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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 ). Caring for the purpose of: - PowerPoint PPT Presentation
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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
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Page 1: Watson’s Theory of Transpersonal Caring applied to BSN students

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

Page 2: Watson’s Theory of Transpersonal Caring applied to BSN students

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

Page 3: Watson’s Theory of Transpersonal Caring applied to BSN students

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

Page 4: Watson’s Theory of Transpersonal Caring applied to BSN students

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

Page 5: Watson’s Theory of Transpersonal Caring applied to BSN students

“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

Page 6: Watson’s Theory of Transpersonal Caring applied to BSN students

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

Page 7: Watson’s Theory of Transpersonal Caring applied to BSN students

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

Page 8: Watson’s Theory of Transpersonal Caring applied to BSN students

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”

Page 9: Watson’s Theory of Transpersonal Caring applied to BSN students

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

Page 10: Watson’s Theory of Transpersonal Caring applied to BSN students

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

Page 11: Watson’s Theory of Transpersonal Caring applied to BSN students

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

Page 12: Watson’s Theory of Transpersonal Caring applied to BSN students

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

Page 13: Watson’s Theory of Transpersonal Caring applied to BSN students

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)

Page 14: Watson’s Theory of Transpersonal Caring applied to BSN students

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

Page 15: Watson’s Theory of Transpersonal Caring applied to BSN students

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.

Page 16: Watson’s Theory of Transpersonal Caring applied to BSN students

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

Page 17: Watson’s Theory of Transpersonal Caring applied to BSN students

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

Page 18: Watson’s Theory of Transpersonal Caring applied to BSN students

#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

Page 19: Watson’s Theory of Transpersonal Caring applied to BSN students

#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)

Page 20: Watson’s Theory of Transpersonal Caring applied to BSN students

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)

Page 21: Watson’s Theory of Transpersonal Caring applied to BSN students

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 D

A = 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, D

24. 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 D

D = professional knowledge and skill; E =attentiveness to the other’s experience

(Wolf et al. 1994)

Page 22: Watson’s Theory of Transpersonal Caring applied to BSN students

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

Page 23: Watson’s Theory of Transpersonal Caring applied to BSN students

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

Page 24: Watson’s Theory of Transpersonal Caring applied to BSN students

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%

Page 25: Watson’s Theory of Transpersonal Caring applied to BSN students

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

Page 26: Watson’s Theory of Transpersonal Caring applied to BSN students

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.

Page 27: Watson’s Theory of Transpersonal Caring applied to BSN students

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

Page 28: Watson’s Theory of Transpersonal Caring applied to BSN students

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.


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