Running head: EXEMPLAR: WATSON’S HUMAN CARING SCIENCE 1
NURS 502 Exemplar: Watson’s Human Caring Science
Lori A. Teleis
Liberty University
EXEMPLAR: WATSON’S HUMAN CARING SCIENCE 2
Abstract
As a nurse in the pediatric setting for nearly three decades, this writer has witnessed
many children with life-or-death diagnoses beat the odds, as well as the ones that don’t. This
writer has stood beside grieving parents as they fight alongside their child, only to have to say a
tearful goodbye when all of the interventions were not enough to save him. The lessons this
writer has learned through these experiences have shaped her into the nurse that she is today. She
has learned to show compassion in the face of anger and resentment, and hope when there is little
hope to be found. She has also learned to see patients as precious beings, made in God’s own
image and worthy of her respect and care as a servant of God. The purpose of this exemplar is to
show how nursing theory intersects nursing practice in the day to day activities and to tell the
story of one particular little boy, and how he impacted this writer’s practice.
Overview of Watson’s Human Caring Science
Jean Watson’s Human Caring Science is one of the newest of nursing’s grand theories,
and the first nursing theory to incorporate the spiritual dimension of nursing (McEwen & Wills,
2019). This theory focuses on human and nursing paradigm, defining three of the four
metaparadigm concepts (human, health, and nursing). Watson believed that a human cannot be
healed as an object, rather that he is part of himself, environment, nature, and the larger universe.
She defined environment as comfortable, beautiful, and peaceful, and that caring on this level
involves the mind-body-soul engagement with one another. Nursing is described as a
humanitarian science and a profession that performs personal, scientific, ethical, and aesthetical
practices. The Human Caring Science strives to ensure balance and harmony between health and
the experiences the human has with illness (Ozan, Okumus, & Lash, 2015).
Watson describes the human as holistic and interactive. Holism in most postmodern
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theories is the idea that “all things are interconnected, and that the larger environment is
contained within the individual, even the smallest aspects of the person” (Shelly & Miller, 2006,
p. 50). She recognized that the spiritual and ethical dimensions are major aspects of the human
care process and that the human cannot be treated as just a disease process. She developed ten
carative factors that are people-oriented and do not compromise mind-body-spirit. They are: (1)
practicing loving-kindness and equanimity within the context of caring consciousness, (2) being
authentically present and enabling, and sustaining the deep belief system and subjective life
world of self and one-being cared for, (3) cultivating one’s own spiritual practices and
transpersonal self, going beyond ego-self, (4) developing and sustaining a helping-trusting,
authentic, caring relationship, (5) being present to and supportive of the expression of positive
and negative feelings, (6) creatively using self and all ways of knowing as part of the caring
process; engaging in artistry of caring-healing practices, (7) engaging in genuine teaching-
learning experience that attends to wholeness and meaning, attempting to stay within other’s
frame of reference, (8) creating healing environment at all levels, 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 in all aspects of care, and (10) opening and attending to mysterious
dimensions of one’s life-death; soul care for self and the one-being-cared for; “allowing and
being open to miracles” (McEwen & Wills, 2019). The carative processes signify that love is the
most important healing source in nursing care and further defines nursing as the process of
human-to-human caring (Watson, 2012).
Exemplar: My Encounter with K.B.
I first met K.B. and his family in the fall of 2012, when he was admitted to the pediatric
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unit where I work. He was an adorable little six year old whose parents brought him in at the
direction of his pediatrician who had seen him earlier that day because K.B. had been
experiencing intermittent, but worsening bouts of ataxia. At first it seemed like his falls were just
those of a rambunctious little boy who was excited about life and ran everywhere he went, but
the falls became more frequent until it was apparent that this was not normal. After undergoing
many scans and bloodwork, it was determined that the cause of K.B.’s ataxia was a tumor, about
the size of a quarter that was pressing against his spine. K.B. was scheduled for a biopsy the
following day. The biopsy revealed that the type of tumor K.B. had was a soft tissue tumor and
that it was cancerous. The official diagnosis that came later was undifferentiated soft tissue
sarcoma, which is a rare childhood cancer that can form in any tissue that supports, connects, or
surrounds other structures and organs in the body (Brennan, Antonescue, Alektiar, & Maki,
2016). Naturally, his parents were devastated by the news. K.B. was the oldest of their three
children and had just started kindergarten when he was given this diagnosis. All he cared about
was getting out of the hospital so that he could go back to school and play with his friends.
Unfortunately, that was not going to happen any time in the immediate future.
In the weeks and months to come, K.B. endured many rounds of chemotherapy and
radiation in attempt to shrink the tumor in hopes of removing it surgically. During his time in the
hospital, he was always surrounded by friends and family. One of his parents always spent the
night with him, while the other would bring his younger siblings in during the day. As you can
imagine, having three small children in one small hospital room did not make for a very good
time for any of them. The nursing staff tried to incorporate as much time as possible where K.B.
and his family could leave the room to go play and be together in other parts of the hospital. The
nurses also made time to play with K.B. to allow his parents time to take breaks, go home and do
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what they needed to do there, and just re-energize. A school teacher was arranged in order to
keep him caught up with his class so that when he went back to school he would not be far
behind. His treatments made him susceptible to other infections so it became a challenge to keep
him from becoming sick from other illnesses while allowing him freedom to be out of his room.
Despite his diagnosis, which he did not really understand, K.B. was just a fun-loving little
boy who was a delight to be around. It was not always fun and games for K.B. though as he still
had to endure his treatments, which often made him sick. Our child life specialists were very
involved with K.B. and did their best to prepare him for all of his treatments and procedures.
They also helped him decorate his room the way he wanted it with pictures and cards, holiday
decorations, and even took him trick-or-treating around the hospital one day. He had to have a
peripherally inserted central catheter (PICC) placed in order to receive the chemotherapy, which
would be much too hard on his veins to be given through a simple intravenous line. The
chemotherapy and radiation made K.B. feel very sick on most days, but he still insisted on
having the staff play video games with him on the days when he did not feel up to leaving the
unit to visit the play areas.
K.B.’s parents were drained and exhausted from trying to maintain two lives while caring
for one child in the hospital and the rest of the family at home. Friends and neighbors rallied
around them to provide meals and offer playdates for the other children so the parents could
focus on K.B. Nurses encouraged them to rest as much as possible while K.B. was off the unit
for various physical and occupational therapies.
Finally the day of his surgery arrived and K.B. underwent an eight hour surgery to
remove the tumor and the connective tissues around it in hopes of removing all of the cancerous
cells. The surgeons removed two ribs, three muscles that supported his spine, and part of his
EXEMPLAR: WATSON’S HUMAN CARING SCIENCE 6
diaphragm that had to be patched with mesh. After the surgery, K.B. was deemed cancer-free but
would still require more radiation and physical therapy in order to keep the cancer from returning
and regain his normal lifestyle. He was discharged and the radiation and therapy was done on
an outpatient basis. By Christmas of that year K.B.’s cancer was considered to be completely
gone. He would now only need occasional scans to make sure it stayed that way. All of our staff
were happy to hear the news of another child who had beat cancer.
Two years later I saw K.B. again. This time he was being admitted for dehydration
related to vomiting and stomach pain. He was given IV fluids and he soon returned to his normal,
happy self. He was discharged after only 24 hours. He went back to school and things seemed to
be going well for K.B. until one day when he was rushed to the ER by ambulance because he
was throwing up blood. The doctors could not control the bleeding, so K.B. was taken to surgery
where the surgeons found a tumor that had grown into the vasculature inside his stomach and
caused him to bleed. They ended up removing the tumor as well as part of K.B.s stomach in
order to feel confident that they had gotten it all. Then they placed a feeding tube past his
stomach and into his duodenum so they could provide nourishment to K.B. while allowing his
stomach to heal. K.B. awoke from surgery and was admitted back to my unit where he suffered
from many complications. He could not tolerate the food that was being fed through his tube so
he was losing weight quickly. He had to have another PICC line placed in order to give him
parenteral nutrition. He also suffered from very low blood counts that required him to have
several blood transfusions. Despite having his bleeding stopped, his surgeons could not figure
out why K.B. was continuing to have low blood counts. The oncologist who was on the
treatment team explained that because of the chemotherapy that K.B. had received two years
prior, in addition to what he was once again started on his body was having trouble making its
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own blood cells resulting in severe anemia. To add to all of that, a subsequent scan indicated
another tumor developing in K.B.’s chest dangerously close to his heart. The doctors opted to
attack the tumor with chemotherapy and radiation in hopes of shrinking it. They were concerned
that it also might be growing into the vessels in his chest and trying to remove would be too
risky.
K.B.’s parents were heartbroken over all of this. They seemed to quickly come to the
realization that this cancer would likely take their sweet son from them and they did not want
him to suffer any more pain. They opted to continue the chemotherapy and radiation as long as
we were able to keep K.B. comfortable with the side effects, but they did not want him to endure
any more surgeries or be put on life support if that were needed. The hospital chaplain and their
church pastor visited them often, as well as their friends and family. His mother sensed that I was
a Christian and we had some conversations about heaven and death. She was not afraid of what
would happen to her son after he died because she had great faith that he would awaken instantly
in heaven. K.B. no longer had the energy to play so he spent much of his time in bed watching
movies and playing video games. The nurses continued to make time to spend with him so that
his family could take breaks. K.B. continued to become weaker and the scans showed that the
chemotherapy and radiation was not having much effect on the tumor in his chest. His breathing
became labored and he was given oxygen by nasal cannula, which seemed to make him more
comfortable. K.B. began to talk about what it would be like when he died. One day when I was
sitting with him while his mom took a break, he asked me if I was afraid to die. Knowing of his
family’s faith, I told him I thought everyone was probably a little bit afraid to die because they
do not know what to expect, but I knew that Jesus would be waiting for me so that made me feel
better. I asked K.B. if he was afraid and he admitted that he was, because he didn’t want to be
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away from his parents. I told him that he didn’t have to be afraid because Jesus would be waiting
for him as well, and that it would be like hanging out with his best buddy all the time. This
seemed to make him happy as he went on to tell me all about who his best friends were at school.
Later I relayed our conversation to K.B.’s mother. I was nervous she would be upset that I had
the conversation with her son, but she was actually grateful because she knew she would also
have to have the conversation one day. It helped her to know what K.B.’s fears were in relation
to his parents. K.B. spent about three months in the hospital before his body could no longer
fight the cancer and he died. In that time I witnessed the love of a family who would do anything
for their son and for one another. I saw friends and medical staff rally around them as they faced
the most difficult days of their lives. I will forever be touched by a little boy named K.B.
Application of Theory
Watson’s Human Caring Science Theory is composed of ten carative processes. Three of
those stand out in this writer’s mind as she thinks back on this event. The first carative process is
practicing loving kindness and equanimity (McEwen &Wills, 2019). Caring for K.B. did not just
mean treating his cancer. He needed care in many other ways, including emotional and
developmental ways. His parents also needed care as they learned to deal with his medical
problems and later as they worked through their grief at the time of his death. The child life
specialists worked a lot to prepare K.B. and his siblings during his lengthy stay at the hospital
and were there to support his siblings when he died. The staff addressed the first carative process
by not only attending to K.B.’s medical needs, but by also making sure that he had play time and
as much opportunity for normalcy with his family and friends as possible while in the hospital.
The eighth carative process is creating a healing environment at all levels to potentiate
wholeness, beauty, comfort, dignity, and peace (McEwen &Wills, 2019). The environmental
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aspects of care were addressed by allowing K.B. to decorate his room the way he wanted, letting
him have family and friends visit, and allowing him time out of his room and off the unit.
Preparing him and his family ahead of time about procedures and tests made for a more peaceful
experience for everyone.
The tenth carative process in this theory is “opening and attending to mysterious
dimensions of one’s life-death; soul care for self and the one-being-cared for; allowing and being
open to miracles” (McEwen & Wills, 2019, p. 179). The nursing staff provided professional and
personal care for K.B. and his family by answering all of their questions, being present for them
and with them when needed, and allowing parents time to get away while they knew their son
was attended to. This writer personally had conversations about life and death with K.B. and his
mother and often prayed with them for a miracle. At the time of his death, the staff made his
room as comfortable and quiet as possible, brought in snacks and drinks for the family, and
stayed quietly in the background to help with whatever they needed.
Conclusion
Early nursing was based on the framework of how Jesus cared for the sick, showed mercy
to the oppressed, and performed miracles. John 14:12 says, “Truly, truly, I say to you, whoever
believes in me will also do the works that I do; and greater works than these will he do, because I
am going to the Father.” (The Holy Bible, ESV). Jesus has commissioned us to follow in his
footsteps with how we care for the sick and the oppressed. God has given us the knowledge and
technology to perform miraculous things in medicine. Nursing theories are building steps with
which to organize our care and are very helpful in nursing practice, research, and education.
Seeing patients the way God intended, as made in his own image, should be in the minds of
nurses practicing within the Christian worldview.
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References
Brennan, M. F., Antonescu, C. R., Alektiar, K. M., & Maki, R. G. (2016). Clear cell
sarcoma/melanoma of soft parts. Management of Soft Tissue Sarcoma 3(1), 291-297.
doi:10.1007/978-3-319-41906-0_18
McEwen, M., & Wills, E. M. (2019). Theoretical basis for nursing (5th ed.). Philadelphia, PA:
Wolters Kluwer Health.
Ozan, Y., Okumus, H., & Lash, A. (2015). Implementation of Watson's theory of human caring:
A case study. International Journal of Caring Sciences 8(1), 25-35. doi:10.1111/j.1471-
6712.2009.00702.x
Shelly, J. A., & Miller, A. B. (2006). Called to care: A Christian worldview for nursing. Downers
Grove, IL: IVP Academic.
Watson, J. (2012). Human caring science: A theory of nursing (2nd ed.). Sudbury, MA: Jones &
Bartlett Learning.
