The grand theory that will be discussed is Jean Watson’s Human Caring Science: A
Theory of Nursing. Watson’s theory is one of the newer grand theories, being initially developed
in 1979 (McEwen et al., 2019). Watson’s personal research led to Theory of Caring. While caring
for her husband, she discovered that caring for a human being by caring has far greater results
than a simple medical cure. Watson believes in a holistic approach to nursing practice and
emphasizes the spiritual aspect of human being rather than the physical (Nikfarid et al., 2018).
In her theory, Watson defined three out of the four concepts of the nursing
metaparadigm: human, health, and nursing (McEwen et al., 2019). Watson defined nursing as a
science of persons and human health-illness experiences that are mediated by professional,
personal, scientific, and ethical care interactions (McEwen et al., 2019). She defined health as
unity and harmony of mind, body, and soul associated with congruence between perceived and
experienced self (McEwen et al., 2019). Lastly, Watson defined person as someone of value to be
cared for, understood, nurtured, and respected (McEwen et al., 2019). Additional concepts that
Jean Watson defined were the ten carative factors.
Rather than defining the fourth metaparadigm, environment, she developed ten carative
factors that she believed needed to be addressed by nurses in patient care and are the basis of the
human caring theory. She makes these statements as a guide and framework for our nursing
practice. Having respect for the patient allows a nurse to be available for the patient (Pajnkihar et
al., 2017). By listening to the patient, the nurse can understand how the patient feels and can
embrace the patient’s faith and hope(Pajnkihar et al., 2017) . By being responsive to patients, it
allows the nurse to develop more caring relationships with patients (Pajnkihar et al., 2017).
Developing a helping and trusting relationship with patients and families allows for a better
patient experience (Pajnkihar et al., 2017). Expressing and accepting both positive and negative
feelings allows for a caring environment and for personal growth (Pajnkihar et al., 2017). Using
the scientific method is great for problem solving and decision making (Pajnkihar et al., 2017).
Interpersonal teaching and learning promotes knowledge and grouth of the patient and nurse
(Pajnkihar et al., 2017). Maintaining a supportive, caring environment promotoes healing
(Pajnkihar et al., 2017). Assisting with human needs helps meet the needs for the patient
(Pajnkihar et al., 2017). Allowing for miracles to occur keeps expectations of situations low so
there are no surprises (Pajnkihar et al., 2017).
There are many identified strengths of Jean Watson’s theory, but, there are also some
negatives as well. One strength of this theory is that the patient is at the center of care. The
patient receives more focus than the technology needed to provide care or the condition they are
being treated for. This theory teaches a holistic approach to nursing care that is easy to
understand and put into practice. Watson’s work can be used in a diverse number of settings and
the carative factors provide a framework for much of nursing practice. One weakness to this
theory is that it focuses less on the physical being of the patient and more on the psychosocial
aspect. This limits care of patients because both physical and spiritual aspects are an important
piece to an individual. When there is more of a focus on spiritual and holistic aspects to a human
being, there becomes less ability to relate to nursing practice. A second weakness to this theory is
that there is little current evidence that this theory continues to be used in practice. With
Watson’s focus being on the spiritual being, there is little focus on their physical aspects. When
there is less focus on the physical side, it becomes more difficult to relate to current practice.
This occurs because many nurses continue to believe that the focus of the patient’s care should
be treatment of conditions rather than how they can best care for their patients.
The middle-range theory that will be discussed is the Theory of Family Vigilance. The
basis of this middle-range theory was hospital policy on the family’s inability to visit their loved
ones in the hospital. The purpose of this theory is to describe experiences of families that stay
with their loved ones during their hospitalization. Allow this theory is a middle-range theory,
there are still major concepts that are focused upon. The major concepts or categories of meaning
include commitment to care, resilience, emotional upheaval, dynamic nexus, and transition
(McEwen et al., 2019). Commitment to care of patients includes advocacy, love, responsibility,
and involvement( McEwen et al., 2019). Resilience refers to taking care of one selves. This
means have perseverance and maintaining hope (McEwen et al., 2019). Emotional upheaval
refers to uncertainty, anxious living, and life and death decisions (McEwen et al., 2019).
Dynamic nexus refers to having relationships with family and friends, but also with healthcare
providers as well (McEwen et al., 2019). Lastly, transition relates to lifestyle, daily rhythm,
comfort, and space (McEwen et al., 2019). Carr used these categories of meaning to define the
relationship among characteristics that compromise family vigilance.
One strength of this middle-range theory is it is very generalized for a vast variety of a
population and can be used across multiple disciplines. The purpose of this theory is specific, but
also clear and concise and gets the point across. Another strength is that this theory is simplistic.
In many of the grand theories, there are numerous major concepts to consider. With the Theory
of Family Vigilance, there is a limited number of concepts and the purpose is clearly stated and
explained in detail. A weakness of this theory is they evolve from various grand theories. Since
middle-range theories can be based on grand theories, they are typically more narrow in scope.
Although this makes the theory more relatable to practice, it prevents the framework of
knowledge within specific ideologies of nursing.
References
Carr, J. (2014). A Middle Range Theory of Family Vigilance. MedSurg Nursing, 23(4).
McEwen, M., & Wills, E. M. (2019). Theoretical basis for nursing. Wolters Kluwer Health.
Nikfarid, L., Hekmat, N., Vedad, A., & Rajabi, A. (2018). The main nursing metaparadigm
concepts in human caring theory and Persian mysticism: a comparative study. Journal of
medical ethics and history of medicine, 11, 6.
Pajnkihar, M., Štiglic, G., & Vrbnjak, D. (2017). The concept of Watson's carative factors in
nursing and their (dis)harmony with patient satisfaction. PeerJ, 5, e2940.
https://doi.org/10.7717/peerj.2940
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