and skills
Attentiveness to the other’s experience
Research Question: “Is there a change in objective and
subjective caring behaviors demonstrated by baccalaureate nursing students completing blood pressure measurement when these behaviors are taught in nursing psychomotor skill curricula?”
Minnesota Baccalaureate Psychomotor Skills Faculty Group, 2008, p.100.
The Descriptive Study Sample: Jr-level nursing students at 6 independent
BSN prog Teaching strategies:
BP measurement served as the forum for integrating caring behaviors
Students viewed demonstration videotape of BP measurement based on the objective tool (Caring Behaviors During BP Measurement instrument )
Teaching included caring behaviors as an integral component of professional nurses’ role
Student identification of caring and non-caring behaviors
The Descriptive Study continued Evaluation: BSN students videotaped (VT)
and evaluated twice 8 weeks apart VT analysis: reviewed for evidence of caring
and non-caring behaviors In response to analysis: Students discussed
thoughts and feelings Specific instruction was not standardized
amongst BSN programs Both tools created by the researchers
#1 Caring Behaviors During BP Measurement instrument
Designed as an objective tool: 30-item procedure (behavior present; 1= yes; 0=
no) Total score = sum of item procedure scores
(max=30) Content validity established via AHA/NHLB
guidelines Relevant caring behaviors (CB) r/t caring
dimensions Evaluators: faculty as patient-role player
#2 Role Player Survey of Caring Behaviors During BP Measurement instrument
3-item Liker-scale evaluating student caring behaviors A) respect B) conveyed warmth and caring C) conveyed competence Score; 1= not at all 2= some 3=much
Documented the role players perception of caring during BP 5 Caring dimensions based on CBI consistent
with WTTC Content validity was established using caring
dimensions as described by Wolf, et al. ( 1994)
Objective Caring Behaviors During BP Measurement
Caring Behavior Caring Dimension
1. Washes hands D 2. Cleans equipment D 3. Introduces self A, B 4. Calls patient by preferred name A, B 5. Explains procedure and elicits questions
A, B, E 6. Provides privacy A 7. Faces client throughout procedure A 8. Maintains appropriate eye contact A A = Respectful deference to others; B = assurance of human presence; C = positive connectness;
Caring Behavior Caring Dimension
9. Posture reveals relaxed muscle tone B
10. Voice congruent with patient's emotions A, B, C
11. Leans toward patient when talking B
12. Asks patient about comfort during procedure B, E
13. Physical contact is performed with a gentle touch C
14. Seats patient with feet flat on floor, uncrossed legs A, D
15. Uses right arm unless unable to do so D
D = professional knowledge and skill; E =attentiveness to the other’s experience (Wolf et al. 1994)
Objective Caring Behaviors During BP Measurement cont.
Caring Behavior Caring Dimension
16. Gently supports patient's arm at heart level C, D 17. Measures arm for correct cuff size D 18. Centers bladder of cuff over palpated brachial artery D 19. Wraps cuff gently, snugly, 1 inch above antecubital A, D 20. Use palpation or patient's reported blood pressure to estimate systolic D 21. Deflates bladder, waits 15 to 30 seconds A, D 22. Applies stethoscope correctly DA = Respectful deference to others; B = assurance of human presence; C = positive connectness;
Caring Behavior Caring Dimension
23. Inflates cuff to 30 mm Hg above estimated systolic A, D24. Deflates cuff 2 mm Hg/second A, D 25. If mercury, keep centered at eye level D 26. Obtains systolic and diastolic blood pressure D 27. Allows 10 mm Hg before complete deflation D 28. Explains findings to patient A, B, E 29. Completes calmly, confidently A, D 30. Obtains accurate blood pressure DD = professional knowledge and skill; E =attentiveness to the other’s experience
(Wolf et al. 1994)
Comparison of Scores of Student Caring Behaviors Before and After Role-Playing
Subjective data:
Score Range Mean Score SD
Caring Behavior Conveyed Pretest Posttest Pretest Posttest Pretest Posttest
Genuine respect 1-3 2-3 2.43 2.82 0.53 0.39
Warmth and caring 1-3 1-3 2.40 2.70 0.58 0.49
Competence 1-3 1-3 2.25 2.68 0.63 0.50
Minnesota Baccalaureate Psychomotor Skills Faculty Group, 2008, p.102
Findings and limitations ↑ in students’ subjective and objective caring behaviors
Greatest gains in professional knowledge and skill caring dimensions
Little to no gain in respect, presence, & attention to other’s experience caring dimensions
Feedback is required in clinical settings as is facilitating understanding within the nursing disciplinary context
Limitations included
Absence of a control group
Absence of standardized information, approaches to teaching and learning, and varying methods to determine role-player inter-rater reliability
Discussion and Evaluation of tool ↑ in students’ subjective and objective caring behaviors
Greatest gains in professional knowledge and skill caring dimensions
Little to no gain in respect, presence, & attention to other’s experience caring dimensions
Caring dimensions addressed by tool: A= respectful deference to others 14/30 46.6% B= assurance of human presence 8/30 26.6% C= positive connectedness 3/30 10% D= professional knowledge and skill 18/30 60% E= attentiveness to the other’s experience 3/30
10%
Further research
Additional research required with an experimental design to broaden the understanding of the best practices assist the student in the development of caring behaviors
Further expand the students development of caring behaviors related to all psychomotor interventions
Congruency
Although the authors used Wolf et al. operationalized definitions
the study focused more on the skill acquisition No mention of relationships Poor Did not stay focused on theoretical construct as refers to
Benner and Watson as well.
Contributions to nursing science Noted by the authors as” a beginning step in
identifying and testing educational strategies for promoting psychomotor skill development” (MBPSFG, 2008, p.104) within the human caring and health experience).
The need to incorporate explicit instruction in caring behaviors throughout psychomotor skill development
ReferencesFawcett, J. (2005). Contemporary Nursing knowledge:
Analysis and evaluation of nursing models and theories, 2nd Ed., Philadelphia: F.A. Davis Company.
Jesse, DE. (2010). Watson’s philosophy and theory of transpersonal caring In Nursing theorist and their works, 7th ed. (Eds.). In M.R. Alligood & A. M. Tomey, Nursing theorist and their works, 7th Ed, ( pp. 91-112).
Johnson, B.P. & Kelley, J.H. (2011). Theory of transpersonal caring: Jean Watson. In Julia B. George (Ed.). Nursing theories: The base for professional nursing practice, 6th Ed. (pp. 454-478). Upper Saddle River, NJ: Pearson.
Minnesota Baccalaureate Psychomotor Skills Faculty Group, 2008. Journal of Nursing Education, 47(3), 98-104.