Review of Research Related to Watson's Theory of Caring

When does witnessing patient mistreatment hurt nurses' performance? Gauging the moderation roles of self-concern and other-orientation

Purpose

Research has found that the effects of directly experiencing mistreatment at work are consistently negative; however, results from studies examining employees' reactions to witnessing mistreatment are less consistent. This study focuses on nurses witnessing patient mistreatment in order to examine how third parties respond when witnessing patients mistreating co-workers. We argue that nurses high on other-orientation are less likely to experience emotion exhaustion in the face of witnessing patient mistreatment, whereas nurses high on self-concern are more likely to experience emotional exhaustion. We further argue that the indirect effect of witnessing patient mistreatment on job performance through emotional exhaustion is moderated by other-orientation and self-concern.

Design/methodology/approach

We used data collected at two time points, with six months apart, from 287 nurses working in a hospital. The study tests the hypotheses by using multiple regression analyses.

Findings

Emotional exhaustion mediated the relationships between witnessing patient mistreatment and two forms of job performance: patient care behaviors and counterproductive work behaviors. Furthermore, other-orientation moderated these indirect relationships such that the indirect relationships were weaker when other-orientation was high (vs. low). Self-concern did not moderate these relationships.

Practical implications

Service and care-oriented businesses may protect their employees from the risk of burnout by promoting prosocial orientation among their patient and customer-facing employees.

Originality/value

This study contributes to the literature by demonstrating the detrimental effects of witnessing patient mistreatment on nurses' performance. It also extends the current understanding of why and when witnessing patient mistreatment is related to performance by demonstrating the joint effects of witnessing patient mistreatment and an individual difference construct, other-orientation on employees' performance.

An Exploration of Characteristics and Behavioral Traits of DAISY Honorees and Nominees: A Qualitative Study

BACKGROUND

In the literature, an abundance of stories exist describing patient situations and caregiver actions, but only 2 studies were identified that outline DAISY honorees' actions and behavioral characteristics.

OBJECTIVE

This study utilized patient nomination data and DAISY honoree insight to identify and gain better understanding of the characteristics and behavioral traits of DAISY nurses.

METHODS

A grounded theory approach and purposive sample were used in this study, which was conducted in 2 phases using 2 different data sets. In phase 1, the NarrativeDx AI platform generated insights from DAISY nomination comments. In phase 2, a survey was administered to DAISY honorees collecting descriptive data that were analyzed in SPSS, whereas insights on DAISY nurses were collected via open-ended responses and analyzed using NVivo software.

RESULTS

Three themes emerged in phase 1 from DAISY nomination data: caring, knowledge/skills, and reliability. A total of 37 DAISY honorees participated in phase 2. Most participants were bachelor's degree-prepared and worked day shift in the emergency department, critical care units, or medical-surgical units; some entered leadership roles post award, and 34% cited nursing as a 2nd career. Four themes emerged from their open-ended responses: engaging in care, environment of care, dedicated to care, and competence of care. Subthemes emerged in both analyses.

CONCLUSIONS

The essence of caring was noted continuously in both nomination and honoree data. Further research aimed at discovering the characteristics and behaviors of DAISY honorees is recommended as examination of these factors may provide a deeper understanding of this exemplary group of nurses. Insights could be incorporated into training and practice programs aimed at increasing patient and nursing satisfaction.

Assessing quality of life in older adults: psychometric properties of the OPQoL-brief questionnaire in a nursing home population

Background

Well-adapted and validated quality-of-life measurement models for the nursing home population are scarce. Therefore, the aim of this study was to test the psychometrical properties of the OPQoL-brief questionnaire among cognitively intact nursing home residents. The research question addressed evidence related to the dimensionality, reliability and construct validity, all of which considered interrelated measurement properties.

Methods

Cross-sectional data were collected during 2017–2018, in 27 nursing homes representing four different Norwegian municipalities, located in Western and Mid-Norway. The total sample comprised 188 of 204 (92% response rate) long-term nursing home residents who met the inclusion criteria: (1) municipality authority’s decision of long-term nursing home care; (2) residential time 3 months or longer; (3) informed consent competency recognized by responsible doctor and nurse; and (4) capable of being interviewed.

Results

Principal component analysis and confirmative factor analyses indicated a unidimensional solution. Five of the original 13 items showed low reliability and validity; excluding these items revealed a good model fit for the one-dimensional 8-items measurement model, showing good internal consistency and validity for these 8 items.

Conclusion

Five out of the 13 original items were not high-quality indicators of quality-of-life showing low reliability and validity in this nursing home population. Significant factor loadings, goodness-of-fit indices and significant correlations in the expected directions with the selected constructs (anxiety, depression, self-transcendence, meaning-in-life, nurse-patient interaction, and joy-of-life) supported the psychometric properties of the OPQoL-brief questionnaire. Exploring the essence of quality-of-life when residing in a nursing home is highly warranted, followed by development and validation of new tools assessing quality-of-life in this population. Such knowledge and well-adapted scales for the nursing home population are beneficial and important for the further development of care quality in nursing homes, and consequently for quality-of-life and wellbeing in this population.

The Effect of Watson's Human Caring Model on Meaning of Life and Symptom Management in Cancer Patients Undergoing Chemotherapy

PURPOSE

The purpose of this study was to determine the effect of Watson's Human Caring Model on the meaning of life and symptom management in cancer patients undergoing chemotherapy.

DESIGN

The study was conducted using a real test model featuring a pretest and posttest and a control group.

METHODS

The sample consisted of 158 adult cancer patients (79 in both the experimental and control groups). The sample size was determined and the participants were allocated to groups using power analysis and a random sampling method. For the pretest, both groups completed an introductory questionnaire, the Life Attitude Profile, and the General Symptom Inventory. Then, the experimenter visited the experimental group patients' homes three times, at 2-week intervals, to provide nursing care based on Watson's model. Finally, after 8 weeks, a posttest was conducted by having both groups complete the Life Attitude Profile and General Symptom Inventory once again.

RESULTS

In the experimental group, the mean total posttest score for the Life Attitude Profile was determined to be 164.21 ± 36.5, and the mean total General Symptom Inventory score was 55.06 ± 13.19; however, in the control group, the mean total Life Attitude Profile score was 127.31 ± 10.61 and the mean total General Symptom Inventory score was 136.91 ± 16.20. The mean differences between the groups were statistically significant (p < .001).

IMPLICATIONS FOR PRACTICE

Care based on Watson's model increases the sense of meaning in life and decreases symptom levels for patients undergoing chemotherapy.

Nurses' Caring Behaviors Toward Patients Undergoing Chemotherapy in Greece: A Mixed-Methods Study

BACKGROUND

Nurses' caring behaviors are central in the quality of care of patients undergoing sophisticated chemotherapy protocols. However, there is a scarcity of research regarding these behaviors in non-Anglo-Saxon countries.

OBJECTIVE

The aim of this study was to explore caring behaviors that nurses perceive as important in caring for patients in Greece receiving chemotherapy.

METHODS

We used a mixed-methods design, including a survey in 7 oncology wards in 3 cancer hospitals in Attica, Greece, and a subsequent qualitative focus group investigation. Caring behaviors were explored through the Caring Behavior Inventory 24 and content analysis of 3 focus group interviews.

RESULTS

A sample of 72 nurses (response rate, 68.5%) were surveyed, and 18 nurses participated in the focus groups. "Knowledge/skills" (5 [SD, 0.7]) was the most important caring behaviors. No significant associations with nurses' characteristics were noted, except for higher scores in caring behaviors in participants who were married (P < .02). Six caring-related categories emerged from the qualitative analysis: "the concept of care," "respect," "nurse-patients' connection," "empathy," "fear of cancer," and "nurses' professional role." Moreover, they stressed barriers they faced in each category.

CONCLUSIONS

Integrated quantitative and qualitative data concur that operational tasks are central in Greek nurses' caring behaviors. In addition, qualitative findings highlighted those skills equipping nurses to provide holistic individualized care in a hectic care environment.

IMPLICATIONS FOR PRACTICE

Supporting nurses in attaining excellence in technical skills and in meaningfully engaging with patients receiving chemotherapy is essential in the realization of their caring role. These should be priorities for continuing education and practice improvement initiatives.

The Current Intervention Studies Based on Watson's Theory of Human Caring: A Systematic Review

This article reviewed 19 intervention studies based on Watson's Human Caring Theory between January 2005 and February 2018. The studies reviewed targeted on promoting patients', nurses', and nursing students' psychological health and patient care experiences. Most (15/19; 78.95%) of the studies in this review indicated that Watson's caring science-based interventions could decrease patients' emotional strains, increase patients' self-management confidence and emotional well-being, increase nurses' job satisfaction and engagement, and improve nursing students' confidence in the clinical performance and the awareness of caring behaviors. Nursing is a discipline that requires both scientific knowledge and the art of human caring.

The Effect of Watson’s Care Model on Anxiety, Depression, and Stress in Turkish Women

This study was designed to determine the effect of the care, given according to Watson’s model, on depression, stress, and anxiety levels of women who underwent medical abortion. This study was conducted between 2016 and 2017 as a real test model with a pretest-posttest control group. The data were collected by the researcher in women’s homes. Watson’s model decreased DAS levels of the women in the experimental group after the medical abortion.

Healthcare interprofessional team members' perspectives on human caring: A directed content analysis study

OBJECTIVES

As Watson's Human Caring Theory continues to evolve and guide the discipline of nursing, the challenge is to find ways to integrate it into practice. The purpose of this study is to describe interprofessional team members' perspectives on human caring based on the Ten Caritas Processes®/Caritas-Veritas Literacy of Watson's Human Caring Theory within the Unitary Caring Science.

METHODS

This is a qualitative directed content analysis study, taking place in a Children's Hospital in the United States between November 2017 and April 2018. Information redundancy was utilized to guide the recruitment. Data were collected via a one-time face-to-face individual interview. A qualitative directed content analysis was conducted using Watson's Ten Caritas Processes®/Caritas-Veritas Literacy as a coding framework.

RESULTS

Twenty-seven healthcare professionals participated in the study. Interprofessional human caring, based on the Ten Caritas Processes®/Caritas-Veritas Literacy, was referred to as performing loving-kindness to patients, each other, and self; maintaining faith-hope in teamwork; valuing inter-subjective interactions and building trust among team members; cultivating heart-centered-caring relations; acknowledging and processing positive and negative feelings non-judgmentally; applying all ways of knowing in caring; encouraging reciprocal teaching-learning; developing caring-healing environments collaboratively; respecting human dignity of patients and each other; and being open-minded to the unknowns and believing in miracles.

CONCLUSIONS

Watson's Human Caring Theory can be an underlying guide to enrich human-to-human relations and create a caring-healing environment. When human caring is applied in interprofessional teams, healthcare professionals find a caring consciousness to care for oneself and each other and promote patient care.

A traditional American Indian death ritual: Developing nursing knowledge through aesthetic exposure

The theoretical and practical application of Boykin and Schoenhofer's Nursing as Caring: A Model for Transforming Practice (2001) provided a framework for the exploration of an aesthetic project of quilting, which was undertaken in order to explain the death journey for a cherished mentor of American Indian nursing students. In particular, the nursing situation was used to guide the making of the quilt sampler. Aesthetics nested into the teaching-learning process became another way to help students solidify their professional self-identity as caring persons. This research has implications for the intentional development of studying quilting as an aesthetic way to express valuable lessons learned while caring for patients and telling stories. This idea of quilting opens up a line of enquiry into caring that can be expressed through a new and creative medium.

Fit for Practice: Analysis and Evaluation of Watson’s Theory of Human Caring

The aim of the authors of this paper is to analyze Watson’s theory of human caring for its usefulness and worth in education, practice, and research. The reason for undertaking this analysis is to evaluate if Watson’s theory would be useful for nursing in those countries where such theories were not an established part of the nursing curriculum. Furthermore, in some European countries, their political past or cultural influences led to an unquestioned adoption of the biomedical model. As their political culture changes, many social structures have had to be revisited, and for nursing, this has meant the introduction of theoretical reasoning, teaching, and practice.

Optimizing Nursing Care by Integrating Theory-Driven Evidence-Based Practice

An emerging challenge for nursing leadership is how to convey the importance of both evidence-based practice (EBP) and theory-driven care in ensuring patient safety and optimizing outcomes. This article describes a specific example of a leadership strategy based on Rosswurm and Larrabee's model for change to EBP, which was effective in aligning the processes of EBP and theory-driven care.

The Magnetism of Theory

Theory was largely considered to be the province of academia until the Magnet Recognition Program brought it into the mainstream of hospital nursing practice. The author describes how 1 hospital selected a nursing theory and philosophy, integrated the concepts across nursing services, and positively affected the hospital as a whole. Jean Watson's theory of human caring was chosen because it closely aligned with the culture of the organization. Specific implementation strategies are discussed, and outcomes of the process are described. This article will assist others engaged in similar endeavors.

The Concept of Intentionality in Human Science Nursing Theories

Nursing as a human science focuses on life and health as humanly experienced. Intentionality is a philosophical idea of particular significance to nursing as a human science, particularly within Parse’s theory of human becoming and Watson’s theory of human caring. These two theorists’ interpretations of intentionality are explored in relation to their respective theories and the implications for research and practice. A persistent thread in nursing discourse positions nursing as a human science—that is, one that focuses on life and health as humanly experienced. In human science disciplines, human beings are viewed as the subjects of their own lives, rather than as mere objects or things, as is the case in the natural sciences. My purpose in this column is to explore intentionality as a philosophical idea of particular significance to theoretical accounts of nursing as a human science. Before beginning, it is important to note that not all nurse theorists whose works could be considered aligned with the human sciences explicitly address the notion of intentionality within their writings (see for instance, Newman, 1994; Rogers, 1970). However, the notion of intentionality is implied in, or at least, consistent with, their works and those of their disciples. As noted elsewhere (Pilkington, 2000), the word intentionality has been in use since medieval times and there are various definitions of the concept in the literature, reflecting different philosophical paradigms or worldviews. In this column, I explore the notion as it appears in two nursing perspectives, Parse’s (1981, 1998) theory of human becoming and Watson’s (1985, 1999, 2005) theory of human caring. Both of these theorists have spoken about how their theoretical thinking grew out of their own life experiences as well as through engaging with the world of ideas (Fuld Institute for Technology in Nursing Education, 1997a, 1997b). And so, I begin by identifying key theoretical influences that shaped their thinking about intentionality. In addition, I will explore