1.

Jean Watson “Philosophy and Science of Caring”

Jean Watson​ (June 10, 1940 – present) is an American nurse theorist and nursing professor who
is well known for her “Philosophy and Theory of Transpersonal Caring.” She has also written
numerous texts, including Nursing: The Philosophy and Science of Caring. Watson’s study on
caring has been integrated into education and patient care to various nursing schools and
healthcare facilities all over the world.

Early Life

Jean Watson was born Margaret Jean Harmon and grew up in the small town of Welch, West
Virginia, in the Appalachian Mountains. She was the youngest of eight children and was
surrounded by an extended family–community environment. Watson attended high school in
West Virginia and then the Lewis Gale School of Nursing in Roanoke, Virginia, where she
graduated in 1961

Personal Life

Jean Watson, RN, PhD, FAAN, AHN-BC

After her graduation in 1961, Jean Watson married her husband, Douglas, and moved west to his
native state of Colorado. In 1997, she experienced an accidental injury that resulted in the loss of
her left eye and soon after, in 1998, her husband, whom she considers as her physical and
spiritual partner, and her best friend passed away and left Watson and their two grown daughters,
Jennifer and Julie, and five grandchildren.

Watson states that she is “attempting to integrate these wounds into my life and work. One of the
gifts through the suffering was the privilege of experiencing and receiving my own theory
through the care from my husband and loving nurse friends and colleagues.” These two personal
life-altering events contributed to writing her third book, Postmodern Nursing and Beyond.

Education

Jean Watson ardently and quickly progressed through her nursing education earning her
bachelor’s degree in nursing in 1964, a master of science in nursing in psychiatric and mental
health nursing in 1966, and a Ph.D. in educational psychology and counseling in 1973, all from
the University of Colorado at Boulder.

Watson also defined three of the four metaparadigm concepts in nursing including person or
human being, health, and nursing. She referred human being as 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. Human is viewed as greater than and
different from the sum of his or her parts. Health, meanwhile, is defined as a high level of overall
physical, mental, and social functioning; a general adaptive-maintenance level of daily
functioning; and the absence of illness, or the presence of efforts leading to the absence of
illness. And nursing as a science of persons and health-illness experience that are mediated by
professional, personal, scientific, and ethical care interactions.

She does not define the fourth metaparadigm concept of environment but instead devised 10
caring needs specific carative factors critical to the caring human experience that need to be
addressed by nurses with their patients when in a caring role.

10 Carative Factors

Watson’s 10 carative factors are: (1) forming humanistic-altruistic value systems, (2) instilling
faith-hope, (3) cultivating a sensitivity to self and others, (4) developing a helping-trust
relationship, (5) promoting an expression of feelings, (6) using problem-solving for
decision-making, (7) promoting teaching-learning, (8) promoting a supportive environment, (9)
assisting with gratification of human needs, and (10) allowing for existential-phenomenological
forces. The first three factors form the “philosophical foundation” for the science of caring, and
the remaining seven come from that foundation.

Within assisting with the gratification of human needs, Watson’s hierarchy of needs begins with
lower-order biophysical needs or survival needs, which include the need for food and fluid,
elimination, and ventilation. Next are the lower-order psychophysical needs or functional needs,
which include the need for activity, inactivity, and sexuality. The higher order psychosocial
needs or integrative needs include the need for achievement, and affiliation. And finally the
higher order intrapersonal-interpersonal need or growth-seeking need which is self-actualization.

2. Patricia Benner “Stages of Nursing Expertise Nursing Philosophies”

Patricia E. Benner, R.N., Ph.D., FAAN is a Professor Emerita at the University of California,
San Francisco.

BA in Nursing - Pasadena College/Point Loma College

MS in Med/Surg nursing from UCSF

PhD -1982 from UC Berkeley

1970s - Research at UCSF and UC Berkeley

Has taught and done research at UCSF since 1979

Published 9 books and numerous articles

Published ‘Novice to Expert Theory’ in 1982

Received Book of the Year from AJN in 1984,1990,1996, 2000

LEVELS OF NURSING EXPERIENCE

She described ​5 levels of nursing experience​ as;

1. Novice

2. Advanced beginner

3. Competent

4. Proficient

5. Expert

6. Novice

Beginner​ ​with no experience

Taught general rules to help perform tasks

Rules are: context-free, independent of specific cases, and applied universally

Rule-governed behavior is limited and inflexible

Ex. “Tell me what I need to do and I’ll do it.”

Advanced Beginner

Demonstrates acceptable performance

Has gained prior experience in actual situations to recognize recurring meaningful components

Principles, based on experiences, begin to be formulated to guide actions

Competent

Typically a nurse with 2-3 years experience on the job in the same area or in similar day-to-day
situations

More aware of long-term goals

Gains perspective from planning own actions based on conscious, abstract, and analytical
thinking and helps to achieve greater efficiency and organization

Proficient

Perceives and understands situations as whole parts

More holistic understanding improves decision-making

Learns from experiences what to expect in certain situations and how to modify plans

Expert

No longer relies on principles, rules, or guidelines to connect situations and determine actions

Much more background of experience

Has intuitive grasp of clinical situations

Performance is now fluid, flexible, and highly-proficient

Different levels of skills reflect changes in 3 aspects of skilled performance:

Movement from relying on abstract principles to using past concrete experiences to guide actions

Change in learner’s perception of situations as whole parts rather than in separate pieces.

Passage from a detached observer to an involved performer, no longer outside the situation but
now actively engaged in participation

SIGNIFICANCE OF THE THEORY

These levels reflect movement from reliance on past abstract principles to the use of past
concrete experience as paradigms and change in perception of situation as a complete whole in
which certain parts are relevant
Each step builds on the previous one as abstract principles are refined and expanded by
experience and the learner gains clinical expertise.

This theory changed the profession's understanding of what it means to be an expert, placing this
designation not on the nurse with the most highly paid or most prestigious position, but on the
nurse who provided "the most exquisite nursing care.

It recognized that nursing was poorly served by the paradigm that called for all of nursing theory
to be developed by researchers and scholars, but rather introduced the revolutionary notion that
the practice itself could and should inform theory.

BENNER’S VIEW OF THE FOUR METAPARADIGMS

A. Person as someone living in the world who is a self- interpreting being.

B. Nurse: Someone with a caring relationship who studies disease, health, and

C. Health: the experience of wholeness and health.

D. Environment: “Situation”-social environment with social definition and illness.

meaningfulness.

1. Katie Eriksson “CARITATIVE CARING “

Katie Eriksson is one of the pioneers of caring science in the Nordic countries. When she started
her career 30 years ago, she had to open the way for a new science. We who followed her work
and progress in Finland have noticed her ability from the beginning to design caring science as a
discipline, while bringing to life the abstract substance of caring.

Eriksson was born on November 18, 1943, in Jakobstad, Finland. She belongs to the
Finland-Swedish minority in Finland, and her native language is Swedish. She is a 1965 graduate
of the Helsinki Swedish School of Nursing, and in 1967, she completed her public health nursing
specialty education at the same institution. She graduated in 1970 from the nursing teacher
education program at Helsinki Finnish School of Nursing. She continued her academic studies at
University of Helsinki, where she received her MA degree in philosophy in 1974 and her
licentiate degree in 1976; she defended her doctoral dissertation in pedagogy in 1982 In 1984,
Eriksson was appointed Docent of Caring Science at University of Kuopio, the first docentship
in caring science in the Nordic countries. She was appointed Professor of Caring Science at Åbo
Akademi University in 1992. Between 1993 and 1999, she held a professorship in caring science
at University of Helsinki, Faculty of Medicine, where she has been a docent since 2001. Since
1996, she has also served as Director of Nursing at Helsinki University Central Hospital, with
responsibilities for research and development of caring science in connection with her
professorship at Åbo Akademi University.

In the late 1960s and early 1970s, Eriksson worked in various fields of nursing practice and
continued her studies at the same time. Her main area of work has been in teaching and research.
Since the 1970s, Eriksson has systematically deepened her thoughts about caring, partly through
development of an ideal model for caring that formed the basis for the caritative caring theory,
and partly through the development of an autonomous, humanistically oriented caring science.
Eriksson, one of the few caring science researchers in the Nordic countries, developed a caring
theory and is a forerunner of basic research in caring science. Eriksson’s scientific career and
professional experience comprise two periods: the years 1970 to 1986 at Helsinki Swedish
School of Nursing, and the period from 1986, when she founded the Department of Caring
Science at Åbo Akademi University, which she has directed since 1987.

In 1972, after teaching for 2 years at the nursing education unit at Helsinki Swedish School of
Nursing, Eriksson was assigned to start and develop an educational program to prepare nurse
educators at that institution. Such a program taught in the Swedish language had not existed in
Finland. This education program, in collaboration with University of Helsinki, was the beginning
of caring science didactics. Under Eriksson’s leadership, Helsinki Swedish School of Nursing
developed a leading educational program in caring science and nursing in the Nordic countries. It
was the forerunner of education based on caring science and integration of research in education.
Eriksson was in charge of the program for 2 years, until she became dean at Helsinki Swedish
School of Nursing in 1974. She remained the dean until 1986, when she was nominated to start
academic education and research at Åbo Akademi University.

Toward the end of the 1980s, nursing science became a university subject in Finland, and
professorial chairs were established at four Finnish universities and at Åbo Akademi University,
the Finland-Swedish university. In 1986, Eriksson was called to plan an education and research
program within the subject of caring science at Åbo Akademi University’s Faculty of Education
in Vaasa, Finland. A fully developed education program for health care, with three focus options
and a research program for caring science, was created. The result of her planning was the
Department of Caring Science in 1987. It became an autonomous department within the Faculty
of Education of Åbo Akademi University until 1992, when a Faculty of Social and Caring
Sciences was founded. Eriksson developed an academic education for Masters and Doctoral
degrees in Caring Science. The doctoral program started in 1987 under Eriksson’s direction, and
44 doctoral dissertations have been published.

With her staff and researchers, Eriksson has further developed the caritative theory of caring and
caring science as an academic discipline. The department has a leading position in the Nordic
countries with students and researchers. In addition to her work with teaching, research, and
supervision, Eriksson has been the dean of the Department of Caring Science. One of her central
tasks has been to develop Nordic and international contacts within caring science.

Eriksson has been a very popular guest and keynote speaker, not only in Finland, but in all the
Nordic countries and at various international congresses. In 1977, she was a guest speaker at the
Symposium of Medical and Nursing Education in Istanbul, Turkey; in 1978, she participated in
the Foundation of Medical Care teacher education in Reykjavik, Iceland; in 1982, she presented
her nursing care didactic model at the First Open Conference of the Workgroup of European
Nurse-Researchers in Uppsala, Sweden; and for several years, she participated in education and
advanced education of nurses at the Statens Utdannings center for Helsopersonell in Oslo,
Norway. In 1988, Eriksson taught “Basic Research in Nursing Care Science” at the University in
Bergen, Norway, and “Nursing Care Science’s Theory of Science and Research” at Umeå
University in Sweden. She consulted at many educational institutions in Sweden; she has been a
regular lecturer at Nordiska Hälsovårdsskolan in Gothenburg, Sweden. In 1991, she was a guest
speaker at the 13th International Association for Human Caring (IAHC) Conference in
Rochester, New York; in 1992, she presented her theory at the 14th IAHC Conference in
Melbourne, Australia; and in 1993, she was the keynote speaker at the 15th IAHC Conference,
Caring as Healing: Renewal Through Hope, in Portland, Oregon

Eriksson has been a yearly keynote speaker at the annual congresses for nurse managers and,
since 1996, at the annual caring science symposia in Helsinki, Finland. In many public dialogues
with Kari Martinsen from Norway, Eriksson has discussed basic questions about caring and
caring science. Some dialogues have been published

Eriksson worked as a leader of many symposia: the 1975 Nordic Symposium about the Nursing
Care Process (the first Nordic Nursing Care Science Symposium in Finland); the 1982
Symposium in Basic Research in Nursing Care Science; the 1985 Nordic Symposium in Nursing
Care Science; the 1989 Nordic Humanistic Caring Symposium; the 1991 Nordic Caring Science
Conference, “Caritas & Passio in Vaasa, Finland” and the 1993 Nordic Caring Science
Conference, “To Care or Not to Care—The Key Question” in Nursing in Vaasa, Finland.

Eriksson’s caritative theory of caring came into clearer focus internationally in 1997, when the
IAHC for the first time arranged its conference in a European country. The Department of Caring
Science served as the host of this conference, which was arranged in Helsinki, Finland, with the
topic, “Human Caring: The Primacy of Love and Existential Suffering.”

Eriksson is a member of several editorial committees for international journals in nursing and
caring science. She has been invited to many universities in Finland and other Nordic countries
as a faculty opponent for doctoral students and an expert consultant in her field. She is an advisor
for her own research students and for research students at Kuopio and Helsinki Universities,
where she is an associate professor (docent). Eriksson served as chairperson of the Nordic
Academy of Caring Science from 1999 to 2002.
Eriksson has produced an extensive list of textbooks, scientific reports, professional journal
articles, and short papers. Her publications started in the 1970s and include about 400 titles.
Some of her publications have been translated into other languages, mainly into Finnish.
Vårdandets Idé [The Idea of Caring] has been published in Braille. Her first English translation,
The Suffering Human Being was published in 2006 by Nordic Studies Press in Chicago.

The Human Being

The conception of the human being in Eriksson’s theory is based on the axiom that the human
being is an entity of body, soul, and spirit (Eriksson, 1987a, 1988). She emphasizes that the
human being is fundamentally a religious being, but all human beings have not recognized this
dimension. The human being is fundamentally holy, and this axiom is related to the idea of
human dignity, which means accepting the human obligation of serving with love and existing
for the sake of others. Eriksson stresses the necessity of understanding the human being in his
ontological context. The human being is seen as in constant becoming; he is constantly in change
and therefore never in a state of full completion. He is understood in terms of the dual tendencies
that exist within him, engaged in a continued struggle and living in a tension between being and
nonbeing. Eriksson sees the human being’s conditional freedom as a dimension of becoming.
She links her thinking with Kierkegaard’s ideas of free choice and decision in the human being’s
various stages—aesthetic, ethical, and religious stages—and she thinks that the human being’s
power of transcendency is the foundation of real freedom. The dual tendency of the human being
also emerges in his effort to be unique, while he simultaneously longs for belonging in a larger
communion.

The human being is fundamentally dependent on communion; he is dependent on another, and it

is in the relationship between a concrete other (human being) and an abstract other (some form of
God) that the human being constitutes himself and his being The human being seeks a
communion where he can give and receive love, experience faith and hope, and be aware that his
existence here and now has meaning. According to Eriksson ,the human being we meet in care is
creative and imaginative, has desires and wishes, and is able to experience phenomena; therefore,
a description of the human being only in terms of his needs is insufficient. When the human
being is entering the caring context, he or she becomes a patient in the original sense of the
concept—a suffering human being .

Nursing

Love and charity, or caritas, as the basic motive of caring has been found in Eriksson as a
principal idea even in her early works. The caritas motive can be traced through semantics,
anthropology, and the history of ideas The history of ideas indicates that the foundation of the
caring professions through the ages has been an inclination to help and minister to those
suffering).
Caritas constitutes the motive for caring, and it is through the caritas motive that caring gets its
deepest formulation. This motive, according to Eriksson, is also the core of all teaching and
fostering growth in all forms of human relations. In caritas, the two basic forms of love—eros
and agapé are combined. When the two forms of love combine, generosity becomes a human
being’s attitude toward life and joy is its form of expression. The motive of caritas becomes
visible in a special ethical attitude in caring, or what Eriksson calls a caritative outlook, which
she formulates and specifies in caritative caring ethics . Caritas constitutes the inner force that is
connected with the mission to care. A carer beams forth what Eriksson calls claritas, or the
strength and light of beauty.

Caring is something natural and original. Eriksson thinks that the substance of caring can be
understood only by a search for its origin. This origin is in the origin of the concept and in the
idea of natural caring. The fundamentals of natural caring are constituted by the idea of
motherliness, which implies cleansing and nourishing, and spontaneous and unconditional love.

Natural basic caring is expressed through tending, playing, and learning in a spirit of love, faith,
and hope. The characteristics of tending are warmth, closeness, and touch; playing is an
expression of exercise, testing, creativity, and imagination, and desires and wishes; learning is
aimed at growth and change. To tend, play, and learn implies sharing, and sharing, Eriksson
says, is “presence with the human being, life and God” . True care therefore is “not a form of
behavior, not a feeling or state. It is to be there—it is the way, the spirit in which it is done, and
this spirit is caritative” . Eriksson brings out that caring through the ages can be seen as various
expressions of love and charity, with a view toward alleviating suffering and serving life and
health. In her later texts, she stresses that caring also can be seen as a search for truth, goodness,
beauty, and the eternal, and for what is permanent in caring, and making it visible or evident
Eriksson emphasizes that caritative caring relates to the innermost core of nursing. She
distinguishes between caring nursing and nursing care. She means that nursing care is based on
the nursing care process, and it represents good care only when it is based on the innermost core
of caring. Caring nursing represents a kind of caring without prejudice that emphasizes the
patient and his or her suffering and desires.

The core of the caring relationship, between nurse and patient as described by Eriksson (1993), is
an open invitation that contains affirmation that the other is always welcome. The constant open
invitation is involved in what Eriksson (2003) today calls the act of caring. The act of caring
expresses the innermost spirit of caring and recreates the basic motive of caritas. The caring act
expresses the deepest holy element, the safeguarding of the individual patient’s dignity. In the
caring act, the patient is invited to a genuine sharing, a communion, in order to make the caring
fundamentals alive and active (Eriksson, 1987a) (i.e., appropriated to the patient). The
appropriation has the consequence of somehow restoring the human being and making him or
her more genuinely human. In an ontological sense, the ultimate goal of caring cannot be health
only; it reaches further and includes human life in its entirety. Because the mission of the human
being is to serve, to exist for the sake of others, the ultimate purpose of caring is to bring the
human being back to this mission

Environment

Eriksson uses the concept of ethos in accordance with Aristotle’s (1935, 1997) idea that ethics is
derived from ethos. In Eriksson’s sense, the ethos of caring science, as well as that of caring,
consists of the idea of love and charity and respect and honor of the holiness and dignity of the
human being. Ethos is the sounding board of all caring. Ethos is ontology in which there is an
“inner ought to,” a target of caring “that has its own language and its own key” Good caring and
true knowledge become visible through ethos. Ethos originally refers to home, or to the place
where a human being feels at home. It symbolizes a human being’s innermost space, where he
appears in his nakedness Ethos and ethics belong together, and in the caring culture, they become
one (Eriksson, 2003). Eriksson thinks that ethos means that we feel called to serve a particular
task. This ethos she sees as the core of caring culture. Ethos, which forms the basic force in
caring culture, reflects the prevailing priority of values through which the basic foundations of
ethics and ethical actions appear.

At the beginning of the 1990s, when Eriksson reintroduced the idea of suffering as a basic
category of caring, she returned to the fundamental historical conditions of all caring, the idea of
charity as the basis of alleviating suffering This meant a change in the view of caring reality to a
focus on the suffering human being. Her starting point is that suffering is an inseparable part of
human life, and that it has no distinct reason or definition. Suffering as such has no meaning, but
a human being can ascribe meaning to it by becoming reconciled to it. Eriksson makes a
distinction between endurable and unendurable suffering and thinks that an unendurable
suffering paralyzes the human being, preventing him or her from growing, while endurable
suffering is compatible with health. Every human being’s suffering is enacted in a drama of
suffering. Alleviating a human being’s suffering implies being a co-actor in the drama and
confirming his or her suffering. A human being who suffers wants to have the suffering
confirmed and be given time and space to become reconciled to it. The ultimate purpose of
caring is to alleviate suffering. Eriksson has described three different forms: suffering related to
illness, suffering related to care, and suffering related to life

Health

Eriksson considers health in many of her earlier writings in accordance with an analysis of the
concept in which she defines health as soundness, freshness, and well-being. The subjective
dimension, or well-being, is emphasized strongly (Eriksson, 1976). In the current axiom of
health, health implies being whole in body, soul, and spirit. Health means as a pure concept
wholeness and holiness (Eriksson, 1984). In accordance with her view of the human being,
Eriksson has developed various premises regarding the substance and laws of health, which have
been summed up in an ontological health model. She sees health as both movement and
integration. The health premise is a movement comprising various partial premises: health as
movement implies a change; a human being is being formed or destroyed, but never completely;
health is movement between actual and potential; health is movement in time and space; health
as movement is dependent on vital force and on vitality of body, soul, and spirit; the direction of
this movement is determined by the human being’s needs and desires; the will to find meaning,
life, and love constitutes the source of energy of the movement; and health as movement strives
toward a realization of one’s potential . In the ontological conception, health is conceived as a
becoming, a movement toward a deeper wholeness and holiness. As a human being’s inner
health potential is touched, a movement occurs that becomes visible in the different dimensions
of health as doing, being, and becoming with a wholeness that is unique to human beings
(Eriksson, Bondas-Salonen, Fagerström, et al., 1990). In doing, the person’s thoughts concerning
health are focused on healthy life habits and avoiding illness; in being, the person strives for
balance and harmony; in becoming, the human being becomes whole on a deeper level of
integration