Caring for terminal patients near the end of life is a practical matter than extends far beyond the skills learned in clinical practice and being a competent nurse. It is based on a level of interaction with another human being that transcends the self and attempts to heal on a non-physical plane. The type of caring involved in developing an effective relationship, as a nurse, with a person facing death is most clearly defined by Jean Watson.
Watson developed a theory of nursing based on caring. It is a theory embedded in art and science, but also includes elements of spirituality and dimensions of mind-body-spirit. Watson challenges the nurse to examine one’s own humanistic values, encouraging the process of self-actualization for the nurse while providing care to other beings. Watson (2003) believes it is necessary to be consistently engaged in the care and also reflective of one’s own humanity and spirituality. Watson is one of the few theorists who considers the well-being of not only the cared-for, but also the caregiver. Promoting the caring values as set forth by Watson enables the nurse to find deeper meaning in his or her life and work.
According to Watson (2001), the major elements of her theory are (a) the carative factors, (b) the transpersonal caring relationship, and (c) the caring occasion/caring moment. Watson uses the term “carative” instead of the medical terminology “curative” to highlight the idea that her nursing theory revolves around the science of caring.
The following are Watson’s (2001) translation of the carative factors into clinical caritas processes: 1) Practice of loving kindness and equanimity within context of caring consciousness.2) Being authentically present, and enabling and sustaining the deep belief system and subjective life world of self and the one-being-cared-for. 3) Cultivation of one’s own spiritual practices and transpersonal self, going beyond ego self, opening to others with sensitivity and compassion. 4) Developing and sustaining a helping-trusting, authentic caring relationship. 5) Being present to, and supportive of, the expression of positive and negative feelings as a connection with deeper spirit of self and the one-being-cared-for. 6) Creative use of self and all ways of knowing as part of the caring process; to engage in artistry of caring-healing practices. 7) Engaging in genuine teaching-learning experience that attends to unity of being and meaning, attempting to stay within others’ frames of reference. 8) Creating healing environment at all levels (physical as well as non-physical), subtle environment of energy and consciousness, whereby wholeness, beauty, comfort, dignity, and peace are potentiated. 9) Assisting with basic needs, with an intentional caring consciousness, administering “human care essentials,” which potentiate alignment of mind-body-spirit, wholeness, and unity of being in all aspects of care; tending to both the embodied spirit and evolving spiritual emergence. 10) Opening and attending to spiritual-mysterious and existential dimensions of one’s own life-death; soul care for self and the one-being-cared-for. (Watson, 2001, p. 347)
The transpersonal relationship that Watson describes is based on the nurse’s connection with the person and the understanding of the other person’s perspective. This approach highlights the uniqueness of both the person and the nurse, and also the mutuality between the two individuals, which is fundamental to the relationship. The result of such interaction is that the one caring and the one cared-for, both connect in mutual search for meaning and wholeness, and perhaps for the spiritual transcendence of suffering (Watson, 2001). The caring moment is the harmony created when this type of relationship is achieved.
Watson’s theory is of exceptional significance when defining a practice for caring for the terminally ill. Terminal patients have needs that are much different from those patients...
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