Seton Hall University Emerging Nursing Theory NUR 8101 Dr Marie Foley PhD RN CSNNJ Jeannie Couper MSN RNBC November 17 2011 Theory of Transpersonal Caring WTTC 1979 ID: 715464
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Slide1
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 Slide2
Theory of Transpersonal Caring (WTTC)
(1979)Caring for the purpose of: Promoting healingPreserving dignityRespecting the wholenessNursing is healing art and science dedicated to the pursuit of harmonious and sacred relationshipsChallenges nursing: To rediscover its healing traditionsExpanding its mission for caring relationshipsSlide3
Based on Nightingale's concepts
Transform the professional Used by schools and hospitals- return the human element back into study and the practice of nursingAdvocates for liberal art educationEmphasis on philosophy and valuesWatson’s intent was not to be prescriptive but a paradigmBiomedical/natural science model ->postmodern/human science perspectiveDistinct from medicine with emphasis on disease and curingSlide4
Human Science Paradigm
Concerned predominantly with the meaning of the lived experienceKey elements of knowledge formation: human environment personal-life spirit or the human-to-human interactionMultiple ways of knowing
Emphasis on “being” and cocreation of RN- pt interactionsSlide5
“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 PublicationSlide6
Major conceptual elements
Original theory included: transpersonal caring relationship10 carative factorsCaring occasion/momentCurrent dimensions which evolved/ emerged from theory:Transpersonal mind/body/spirit onenessImportance 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 environmentSlide7
Nursing as Profession and Praxis
Caring in Nursing:Reciprocal relationship btw nurse and “othersNurse is the co-participant with patient (the change agent)Coparticipants in a pattern of subjectivity-inter subjectivity“ConsciousnessIntentionalityPerceptions 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 healthSlide8
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”Slide9
Nursing student caring behaviors during blood pressure measurement
Minnesota Baccalaureate P
sychomotor
S
kills
F
aculty
G
roup
(MBPSFG) Journal of Nursing Education, 2008, 47(3)
Study partially funded by Kappa Phi Chapter of STTI
and 6 participating nursing programsSlide10
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 theoriesteaching strategy included: required reading: Caring made visible, Swanson, 1998Video tape analysisFeedbackBP measurement taught in nursing perspective based on Watson’s theory of caring in the human health experience
Slide11
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 intentionalitySlide12
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 behaviorsSlide13
Watson’s Theory of Transpersonal Caring “operationalized”
(1994) Focused on five caring dimensions or categories:Respectful deference to othersAssurance of human presencePositive connectednessProfessional knowledge and skillsAttentiveness to the other’s experience Wolf, Giardino, Osborne, & Ambrose (1994)Slide14
Watson’s (1988)Transpersonal Caring Theory “operationalized” by Wolf et al.,
1994Watson’s Carative Factors:1. Formation of a humanistic-altruistic system of values2. The instillation of faith-hope5. Promotion and acceptance of the expression of + and - feelings7. Promotion of transpersonal teaching-learning4. 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 experienceSlide15
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
F
aculty
G
roup, 2008, p.100.Slide16
The Descriptive Study
Sample: Jr-level nursing students at 6 independent BSN progTeaching strategies: BP measurement served as the forum for integrating caring behaviorsStudents 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 behaviorsSlide17
The Descriptive Study continued
Evaluation: BSN students videotaped (VT) and evaluated twice 8 weeks apartVT analysis: reviewed for evidence of caring and non-caring behaviorsIn response to analysis: Students discussed thoughts and feelingsSpecific instruction was not standardized amongst BSN programsBoth tools created by the researchers Slide18
#1 Caring Behaviors During BP Measurement
instrumentDesigned 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 guidelinesRelevant caring behaviors (CB) r/t caring dimensionsEvaluators: faculty as patient-role playerSlide19
#2
Role Player Survey of Caring Behaviors During BP Measurement instrument 3-item Liker-scale evaluating student caring behaviorsA) respect B) conveyed warmth and caring C) conveyed competenceScore; 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) Slide20
Objective Caring Behaviors During BP Measurement
Caring Behavior Caring Dimension1. 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)Slide21
Objective Caring Behaviors During BP
Measurement cont.Caring Behavior Caring Dimension16. 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)Slide22
Comparison of Scores of Student Caring Behaviors Before and After Role-Playing
Subjective data: Score Range Mean Score SDCaring Behavior Conveyed Pretest Posttest Pretest Posttest Pretest PosttestGenuine respect 1-3 2-3 2.43 2.82 0.53 0.39Warmth and caring 1-3 1-3 2.40 2.70 0.58 0.49Competence 1-3 1-3 2.25 2.68 0.63 0.50
M
innesota
B
accalaureate
P
sychomotor
S
kills
F
aculty
G
roup, 2008, p.102Slide23
Findings and limitations
↑ in students’ subjective and objective caring behaviorsGreatest gains in professional knowledge and skill caring dimensionsLittle to no gain in respect, presence, & attention to other’s experience caring dimensionsFeedback is required in clinical settings as is facilitating understanding within the nursing disciplinary contextLimitations includedAbsence of a control groupAbsence of standardized information, approaches to teaching and learning, and varying methods to determine role-player inter-rater reliabilitySlide24
Discussion and Evaluation of tool
↑ in students’ subjective and objective caring behaviorsGreatest gains in professional knowledge and skill caring dimensionsLittle to no gain in respect, presence, & attention to other’s experience caring dimensionsCaring 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%Slide25
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 behaviorsFurther expand the students development of caring behaviors related to all psychomotor interventionsSlide26
Congruency
Although the authors used Wolf et al. operationalized definitions the study focused more on the skill acquisitionNo mention of relationshipsPoor Did not stay focused on theoretical construct as refers to Benner and Watson as well.Slide27
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 developmentSlide28
References
Fawcett, 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, 7
th
E
d, ( 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, 6
th
Ed. (pp. 454-478).
Upper Saddle River, NJ: Pearson.
Minnesota Baccalaureate Psychomotor Skills Faculty Group, 2008. Journal of Nursing Education, 47(3), 98-104.