Can Someone Be a Nurse Without Jean Watson??

Zookeeper3 · Nov 18, 2009

Excellent thread! The below quote mirrors mine yet I need to add more. I understand Watson, we need to have an understanding of a "love and caring" for another human being that we truly understand the trust they place in us.

Because we recognize this, we turn our sedated vent patients and give them oral care every two hours, knowing that they are dependent upon us and cannot complain about lack of care. Their trust in us to be diligent results in a "bond" that I believe Watson misclassified as caring. We provide "CARE" through due diligence because we ultimately want the best for our patients.

OUr personal internal feelings may not connect to the extent that the theory may imply, but our actions in providing OPTIMAL care, show our connection and commitment to our patient, thus Watsons idea and theory of caring.

My own two cents.

My professionalism is for my patients. My emotions are for my family.
In order to treat all of my patients equally with the highest possible quality of care I must maintain a emotional barrier so that I do not favor one patient over another.
You cannot tell me that when you start "loving" and becoming emotionally attached to patients that you can still function as a professional that is providing an equal level of care to all of your patients.
Could you function at 100% if that was your mother/father/child laying in that bed? I know that personally I would be an emotional wreck.
I never wish to place myself in a position that would compromise my professional clinical abilities because of an emotional attachment.

nursemike, ASN, RN · Nov 18, 2009

I had an interesting night, recently, with a patient on suicide precautions. The patient had obvious psych issues. That doesn't quite go without saying, but in this case, it does. The sitter, an aide, provided was very understanding and patient. At one point, the patient got rather agitated. No one had thought to explain when the sitter was initiated that the patient would have to be in constant sight of the sitter, including showers.

Another aide, a very good one and a kind, decent person, got involved and was making the situation progressively worse. The attitude she was taking was that the rules had to be enforced. I think it probably offended her that the patient was up ambulating in the halls (which is permissible) and even went out to smoke (escorted) a couple of times (not really correct, but it helped calm the patient). At one point, she remarked to me that my patient couldn't be allowed to jeopardize the other patients. Quite true, but not really relevant, no other patients were being jeopardized.

I found myself in the position of trying to calm a very agitated, severely anxious patient. The irritated aide used the term "placate," but this had nothing to do with Press-Gainey. I was trying to de-escalate a psychiatric crisis. It took some time. It took persuading the patient that I truly and honestly cared. It took Jean Watson. I think, by the time the immediate crisis was passed, that the patient understood that I don't see the nurse-patient relationship as a casual one, that in accepting my assignment, I accepted a vow to do whatever it takes to keep my patient safe, and as comfortable as practical.

I gotta admit--if it isn't already obvious--I'm proud of myself. I promissed things would look better in the morning, and they did. I was able to avoid the use of behavioral restraints. (We use med-surg restraints pretty often as a lot of our patients are too cognitively impaired not to pull IVs, NGs, etc., but this pt was AOX4, albeit with impaired judgement r/t the psych disorder.) Nobody got hurt, and I finished my charting by 0830, which wasn't bad, considering.

So, now, my remaining task, when we work together again, is to educated the aide. I'm not going to make her read Jean Watson. That would be cruel and unusual punishment. But I'll try to get her to understand that our patients--even the ones who truly are confused and can't remember where they are-- are very sensitive to how we feel about them. Honestly, I don't have a problem if a patient who is merely obnoxious picks up that I'm annoyed. Sometimes I have every right to be annoyed, and they need to know they're acting like a jerk. But I deal with a population who can't always control their behaviors. The patient mentioned above may well have had a history of psych issues, but a traumatic brain injury was not helping, and who knows what personality changes that entailed? Blaming the patient was probably not fair, and more importantly, definitely didn't help. In situations like that, I think you have to be able to find a basis to genuinely care about their outcome. The science of nursing is crucial--without it, all we have is good intentions. But it can't often suffice without the art of nursing, and I think that comes from the heart. So I believe you have to be ready to really engage with the patient. You can't work from a script. Human beings just aren't that predictable.

susanthomas1954 · Nov 29, 2009

When I was in school in the early 1970's, my instructors taught us that we DO NOT UNDER ANY CIRCUMSTANCES FORM RELATIONSHIPS WITH PATIENTS. You put on your nursing attitude with your uniform, and you take it off with your uniform. When I am working, patients are my work (for 35 years this has been so.) and when one of my family members needs a nurse, I get them one. (In rare circumstances, I have started IV's on family members, but these are RARE circumstances and I am/was an EXCELLENT IV nurse.) This has worked for me, and I see a lot of problems with a "caring" model, as described by your posts in the beginning. I watch nurses get into a lot of trouble by losing their professionalism under the auspices of caring. Patients assume we "care" when we are at work, but none of them expect us to treat them like we treat our families. Most older patients really wouldn't mind if we wore uniforms so that they could tell the nurses from the aides or the diet techs or the housekeepers, too.

From a spiritual perspective, I learn totally different lessons from my family than I do from patients, and I need all those lessons.

I didn't become a nurse because I wanted to help people. I became a nurse because my dad knew I already cared about people and that I would be getting hurt a lot in my life if I didn't find a profession that would let me separate the two. (Bright man, he was, suggesting that even though I was a girl and I would obviously get married, I might need to work at some point in my life, and it might as well be a fairly good paying job that I could "fall back on." Thanks, Dad-good advice, particularly after the second and third marriages :)

jlcole45 · Feb 20, 2010

In my humble opinion there are three things that define a good nurse

1. the ability to care (actually giving a darn about your patient) how can you be an advocate if you don't care?

2. the ability to become competent.

3. the ability to critically think and not just follow a "task list" of what needs to be done that

shift with a patient. In other words our eyes have to be open and we need to be able to detect change in our patients and act accordingly.

All three are critical.

Hushdawg · Feb 25, 2010

I feel that this boils down to the difference between empathizing and sympathizing.

Empathic people make excellent nurses and this is what many of you are talking about; being able to UNDERSTAND how the patient feels and yet be able to separate yourself emotionally to do what is needed to provide care for the patient.

Note: "Providing care for" and "caring for" are two completely different things.

Sympathetic people, on the other hand often have great difficulty maintaining themselves in the nursing position; they FEEL as the patient feels, they become over consumed with emotional responses and it impacts the ability to provide quality care when things turn bad rapidly.

I think that perhaps Jean Watson's heart was in the right place but her brain was having a disconnect when trying to illustrate her points.

Moneypitt · Feb 27, 2010

Ok now, as I delve back INTO nursing philosophy and theories, I come across, again, the theories of Jean Watson that have been hailed as the greatest thing since polyurethane IV bags - The Caring Theory of Nursing.
Personally, I have never been a fan of Watson, only because I feel that she OVERemphasized the caring aspect, and, in my opinion, dumbified nursing - hence, the ad campaign in the late 80's "If Caring Were Enough, Anyone Could Be a Nurse." Watson threw a fit when she saw this.
As nursing evolves to a more technically challenging field, requiring more acute assessment skills, and as the
"How Women Know" movement which has shaped nursing education for the last decade or so has become archaic, wondering what your thoughts are on if someone can be a nurse and NOT subscribe to the caring theory. Can one be a competent nurse and NOT care about her patients any more deeply than simply getting the job done?
Watson's theory goes a bit deeper than simply "caring" - more so than "caring" about any other job. But "caring" as far as honestly caring about the patient as you would your mom or dad.
Do you think someone CAN be an effective nurse WITHOUT having so much an emphasis on loving her patients?

Absolutely! Nursing is about adhering to the standards of care that your hospital and the state have dictated. Simple. But in reality we need to understand and deliver the customer service that is demanded by our patients. It is the only way to stay alive in this economy and in this narcissistic age we live in. With that in mind a nurse in no way needs to subscribe to the Pollyanna attitude that some disturbed individuals would like us to adhere to. I am a nurse, not a battered wife who kisses the shoe that kicks me. Trying to balance it all is tough. But at the end of the day I kiss butt because it helps me stay in my position and I think the pay is worth it. I do not kiss butt because I believe I am not worthy of respect. I deliver excellent care to the patients and the staff and that is enough for me.

inaya · Feb 27, 2010

hello everybody,

I was reading about jean watson... he made great caritas to apply in nursing practice...

i was reading a case study as follows:

Mrs. Karry is 55 year old obese white woman who had her total knee replacement 2 days ago.

She also had a total hip replacement 3 year ago. She had a hard time with last surgery, as

incision took a long time to heal properly. Both of her surgeries were due to the result of

Rhematoid arthritis. She had deformities in her hand and foot due to Rheumatoid arthritis. Mrs.

Karry has a history of hypertension, diabetes on metmorphin and remote smoking history. She had been diabetic for several years; however she had limited knowledge and understanding of diabetes. She is doing well with her current knee surgery, but she is worried about the incision and shows her concern that it might also take a long to heal. Due to this reason she is unable to cooperate with the physiotherapist with fear that more movement might delay wound healing. She stopped her education after grade 10. She had two daughters settled in U.S and one son who moved out after marriage. She is very attached to her grandson and wanted to visit him on his 6th birthday. She is living with her husband who is doing full time 12 hour shift job. According to Mrs. Karry, her husband is supportive but sometimes gets frustrated when she is not able to do simple households chores during flare-ups of her Rheumatoid arthritis. She gets tearful and said he no longer loves her anymore. She expresses great concern over healing of her incision wound and is worried about her care at home. She believes that due to her deformities people do not respect her anymore and she no longer has social recognition and usefulness.

if you have to apply her two caritas , how would you apply her two caritas cased on above situation...

if anyone can help me in this

scrubs09 · Feb 28, 2010

One can be a good nurse without "caring deeply" for the pt. My experience in corrections showed me that. I had to provide care to child abusers, molesters, and murderers. Did I like these people? NO. I did provide them with the best possible nursing care though.

i was always interested in taling to nurses from this sector as one of my sisters is a C.O. and always sugests i come to the corrections side

TipitiwichitRN · Jun 23, 2010

I think to survive nursing and remain mentally/emotionally intact it is VITAL to be able to separate yourself as much as possible. That is NOT to say I do not care, but I do keep it in perspective. YOU HAVE TO or you risk BURNOUT! I am empathetic and there for the patient, to talk to, to hug, but honey, when I go home, it stays at WORK! It is how I stay emotionally intact and keep my family close.

This is what I am currently working on right now... I think it takes practice!!!!